Qualifying for MassHealth can be a financial lifesaver as you age since it can help pay for long-term care and necessary medical treatment, which otherwise could eat away at your savings and deteriorate any wealth that you intended to pass down to your loved ones. Although MassHealth can be enormously beneficial, qualifying for it isn’t automatic.
Your assets and income may disqualify you unless you take further action. And even then, you could still wind up seeing your MassHealth application denied. When that happens, you need to carefully consider your options so that you know what you can do to protect your interests.
Why are MassHealth applications denied?
There are multiple reasons why a MassHealth application may be denied. This includes:
- Your income is too high: If you make too much money, then the government is going to expect you to pick up the tab for your medical care. That’s why the income eligibility threshold is difficult to meet. If you have questions about what those limits are in your unique situation, be sure to discuss with your attorney.
- You have too many assets: While your income will be considered for eligibility determination purposes, so, too, will your assets. The government thinks that if you have a lot of assets, then you should liquidate them to cover your medical and long-term care needs. So, you’ll want to make sure you reduce your assets prior to applying for MassHealth if possible.
- You neglected to provide supporting documentation: When you submit your MassHealth application, you may be required to submit additional documentation to demonstrate that you meet eligibility requirements. You need to read all requests closely so that you can adhere to them as fully as possible.
- You neglected to provide documentation showing disability if disability is the reason for your application: To show that you’re disabled, you need to submit persuasive medical documentation. If you fail to provide that documentation, then your application is bound to be denied.
Can you appeal a denied MassHealth application?
Yes. When you’re denied, you should receive a letter that specifies the justification for the denial. That letter will also indicate the amount of time you have to request an appeal. Be sure to file your appeal by that deadline and gather the evidence needed to address the reason for the denial.
This might include gathering additional medical records and financial documents. You’ll want to be as comprehensive here as you can be so that you don’t open the door for the government to deny your appeal.
If you present a strong enough case, your application may be granted on appeal. If this happens, then you might even be able to successfully request that your benefits be retroactively applied to cover medical expenses that you’ve already incurred. This can provide significant financial relief and perhaps spare your remaining assets so that they can be handed down to your loved ones.
Engage in competent MassHealth planning
The best way to avoid a denied MassHealth application and the appellate process is to engage in proper MassHealth planning early on. It’s best to reduce your assets over time in an effective way that shields them from the eligibility determination process while still protecting them for your loved ones to enjoy.
You might have several options for achieving this, but given the lookback period, it’s in your interests to start thinking ahead now. With a solid plan on your side, you’ll hopefully be able to secure the treatment and care you need without having to worry about what’s going to happen to your assets.