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Why Can Your Medicaid Be Canceled?

    The government offers many benefits and subsidies to people who are below the poverty line and are suffering both financially and physically. Some of the popular ones include Medicaid, cash assistance, food stamps, subsidized housing, and more. Out of these Medicaid is the most popular and most widely used program.


    • What is Medicaid?


    Medicaid is a federal and state program that provides medical assistance for low-income people and for others who qualify for it. This program came into being in 1965 by amending the Social Security Act of 1935 and is administered by the Centers for Medicare and Medicaid Services at the federal level and the respective Department of Health and Human Services (DHHS) at the state level.

    This insurance coverage is available for you even if you have private insurance.


    • Reasons For Canceling


    There are many reasons for your Medicaid to get canceled. Here are some well-known reasons.

    Your income is above the eligibility limits laid down by the rules. Some states base it on your household income while others will use your actual income to determine your eligibility. This varies from state to state.

    Medicaid does not cover any cosmetic surgery that is deemed unnecessary. The same rule applies to the dental health of patients as well, unless it is considered to be essential for the overall health of a patient.

    Some states may require you to buy the generic versions of the prescribed drugs and may not cover any additional prescriptions that are not deemed essential for your health.

    You can continue to have Medicaid even if you have private insurance. It is a good idea to present both the cards at the time of billing so you can get the best coverage from both the plans.


    • What To Do If Medicaid Has Been Canceled?


    If your Medicaid is canceled, you should get a notice in writing that states the reason for the cancelation in a language that you can understand. The exact reasons, as well as the decision-making process, should be explained to you. For example, if you were denied Medicaid because you’re over the income limit, the same should be explained in a detailed manner in the notice. The DHHS should also show how it computed your income and determined that you’re over the limit for this assistance.

    Income may be just one of the reasons and there could be many others for this denial, but the key is you should get a notice and it should explain it to you clearly. For some reason, if you’re unable to understand what the notice is saying or if the notice does not have adequate information, it is difficult to determine if the DHSS is right or not. In fact, it is not fair for you and you have a right to appeal the same to DHHS in writing.

    The appeal process begins with a hearing. You can always request for hearing if you believe that the DHHS is wrong or if you believe you have been treated unfairly. You should, however, request for this hearing within 30 days after you receive the notice. In some cases, a supervisor will resolve the issue without going in for a hearing. The hearing will not be as formal as a court trial, but it will be impartial and will be preceded by someone who has to maintain impartiality under the terms of their employment.

    All the hearings will be recorded and you have the right to have an attorney by your side. The officer will examine the merits of the case and will even take the evidence of witnesses to get a clear idea of the case. The final verdict will be whether the department followed the rules or not. Please note that the person giving the verdict does not have the right to change the rules of DHHS. They can only determine if DHHS followed them to determine your Medicaid eligibility.

    If you don’t win during the first appeal, you always have the right to appeal this decision through the legal system. You can approach your state court and file case against the DHHS for that wrong decision.

    In the meantime, it is a good idea to reach out to a health insurance company to keep your medical treatment going. For example, if you live in the Las Vegas area, reach out to an affordable health insurance in Las Vegas to cover your medical expenses while the trial keeps going on.

    In short, Medicaid is a federal and state financial assistance program that can help to meet your medical expenses. But it can also be canceled if you fail to meet the eligibility and in such a case, you should get it in writing. You have the right to appeal this decision.