As most providers and nursing home residents are aware, getting an application, even a seemingly simple application, for Medicaid benefits processed and approved is rarely a smooth process. There can be delays, multiple requests for the same piece of information, or no information provided at all to the applicant. Recently, the New Mexico Human Services Department (HSD) has blamed current errors in processing submitted Medicaid applications on “computer glitches.”
Typically when individuals submit an application for Medicaid benefits, they must also submit supporting documentation to verify their assets, income, and resources, meet the eligibility requirements. New Mexico regulations require applications for Medicaid benefits to be processed within 45 days, but with over 431 vacancies in HSD (about 20% of total staff), applications for benefits in New Mexico are not being processed in a timely manner. The shortages in staff are not only causing delays in processing, but also causing applications to be erroneously denied. HSD’s computer system is set up to automatically issue a denial if an application has been pending for more than five or six months. This means that regardless of whether or not an eligibility worker has reviewed an application and its supporting documentation, its applicant could be wrongfully denied benefits because the agency has taken too long to process the paperwork.
As an example, in one recent case in New Mexico, a Medicaid recipient needed only to re-certify her benefits for the coming calendar year and submitted her redetermination application and supporting financial documents in a timely fashion. HSD, however, took over five months to process the information. Due to this delay in processing, a Denial Notice was issued to the applicant, despite the fact she clearly met the eligibility requirements to receive benefits.
Therefore, it is important to follow up and verify that HSD is processing and working on submitted Medicaid applications. It is also important to know if and when a resident’s application for benefits has been denied. If your resident’s applications are not being processed in 45 days from the date of application or you believe you have a resident who has been erroneously denied benefits, contact our office for an evaluation of your case. In most instances, there are actions we can immediately take to address the delay in processing, and, depending on when the denial was issued, to challenge a wrongfully denied application.
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