Two common reasons for denial are not meeting eligibility rules and not sending complete information. Not meeting eligibility rules might mean that your family income is higher than the limits your state set for this program. Another reason for denial might be because you did not include requested information or documents in the application.
If your child is denied coverage, the notification from the state's program should include a written reason. If after reading this explanation you still don't understand why your application was denied, contact your state program to make sure you fully understand the reasons for denial of coverage.
If you don’t agree with the reasons for denial and want to appeal, contact your state program. They will tell you how to appeal. You will need to provide reasons why you think the decision was wrong. You may be asked for additional information in the appeal process.
Each state has its own appeal process. Your state’s process may begin with you completing an appeal form. The final step will probably be a hearing before an administrative judge who has the authority to make a final ruling. At this point in the process, you may want to seek legal advice. If you cannot afford this, contact the legal aid program in your community to determine if you qualify for assistance. Persons at your state’s Medicaid program may also be able to direct you to someone in your community who can help you in the appeal process.
The appeal process can also be used for other grievances, such as disagreement over the starting date of coverage.
