Medi-Cal is one of the best sources of health benefits for senior citizens living on a limited income in Los Angeles County. As Medi-Cal is a needs-based program, meaning one has to show financial need or hardship in order to receive benefits, there are times when Medi-Cal benefits can be denied by the state agency. However, there are mechanisms in place to appeal the Medi-Cal denial and receive the benefits for necessary medical care.
Denials most often occur due to the applicant’s income or assets exceeding the state eligibility levels, which are set each year. If a denial is sent, the applicant is given the chance to appeal the ruling. The ruling must be appealed within 90 days from the Medi-Cal denial, otherwise the initial denial ruling will stand firm.
A Medi-Cal appeal is very similar to a court case; there will be a hearing in front of a panel where evidence proving the denial is in error must be presented, and the applicant can be represented by an attorney. A Los Angeles County elder law attorney experienced in Medi-Cal laws and regulations can be an asset in Medi-Cal denial appeals, since Medi-Cal laws are extremely complicated.
If an applicant chooses to appeal their Medi-Cal denial, a hearing date will be set. The California state Medi-Cal agency will send information regarding the hearing, such as the time and date – if the hearing date is missed by the applicant, the entire appeal will be thrown out and the denial ruling will stand.
Just like a court case, it’s important for the applicant to provide their Los Angeles County elder law attorney with evidence that backs up their claim to Medi-Cal benefits, including any medical exams or financial documentation that can help their case. The best chance for winning an appeal lies in having as much correct, relevant information as possible that bolsters the case.
After the hearing, the applicant will receive notice from the state agency informing them on the outcome of the appeal. If successful, Medi-Cal coverage will be given going back to the date the applicant became eligible for coverage. If the denial still stands, the applicant may have one more chance to appeal, but it’s best to consult with a Los Angeles County elder law attorney to determine best options and next steps after a denied appeal.
If you would like to learn more about appealing a Medi-Cal denial, or if your loved one has been denied Medi-Cal services and you’d like to help them appeal, please set up an appointment at our Los Angeles County elder law office by calling (818) 905-6088.