October 21

What to do if your Medicaid Application is Denied?


What to do if your Medicaid Application is Denied?

If you get a notice from a county Board of Social Services in New Jersey saying that a Medicaid application is denied, you have options and there is a procedure to follow to continue pursuing the application. However, that procedure is time-limited and you need to act right away. Here’s what you can expect to have happen if your application gets denied, and what you need to do to contest it.

First, a notification will arrive from your county’s Board of Social Services. There will be several boxes with possible outcomes and the one marked ‘Denied’ will have an ‘X’ next to it. Following that will be the reason for the denial. It will explicitly state that the application process is over and that eligibility is denied. Finally, instructions for re-applying will appear followed by an attachment identifying the information that is still required. For example, if the reason for denial was a failure to provide sufficient evidence, a list of verification documents will be provided. There are many reasons for a denial, and the notice has to contain the section of the New Jersey Administrative Code that the county is relying upon for its decision.

Once you receive the notice and if you decide to appeal, you must ask for a hearing before the Office of Administrative Law (OAL) within 20 days from the letter. You need to send something in to an address in Trenton, and at that point you will wait for OAL to process the case and ultimately assign it to a judge. The OAL does not receive the requests directly, but acts once they receive them from the agency that made the decision you are appealing. An administrative law judge hears the case and writes the initial decision. This is passed back down to the agency, which will make a final decision. If it is favorable to you in the end, you win! If not, you have other judicial remedies but they will be increasingly intricate and difficult.

It is important to note that this process is involved, difficult, potentially expensive, and that there is no guarantee that it will work out to your benefit. My office is experienced in handling appeals of denied Medicaid applications, and we are often able to point out where it is best to devote your resources, and how best to pursue the matter when things turn sour. If you think we may be of assistance to you and your loved one, feel free to contact this office with any questions.

Archer Law Office Can Help

For More Information Contact this office (609) 842-9200


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