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Reasons you may be denied Medicaid coverage and what you can do

Health coverage through Medicaid is crucial for millions of Americans. Without it, people can lose or be denied access to dental services, prescription medication, preventative health care and emergency care.

Therefore, it is important to understand what factors may lead the state to deny an application for Medicaid and how you can improve your chances for eligibility.

Common reasons for denying Medicaid

The state may deny an application for Medicaid if you:

  • Fail to complete the necessary paperwork
  • Are missing financial documentation
  • Are not a citizen or lawful permanent resident of the United States
  • Do not meet income guidelines established by Health First Colorado
  • Are not part of a mandatory eligibility group, including low-income families and qualified children and pregnant women
  • Complete disqualifying transactions, including transferring money or property during the look-back period

These reflect some of the more common reasons why the state may deny your Medicaid application.

Avoiding a denied application

To minimize the chances of a denied claim, one thing you can do is to start thinking about your application long before you must complete it.

For instance, you can explore asset protection measures when you are doing your estate planning. You can also track down critical documents like tax statements, health insurance coverage plans and proof of citizenship.

Appealing a denied application

Unfortunately, you could still have your application denied if there is insufficient or unverifiable information, or if the state does not agree that you are eligible. You could also lose coverage if you no longer qualify.

Under these circumstances, it is important not to lose hope. There is an appeals process in place that gives you the opportunity to challenge a decision with which you do not agree. However, you must file an appeal within 30 days of receiving the Notice of Action informing you of the decision, so it is important to act quickly.

Any issue related to medical coverage is serious, especially when it comes to how you will pay for the care you need. Understanding why the state may deny a claim could help you plan accordingly and avoid regrettable missteps. 

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