11 Reasons Your Medicaid Could Get Denied

11 Reasons Your Medicaid Could Get Denied

In the state of Florida you may apply for Medicaid online. Easy access to the application unfortunately has not made obtaining the benefit any easier. In fact, “do it yourself” Medicaid can be a costly endeavor if you are DENIED. Many find the Department of Children and Families’ (DCF) online information difficult to interpret, causing frustration and wasted time. Here’s why you should consider hiring an Elder Law attorney to prevent significant financial losses. In January 2015, the Florida Supreme Court decided that non- attorney Medicaid planners cannot advise Medicaid applicants on the topic of asset or income protection. Nursing Home employees are no longer allowed to print Qualified Income Only Trust forms for their residents. DCF case workers are rarely forthcoming with information about allowable asset protection strategies. Elder Law attorneys are the best resource to assure a successful application, especially if income or assets exceed the eligibility limits.


  1. Application Deadlines

Medicaid requires that specific documentation be provided within 30 days of starting your application. If a complete application is not submitted in a timely fashion the case may be denied. It is also important that an application be complete prior to submission. It is essential to provide your attorney with all requested documentation from the beginning in order to avoid delays and denials due to incomplete applications. The attorney will  track all deadlines.


  1. Improper Transfers

Assets, such as bank accounts, houses, cars, boats, businesses, etc. are carefully scrutinized by DCF.  Assets can only be transferred with the proper documentation. It is prudent to a seek the advice of an attorney before making changes to title. Medicaid has very strict rules regarding asset transfers and eligibility. This is where the “look back period” may apply. Medicaid uses an Asset Verification System to locate any financial accounts you may have. Transfers over the amount of $8,346 occurring in the last 60 months may be reviewed. Any transfers made over $8,346 may result in a penalty. Penalties are expressed in terms of how many months you must wait before becoming eligible for Medicaid. Medicaid considers any amount of money or  something of value which was given to another person, to be a GIFT. When gifts have occurred, your attorney will offer solutions as to how to correct the problem so Medicaid can be approved. Improper transfers may take weeks or months to correct and can be very costly if Medicaid eligibility is delayed.


  1. Income or Assets Over The Eligibility Limit

Florida places a limit or cap on the amount of income and assets a Medicaid applicant may have if they wish to apply for benefits. These amounts are subject to   change so it is important to know the current limits. These limits must be maintained throughout the application process and the entire time benefits are being received. There are legal solutions and strategies to address excess income. Appropriate solutions for applicants are devised on a case by case basis and should be discussed with a qualified attorney.


  1. Failure to Protect Assets

Medicaid allows for the protection of applicant assets, if done properly. There are legal strategies you may use to protect some of your hard earned savings. A consultation with a legal professional could help you protect your assets and still afford the long term care option of your choice. Whether you desire home health care, skilled nursing or assisted living facilities, there is a Medicaid option. Planning is essential because some programs have long waiting lists.


  1. Improper Title of Assets

For the purpose of applying for Medicaid, you are required to submit financial statements. All financial accounts must be properly titled and contain all the pertinent information to the applicant’s financial history. An attorney can review the titles to financial accounts and property to help you make changes to accounts and titles, if needed.


  1. Failure to Disclose Information

When applying for Medicaid, full disclosure is the law. To submit falsified or partial information is a federal offense which may result in serious penalties and denial. All information pertaining to financial accounts, life insurance, annuities, loans, properties, transfers or title or finances, gifts, etc. is required by law. Medicaid WILL locate ALL of the applicant’s assets during their asset search. Asset protection for Medicaid must be done within the law and with full disclosure.


  1. Lack of Wisdom

Wisdom is knowledge and knowledge comes from experience. If this is your first time applying, there is a good chance that you do not understand the rules and regulations and how they may apply to you. For example, it is a common misconception that a Revocable Trust, typically used to protect assets from taxation, can protect your assets from Medicaid. Transfers such as gifts to children that are allowed by the IRS for tax purposes, are usually not allowed for qualification. Because the Medicaid laws and rules differ from state to state and periodically, many people are misinformed by the time they attempt to apply for Medicaid on their own. Elder Law attorneys are specialists in Medicaid qualification and make it their business to know all the latest rules and laws.


  1. “Second Marriage Syndrome”

A number of complications may arise from previous marriages, divorces and the conflicting interests of the children from each marriage. Couples who maintain separate finances are often uncomfortable disclosing their assets when one of them needs Medicaid, but it is required. An attorney can advise how you may achieve Medicaid eligibility and address the concerns of the family members.


  1. Business Ownership

Current and past business partnerships, corporations and shareholdings may result in a complicated application process and denial if the disclosure is not done properly. An attorney can review state records to make sure previous or current business ownership does not hinder the application process. Many times business valuations and other assessments are required before the application can be submitted.


  1. Joint Accounts

If bank accounts are titled with another party who is unwilling  to provide all asset information, Medicaid may be denied. Medicaid often considers the entire balance in a joint account to be the property of the applicant unless the other party can prove that some of the assets are theirs. An attorney can advise you if account ownership should be changed.


  1. Refusal to Prosecute Those Who Exploited The Applicant

If you have had the unfortunate experience of being financially exploited by family members, friends, caregivers or others, within the past 60 months, you may be forced to make a police report in order to obtain Medicaid assistance. DCF considers all transfers of assets to be a gift unless you can prove it was not a gift. In the case of theft, the only way to prove it was not a gift is to make a police report. Some victims are hesitant to prosecute but exploitation of an elderly or disabled person is a serious crime. An attorney can help you manage this situation so Medicaid can be approved.

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  • Johnd89

    This is truly a great and useful piece of information. I’m thankful that you shared this helpful information with us. Please keep us informed like this. Thank you for sharing.

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