Medicaid approval notices are one of the most exciting form letters a Raleigh Elder Law attorney can receive. The approval letter represents the culmination of most likely several months’ worth of gathering, organizing, and submitting information to the caseworker responsible for the Medicaid application. This may be on top of the month’s worth of Medicaid spend down planning that took place in order to ensure eligibility. Receiving the approval notice means that all the hard work on both our part and the part of the client was worth it. However, approval notices can be confusing but should be understood in order to avoid eligibility issues down the road.
The approval notice you receive will depend upon the program from which you are requesting assistance, but both programs utilize the same form.
The first confusing part about these notices is that they are used for both approvals and denials of coverage, so be sure to read exactly why the notice is being issued.
The second confusing part is that the notice may approval all or a part of the Medicaid coverage you requested. For example, if you requested retroactive Medicaid coverage for your medical expenses, and the applicant was “over reserve” for all or a part of that three-month retroactive period, the notice may say that Medicaid is denied for two months and approved for the last month. Be sure to carefully read what coverage has been issued and what has been denied, if any.
The third confusing part about the approval notice is the section that discusses a patient’s monthly liability. (Unsure about what a patient’s monthly liability is? Click here to review our post about frequent terms.) When you look at the amount assigned to each month, you may think to yourself “the applicant doesn’t even get that much money a month! How can they afford to make that payment??” After a certain period of time, the patient’s monthly liability will stabilize and remain consistent. However, the first few months of approval, including any retroactive coverage requested, may be higher than the individual’s income. That is often because the individual made transfers prior to eligibility, or had income (such as an annuity or 401k payment) that terminated at a later date. However, if the stated PML never reaches the level of the person’s gross income, you will need to contact your caseworker to ensure that the calculations done were correct.
The last confusing part of the approval notice is that is says the person’s Medicaid is approved starting on a certain date, and that it will end on a date one year later. This does not mean that the applicant is only going to be covered by Medicaid for one year and one year only. The termination date simply marks the point at which the applicant’s eligibility for continued coverage will have to be re-evaluated in order to sure that there have been no changes in situation that would cause the applicant to no longer be eligible. So don’t worry - Medicaid coverage will continue provided that the applicant continues to be eligible.
If you have received an approval notice that continues to be confusing even after reading this post, give me a call or send me an email. I would welcome the opportunity to review with you and assist in appealing any problems if necessary.