An Experienced Florida Medicaid Attorney Shares 7 Reasons Why Medicaid Gets Denied

As an Elder Law Attorney, helping my clients is a personal mission rooted in a tragic, real-life event. My grandmother, who did not have Long-Term Care insurance, got bad advice from a nursing home when she fell ill and spent down all her assets—until she had nothing left. This profound experience ignited a deep passion within me to prevent others from enduring the same hardships and to allow every client to age with dignity while receiving the care they need and feeling like a source of joy, not a burden, to their families.

Did you know that a semi-private room in a Florida nursing home costs more than $12,000 per month? For most people, this is a significant expense. However, with strategic and individualized Medicaid planning, you can use this government assistance program to cover the costs of Long-Term Care, including a nursing home or assisted living facility.

Obtaining approval for Florida Medicaid can be challenging, often complicated by bureaucratic hurdles, guidelines, regulations and rules. Whether you’re preparing for Medicaid eligibility or have received a denial, understanding the reasons for rejections of Medicaid applications will help you avoid costly mistakes.

This blog from a knowledgeable and experienced Florida Medicaid Attorney discusses the seven most common reasons for Medicaid denials in Florida and offers guidance on navigating these potential obstacles.

Are you considering becoming a Medicaid applicant? Have you already received a Medicaid application denial and have questions or need help? Call us at (561) 955-8515(561) 955-8515 to schedule a free consultation.

At The Siegel Law Group, P.A., we offer personalized solutions tailored to your needs.

1. 1. Failing to Meet Medicaid Eligibility Requirements

One of the primary obstacles you may encounter with Medicaid programs is meeting the requirements for income and assets. This type of government assistance is specifically designed to support Americans aged 65 and older who fall below a certain income threshold.

If your total income and assets exceed the established limits set by Medicaid, the government will reject your application; however, proven strategies exist to safeguard your assets and income and ensure that you qualify. Consult a Florida Medicaid Lawyer who has helped multiple clients avoid costly mistakes and devise a strategy to render them eligible for this vital government program.

Moreover, even if your income initially appears too high to meet the standard eligibility criteria, there is hope through the “medically needy” program, which specifically caters to seniors in need of Long-Term Care and blind or disabled individuals. Despite your income level, this program could be the lifeline you need.

1. 2. Improperly Disclosing Assets in a Medicaid Application

As an experienced Elder Law Attorney can attest, maintaining complete transparency is a priority for every Medicaid applicant. You may receive a denial if you fail to disclose any assets, including real estate, stocks, retirement accounts or bank account balances. You must include every asset, regardless of its value because even an unintentional discrepancy could jeopardize your application’s approval.

1. 3. Failing to Meet Residency and Citizenship Eligibility Requirements

In Florida, Medicaid is exclusively allocated to individuals who are residents of the state and either U.S. citizens or qualified aliens. Failure to meet these requirements could result in a denied application. To enhance your chances of success, seek the guidance of a qualified Florida Medicaid planning attorney who can assist you in validating your eligibility and compiling the necessary documentation to support your application.

1. 4. Submitting An Incomplete Application or Forgetting to Include All Documentation

Failure to provide all necessary documents, such as proof of income and Social Security number verification, can lead to application denials. Here’s where a dedicated and seasoned Elder Law Attorney becomes vital. By entrusting your application to a legal professional, you can ensure that you gather all necessary paperwork properly, submit it, and complete it within the required timeframe. The assistance of a Florida Medicaid Lawyer can significantly smoothen the process and improve your chances of a successful application.

1. 5. Understanding the Medicaid Look-Back Period: Avoiding Common Pitfalls

When applying, consider any asset transfers you’ve made within the last five years. Medicaid carefully reviews this period, known as the look-back period. If you’ve transferred assets for less than their fair market value during this time, you could risk becoming ineligible.

One common pitfall that many applicants encounter is selling a property to a family member at a significantly reduced price. Medicaid may view this transaction as an artificial attempt to meet asset limit requirements, potentially resulting in a period of Medicaid ineligibility.

While there are cases where you may purposefully “spend down” your assets to qualify for Medicaid, proceed with caution and seek guidance from an experienced Medicaid Planning Attorney. The “spend down” process involves reducing your countable assets to fall within Medicaid’s eligibility limit. It can include paying off debt, making home improvements or covering medical or education expenses.

1. 6. Applying Too Soon

Applying too early can result in denial, so it’s important to understand the eligibility criteria before submitting your application. This is where a Medicaid Attorney becomes invaluable. They can help you navigate the timing of your application to meet the financial requirements and manage your income properly.

1. 7. Understanding Ineligibility Based on Health

Your health status is a crucial factor in determining your eligibility for Medicaid because Medicaid’s Long-Term Care programs support individuals requiring a specific level of care. If your health conditions do not meet these requirements, you may experience a denial of Medicaid benefits.

For instance, if you need assistance with everyday activities like bathing, dressing or eating, but are otherwise in good health, you may not qualify for Long-Term Care benefits under Medicaid. Seeking guidance from a Medicaid lawyer can help ensure that your needs align with the program’s requirements.

Let The Siegel Law Group, P.A. Assist You with Your Florida Medicaid Application

At The Siegel Law Group, P.A., our goal is to help our clients and their families have better futures. We understand that dealing with a Medicaid denial can be frustrating, but rest assured, it’s not the end of the story. You have the right to appeal, and our dedicated Medicaid Planning team is here to assist you every step of the way. We will carefully examine the reasons behind your denial, develop a strategic action plan, and prepare for your appeal drawing upon our knowledge and experience.

Our experienced Medicaid Attorneys don’t just handle appeals – we are also well-equipped to guide you through the application process from the beginning, saving you invaluable time and effort. By strategizing to ensure your eligibility for benefits, anticipating potential issues and creating a comprehensive plan for appeals (if necessary), we will work toward the best possible outcome.

For more information about elder care and Medicaid planning, I invite you to pick up a copy of my book, Caught in the Middle: Juggling Your Elderly Parents’ Affairs While Raising Your Own Family, for just 99 cents.

Whether you have already received a Medicaid denial or are preparing to apply, trust in the skill, knowledge and experience of the Medicaid Planning Attorneys at The Siegel Law Group, P.A.. Contact us today at (561) 955-8515(561) 955-8515 or complete our online form to schedule your free consultation. With a combined 100 years of experience, we have been serving South Florida for over 22 years, and are here for you and by your side 24/7.

Copyright © 2023. The Siegel Law Group, P.A. All rights reserved.

The information in this blog post (“post”) is provided for general informational purposes only and may not reflect the current law in your jurisdiction. No information in this post should be construed as legal advice from the individual author or the law firm, nor is it intended to be a substitute for legal counsel on any subject matter. No reader of this post should act or refrain from acting based on any information included in or accessible through this post without seeking the appropriate legal or other professional advice on the particular facts and circumstances at issue from a lawyer licensed in the recipient’s state, country, or other appropriate licensing jurisdiction.

The Siegel Law Group, P.A.
2500 N Military Trail Suite 470
Boca Raton, FL 33431
(561) 955-8515(561) 955-8515
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