Are expedited Medicaid appeals available for nursing homes?

Are expedited Medicaid appeals available for nursing homes?

On Behalf of | Dec 12, 2022 | Medicaid |

It costs thousands of dollars per month for patients to pay for a room in the average nursing home facility, and many older adults do not have enough money set aside for retirement to cover those costs. Nursing home facilities in Pennsylvania largely depend on government payments to continue providing services for their residents.

Many aging adults living in nursing homes use Medicaid benefits to pay for their room charges and may not have engaged in advance planning to improve their chances of getting benefits when they first apply. Unfortunately, a facility could find itself in a position where a resident has already begun receiving services but then receives a rejection from Medicaid.

Your facility would suffer in that situation, and your business may have grounds for an appeal. Do you have to go through the formal appeals process or is an expedited appeal available?

Service providers sometimes qualify for expedited appeals

The standard Medicaid appeal is a lengthy process with numerous mandatory reviews involved. In a situation where you hope to appeal an unfavorable benefits decision, you may qualify for expedited processing if all parties agree that it would be appropriate.

In an expedited Medicaid appeal, you forego many of the meetings and reviews necessary before a hearing and can potentially make your case in court more quickly. For a facility struggling to balance its budget and in need of funds to reimburse for services already rendered, an expedited Medicaid appeal may be the best solution. A formal appeal could also be necessary in certain situations.

Knowing what to expect during a Medicaid appeal will help nursing homes secure payment for the services they provide to their residents.