What Can I Do if I Have Been Denied Medicaid?

As people age, many count on Social Security and Medicare to help them live happy, healthy, and comfortably in their golden years. However, some older Americans are unable to fully provide for themselves and must seek assistance before they become eligible for the landmark elder social services we have become accustomed to. Hard economic times, disability, and other unforeseen events are just some of the reasons elders may be eligible for Medicare.


One of the most important parts of the Medicare program is the nursing home care services members are eligible to receive, particularly seniors. However, not everyone may qualify for Medicare after applying, leaving many families to wonder how they will take care of their beloved elders. Fortunately, denied applicants are eligible to receive a Fair Hearing at their local Medicare office.


What is a Fair Hearing?


After being denied for Medicare benefits, applicants can request what is known as a Fair Hearing that is essentially a second chance to qualify for benefits. At the hearing, an administrative law judge for the Office of Temporary and Disability Assistance will hear arguments from the petitioner why he or she was erroneously denied benefits. It is important to know a representative from the Human Resources Administration will also be there to argue why you or your loved one should not receive benefits.


It is important to note that if you or your loved one were already receiving services from Medicare you will need to file your request for a Fair Hearing as soon as possible to retain your benefits while your case is adjudicated. The deadline is 10-days from receiving a notice of reduction or termination of benefits and you will need to mark “aid continuing” on your petition.


What should I bring to my hearing?


In preparation for your Fair Hearing in front of the administrative judge, you will need to gather several key pieces of information. The most important is your “evidence packet,” which you will need to request. When filing for these documents, be sure to include your name, address, case number, fair hearing number, and the date of your hearing.


Other important documents you should bring to the hearing include copies of your your lease, pay stubs, doctor’s note, and anything else you think can help your case. With so much on the line, particularly vital aid for nursing home care, you should take the matter seriously and be diligent in your preparation for the event.

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