My most frequent call comes from someone who completed an application on their own and was denied coverage because they failed one or more of the eligibility rules. The call is urgent and desperate. They are completely frustrated with the Medicaid system and don’t know where to turn. Gratefully someone finally gave them my name – and they are very anxious and hopeful there is something I can do to fix their problem.

As I visit with them, I find a common thread of events lead them to their crisis. They tell me it was the nursing home that sent them straight to the case worker to start a Medicaid application. They complain no one advised them it might be a good idea to first visit with someone who could review their situation and give them advice on any issues or problems they might have – and tell them ways they might protect some of their assets. But that didn’t happen. They were just pointed straight to the case worker.

Then, trusting this advice, they submitted all the documents and information the case worker requested and waited for the good news. But something had gone haywire. Their application was DENIED. They didn’t qualify. They can’t qualify. They did something wrong and failed some eligibility rule that no one warned them about.

With discouragement, they relate how they felt alone in the system and it was anything but a helpful environment. What they found was a process fraught with complicated rules, unyielding consequences, conflicting advice, and no one telling them they had a problem and how to fix it or how they could have saved a lot of their assets for their spouse or family.

Unfortunately, I am often faced with informing them that because they filed their application without first fixing problems or first taking advantage of planning strategies that could have allowed them to save some of their assets – that Medicaid’s denial has left them with very few options. I do my best to help them with what can be done – and in some cases, I can help them get eligible and maybe even salvage some of their resources. But sometimes there’s just nothing that can be done.

The take away reality is, that once an application has been filed with Medicaid, and the “Decision Letter” issued, it is very difficult (and often impossible) to go back and fix it. That’s why it’s so important for every person applying for nursing home long term care Medicaid, to first get advice and input from an expert knowledgeable about Utah’s Medicaid eligibility rules before submitting their Medicaid application.