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Lane
Lane, JD, CFP, MBA, CRPS
Category: Finance
Satisfied Customers: 10865
Experience:  Law Degree, specialization in Tax Law and Corporate Law, CFP and MBA, Providing Financial & Tax advice since 1986
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How do i write a letter to medicaid to get a hardship

Customer Question

how do i write a letter to medicaid to get a hardship exemption for the state of louisiana
Submitted: 1 year ago.
Category: Finance
Expert:  Lane replied 1 year ago.

Hi,

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Can you'd tell me more about what you're asking

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... Hardship letter for what purpose?

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Are asking about the Hardship exemptions from the requirement to have health coverage?

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If so, there are different typos of hardship exemptions (exemptions for different reasons)

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Following are all health coverage exemptions based on hardships. The links below take you to a page with details about each exemption, forms, and instructions.

  1. You were homeless
  2. You were evicted in the past 6 months or were facing eviction or foreclosure
  3. You received a shut-off notice from a utility company
  4. You recently experienced domestic violence
  5. You recently experienced the death of a close family member
  6. You experienced a fire, flood, or other natural or human-caused disaster that caused substantial damage to your property
  7. You filed for bankruptcy in the last 6 months
  8. You had medical expenses you couldn’t pay in the last 24 months that resulted in substantial debt
  9. You experienced unexpected increases in necessary expenses due to caring for an ill, disabled, or aging family member
  10. As a result of an eligibility appeals decision, you’re eligible for enrollment in a qualified health plan (QHP) through the Marketplace, lower costs on your monthly premiums, or cost-sharing reductions for a time period when you weren’t enrolled in a QHP through the Marketplace
  11. You were determined ineligible for Medicaid because your state didn’t expand eligibility for Medicaid under the Affordable Care Act
  12. Your individual insurance plan was cancelled and you believe other Marketplace plans are unaffordable
  13. If you experienced another hardship obtaining health insurance, use this form to apply for an exemption with the Marketplace (PDF)
Expert:  Lane replied 1 year ago.

Hardship exemptions usually cover the month before the hardship, the months of the hardship, and the month after the hardship.

But in some cases the Marketplace may provide the exemption for additional months, including up to a full calendar year.

  • For people ineligible for Medicaid only because a state hasn’t expanded Medicaid coverage, the hardship exemption will be granted for the whole calendar year.
  • For people eligible for Indian Health Services, the hardship exemption lasts as long as you remain eligible.
  • For people under 21 who are eligible for an exemption due to religious conscience, you’ll need to reapply if you remain a member when you turn 21.

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I think this covers the bases .. Each of the lines above give you the appropriate forms

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No. 13 may work when none of the others apply specifically

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Let me know if I've misunderstood your question and you're referring to a different kind of hardship

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If this HAS helped, (and you don’t have additional questions on this), I'd really appreciate your positive rating … (by clicking or touching the stars or smileys on your screen) … … That’s the only way I'll be credited a portion of what you've paid JustAnswer.
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Thank you,
Lane

Customer: replied 1 year ago.
I AM asking on behalf of my brother. he applied for louisiana medicaid and was denied. they said he needed to appeal by asking for a hardship exemption?
Customer: replied 1 year ago.
Posted by JustAnswer at customer's request) Hello. I would like to request the following Expert Service(s) from you: Live Phone Call. Let me know if you need more information, or send me the service offer(s) so we can proceed.
Expert:  Lane replied 1 year ago.

Ok, thanks.

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The denial letter should ave provided the basics of what's needed

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The appeal deadline is one of the most important pieces of information on your appeal notice. You must request your appeal within the deadline, or you will be required to justify a late appeal. States have different deadlines, but all are required to be no more than 90 days from the date that the denial notice is mailed ( under Federal Medicaid law)

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Here are some of the best practices from Health and Human Services.

Expert:  Lane replied 1 year ago.

You can write a simple appeal request like “I want to appeal the denial notice dated 8/1/12.” If possible, submit your request in person at your local state Medicaid agency office, and have it date stamped to show that it was received by the deadline. You want to avoid having to prove later that you submitted your appeal on time or having to justify a late appeal.

Expert:  Lane replied 1 year ago.

Your state Medicaid agency will send you information about how the hearing will be conducted.

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Some do so by phone

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In some states, the state Medicaid agency conducts the hearings, while other states have separate hearings agencies or use their court systems for hearings.

Customer: replied 1 year ago.
do u have a sample ..
Expert:  Lane replied 1 year ago.

Hearings can be conducted by one or more hearing officers (judges), as long as those individuals are impartial and were not directly involved in the original decision to deny your benefits. Hearing officers can work for the state’s Medicaid agency even if the hearing is at a separate agency.

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No sorry I do not ... But again, it's getting it filed and getting a receipt that's important ... The CONTENT of your appeal will come out in the hearing ... Not the letter

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Again, the letter itself can simply say that you were denied on xxxxxxx date, and you would like to request an appeal of that decision, as allowed under LA. [AND] Federal law .

