Appealing Denied Medicaid Applications in New York and New Jersey

Affordable health insurance can be difficult to come by. If you are low-income or have a disability, you may qualify for Medicaid in New York or New Jersey. Medicaid is a coverage plan that covers health care for you and your family at little to no cost. However, in order for these programs to run efficiently, the state government needs to limit the number of people who receive Medicaid. If you are denied upon application, you may have the right to appeal that decision.

Potential Reasons for Denial of a Medicaid Application

In New York and New Jersey, there are several reasons that you may be denied Medicaid. You may not meet the requirements, such as being a non-incarcerated resident of New York State, or earning a certain percent of the federal poverty line. These decisions, among others, can be appealed. You can even fast-track your appeal if you specify that you must do so in order to handle a current medical condition.

How to File Your Appeal

New Yorkers have 60 days to file an appeal to NY State of Health, the government agency that administers New York’s Medicaid benefits. You may file your appeal by phone, fax, or mail — from that point on, it should take approximately 90 days to consider your application and make a decision on whether to grant your request for coverage. You will have a hearing, and you have a right to a lawyer at that hearing.

In New Jersey, the process of appealing denied Medicaid applications changed on July 1, 2017 in order to be in compliance with new federal laws regarding managed health plans. Now, you must file an internal appeal within 60 days from the date that you received a letter of denial. If you are denied again after your internal appeal is completed, you will have an additional 60 days to file an external appeal. An external appeal must be filed in writing, and should contain the required form, application, and a copy of your rejection letter.

Planning Your Appeal

If you are denied Medicaid on your first application, there’s still hope, even though the appeals process can seem daunting By hiring an experienced Medicaid planning attorney to handle your appeal, you can focus on what’s important: the health of you and your family. At Lissner & Lissner LLP, we have over 65 years of experience in elder law and Medicaid planning. Call (212) 307-1499 or contact us to schedule a consultation today.

Micheal Lissner
About the Author: Michael Lissner
Micheal D. Lissner is an experienced trust and estate planning and administration attorney serving the New York City area. He handles cases ranging from estate planning to trust administration, medicaid planning, elder law, and representation of survivors of the Holocaust and their heirs