Medicaid Appeals

Denied. Is there a more unsettling word than that when you’re planning for your future or for the well-being of a loved one?

This is a troubling reality: some Medicaid applications are denied. If that happens, you have the right to file an appeal. A Medicaid appeal is held before a hearings officer. The hearings officer is not a judge, but rather is an official who works for the appeals unit of the Medicaid agency. An appeal is not a second bite at the apple. Rather, the job of the hearings officer is to determine whether the Medicaid agency made a mistake in assessing the facts or a mistake in applying the law.

Although a Medicaid appeal is not exactly a trial, it is quite similar, in that there can be testimony of witnesses, exhibits, legal briefs and legal arguments. The state Medicaid agency will have an attorney to represent it. The burden is on you to prove that the Medicaid agency made a mistake. Therefore, in most cases, unless you have competent legal representation, the odds will be greatly stacked against you. Our firm has many years’ worth of experience in handling Medicaid appeals, and can provide representation in these cases.