Denied Medicaid?
You don't have to
face it alone.
If your family has been turned down for Medicaid coverage or services in Virginia, there is still time to appeal — and an attorney who will stand beside you through every step of it.
Whatever your notice says, there's likely a path forward.
Coverage refused for skilled nursing or assisted living care — often the most urgent and costly denial a family can face.
Turned down because income or assets were counted as over the limit, or because of how a transfer of property was treated.
The Commonwealth Coordinated Care Plus (CCC Plus) Waiver funds home-based personal care, respite, adult day health, and other services that allow people to remain in their homes. Denials and reductions of these services are fully appealable.
Coverage you already have suddenly stopped, suspended, or threatened with reduction.
Ineligibility periods imposed because of past gifts or asset transfers, and recovery claims filed against a deceased member's estate.
We prepare the full record and represent you before the DMAS Appeals Division — so you are never the one explaining your case alone.
We represent providers, too.
If you are a nursing facility, home care agency, physician practice, or other Medicaid provider facing a payment denial, retraction, audit finding, or termination from the program, we can represent you through the DMAS provider appeal process — from the informal appeal through the formal hearing and beyond.
See our provider appeals practiceOur practice is HIPAA compliant — patient and member records are handled securely.
Five steps. We carry most of them.
A free, no-pressure conversation. Bring the notice and any questions — we will identify your deadline on the spot.
Virginia Medicaid appeals go to the DMAS Appeals Division. If you are in a managed care plan, we handle the required internal appeal with your plan first, then the state-level hearing. Every deadline is tracked, but at this point, you need to initiate the appeal yourself before the work can begin.
Medical records, financial documents, care plans, and the applicable law — assembled and organized for you.
DMAS hearings are de novo proceedings — the hearing officer considers the case fresh from the beginning. We present your evidence and argue your position.
The hearing officer issues a written final decision. If the result is favorable, we help you get your coverage reinstated. If not, we explain your options for circuit court review under the Virginia Administrative Process Act.
It's okay to not know where to start.
What does this service cost?+
All pricing is done on a flat fee. Most private client cases are handled start to finish for a flat fee of $2,500, payable up front as a retainer. Provider cases generally cost around $3,500.
How long do I have to appeal?+
It depends on how your Medicaid coverage is structured. For most direct Medicaid denials, you have 30 days from the date you receive the written notice (DMAS presumes delivery within five days of the mailing date). If your coverage is through a managed care organization — such as Cardinal Care — you must first appeal internally to the plan within 60 days, and then you have 120 days after the plan's final decision to bring the case to DMAS for a state fair hearing. Your notice should state the exact deadline that applies to you. Call us and we will confirm it the same day.
Can I keep my benefits while we appeal?+
Often, yes — but timing matters, and there is a real financial risk you need to understand before you decide. If you request continuation of coverage before your benefits are terminated, or within 10 days of your notice date, your benefits can generally continue through the end of the appeal. If you win, there is no downside — your coverage simply continues uninterrupted. If you lose, however, DMAS has the authority under federal law to pursue recovery of the cost of services you received during the continuation period. For nursing home or other long-term care services, that amount can be substantial. Recovery is not automatic — DMAS has discretion over whether to pursue it — but the risk is real and varies by case. For managed care members, the MCO may also seek to recover costs if the adverse determination is ultimately upheld. We will explain how this risk applies to your specific situation so you can make an informed choice. For some clients the continued coverage is worth it; for others the potential liability is not.
What does it cost to talk to you?+
Your first case review is free. If we take your case, we will explain any fees clearly before you decide anything.
I think I already missed the deadline. Is it hopeless?+
Not necessarily — but it depends on your situation. For direct Medicaid cases, DMAS can excuse a late filing if you had a good reason (called "good cause"), and a hearing officer makes that call. For managed care cases, the 120-day deadline to bring a case to DMAS after your plan's final decision cannot be extended under any circumstances. Either way, reach out immediately — the window to act may be shorter than you think, and there may still be other options worth exploring.
Do I have to face the hearing by myself?+
No. We prepare the full evidentiary record and represent you at the hearing. All DMAS hearings are conducted de novo — meaning the hearing officer reviews everything from the beginning — so the quality of the record and the presentation matters.
My situation is urgent. Is there a faster process?+
Yes. An expedited appeal is available when a standard timeline could seriously jeopardize your health or ability to function. For managed care cases, expedited internal appeals must be decided within 72 hours. We can assess whether your case qualifies and make sure the request is filed correctly.
My coverage is through a managed care plan. Does that change anything?+
Yes, significantly. Most Virginia Medicaid members receive their services through a managed care organization — plans like Aetna Better Health, Anthem HealthKeepers, Optima Health, United Healthcare, or Virginia Premier. If your plan denies or reduces a service, you must first appeal internally to the plan before you can bring the case to the DMAS Appeals Division. Missing the internal appeal deadline can affect your ability to get a DMAS hearing. We handle both levels and make sure nothing falls through the cracks.
Let's take the next step together.
Send us a little about what happened. We'll get back to you quickly — usually the same day.
Alexandria, VA 22307