Denied Florida Medicaid for Excess Assets: The Fair Hearing

Start With the Notice: What It Actually Says

In my practice, the first thing I ask a worried family to do is slow down and read the denial notice line by line. Florida calls this document a Notice of Case Action, and it will state the specific reason for denial, the effective date, and the deadline to challenge the decision. For an asset-based denial, the notice usually identifies the exact resource that pushed the applicant over the limit.

That is exactly what happened to the Okafor family in Orlando. Emmanuel, a widower in his eighties, had applied for Institutional Care Program Medicaid to help pay for his nursing home care. Months into the process, a $14,000 certificate of deposit surfaced that the family had genuinely forgotten about, an old CD Emmanuel opened years earlier and never mentioned to his children. DCF found it during verification, and the case was denied because his countable assets exceeded the strict resource limit Medicaid allows for an institutionalized applicant. (Emmanuel is a composite example, not an actual Truestead client, but his situation reflects one of the most common reasons Florida families end up appealing.)

Reading the notice carefully matters because it tells you whether this is truly an asset problem, an income problem, or a paperwork problem. Each has a different fix, and confusing them wastes precious time.

The Deadline That Actually Controls Everything

Once the notice is in hand, the clock is already running. Florida gives Medicaid applicants 90 days from the date of the Notice of Case Action to request a fair hearing. Miss that window, and the denial generally becomes final, requiring a fresh application rather than an appeal.

A fair hearing request does not need to be a formal legal filing. It can be submitted in writing or, in many cases, by phone to the Department of Children and Families. What matters is that it happens before the 90 days run out and that it clearly states the case is being appealed.

Two Very Different Paths: Fix and Reapply, or Appeal

This is the fork in the road every family in the Okafors' position faces, and it is worth thinking through deliberately rather than reflexively appealing everything.

• Curing the excess asset and reapplying. If the excess is small, clearly identifiable, and can be spent down properly (on care costs, exempt purchases, or an allowable planning strategy), a new application may resolve the problem faster than a hearing.
• Reapplying instead of appealing. Because Florida allows Medicaid coverage to begin as of the first day of the month of application once eligibility is established, a family that can cure the asset issue quickly may not lose meaningful ground by reapplying rather than fighting the original denial.
• Requesting a fair hearing. A hearing makes more sense when the denial itself appears to be wrong, when the applicant needs benefits to continue without interruption, or when there is a legal argument that the asset should not have been counted at all, for example if it was already committed to an approved spend-down strategy before the notice was issued.

For the Okafors, the $14,000 CD was real and countable. There was no legal argument that it should be excluded. In cases like this, curing the excess through a properly documented spend-down and filing a new application is often the more direct route, though every family's asset picture and timeline are different and should be reviewed individually.

What a Fair Hearing Actually Looks Like

When a hearing is the right tool, it helps to know what to expect. Florida's Office of Appeal Hearings within DCF assigns the case to an independent hearing officer who had no role in the original eligibility decision. This is not a courtroom in the traditional sense, but it is a formal proceeding, and it carries real legal weight.

• The appellant (or their representative) can present documents, testimony, and other evidence.
• Witnesses can be called, including family members, financial advisors, or caseworkers.
• The applicant has the right to be represented by an attorney, an advocate, or a family member.
• The hearing officer issues a written decision based on the evidence and the applicable program rules.

One protection families often do not realize exists: if benefits are already in place and are being reduced or terminated, requesting a hearing promptly and asking to continue benefits during the appeal can keep services running while the case is decided. This request typically has to be made at the time the appeal is filed, so it is not something to leave for later.

The Evidence That Actually Moves the Needle

Hearing officers are not persuaded by frustration or sympathy alone. They rule on documented facts measured against Medicaid's rules. The strongest cases I see built around asset denials typically include:

• Complete, dated account statements showing the true balance and history of the disputed asset.
• Documentation showing the asset was spent down, transferred for value, or otherwise brought into compliance, with clear dates and amounts.
• Proof that any transfer was not a disqualifying gift under Florida's five-year lookback rules, if that issue is in play.
• A clear, organized timeline connecting the denial notice, the corrective action, and the current asset picture.

What Happened With Emmanuel

Once the family confirmed the CD was genuinely excess and not tied to any exempt purpose, they chose not to spend months fighting the original denial. Instead, they worked through a proper spend-down of the $14,000, applied it toward Emmanuel's outstanding care costs and allowable expenses, and documented every dollar with statements and receipts. They then filed a new Medicaid application rather than pursuing the fair hearing.

Because Florida Medicaid coverage can begin on the first day of the month of a successful application, the family did not need to relive the entire prior application from scratch, and Emmanuel's care costs during the gap were addressed through the cure itself. The 90-day appeal deadline still mattered here, not because they used it, but because knowing it existed gave the family the confidence to make a deliberate choice instead of a panicked one.

Sources

• Florida Department of Children and Families, Office of Inspector General, Appeal Hearings Section, "Appeal Hearings," myflfamilies.com, April 8, 2026
• Agency for Health Care Administration, "Ask for a Fair Hearing About Screening Results or Eligibility," ahca.myflorida.com
• Disability Rights Florida, "Know Your Rights: Navigating Medicaid Waivers and Fair Hearings in Florida," September 26, 2025
• Berg Bryant Elder Law Group, "How to Appeal a Medicaid Denial in Florida: Step-by-Step Guide," September 30, 2025
• Berg Bryant Elder Law Group, "Retroactive Medicaid Coverage in Florida: What You Need to Know in 2025," July 29, 2025
• Elder Needs Law, "Understanding Retroactive Medicaid Eligibility for Nursing Home Care in Florida," November 18, 2025

This article is for general informational purposes only and does not constitute legal advice, nor does reading it create an attorney-client relationship. Florida estate, elder, probate, and real estate law are fact-specific and change over time. Consult a licensed Florida attorney about your individual circumstances. Arthur Simpson, Esq. is licensed to practice law in the State of Florida. Attorney advertising.