Medicaid is a joint state and federal program that provides health coverage to certain groups of individuals, including the elderly. Medicaid can cover your health-related expenses, such as doctor or hospital visits, preventative care, prescription medication, and mental health or substance abuse counseling and care.
Whether or not you are eligible for Medicaid will depend on various factors, such as income, age, or if you have a disability. You should consult with a Warrendale Medicaid lawyer as soon as possible when you have questions about the Medicaid process. Our experienced elder law attorneys can guide you through the application process, help you file appeals when needed, and more.
The Department of Human Services runs the state’s Medicaid program. Its managed care programs for Medicaid or medical assistance are called “HealthChoices.”
Individuals can qualify for Medicaid under two general categories, either due to their financial situation or certain non-financial eligibility requirements.
Financial eligibility is determined by your modified adjusted gross income. Individuals can qualify via financial eligibility if they are pregnant, have children under 18, are parents and caretakers of children under age 21, or are any adult under 65 who lives at or below 133 percent of the federal income poverty guidelines.
Regardless of your financial resources, you can also qualify for Medicaid if you are age 65 or older, blind, disabled, a worker with a disability, or receive long-term care or home and community-based services.
Additionally, the state imposes certain other eligibility requirements, including:
The state will also look at household composition and relationships in conjunction with individual needs to determine medical assistance eligibility.
If you disagree with a decision by the DHS regarding issues, such as your Medicaid eligibility or level of coverage, you can file an appeal with the DHS Bureau of Hearings and Appeals. A Medicaid lawyer in Warrendale could guide you through the process of filing an appeal.
When you receive your Medicaid decision, the letter will often tell you how to file an appeal and the applicable deadline. Some examples of actions you can appeal are denials or reductions of Medicaid, determinations regarding a level of care for home health services, and payment responsibility obligations.
You must file an appeal with the DHS office that made the decision. An administrative law judge will preside over the hearing and obtain testimony and evidence from each side.
The administrative law judge can issue either an oral decision or a written opinion to decide the outcome of the appeal. When you disagree with an appeal, you can seek reconsideration by the Secretary of Human Services by requesting such action within 15 calendar days from the date of the decision.
A Warrendale Medicaid lawyer can also advise you in situations where you are accused of Medicaid fraud. If you are suspected of Medicaid fraud, you could be subject to a DHS investigation or prosecution by the state attorney general’s office of Medicaid fraud control.
Some examples of actions that could subject a Medicaid recipient to investigation for fraud are:
Medical providers are also subject to investigations for Medicaid-related fraud, neglect or abuse. Care providers can get charged with criminal neglect if they fail to provide adequate services while taking part in the Medicaid program.
If you believe you or your loved one are the victim of elder abuse or neglect by a medical services provider, you should speak with an attorney right away.
Medicaid is a complicated system involving different laws at the state and federal levels. If you have questions about Medicaid planning, eligibility or benefits, a Warrendale Medicaid lawyer is available to provide guidance.
Our attorneys can also provide assistance on issues such as denied claims and pursuing appeals. We have the knowledge and experience to guide you through all the necessary protocols and paperwork for appeals. We also provide elder law workshops that can give you more information about estate planning. Contact us today to schedule a confidential consultation.
