I went through the application process a few months ago with Mom. The one piece of information that was needed for the rest of the points came in after they had closed the case. The assessor told me to reapply immediately, which I did. I spoke with the current assessor for this round and am almost certain that she is going to deny Mom the coverage. (Mom was close to the minimum of points required.) Would it be better for me to wait a month and apply again, or would it be better to appeal the denial?
You maybe better placing Mom into a LTC facility. What was she turned down for? I spent my Mom down by placing her and paying privately for two months. In that two months, I was able to get all the info Medicaid required. I placed her in May, confirmed in June she was spent down and Medicaid started in July.
Why would they close the case if all the info was not in. My state only allows 90days to complete the process, was this your problem?
They have not yet denied her, but the assessor just seems very dismissive of what's going on with Mom, like it's not worth the effort to assess her.
You should research whether Medicaid in your home state even covers MC. In MN (where I live) it only covers LTC, and this is assessed by a doctor (or the facility itself) as being medically necessary. Maybe her app is being declined because they don't cover MC for anyone. There are 2 qualifying factors for Medicaid: medical and financial.
There are so many things to try and keep track of and it's so freaking stressful. Not as stressful as having Mom under the same roof as me 24/7 tho, I will say that!
For my mom she initially had a medical denial, I as her POA had to file the appeal and a hearing was scheduled but after that the DON and nursing staff dealt with it. As the documentation has to come from providers with the ICD-10 codes and the labs done and RX needed along with a descriptive as to why skilled nursing is now necessary. They sent in to the State a stack of documents within a couple of weeks of the denial, For my mom, all this came about as the initially intake staff for the Nh left out my moms RXs and labs and diagnostic tests from her new NH health chart that were in my moms referring physicians charts (from the past 6 mos prior to entering the NH). A gross oversight, but resolved and with freshy fresh labs and exams done. All resolved before the hearing date too.
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AI apps will now be coming out of the woodwork every other minute. OpenAI just launched Atlas...
"1. Understand the reason for denial.
Before deciding whether to appeal or reapply, try to get clarity in writing from the assessor or agency about why your mother is being denied:
- If it’s due to financial eligibility (income/assets too high), that usually requires changes in her finances before reapplying.
- If it’s due to functional eligibility (not enough points on the care assessment), that can often be challenged with more documentation or testimony.
- If it’s procedural (missing paperwork, outdated info, etc.), that’s almost always better handled by a quick reapplication.
2. When to appeal (instead of reapplying)...
File an appeal if:
- You believe the denial was wrong, based on misunderstanding or incomplete information.
- You have new evidence (doctor’s notes, hospital discharge summaries, daily care logs) that would change the points or show higher care needs.
- You want to preserve the original application date, because benefits can be backdated to that date if your appeal succeeds.
➡️ Advantage: Keeps the original “application date” and may entitle your mom to retroactive coverage.
➡️ Disadvantage: It can take weeks or months, and you must meet strict appeal deadlines (often 30 days from denial notice).
3. When to reapply instead...
Reapply if:
- There’s no new evidence or strong basis to challenge the denial.
- You can reasonably expect her condition to worsen or become more clearly qualifying in the near future (e.g., more assistance needed with activities of daily living).
- You were denied for something procedural that’s now fixed (like missing documentation).
➡️ Advantage: Fresh start, possibly faster processing.
➡️ Disadvantage: You lose the earlier application date (no back pay).
4. Strategic approach in your case...
From what you’ve said — your mom was “close to the minimum points” and you expect a denial — here’s a smart sequence:
Wait for the official denial letter.
You’ll need that to see the reason and to start any appeal clock.
If she’s still right on the border:
File an appeal within the deadline (usually 30 days).
Simultaneously, prepare to reapply after a month or two if her condition declines or you can strengthen the case with new medical notes or care documentation.
If you can strengthen the case now (e.g., by showing more assistance required daily), you can also submit additional evidence during the appeal.
5. Tip: request a “reassessment”...
Sometimes, before going through the full appeal, you can request a reconsideration or reassessment—a more informal review by a different assessor. This is often faster and less adversarial."