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How common are Medicaid denials and how do I appeal one?

If you recently received a denial on your application for New York Medicaid benefits, you probably have a lot of questions.

A Medicaid denial is a nerve-wracking experience, especially when you are not sure why you received it in the first place. Here are some potential reasons why Medicaid denied you and what you can do about it.

How common are Medicaid denials?

Medicaid denials are rather common, so you are not alone in this. Medicaid is an extensive program, and errors can easily slip through the cracks. For example, if a caseworker misinterpreted the information on your application or misplaced some of it, you may receive a denial. Similarly, they may deny your application if you missed a piece of information when you submitted it. There is also a possibility that your income is not within the eligibility parameters. Single applicants and couples without children can only make up to $18,755 a year and still qualify for Medicaid benefits.

How do I appeal a denial?

If you want to appeal your Medicaid denial, you should identify whether it came from a local office or the New York State of Health. You can submit an appeal for a fair hearing online, over the phone, via fax or in writing, but you need to request the hearing within 60 days of receiving your denial notice. At the hearing, you must present evidence to support why you think your application deserves approval. An administrative law judge will hear your argument and approve or deny your appeal.

A Medicaid denial is discouraging, but do not lose hope. You can appeal the decision if you believe your application denial was an error.

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