Applying for Medicaid in New York can be a critical step for families in need of home care services. But for many, the application process can be difficult — and unfortunately, denials are not uncommon. Understanding the most frequent reasons for denial can help you avoid common pitfalls and improve your chances of approval.

In this post, we’ll walk through typical reasons Medicaid applications are rejected in New York, explain the rules, and give practical advice to help you navigate the process successfully.

Why Medicaid Applications Get Denied: Key Reasons & How to Prevent Them

1. Income Exceeds the Medicaid Limit

• What happens: Medicaid programs have strict income limits, depending on the type of coverage (community-based, long-term care, aged/blind/disabled).
• How to avoid it:
  • Know the current income limits. For example, as of 2025, for many New York home care Medicaid programs, the limit is about $1,800/month for an individual and $2,433/month for a married couple.
  • Report income accurately. Include all sources, such as wages, benefits, pensions, and unearned income.
  • Use allowable “disregards”: certain income (like some health insurance premiums) may be excluded when calculating eligibility.

2. Resources / Asset Limits Are Exceeded

• What happens: Non-MAGI Medicaid (for older adults or people with disabilities) requires you to stay below a certain asset threshold.
• How to avoid it:
  • Be transparent about all resources: bank accounts, investments, real estate, retirement accounts.
  • Understand what counts and what doesn’t: primary home equity (up to a limit), one vehicle, and some personal property are often exempt.
  • Make sure you authorize the Asset Verification System (AVS): NY uses electronic asset verification; declining it can lead to denial.

3. Missing or Incomplete Documentation

• What happens: Medicaid requires a variety of documents (tax returns, bank statements, proof of assets). If these are missing or inaccurate, the application may be denied.
• How to avoid it:
  • Prepare your documents ahead of time: recent pay stubs, retirement statements, life insurance policies, bank statements, tax returns.
  • Keep copies and submit accurate versions.
  • If Medicaid requests follow-up information, respond quickly. Delays or non-responses often trigger rejections.

4. Failure to Report Changes Promptly

• What happens: When your income or assets change (job change, new savings), and you don’t report it, your Medicaid application or renewal may be denied.
• How to avoid it:
  • Report any changes as soon as possible.
  • When recertifying, make sure all current financial data is up to date.
  • Use the New York State of Health website or your local Department of Social Services to update your status.

5. Not Meeting Categorical or Functional Criteria

• What happens: Some types of Medicaid look at more than just financial eligibility — they also assess “need.” For example, long-term care Medicaid typically requires a determination of medical or functional need.
• How to avoid it:
  • Work with a care coordinator or case worker to collect necessary medical documentation.
  • Make sure assessments (such as nursing or home care needs) are completed thoroughly.
  • Consider “spend-down” if your income is slightly over the limit: you may be able to qualify by demonstrating high medical costs.

6. Delays or Non-Response to Medicaid Requests

• What happens: After submitting, Medicaid might request additional information or clarifications. Failure to meet deadlines can lead to automatic denial.
• How to avoid it:
  • Monitor your mail and email after you apply.
  • Keep copies of everything you submit.
  • If you miss a deadline, ask for an extension or help from an advocate or agency.

7. Incorrect Application Path

• What happens: Applying through the wrong system or program can lead to denial (for example, applying as non-MAGI when you qualify under MAGI or vice versa).
• How to avoid it:
  • Understand which category you fall into: MAGI (for many adults) vs non-MAGI (elderly, disabled).
  • Apply via the correct channel: New York State of Health, your local DSS, or other relevant program.
  • If unsure, speak with an enrollment assister or Medicaid planner before applying.

Tips to Strengthen Your Medicaid Application

• Work with a Medicaid eligibility specialist or attorney, especially for complex cases (e.g., long-term care).
• Keep all your financial documentation organized in a folder.
• Ask for help from a community-based organization if you’re unsure how to gather or submit documentation.
• Reapply or appeal if denied: you have the right to a fair hearing and to provide additional evidence.

Conclusion

Getting denied Medicaid can be disheartening, but many denials can be prevented with preparation. By knowing the income and resource thresholds, submitting complete documentation, staying on top of changes, and responding promptly, you significantly improve your chances of approval. At our Eagle Eye Home Care, we’re here to guide you through the process every step of the way — because you deserve access to the care you need.