Expert:  Lane replied 1 year ago.

Get to the local field office and file the letter as soon as possible ... Then you/he will be told what to expect next ( a call or a letter giving a date for the hearing)

Expert:  Lane replied 1 year ago.

Finally, let me share a good overview of how one prepares for that hearing, from the attorneys at Nolo.com

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Expert:  Lane replied 1 year ago.

Preparing for the Hearing

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Before the hearing, federal Medicaid rules require states to allow Medicaid applicants to view their files and to review all of the documents that the agency has relied on to deny you Medicaid coverage.

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It can be helpful to write down the points you want to make to the judge or hearing officer so that you don’t forget them during the hearing. You also have the right to have your own witnesses testify at the hearing and the right to ask any of the agency’s witnesses questions.

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If something arises during the hearing (such as a medical question) that you think could be resolved if you could submit some additional evidence to the judge, ask the judge to give you more time to get the information before making a decision.

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You may want to find an attorney to represent you. You can contact your local legal aid office to find out if they represent clients in Medicaid appeals, or contact a lawyer. Federal Medicaid rules also allow you to use a relative, friend, or any other spokesperson that you choose to help you with your appeal, or you can represent yourself.

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Medical Exams

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If your Medicaid application was denied because the state Medicaid agency thought you were not disabled, the hearing officer may decide to order another medical exam for you. If the hearing officer does that, you must submit to the medical exam or you will lose your appeal. The state will pay for any medical exams or tests that it orders.

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After the Hearing

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You will receive written notice of the hearing officer’s decision. If you lose your hearing, the notice will tell you how to appeal. Depending on the state’s particular procedures, at your next appeal, you may not get another chance to testify and bring witnesses (at what's known as an evidentiary hearing). Instead, you may have an appeal in which you are limited to making written arguments about evidence that came out at the first appeal hearing. Check your denial notice carefully to find out what the appeal processes are in your state.

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Retroactive Coverage

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If you win your hearing and qualify for Medicaid, the state Medicaid agency will apply your Medicaid coverage retroactive to the date that you became eligible. In most circumstances, that will be the date that you filed an application for Medicaid. Keep track of any medical expenses that you incur from the date of your Medicaid application so that you can notify the state Medicaid agency of those expenses when you qualify for benefits.

Expert:  Lane replied 1 year ago.

Bot***** *****ne, the letter is nothing more than a statement that you want an appeal

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The more important piece here is putting together your logic, your case, fie why you believe the eligibility should be granted

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I hope this helps.

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Let me know if you still have questions

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Lane

Expert:  Lane replied 1 year ago.

Just found something for you

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How to Appeal a Medicaid Decision

Can I Appeal a Medicaid Decision?
Yes, you have the right to appeal:

  • If all the services you requested were denied
  • If part of the services you requested were denied
  • If you were offered different services than you requested
  • If the service provider did not submit for full amount of services you requested. (In this case, a doctor's note showing the need for the requested services must be included with the appeal.)

Is There Anything Besides Appealing That I Can Do to Get Services?
The provider that sent in your request for services can request a reconsideration, with additional information. This must be done within 30 days of the denial. You will get a new decision, and if services are denied again, you can appeal then.

How do I appeal?

You can request an appeal using one of these methods:

  1. complete an appeal request form online at: http://www.adminlaw.state.la.us/HH.htm
    or
  2. send a written request for appeal to:

    Division of Administrative Law
    Health and Hospitals Section
    P. O. Box 4189
    Baton Rouge, LA###-##-####br />(fax)(###) ###-####/strong>

    Or

  3. call:(###) ###-####or(###) ###-####br />(Telephone appeals are allowed, but are not encouraged)

Use only one method to file your appeal. Do not duplicate the same appeal.

Do I Have to Get Another Doctor's Statement?
To win the appeal, you may need to get your doctor to give a statement with more details about why the services are needed. The doctor's statement should include the number of hours of services needed.

Can my Case Manager help with my appeal?
YES! Your case manager should have received training to assist you with an appeal. He/she can help you gather the necessary information within the allotted time.

What Deadlines Apply?
The notice of denial will tell you when the appeal must be filed. You must appeal before or by that date. Appealing within 10 days of denial may keep services you are already receiving from being cut while the appeal is going on. You must get a final decision on your appeal within 90 days of the date you file it, unless you request or agree to additional time.

Can Someone Help me with the Appeal?
You can have someone else represent your situation if you choose. That person can be a friend, relative, attorney or other spokesperson. The Advocacy Center (1-***-***-****) helps.Click here to download a cop

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Expert:  Lane replied 1 year ago.

And Here's an overview of Louisiana's appeal hearing process

Expert:  Lane replied 1 year ago.
Expert:  Lane replied 1 year ago.

Hope this has helped .

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Let me know of you still have questions

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If not, I'd really appreciate your positive rating … (by clicking or touching the stars or smileys on your screen) … … That’s the only way I'll be credited a portion of what you've paid JustAnswer.
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Thank you,
Lane