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Top Reasons Medicaid Qualifications are Denied in North Carolina

Posted on December 29th, 2022

Our Daly Mills Estate Planning attorneys in Lake Norman know that North Carolina Medicaid supports the health and well-being of more than 2.3 million annually.

For thousands of North Carolina residents who will count on Medicaid as part of their long-term care services in the future, qualifying can be more challenging than most people realize.

Our Medicaid and Long-Term Care Planning attorneys in Lake Norman are dedicated to removing the barriers that keep our residents from having access to the healthcare and services they need by properly enrolling the first time around.

But first, it is important to know what can lead to a delay or denial in coverage, so you can plan accordingly.

What are the Most Common Reasons North Carolina Medicaid Delays or Denies Coverage?

Like most government-run programs, successfully enrolling in Medicaid requires the applicant to do an exceptional amount of legwork before their applications are even considered, let alone approved. Because of the stringent filing requirements, many of the obstacles to obtaining coverage begin with the application process.

The top reasons most Medicaid qualifications are delayed or denied include, but are not limited to:

  1. Incomplete Applications or Documents

There is very little room for error when submitting a Medicaid application or providing the supporting documentation that will lead to a swift approval. In the past, the North Carolina Medicaid Division of Health Benefits would wait for additional information before denying a claim. Now, they will often deny coverage outright if the initial package is not complete.

  1. Failing to Respond Quickly

If your Medicaid application and supporting documentation are not complete upon submission, the agency will send a letter requesting the additional requirements to consider your application. You will have ten days from the date of the letter — not the date you receive it — to respond. Depending on your neighborhood’s mail delivery, you may not receive their request until their ten-day-response period has passed. Therefore, it is important to ensure your application is accurate and complete from the beginning.

  1. Insufficient Physician’s Statement

When you count on your physician to properly support your Medicaid application and supporting documentation, you may simply attach their statement without reviewing it first. This is a mistake. Be sure to go over the statement with your physician, and ensure it is completed by Medicaid standards before submitting it with your application.

  1. Your Income is Too High

To be eligible for North Carolina Medicaid, you must be a resident of the state of North Carolina, a U.S. national, citizen, permanent resident, or legal alien, in need of healthcare/insurance assistance, whose financial situation would be characterized as low income or very low income.

You must also be one of the following:

  • Responsible for a child 18 years of age or younger.
  • Have a disability or a family member in your household with a disability.
  • Be 65 years of age or older.
  1. You Have Too Much Money

Medicaid has strict limits on how much money an individual and their spouse (if applicable) can have to be eligible for enrollment. To be sure, your definition of “too much money” and Medicaid’s threshold will be very different. With proper and careful planning, certain assets can be protected from counting towards this important income cap, so you can successfully enroll and get the coverage you need.

Get Ahead of the Medicaid Requirements by Speaking with Our Lake Norman Attorneys

To learn more about your eligibility and to devise a strategy to help you qualify for Medicaid benefits in North Carolina, call our skilled Asset Protection, Medicaid, and Long-Term Care Planning attorneys in Lake Norman today at (704) 286-8437 to schedule an initial consultation. We are here to help you understand each federal and state nuance associated with Medicaid, so you can get it right the first time around.