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Can you challenge a Medi-Cal denial?

On Behalf of | Mar 28, 2023 | Medi-Cal and Long Term Care Planning

You may be able to apply for Medi-Cal if you have limited assets and income and you’re an elderly person or a person with disabilities. Medi-Cal is a needs-based system that can cover free and low-cost health benefits. It can provide a number of services, such as outpatient services, prescription drug coverage, physical and occupational therapy and wellness services.

You should know that your Medi-Cal application can be denied. This can seem confusing, especially if you believe you’re eligible for the benefits. When a denial occurs, applicants can try to challenge the denial. 

It can help to understand why your Medi-Cal application was denied if you plan on challenging it. Here’s why you may have been denied:

Understanding why your Medi-Cal was denied

There are different kinds of Medi-Cal denials. Understanding which denial you’re facing can help in amending the decision. Here are two possible reasons:

  1. Applicant error: The denial may be as simple as a small error when you filled out your application. People commonly get confused and overwhelmed because of the complex Medi-Cal documents. Or, you may have forgotten to provide enough or accurate information.
  2. Caseworker error: People are frequently applying for Medi-Cal benefits through caseworkers. Many caseworkers get overwhelmed and this can create issues when viewing applications. As a result, a rushed caseworker may have denied an application simply by mistake.

Now that you have an idea as to why your Medi-Cal benefits were denied, you can move forward with getting it resolved. 

Reversing a Medi-Cal denial

Medi-Cal applicants facing a denial are given three ways to resolve the issues. You may be able to request a reversal, appeal the denial or re-apply for the benefits. You may need to reach out for legal help to know which option is best for you.