Maneuvering Medicaid denials and/or appeals is extremely challenging. To a Medicaid recipient receiving a denial or reduction of services is devastating. Most Community Medicaid denials or reduction in services require the recipient to file an appeal with Aid Continuing within 10 days. Nursing Home Medicaid denials offer 60 days for filing a “fair hearing.” Denials can be for issues regarding assets or income or approved with a disqualification period or insufficient hours of services.
When appealing decisions made by the applicant’s Manage Long-Term Care (MLTC) agency, applicants must first request an appeal from the Agency. If denied a second appeal is required and only after the second denial can the applicant apply for a fair hearing through the State.
Nursing Home applicants receive 60 days to request a State fair hearing. Hearings are held before an administrative law judge either in person or zoom.
For additional information contact us at Elder Care Services, Inc.