Jan92026
Guardianship Q&A Series

What happens if I can’t submit the requested tax return right away for the Medicaid review? – North Carolina

Short Answer

In North Carolina, if a county Department of Social Services (DSS) requests a tax return during a Medicaid review and it is not provided on time, DSS can move forward using the information it has and may redetermine eligibility. That can lead to a denial, termination, or a request for more documentation, depending on what is missing and why it matters. The safest approach is to respond in writing right away, explain the delay, and provide an expected date (or alternative proof) so the review does not stall.

Understanding the Problem

In North Carolina Medicaid planning and guardianship-related cases, a common issue is timing: can a Medicaid applicant or representative delay providing a requested tax return without the county DSS treating the file as incomplete? The decision point is whether the requested tax return is needed as verification for the specific review step (such as confirming residency, income, or other eligibility facts) and whether DSS has a response by the deadline stated in the notice.

Apply the Law

North Carolina Medicaid eligibility decisions and ongoing eligibility monitoring run through the county DSS. When DSS identifies a discrepancy or needs verification, it can send a written notice requiring a written response within a short time window. If the response does not arrive, DSS may proceed to redetermine eligibility and then send a formal notice of its decision. Separately, Medicaid applications have statewide “timely decision” standards, but missing verification can still slow down or derail an approval if DSS cannot confirm required facts.

Key Requirements

  • Timely written response to DSS: When DSS sends a written request tied to a discrepancy or review item, the response generally must be in writing and within the deadline stated in the notice.
  • Verification (not just an explanation): DSS typically needs documents (or other credible evidence) to verify key facts; a statement alone may not be enough for certain items.
  • Eligibility facts must still be provable: If the tax return is being used to verify something material (for example, residency history, income pattern, or other financial facts), DSS can treat the file as unsupported until acceptable proof is provided.

What the Statutes Say

Analysis

Apply the Rule to the Facts: Here, a tax return is being requested so a Medicaid undue-hardship submission can be reviewed and supported. If the return is not available right away, the risk is that the review cannot be completed on schedule, and DSS may treat the record as missing verification if the return is needed to confirm a key eligibility fact. A prompt written response that (1) acknowledges the request, (2) explains why the return is delayed, and (3) provides an expected delivery date (or acceptable substitute documentation) helps reduce the chance that DSS proceeds without the missing proof.

Process & Timing

  1. Who responds: The Medicaid applicant, authorized representative, guardian, or attorney (if properly authorized). Where: The county Department of Social Services (DSS) handling the Medicaid case in North Carolina. What: A written response to the DSS request/notice, attaching the tax return if available or stating when it will be provided and what substitute documents are enclosed. When: Follow the deadline in the DSS notice; for certain monitoring notices, the statute references 12 calendar days from mailing.
  2. If the tax return is delayed: Provide partial documentation immediately (for example, proof of filing, IRS transcript request confirmation, W-2/1099s, or other records that address the specific verification issue), and ask DSS in writing whether an extension or alternative verification will be accepted.
  3. Decision/notice: If DSS redetermines eligibility based on an incomplete record, DSS should issue a written notice of its decision. If the decision is adverse, the next step is usually an appeal request within the time stated on the notice.

Exceptions & Pitfalls

  • Assuming “no tax return” means “no problem”: Even if a person did not file, DSS may still require proof of non-filing or other records that verify income and resources for the period under review.
  • Responding late or informally: A phone call alone may not satisfy a written-response requirement. A short written response with attachments is usually safer.
  • Sending the wrong document: DSS may need the signed return, all schedules, or a transcript. If the request is unclear, a written clarification request can prevent a second delay.
  • Undue-hardship submissions need support: Hardship arguments often depend on clear documentation. Waiting to gather “perfect” paperwork can backfire if it causes a missed DSS deadline; sending what is available now and supplementing later is often more effective.

Conclusion

In North Carolina, if a requested tax return is not submitted on time during a Medicaid review, the county DSS may proceed to redetermine eligibility based on the information available and then issue a notice of its decision. When the request comes through a written discrepancy notice, the response deadline can be short (often tied to a 12-calendar-day window). The most important next step is to submit a written response to DSS immediately, provide the tax return if available, and if not, provide an expected date and substitute verification.

Talk to a Guardianship Attorney

If a Medicaid undue-hardship submission is pending and a requested tax return is delayed, our firm has experienced attorneys who can help coordinate the documentation, communicate with DSS, and keep the case moving on the right timeline. Call us today at (919) 341-7055.

Disclaimer: This article provides general information about North Carolina law based on the single question stated above. It is not legal advice for your specific situation and does not create an attorney-client relationship. Laws, procedures, and local practice can change and may vary by county. If you have a deadline, act promptly and speak with a licensed North Carolina attorney.

Category: Guardianship Q&A Series

Author: Pierce Law

Pierce Law Group is a North Carolina law firm focused on probate administration, real estate partition matters, and surplus funds claims across North Carolina. We know these situations often come with stress, family dynamics, and time-sensitive decisions—so we prioritize clear communication, steady guidance, and a practical plan from day one. Our goal is to make a complicated process feel manageable, while protecting what matters most to you.