When Applying for Medicaid, One Size Does Not Fit All
As budget deficits grow and the State tries to find better ways to deliver services on limited funds (think Missouri Health Net and KanCare) it's becoming more common for Medicaid applications to be denied.
For years we have taught that there are certain situations that require legal assistance to get the best result when a Medicaid application is filed. Among the most common are those cases where someone has made a gift of money or property during the five year look back, or when they have paid private caregivers or have large retirement plans. In those instances, it's likely that without expert guidance in most cases you won't get the hoped for result.
Other simple cases can be more straightforward and handled without getting legal assistance.
In recent months, however, that has begun to change. This is because more and more individuals are experiencing delays and denials due to a lack of complete information provided along with the application or by mistakes made in the processing of the application. What happens next is the dreaded, "your application has been denied." What do you do when your application has been denied?
First of all, if you are able to reach a caseworker (difficult in and of itself nowadays) you may be able to advocate for the application which was originally filed and explain why it should have been approved. In certain cases that can work.
In other cases, however, it may be necessary to file for a Fair Hearing. A Fair Hearing is done through the Office of Administrative Hearings and is an opportunity to go before a Hearing Officer to explain why the application should have been approved. In order to handle the appeal in the appropriate manner, a hearing brief should be prepared outlining the facts and legal precedents that bolster your position.
Preparing a Fair Hearing brief can be complicated. The brief establishes the record for what is to be considered in the event that the case ultimately winds its way through the administrative hearing system and into the courts.
If you have a situation where the application has been denied and it is necessary to go into the administrative appeal process through a Fair Hearing, you should not undertake this lightly. In many instances pursuing a Fair Hearing is the practice of law and should be undertaken by an elder law attorney very familiar with the entire Medicaid process and the art of prevailing at a Fair Hearing.