According to the Department of Social Services (DSS), if you are 65-years-old or older OR if you are the primary caretaker of minor children, you are able to receive Medicaid without proving that you are disabled. However, if you are under the age of 65 and do not have minor children living with you, you must prove that you are disabled in order to qualify for Medicaid benefits. At a medical disability hearing, you must show the following:
- You cannot work regularly due to your disability.
- This disability is expected to last for at least 12 months OR will result in death.
Your illness or medical condition must be so severe that you are unable to work at your past job or most other jobs for at least one year.
- In addition to being disabled, you must also have limited income and assets.
- If you are over age 50 and have limited education and work skills, it is easier to meet this disability test.
Before applying for Medicaid, it is important to be well-informed. By understanding the following frequently asked questions, the chances of your Medicaid claim being denied significantly decreases.
How is Medicaid related to Social Security and SSI?
Medicaid uses the same test as Social Security and SSI to determine disability. If you are approved for Social Security or SSI disability, you should inform the DSS right away and they will automatically approve you for Medicaid. It is important to note that you are able to get Medicaid before you get approved for Social Security disability and/or SSI benefits as it could take up to two years or more to get approved for Social Security disability or SSI benefits. If you are denied disability by Social Security, you have 60 days to file an appeal. After being denied, contact our Social Security disability attorneys immediately for a free consultation. At Mike Lewis Attorneys, we do not charge a fee unless we win your disability case.
What should I do if I am denied Medicaid by the Department of Social Services?
It is important to read the letter carefully and make sure that it says you were denied Medicaid because you did not meet the definition of disability. If you have questions or would like to appeal, contact your Medicaid worker. Their telephone number is written on the letter you received from the DSS. If you are denied Medicaid benefits, you have the right to appeal to a State Hearing Officer. Make sure that you appeal as soon as possible as you only have 60 days to appeal a Medicaid denial. If you have a good reason, the statute of limitations may be extended up to 90 days.
What do I do if I receive a notice that a hearing has been scheduled?
Read the notice carefully. If you are unable to attend the hearing as scheduled, be sure to call both the DSS and the Hearing Officer as soon as possible. You are able to request that your hearing be rescheduled, but it’s important to keep in mind that this will delay your case.
How do I prove to the Hearing Officer that I am disabled?
By taking the following steps, you can show the Hearing Officer that you are disabled and deserving of Medicaid benefits:
- Get regular medical treatment. Make an appointment with a physician if you have not been to see a doctor recently. If you cannot get an appointment with a doctor and feel that you are really sick, go to the emergency room of your local hospital. Additionally, if you cannot afford to see a doctor, contact the North Carolina Department of Health and Human Services to see if you are eligible to receive free medical care.
- Obtain copies of your medical records. Get copies of your medical records from the doctors, hospitals and clinics that have treated you in the last two years. Explain that you are trying to get their bills paid by Medicaid, and ask that they not charge you a fee for your records because of your low income.
- Request a letter from your doctor. If possible, try to get a doctor who is currently, or has recently, treated you to write a letter stating your medical condition and the treatment you are undergoing. It is important that the letter states that you are disabled from working because of your medical conditions, that this disability has lasted 12 months or is expected to last 12 months, and why the doctor believes that you are disabled.
- Be prepared. Remember, the hearing is your opportunity to explain how you are disabled and why you are unable to work at this time. Make notes for your use at the hearing, including a complete list of your medical conditions, a list of all the doctors and hospitals that you have gone to in the last two years, your employment history, the medication you are taking, your symptoms that are preventing you from working, and your average daily activities that you either do slowly or do with the assistance of another.
What do I do at the end of the hearing?
Before the hearing is over, ask the hearing officer if he or she needs more evidence to decide your case. If so, ask the hearing officer to “hold the record open” while you get any missing medical records or go back to the doctor or mental health office. The hearing officer may also schedule an appointment for you to see a different doctor at the state’s expense.
If the Hearing Officer does not require any more information, he or she will make a decision on your case and send you a certified letter with the decision. If you do not receive a letter within one month of your medical disability hearing, call the Hearing Unit at 919-255-3901 to find out when you can expect to receive your decision.
What do I do if I win my Medicaid Hearing?
If you win your Medicaid appeal, call your worker at Social Services. Give your worker any information that they request regarding your income and assets. Social Services should approve your Medicaid benefits within 30 days if you meet all the requirements. If you are not approved for Medicaid after you receive a favorable decision from the Hearing Officer, contact your local Legal Aid of North Carolina office.
If you win your Medicaid hearing, you must still have a Social Security or SSI disability appeal pending in order to receive and keep your Medicaid. If you are denied either of these, it is important that you appeal the decision right as you only have 60 days to take action. If your benefits have been denied, it is important that you contact our Social Security lawyers at Mike Lewis Attorneys for help with your claim. With the aid of an experienced North Carolina Social Security attorney, you have a higher chance of receiving a favorable outcome.
What do I do if I lose my Medicaid hearing?
You have ten days from the date of the hearing decision to appeal to the Chief Hearing Officer. The contact information of the Chief Hearing Officer will be listed on your denial letter. If you win your appeal, take that decision to the DSS to reopen your Medicaid case. You can reapply for benefits at any time at the DSS.
Can I get Food Stamps if I don’t get Medicaid?
Yes, you do NOT need to be approved for Medicaid in order to receive Food Stamps. You can apply for Food Stamps at the DSS. If you live with someone else, you may still be eligible to get your own Food Stamps if you buy and prepare your own food.
If you are approved for Medicaid, you will no longer need a doctor’s statement in order to receive Food Stamps. If you are denied Food Stamps, you have 90 days to appeal. Contact your local Legal Aid office if you have other issues with Food Stamps.
Important Contact Information
Mike Lewis Attorneys
285 Executive Park Blvd.
Winston-Salem, NC 27103
Legal Aid of North Carolina (toll free, statewide number)
Legal Aid of North Carolina – Greensboro
122 N. Elm Street, Suite 700
Greensboro, NC 27401
Legal Aid of North Carolina – Winston-Salem
102 W. Third Street, Suite 460
P.O. Box 20188
Winston-Salem, NC 27120
NC Department of Health & Human Services – Office of Hearings and Appeals
325 North Salisbury Street
2418 Mail Service Center
Raleigh, NC 27609-2418
North Carolina Lawyer Referral Service