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Medicaid Appeals

Medicaid Appeals

Administrative Appeals Attorneys Can Help You Get Benefits

Government benefits such as Medicaid health care coverage and New York Office of People with Developmental Disabilities (OPWDD) programs could provide crucial support for you or a loved one with disabilities.

So if you applied but were denied, it’s frustrating and disheartening.

But it’s not over.

Many people are denied. But you can appeal the decision.

At the Cuddy Law Firm, our attorneys are experienced in representing people in the appeals process. This includes representing you or a family member in a Medicaid hearing with an Impartial Hearing Officer (IHO), or at a New York State Fair Hearing for OPWDD services.

The government doesn’t always get things right. If you or a loved one with disabilities were denied the benefits you deserve, let our attorneys help you get to a better resolution.

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Appealing Medicaid Denials

Medicaid provides government-supported health coverage to people with limited economic means, including children whose families qualify financially.

Children with disabilities who receive Supplemental Security Income (SSI) benefits to help their families pay for basic expenses also can qualify for Medicaid.

These benefits can be a vital part of your plan to ensure a stable and secure life for your child with special needs.

Sometimes, however, people get denied Medicaid benefits if the government decides they don’t meet financial or other requirements.

If that happens, you can appeal the decision.

Appealing is a complex process. In New York State, for example, it starts with sending a request to appeal the denial, responding to state officials when they answer your request, and possibly attending a telephone hearing on your claim.

During the hearing, you’ll explain to an Impartial Hearing Officer (IHO) why the decision to deny your Medicaid benefits should be reversed.

The IHO is someone who has not participated in any decisions on your claim so far.

If you disagree with the IHO’s decision, you could file a further appeal with the U.S. Department of Health and Human Services. Or you could file a lawsuit.

You may want to talk to an administrative appeals attorney to guide you through this process.

The special needs planning lawyers at the Cuddy Law Firm can help people after they’re denied Medicaid coverage.

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Appealing OPWDD Denials in New York

If you or a family member live with a developmental disability, including autism, cerebral palsy, Down syndrome and others—and you live in the State of New York—the OPWDD is the state’s service for connecting you to potentially life-changing services and supports.

The services include programs where people can learn living skills and make social connections. They include help making housing arrangements and help seeking employment.

The OPWDD says it works with 500 different groups, including non-profit organizations and state-run services, to deliver support to people with developmental disabilities.

To qualify for services, you have to submit records describing the developmental disability, including:

  • Intellectual functioning rest results, such as IQ tests
  • Supporting documents interpreting the intellectual test results
  • Medical reports showing diagnosis of the disability
  • A report on the history of the applicant’s developmental disability, showing that the disability began before age 22

If this process confirms that you have a developmental disability, you will be approved for services.

If the OPWDD decides you don’t have a qualifying disability, you’ll be turned down.

But as with Medicaid denials, you can appeal the decision. An administrative appeals attorneys can help.

Your next steps include requesting a meeting and asking for further review of your case.

If the services you’re seeking are funded by Medicaid, you can ask for a New York State “Fair Hearing” on your denial of services.

The special needs planning attorneys at the Cuddy Law Firm can help you in an NYS Fair Hearing, or at any step in this process.

You can protect your access to services that could make a difference for you or a loved one with special needs.

Contact Cuddy Now!