How to Respond When You Are Told You Can’t Get Medicaid

Robin Mead

Heidi’s Story

“My Medicaid spend-down was miscalculated three different times. Finally, I filed a complaint and got to speak to a supervisor.

The end result was I saved $3,000 per year on the spend-down, and got my Medicaid backdated by six months. Some Medicaid employees have an imperfect understanding of how to apply different regulations and formulas. You will get a different story depending on who you talk to.” – Heidi C. Johnson

Pansy’s Story

“My local Social Services and Medicaid Department were completely clueless about the particular Medicaid program I was applying for. I had to find the actual employee training manual and educate them about it and they still refused to find me eligible. So, I had to take it to the state level. Finally I was approved, and got a $40,000 hospital bill paid.”

Jill’s Story

“The woman on the phone looked up my file and told me there was no way that I was eligible. She was very clear and specific. I applied anyway and got approved.”

Your Story

If you get turned down for Medicaid, or if someone from the Medicaid office tells you that you are not eligible, don’t give up hope! Just get scrappy. A few things it might help you to know:

πŸ’— The people who work at Medicaid often tell people that they don’t qualify. It is not always true.

πŸ’— Some people apply and get turned down because there was a mistake made on their case.

πŸ’— Many, many people don’t realize there is more than one Medicaid program. You may not be eligible for one, but you may be eligible for a different one!

πŸ’— Find a program you want to apply for and learn the rules yourself! The rules are different in every state. The people who answer the phones at Medicaid often do not know all the rules. Medicaid policy manuals are usually available online.

πŸ’— Important rule for any program you ever apply for anywhere: Never take no for an answer over the phone or verbally. The worst thing that happens is people get discouraged out of even trying to apply.

πŸ’—Β If you can find the actual manual and rules and regulation that your state has, then if you are denied, you can find out why. If you find that you should be eligible, you can appeal. Look online to find the regs.

πŸ’— If you discover that Medicaid is not following the regs, you can also contact your congressional rep. They can help get this corrected.

πŸ’— Medicaid can back bill for 3 months before the time of application. So, if you have a big hospital bill in January, and then apply for Medicaid in February, when your application is approved, the hospital can bill Medicaid.

πŸ’—Β  If you get turned down, try contacting disability rights organizations. In some states, they offer legal assistance to help people with Medicaid appeals. You can also appeal on your own.

What to Say When Someone Tells You “No” or “Not Possible” or “You Don’t Qualify”

πŸ’— There are a few magic sentences you can say that can turn a No into a Yes!

πŸ’— Also try these tips for: How to Have a Good, Helpful, Pleasant, Reasonably Successful Phone Call With a Social Service Agency

πŸ’— Don’t forget the Golden Rule The Golden Rule: Never Take No for an Answer Over the Phone

Be Like Pansy

Pansy was told she couldn’t get Medicaid. But she was courageous and smart and persistent and…. She researched and found a Medicaid program she would qualify for. In the end, not only did she get on Medicaid but she also avoided a $40,000 hospital bill. Pansy was kind enough to share her story to help others. How Pansy Got on Medicaid (Including the letter she sent that got her approved!)


Are you having one of these problems?

πŸ’— Β “My spouse makes too much money”

πŸ’— Β “Someone else I live with makes too much money.”

πŸ’— “My parents have too much money”

πŸ’— Β “I have a too much income.”

πŸ’— Β “I was approved but the Spend Down is really expensive”

πŸ’— Β “I have too much savings or I might get an inheritance”

πŸ’— Β “Child support is making my child not eligible”

πŸ’— Β “Medicaid said I’m not disabled or not medically eligible”


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