The Elrod Firm


What Can We Do About This Medicaid Denial?

Justin, My mother just received a Medicaid denial letter in the mail, and we desperately need some help. She worked with my father’s nursing home to apply for Medicaid six months ago, and based on what she was told when the application went in, we assumed Medicaid coverage for my father was a done deal. Now the nursing home is telling us that my mother owes almost $30,000 because of this denial. Can you help us? – Dave

Dave, I’m sorry to hear about what your parents are going through, but I’m not sure if I’ll be able to help. This scenario is extremely common, which is very unfortunate for seniors in Arkansas. Medicaid rules can be complicated, and there are times when even those who work with Medicaid on a regular basis, like the business office staff at a nursing home, can miss a technicality that will ultimately result in a Medicaid denial.

That would be bad enough if the denial were to come quickly, so that the family could fix the problem before they built up a huge liability to the nursing home. But all too often, the denial only comes four, six, or eight months down the road, after a huge and unexpected nursing home liability has been created.

In cases like this, there is a possibility that the Medicaid denial is incorrect, in which case I could help you with an appeal as long as we move quickly before any deadlines are missed. But if the Medicaid denial was correct based on some overlooked technicality, all you can do is fix the problem and quickly refile for Medicaid coverage. The bad news is, refiling will not help with the large liability your mother owes to the nursing home. At best, it can only obtain coverage effective after the fix, and you will still have to work with the nursing home regarding the large liability.

Are you in a similar situation?

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