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What Should I Know About Medicaid Fair Hearings?

Applying for Medicaid can be a difficult process, and that process is made even more challenging if you are helping an elderly family member or loved one. Medicaid for the elderly is not guaranteed. You may believe you or your elderly loved one can receive Medicaid at any time, but there are strict guidelines that must be followed.

If you attempted to complete your application on your own, you may need additional help. You may have been denied, and you have a right to a Fair Hearing.

You may also need a Fair Hearing if you are currently on Medicaid and have lost your benefits. If you need home care services or need more home care service hours, you may also need a Fair Hearing.

You may believe a Fair Hearing is almost impossible because you do not have a lawyer or do not know what to say at a hearing. Contact our Brooklyn Elder Law attorneys when you must attend a Fair Hearing.

What Is A Fair Hearing?

Essentially, a Medicaid Fair Hearing is an appeal to request that a denied application for Medicaid is reviewed. You have the right to appeal for a Medicaid Fair Hearing in a few situations. Our attorneys are dedicated to preserving the rights of elderly citizens throughout New York and are ready to represent you in a Fair Hearing if:

  • You were ruled ineligible for Medicaid.
  • Your Medicaid coverage was denied, suspended, reduced or stopped.
  • Your Medicaid request was delayed, or you received no response.
  • Your request for home care hours has been denied.
  • Your request for additional home care hours has been denied.
  • Your request for Licensed Practical Nurse hours has been denied.
  • Your request for additional Licensed Practical Nurse hours has been denied.

You will receive a letter detailing the reason for the denial or suspension. You should bring that letter to us so we can investigate your case. We will work with the administration that handles Medicaid, and we will ensure that your application is completed properly.

Why Were You Denied?

Medicaid denials occur for several reasons. You may not understand the exact reason for your denial, but it helps to know what might have gone wrong when you sent your application. Medicaid is renewed every year, and you may be able to avoid these issues in the future. Talk to one of our attorneys if you encounter the following issues:

  • Your application was incomplete or contained incomplete data: Incomplete applications will be denied because the caseworker does not know how to fill in the rest of the information. This is a simple matter to resolve, but you may want help explaining why the application was incomplete. We can help you plead your case successfully with a complete application. You must be prepared to offer proof of address, tax documents, pay stubs and even bank statements. You are establishing your financial situation when sending the application, and we will help you collect this information if it was not included in the initial application.
  • You may have too many resources: Clients are deemed to have too many resources when they have more holdings or income than the law allows. You may have won some money or received cash gifts during the year. This financial situation can be explained during your hearing, but you must disclose all the information you have about your finances. Many family members will help Medicaid applicants by transferring money away from the applicant’s bank account. These disqualifying transfers will not allow your elderly loved one to receive the coverage they need. Instead, you must explain the financial situation at the hearing with the help of one of our experienced attorneys.
  • You might not be medically qualified: You may not qualify medically for Medicaid coverage because your conditions are not serious enough, according to local statutes. We will collect information from your doctors or mental health professionals to build a case for your appeal. We will argue your case vigorously during the appeal hearing, and we will use our understanding of local law to help you obtain the coverage you deserve.
  • Your caseworker misreported or misunderstood your case: Sometimes, caseworkers may have misunderstood your application or misreported the information contained therein. For example, a caseworker may not have transcribed information from your application properly. You cannot expect every caseworker to be perfect, and we will discover the error, present that error at the appeal hearing and help you regain your coverage.

What Does A Medicaid Appeal Do?

A Medicaid appeal will grant you the opportunity to petition for the benefits that you need. To learn more about your options for a Fair Hearing or to discuss whether you are eligible for Medicaid, speak with our attorneys. We have extensive experience representing individuals and families in a number of Elder Law matters and will aggressively pursue your right to long-term care or coverage in a Medicaid Fair Hearing.

We can petition immediately for the coverage or care you need. Those who do not attend appeal hearings with an attorney are forced to complete more applications, the same paperwork the state might have mishandled or paperwork that they do not quite understand. If you are learning about the benefits that your elderly loved one can receive, you might want to reach out to us for help completing your application. It is possible to avoid problems before you send the application, but most people do not know what to do until they receive a denial. As we grow old, we need trusted advocates to work on our behalf and we pledge to fight for your family.

When To Request A Hearing

When you receive notice that you were denied or that your coverage has been delayed or reduced, you may request a Fair Hearing with the New York State Office of Temporary and Disability Assistance (OTDA). If your request is approved, your Fair Hearing process may include the following:

  • A hearing in the presence of an administrative judge for the OTDA
  • Your argument for the need for Medicaid or continued enrollment
  • The court decision as to whether the original ruling was correct
  • A formal written response regarding the final decision, which should be sent within 90 days

Because your hearing is held before a judge, you should bring an attorney. Our attorneys will schedule a time to attend your hearing or any meetings with the administrative judge for the OTDA. We will argue that you should be enrolled or maintain your enrollment in the program. We will also argue for retroactive benefits if your plan was mistakenly suspended, and we will request a summary of the decision.

The summary of the decision is very important because it helps show that you have the coverage you requested. You may use this document to prove that you have coverage before your new insurance cards arrive, and we will keep a copy for our records in case you have any problems in the future.

Why Should You Bring A Specialist To The Hearing?

A skilled specialist from Korsinsky & Klein LLP, will go the distance to ensure that your side of the story is heard. You must tell us everything during your consultation. You may think certain details do not pertain to your case, but you should not omit small details. Our firm was founded on representing the best interests of our clients, and we consistently put in the effort to successfully appeal the denial or discontinuance of Medicaid coverage for elderly or disabled citizens.

Korsinsky & Klein LLP, Attorneys Provide Powerful Representation

Reach out to the Brooklyn Elder Law attorneys at Korsinsky & Klein LLP, to set up your case evaluation. We will use our experience to ensure that you are effectively represented from the beginning of your case to the end. If we must attend more than one hearing, we will be there. We take your long-term care needs seriously, and we will go to great lengths to ensure that all necessary documentation or petitions are present at your Medicaid hearing.

Call us at 212-257-0199 or contact us online for an initial consultation. Enjoy your life without worrying about how to pay for health care. We provide legal counsel to clients throughout New York and New Jersey from our offices in Brooklyn, Manhattan and Lakewood, New Jersey.