New Hampshire Medicaid Denial Appeal: How to Fight a Rejected Application

A Medicaid denial doesn't mean your parent doesn't qualify. It often means the Bureau of Family Assistance didn't get the documentation it needed, or made a calculation error that can be corrected on appeal. Understanding why applications get denied — and how the appeals process actually works — can save months of private-pay nursing home bills.

The 30-Day Deadline

When the BFA issues a Notice of Decision (NOD) denying your parent's Medicaid application, the clock starts immediately. You have exactly 30 days from the date printed on the NOD to file a written appeal with the DHHS Administrative Appeals Unit.

This deadline is not flexible. If you miss the 30-day window, you lose the right to appeal that specific decision and must start the entire application process over. If your parent is already in a nursing home at $13,000/month, the financial consequences of a restart are severe.

Common Denial Reasons

Most denials fall into predictable categories:

Missing documentation. The BFA requested additional verification (Form 800V) and didn't receive it within their timeline. This is the single most common denial reason. Bank statements, property deeds, or tax returns that the applicant thought were submitted but weren't received, or were incomplete (missing pages, wrong account, wrong date range).

Countable assets above the $7,500 effective limit. The BFA determined that your parent's countable resources — including bank accounts, investment accounts, IRAs, 401(k)s, and life insurance cash values — exceed the threshold. Sometimes this is a legitimate calculation; sometimes the BFA incorrectly counted an exempt asset (like a burial trust or the primary vehicle) as countable.

Transfer penalty from the lookback period. The BFA identified a transfer for less than fair market value within the 60-month lookback window. The denial may include a calculated penalty period showing how many months of Medicaid ineligibility the transfer created.

Clinical assessment didn't meet NFLOC threshold. The Medical Eligibility Assessment determined that your parent does not require a Nursing Facility Level of Care — typically meaning the assessor found they could perform most Activities of Daily Living independently.

Income calculation errors. The BFA may have counted a non-recurring payment (like a one-time tax refund or insurance payout) as ongoing monthly income, or failed to apply the Medically Needy spend-down pathway correctly.

How to File the Appeal

File a written appeal with the DHHS Administrative Appeals Unit within 30 days of the NOD date. The appeal should:

1. State clearly that you are appealing the denial and reference the NOD date and case number
2. Identify which finding you disagree with — was it the asset calculation, the clinical assessment, a transfer penalty, or missing documentation?
3. Include any missing documentation that caused the denial — this is your chance to submit what was missing
4. Request continued benefits if your parent was already receiving Medicaid and is being terminated (this triggers a "continuation of benefits" until the appeal is resolved)

The Hearing Process

After filing, the DHHS Administrative Appeals Unit schedules a fair hearing. This is a formal proceeding where:

• A hearing officer reviews the BFA's decision
• You can present evidence, testimony, and documentation
• The BFA representative explains their rationale
• The hearing officer issues a written decision

You don't need an attorney for the hearing, but having one can help — particularly for transfer penalty disputes or cases where the clinical assessment needs to be challenged with independent medical evidence.

What Happens During the Appeal

If your parent was already receiving Medicaid benefits and you filed the appeal within the 30-day window, benefits may continue at the current level until the hearing officer issues a decision. This prevents a gap in nursing home coverage while the appeal is pending.

If this is a first-time application denial, there's no continuation — your parent remains on private pay until the appeal is resolved or a new application is approved.

When to Reapply Instead

Sometimes reapplying is faster than appealing. If the denial was caused by a fixable issue — assets that have since been spent down, missing documents you can now provide, or a clinical situation that has worsened — a fresh BFA Form 800 may reach approval faster than waiting for a hearing date.

The New Hampshire Medicaid Long-Term Care & Asset Protection Guide includes an appeals checklist and a denial-response worksheet to help determine whether appealing or reapplying is the faster path to coverage.

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