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Medicaid for Long Term Care: 4 Stages of the Application Process

Applying for Medicaid for Long Term Care can be a long and challenging process. It begins with determining your loved one’s eligibility status and it doesn’t end until he or she is on Medicaid and receiving long term care services. Not many people know what the application process really looks like, and its detail and complexity can come as an unwelcome surprise during an already difficult time.

Once you’ve determined your loved one is eligible for Medicaid for Long Term Care, what’s next?

Applying for Medicaid and Long Term Care: 4 steps to the process

Step 1 – Medicaid Application

The first step is to fill out the Medicaid application. The purpose of the application is so that your state’s Medicaid department can evaluate whether the applicant is, in fact, eligible to receive Medicaid. Applications vary, but all request extremely detailed information about the applicant’s personal and financial situation.*

The application starts out by asking for typical identifying information such as name, phone number, address, date of birth, place of birth, social security number, citizenship status, and veterans status. Residency is an important requirement, so the application may also ask how long the applicant has lived in their state or if they have recently moved to a new state or county.

If the applicant is currently in a nursing home, the name, address, and phone number of the nursing home as well as the date the applicant was admitted will be required. If the applicant is not in a nursing home (or is, but maintains his or her own residence as well), shelter expenses such as rent, mortgage, water bill, gas bill, electric bill, and property taxes will be requested. Any outstanding medical bills, the amount paid for prescriptions, and any health insurance information including a Medicare number or insurance ID number must be listed as well.

The request for financial information is the most extensive part of the application. First, you must list any sources of income, earned and unearned, where the income comes from, gross amount, and frequency. Next, you must include any open and closed bank accounts, including the bank name, account owner, total dollar amount, and the date closed and closing balance if applicable. Any other assets must also be listed including retirement accounts, life insurance, annuities, stocks, bonds, and mutual funds, trust accounts, and funds set aside for burial. The application will ask for any institution names, account numbers, policy numbers, owners, and values for all of the above. Vehicles will also need to be listed, including owner, year/make/model, fair market value, and amount owed on any lease, and so will the amount of equity the applicant owns in his or her home. There will also be a question about any other property in which the applicant has an interest including the address of property, the type of ownership, and the equity value owned.

It is important for any transfers that the applicant has made to be included. The application will ask if and when the applicant has sold property, given away or sold other assets, purchased a life estate in a home, purchased a mortgage or promissory note, purchased or changed an annuity or transferred any interest into or out of a trusts.

Once you have completed the application, you will submit it – likely by fax but sometimes via email or, in some states, by hand walking it in – to the appropriate state department. Your first contact from the department should then be a confirmation that the application was received.

Step 2 – Verification Process

The next contact you’re likely to have with the Medicaid department is a request for verification materials. The purpose of this request is to verify any aspect of your application that might require proof. The list of documents a Medicaid office may request to see is extensive. They can seek to verify each and every question on the application leading to a list of – in the case of New York, for example – over 80 possible documents they may ask to see.

While the Medicaid department can ask for any verification materials they decide they need, you can anticipate what they are likely to request. For example, if the applicant rents a home, the department may want to see a copy of the lease, rent receipts, and utility bills for the past few months. If the applicant receives social security, the department may request to see an award letter or certificate or an annual benefit statement. The department will almost always ask for proof of citizenship and identity, requesting a birth certificate, passport, and/or photo ID.

Typically, the Medicaid office will send a letter with a list of documents that they would like to see. The letter will include a due date, upon which all of the materials must be submitted to the department. However, depending on the state, and sometimes even depending on the particular caseworker in charge of reviewing your application, you may receive a phone call instead of a letter.

The Medicaid office often gives very little time to gather and submit your verification materials. Recently, a FamilyAssets customer received a request for verification materials one week before the materials were due. While you may be able to call the Medicaid department to request a deadline extension, make sure to do this as far in advance as possible. In our case, our request for a deadline extension was denied. Additionally, it is important to note that a delay in submitting any verification materials may result in a denial of the application.

