What Should The Medicaid Denial Notice Contain?

The eligibility criteria must be duly satisfied before being granted Medicaid benefits. Some applications, however, may still be denied at first, decreased, or terminated for the wrong reasons.

When the state Medicaid agency rejects an application, the applicant will receive a written denial notice, which should expressly state the justifications for the denial. For example, if the reason is that the applicant is not really disabled, the denial must show what makes the applicant unfit for the federal’s criteria for disability and the specific rules that it uses to deny eligibility. The date of receipt shall also be based on federal deadlines set.

The explanation must be clear enough for the applicant to understand how the decision was arrived at. The notice must also inform that the applicant has the right to appeal, explain how to request a hearing, and state that the right for self-representation—or the option to hire a lawyer or spokesperson—is recognized. If the notice is unspecific and the applicant believes it is founded on wrong information, or where the reasoning appears flawed, then it could be possibly argued that there was a violation of the applicant’s rights.

If benefits were denied as well, then the appeal should include both the denial and the faults on the notice. Remember to read the notice carefully and keep it in a secure place.


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