What is possible if a Medicaid application is denied?

traveler2021

I'm not sure if I am using the proper terminology. Hoping this is clear.

What happens if a Medicaid application for nursing home or AL facility is denied? 

Is there an appeal process generally or does it depend on the state? 

Is it advisable to hire a CELA to help with the appeal (if an appeal is possible?)

JJAz

1. If it's denied because money was gifted-away, the family has to arrange care and/or get money back for a specified period of time.
2. If it's denied because applicant has too many assets, they have to be spent down or put in a Medicaid approved annuity.
3. If it's denied because applicant doesn't need the care, you may be able to provide additional documentation on appeal.
4. CELA on appeal, YES.
5. Waiting list for bed availability is more likely.  Hospital discharges get priority over those living at home.

King Boo

The CELA ideally should have been hired at time of diagnosis. Definitely when your brother took in your mother for care.  But they are always important.

www.nelf.org

Cynbar

Sometimes a Medicaid applicant gets a denial letter when they are over the asset limit. In this case, it's not really a denial. The excess assets need to be spent down for medical care or in another permissible way (a CELA can guide this) --- documentation of getting down to the limit is sent to Medicaid, and the application is then approved. Sometimes a Medicaid applicant is denied because they own property other than the home they live in, such as a condo in Florida. In this case, the extra property has to be sold and the proceeds used for care. But most difficult is when a denial is due to money being given away or missing. There seems to be no appeal if this is the case, Medicaid just doesn't care. Family would have to continue to care for the applicant until the lookback period expires. I have actually never seen a case like this when the person had no family, it's usually the family who got the missing money and can't pay it back. I have read your other thread on your difficulties with your brother, and I do sympathize. He has done a good job caring for your mother for 7 years, I think he will work this out, even if he has to continue caring for her for awhile longer. If he asks you to contribute financially at this point, that would be up to you --- but if she is denied Medicaid due to missing assets, he likely was the beneficiary.

Quilting brings calm

One more thought( and I posted this on your other thread)…it may be that the care level ( assisted living, memory care) isn’t eligible for Medicaid in the system your brother lives in.

traveler2021

Thank you all. I appreciate the information and it will help to prepare even if it seems we're a little behind the curve (although my brother gets prickly when I discussed legal and financial matters for some reason, so I don't know much there. It could also very possibly be the case that everything is in order.) There has been some money (house sale, small savings) but I don't know how they've been used.

@Cynbar - Thank you. Although he has not accepted my offers in the past he did specifically ask recently whether I would be able help should Medicaid be denied and appeal denied. I suspect the change of heart stems from him seeming very motivated to move forward at the moment. Of course I am happy to as I have always been (and fortunate to be able) to do so to make sure Mom gets the care she needs and, hopefully, he and his family get the peace of mind they are seeking.