Health & Benefits

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Being denied Medicaid coverage with a disability

If you get Social Security or SSI benefits because of a disability. Then, you may be eligible for Medicaid.

If you do not get Social Security or SSI, but you have a disability. Then you have to prove that you are disabled. Many people are denied if they are unable to prove they are disabled.

You must provide your caseworker with all available medical evidence of your disability. HFS must pay for a medical exam if:

  • You do not have any current medical evidence, and
  • You cannot afford to pay to see a doctor.

It is often necessary to file an appeal. You can get a lawyer to establish that you are "disabled" and eligible for Medicaid.

If you are eligible for Medicaid, they may deny coverage of medical services. Common reasons for denial include:

  • Failure to obtain prior approval,
  • The treatment or equipment is not medically necessary,
  • There are more cost-effective alternatives,
  • The medical service or item is not a Medicaid covered service.
Last full review by a subject matter expert
April 22, 2020
Last revised by staff
May 24, 2020

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