Can a state reverse a previous agreement to reimburse costs of care during a Medicaid pending period of time?

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Riverdale Asked February 2020

Can a state reverse a previous agreement to reimburse costs of care during a Medicaid pending period of time?

My friend's husband required home health care after a stroke. The wife has a full time job. They hired a lawyer who deals with elder care issues. They provided tons of required paperwork and were living with the Medicaid guidelines. They are in NY. They were Medicaid pending for 6 months and then were told they were accepted as being Medicaid eligible. Now and another 6 months later they are being told that the state is reversing their decision for the original 6 month period. They do have their lawyer working on this but I am posing this question as I know there are experts here regarding Medicaid and am wondering if this is possible. They did hear that the state does not have enough money.

Medicaid Paying for Care

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score 0 · Answer 1

Riverdale, I am so sorry that your friends are facing this issue.

Just makes my blood boil when I hear stories like this and I see young, abled body people collecting disability because they are entitled.

Just doesn't make any sense that they can renege on an approval.

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score 0 · Answer 2

The state has less money? - maybe it was a waiver program and something came up. Or the sale of items raised them above limits. Good that lawyer is working on it. But short answer is that yes they can revoke approval if legal reason exist. That doesn’t sound like you got whole story and she may not know as language of Medicaid is dense and foreign to non Experts. And I’m not expert but did see my mother in law get letter in facility threatening to revoke if paperwork not returned promptly or she went over asset limit in bank with timing.

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score 1 · Answer 3

Thanks for answering. I will ask my friend but from what she told me it was not an issue with any other information she had that was not provided but rather that the state has less money. Her lawyer is appealing this. It is around $68,000 that they are stating will not be covered for the pending period. Previously they were told it was accepted for them. Naturally it is very distressing. They moved to a modest house,sold one car and abided by the guidelines Medicaid stated was necessary.

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score 0 · Answer 4

Did something pop up in the Medicaid review-gifting or unreported income or assets? Did the state ask for paperwork that was not filed on timely basis? If new facts emerge or query not responded to, Medicaid can be reversed. But can be reinstated on appeal.

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Can a state reverse a previous agreement to reimburse costs of care during a Medicaid pending period of time?

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