michael s. simone, esq.
Was your Medicaid application denied?
When you or a loved one need long-term care, the possibility of losing those vital benefits is devastating. How will those expenses get paid if Medicaid services are pulled out of the equation?
The good news is that a Medicaid denial isn’t the end of the road. An Elder Law and Medicaid appeals lawyer can help you navigate the complicated appeals process and get the benefits you’re entitled to. Our attorneys at The Simone Law Firm practice law in Cinnaminson, New Jersey, and serve surrounding areas. Contact our team today for a legal consultation.
When an individual applies for Medicaid benefits, Medicaid will determine eligibility based on information provided in the application. To be eligible for benefits, you must meet income and assets requirements and provide documentation to support your income claim.
This can often be an issue for those who are elderly, incapacitated, or suffering from disabilities, so a Medicaid appeals lawyer is often a beneficial resource for properly handling documentation.
If an application is denied, the county where you applied for Medicaid must provide the applicant with an explanation of the denial in writing and information regarding the appeals process. The applicant must then file a written appeal within 20 days of the denial letter being issued for the appeals process to move forward.
If Medicaid benefits are being revoked or reduced, the program must send a notice to the recipient of the benefits ten or more days before the action occurs. This notice must also include information regarding how to appeal a Medicaid denial in New Jersey. The U.S. Supreme Court set these standards.
Once the appeal is filed, a hearing will be scheduled, where a hearing officer will hear the applicant’s case for eligibility. The officer will listen to statements and witnesses and then rule whether the
Medicaid program was within the federal court and state laws for denying the individual’s benefits. Finally, the director of the state Medicaid agency will decide whether the ruling will stand.
If an appeal is denied, the applicant’s only course of action may be to appeal to the Superior Court of New Jersey’s Appellate Division.
Wherever you are in your Medicaid appeals process, it’s helpful to have an experienced attorney with knowledge of Medicaid planning and healthcare laws.
At The Simone Law Firm, our significant experience with healthcare law spans multiple practice areas and relates to various clients. We’ve represented both Medicaid recipients and nursing home facilities in legal issues, so our knowledge of healthcare and Medicaid laws allows us to serve you with expert contributions.
We’ve helped individuals enter assisted living facilities or skilled nursing homes in New Jersey and Pennsylvania. Many of our clients require assistance resolving Medicare and Medicaid issues or finding the right facility for their needs and coverage restrictions.
Similarly for facilities, we can assist in the Medicaid appeal process. The power to request a subpoena to obtain documents is a key aspect we can utilize to obtain documents required in the Medicaid application process. By ultimately obtaining the missing documents that caused the Medicaid denial can significantly impact the ability for Medicaid approval for the current or future application if needed.
The Simone Law Firm has also represented clients on the other side of the coin by assisting long-term care facilities with collection issues. We are skilled at navigating the Fair Debt Collection Practices Act and utilizing New Jersey’s Medical Assistance Application and Appeal process to resolve outstanding balances and perform debt collection.
We have become skilled at finding and collecting bad debts quickly from uncooperative debtors using comprehensive software and internet tools. We can even send demand letters and promptly file lawsuits to settle debts if necessary.
Our attorneys are experienced in legal healthcare matters and knowledgeable about crucial federal and state laws regulating healthcare. We are committed to providing those healthcare collection services at a reasonable cost.
If you’ve found yourself in a situation where Medicaid benefits have been denied or need help with collection efforts from an experienced Medicaid appeals attorney, give The Simone Law Firm a call. We’ll use our extensive experience in healthcare law to get you the best possible outcome for your case.
Our law practice offers a wealth of legal services to New Jersey residents, including Estate Planning, Trust Administration, Business Law, Real Estate, Bankruptcy, and other practice areas.
For your appeal to be properly processed and result in the possible approval of benefits, it’s crucial to be sure it includes supporting documentation that you are indeed eligible for Medicaid benefits.
There are several reasons a claim may be denied, so the documentation you provide will need to support your claim that the reasoning is invalid.
For example, appeals in denials for insufficient income documentation should include tax returns, pay stubs, Social Security statements, or other documents stating your household income.
Appeals in denials for insufficient citizenship or immigration status documents should include permanent resident cards, birth certificates, or other documentation confirming your status.
From the initial filing through the final decision of the appeal hearing, the entire process for appealing your Medicaid denial could span over a few months.
When you appeal a denial of Medicaid benefits, you’re saying you were wrongfully denied benefits or a reduction in benefits was wrongfully executed. You need to prove that the reason for the denial that’s listed on the notice is invalid. This may be due to an administrative error or new documentation and information you can provide that would invalidate the denial reason.
The core values of our team distinguish our firm from all others. We know there are many choices in legal representation and we appreciate you considering our firm for your legal needs. Our firm has maintained great relationships with our clients with some lasting over twenty (20) years. Our satisfied clients demonstrate the dependable, trustworthy, honest and efficient representation that we provide in order to vigilantly protect and serve our clients’ legal needs.
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