Because of these timing issues, it’s best to try to anticipate what materials the department may request before you even submit the application and gather whatever you can in advance. The documents you’ll need to gather will come from a few sources. The first, and perhaps easiest, is from the applicant’s own records. Maybe your relative has a copy of his or her birth certificate or marriage certificate in their home. If so, it’s best to look for those documents sooner rather than later. Other documents will need to be requested from banks and other private companies. If you don’t have a statement handy, you’ll need to call the institution at which the applicant has a life insurance policy or retirement account to get proof of its value – and depending on the company this could take a few weeks to receive. Even more cumbersome is the third source of documents, a government agency. Another FamilyAssets customer recently put a rush on a request for his mother’s state pension statement and as of now we have yet to receive it.

Once you have compiled all of the documents the Medicaid department requested, you can submit those documents, usually via fax. It is best to organize the documents in the same order they’re requested, provide a cover sheet listing the documents, and include the case name and number on each sheet.

Related: With Medicare Enrollment Poised to Skyrocket, What Does it Mean for Assisted Living?

Step 3 – Contact with the Medicaid Office

There are several steps along the way where you may need to be in contact with the Medicaid office, and in particular, with the caseworker assigned to review your case. For example, during the verification process, you may need to request a deadline extension, clarify a question, or, if you don’t have the requested document, to ask what other document might serve as sufficient proof. Each caseworker handles a full load of cases, so you may also need to call the department if you haven’t received any news on your case at all. In a recent case we  handled, the department claimed not to have received the initial application after we called to inquire about the delay. We had to submit the application via overnight mail along with the fax confirmation sheet showing the original date of submission so the applicant would receive benefits for the appropriate period of time.

If you are the applicant’s authorized representative, you may have even more contact with the Medicaid department. You may have to participate in a telephone interview during the verification process, and some states even require in-person interviews so the authorized representative has to be nearby. Often, authorized representatives are family members of the applicant, but in many states you can also hire someone to be an authorized representative.

Step 4 – Denials

Initial denials happen often, sometimes with no apparent rhyme or reason. If the application gets denied, this will be another time when you’ll need to keep in close contact with the Medicaid office. You may want to ask for a review of the case or a fair hearing. If that step doesn’t go your way, you may even end up in state court which could require legal representation. Or else, you may want to re-apply and, if possible, work with the caseworker to ensure your re-application process is successful.

Remember that throughout this process the nursing home will not be getting paid its full price while the applicant has what we call “Medicaid-Pending” status. So while this application process is happening, the nursing home may also be calling you and asking for updates or to be kept in the loop. Dealing with a nursing home, working your way through the Medicaid system, and caring for an elderly loved-one are all high pressure situations individually, but combined they can be overwhelming. The most important tool you need to take charge of the Medicaid process is information about what that process looks like and what steps you need to take to get through it!

* Applications vary by state (and sometimes county). The New York State Medicaid application and the New York City specific supplement were used as an example throughout the “Application” section above.

