What If Someone's Medicaid Application Is Denied?

The denial notice explains the reason. Common reasons in Virginia include:

• Income above the Medicaid limit
• Savings above the limit
• Missing bank statements or other required documents
• Residency or citizenship not verified

The letter lists the income or savings amount Medicaid used in its decision. Make sure those numbers match your records.

Correcting Simple Errors

If the denial was caused by incorrect or missing information, you can request a correction. Examples:

• A bank statement was not received
• Income was entered incorrectly
• A submitted document was possibly overlooked/not processed

When to Submit a New Application

Reapply if the applicant's financial situation or residency status has changed. Examples:

• Monthly income is now below the Virginia Medicaid income limit
• Savings are now below the asset limit
• They've recently become a citizen
• They did not qualify before but now meet the requirements

Virginia does not limit how many times you can apply.

When to Appeal the Decision

File an appeal if the denial was incorrect based on the information that was submitted. Appeal if Medicaid (for example):

• Counted income incorrectly
• Counted assets that should have been excluded
• Claimed documents were missing when they were submitted

See also: What If Someone Doesn't Qualify for Medicaid in Virginia?

How to File a Medicaid Appeal in Virginia

You have 30 days from the date on the denial notice to request a fair hearing. You can file:

• Online through the Virginia Medicaid appeals
• By phone at 804-371-8488
• By email at appeals@dmas.virginia.gov
• By fax at 804-452-5454

Include:

• Applicant's name
• Case number
• A written request for a fair hearing

You are not required to hire an attorney.