Being Denied Medicaid in Michigan

Medicaid is a government health insurance program for low-income people. It is jointly funded by the federal government and the states, including Michigan.

The Michigan Medicaid plan identifies who is eligible for coverage, what health services plan participants can receive, the state’s reimbursement policy, and other requirements.

Who Is Eligible for Medicaid in Michigan?

You qualify for Medicaid if your household income is below:

• 195 percent of the federal poverty level for infants under 1-year-old and pregnant women;
• 160 percent of the federal poverty level for children ages 1 to 18 years old; and
• 133 percent of the federal poverty level for parents and other adults.

The blind, disabled and other groups may also qualify for Medicaid.

Note that children with household incomes that are 212 percent of the federal poverty level qualify for the Children’s Health Insurance Program (called MIChild in Michigan).

The Michigan Department of Health and Human Services determines whether a family or individual is eligible for Medicaid.

What If My Medicaid Application Is Denied?

There are several reasons your Medicaid application might be denied. The most common reason is that you do not meet the income requirements. In other words, you make too much money. Here’s another example: If you claim eligibility based on disability and the Department of Health and Human Services doesn’t believe that you are disabled, then your application will be denied.

If the department denies your application you will receive a letter that explains why you were denied. The letter will also explain how you can appeal the denial of your Medicaid application. Here is what you need to know about the appeals process:

1. You have 90 days after receiving the denial letter to request an administrative hearing.
2. A hearing request form should be included with the letter. You don’t have to use this form to request the hearing, but your request must be in writing and signed by you or your legal guardian.
3. A notice specifying the time, date and location of your hearing will be mailed to you. Note that most hearings are actually held over the phone.
4. You may be represented by an attorney, but you must provide the department with the name of your representative, in writing. The department will not provide you with an attorney.
5. An administrative law judge from the Michigan Administrative Hearing System for the department will hear your case.
6. The hearing will be recorded, and both you and department officials may ask each other questions.
7. The judge will not announce his or her decision during the hearing but will send it to you in the mail.

If the judge upholds the denial, you have 30 days to file an appeal with the Circuit Court, typically in the county in which you reside. You could also choose to file a motion for rehearing or reconsideration with the administrative law judge.

Contact Us Today

The appeals process can be complicated, and you shouldn’t have to navigate it alone. Contact our experienced Grand Rapids Medicaid lawyers today if your Medical application is denied. We will help you receive the health insurance coverage that you deserve.