40 Comments

  1. I have a 33yr old daughter who was shot in the neck and is now a quadriplegic. She has finally been approved for medicaid and ssi but I am having a very difficult time in obtaining long term care Medicaid. The hospital she is in wants her out but I have no way of paying for in home health care. She wants to give up but her 2 children want her to fight. Any help would be greatly appreciated.
  2. In Pinellas County, Florida, dad’s medicaid app for ICP/nursing home care has been pending for over 3 months. Did a QIT for income, home and car are exempt, and that’s all he has. Did NOT apply for Medically Needy Share Cost program, yet they approved him for this a month after the application was submitted. The DCF office rep’s assessment of the LOC is for ICP/Skilled nursing. My question is this — is there a way to talk to an actual person at the DCF office? So far, we don’t even have the name of a case worker. The nursing home he is in will not wait much longer, as they are not a ‘medicaid pending’ facility. How do we talk to DCF, other than via fax, to discuss his application? Any help or info is greatly appreciated.
  3. why do they ask for my dads income from five years ago and the rest of the family, and will his income from five years ago make him not egible
  4. Hi! my fathers wife passed in her sleep june2, my father has dementia. After her passing he was at a mental hospital with physicosis . Now he is at an ALF and they applied for medicaid. My father and his wife had a mobile home and around $17,000 in their bank account. No beneficiary’s or power of attorney. Basically nobody have access to that money, in fact we need a lawyer to take assets to a probate . I don’t have money for a lawyer, to get free legal assistance is a waiting list. I am wondering if medicaid will denied him even though he and no one have access to that money. I am paying ALF out of pocket, waiting for social security to kick in , but we will need medicaid to pay difference.
  5. Hello, I have read .most comments on here and think you may be able to give me sound advice as the more you read the more confused you get, on 6/9/19 my 69 year old sister was in a horrific car accident allegedly her fault, she has been disabled and recives,medicare and Medicaid (freedom) in florida , she is permanently paralyzed waist down and requires at least 2 people to just turn her, she also has a broken neck that they won’t touch at this time so she’s in a big neck brace, her o,ly acc Asset is a single wide on rented land so she’s broke in the pocket as well, I’m her poa on medical as well, both me and my wife are both,disabled and on ssd and can’t afford to go back and forth to visit her, the rest of our family all live in NY, we would like to get her in a facility near us in little river south Carolina. Can you guide me as to make this happen, she was just transferred today 7/9 to Adventist health care in Orlando its not a long term facility but all they could get her in for now, my extended family is willing to raise the money to transport her here if we can get here in somewhere in our area, I’m reading about institutional Medicaid but there’s no direct I,formation , our family would appreciate any input you may have, God bless and would appreciate if you do have anything please email
  6. My sister at age 48 (Dec-2001) suffered multiple strokes which left her disabled. In 2002 she was approved and began receiving Social Security Disability Insurance of $1,312 (which converted to SS Retirement Income when she reached 66 in Jan-2019). In 2002 she also began receiving a monthly income of $764 from a private long term disability insurance policy she had through her employer at the time of her stroke (which has now ended when she turned 66 in Jan-2019). Following her strokes she lived with our Mom for a few years and then came to live with me and my husband for about 10 years. We found a very nice independent living retirement facility that she moved into coming up on 2 years ago. Since she has lost the private disability income of $764 in Jan-2019, I had to transfer money from my checking to my sister’s checking account monthly so she can pay her monthly rent at an independent retirement facility. Will the fact that family has been partially supporting her financially hinder her from being approved for Medicaid? -Andrea from Texas
  7. My mother is Medicaid pending while in a nursing home. We are early in the process. I have power of attorney for property. The nursing home has asked me to sign an Approved Representative Form that would make the nursing home employee my mother’s representative with Medicaid in the State of Illinois. I am very organized and am able to quickly provide whatever documents are needed and monitor the online communications with Medicaid/Illinois. The nursing home person who has been working with me, though, apparently dropped the ball and now has been replaced with someone else who asked that I sign the form. I’m guessing that it’s common for nursing homes to have residents (or their family members) sign such forms so the nursing home can more easily facilitate the process of getting approval of Medicaid (they have a big interest in faster approval). I’ve read the form and am not worried about the nursing home having access to Mom’s medical and financial info. But the form seems broad as it says the approved rep acts “on my behalf in all matters, including all items listed below.” The listed categories are: (1) application for benefits; (2) continuing eligibility; (3) health information; and (4) health plan enrollment and disenrollment. Any insights are appreciated! — Ken
    1. I am having the same issues except the nursing home is going through some trasitions. They were handling the medicaid approval. From Jan 2019 to July 20 2019 they have been through 3 secretary. No one knows what the status. Answers like there waiting on me, no one every completes or knows the status. Been told she was not approved but was never told. Now my sister has to have a Qit and medicaid will not pick up any of the expense. I wonder how they expect my sister to pay it back….
  8. My mother passed away in August of 2018 found out that nursing home never filed the papers for Medicaid can I still apply the nursing is trying to hold me responsible for the balance.
  9. I am trying TO get my medical card from my caseworker AND she says that i’m on a long term plan AND can still get my moms’ meals and food stamps but no medical card, how am I supposed TO pay for my bills AND see drs. If I don’t have a medical card?
  10. I have a question. Over the past three years my mother went into short term rehab care then was released back home. The third time she was sent to assisted daily living. She, yet again, deteriorated physically and when she went to rehab was told that they would only approve long term skilled care. She is determined to “buck the system” and get back into assisted daily living. My understanding is that medicaid will not approve that since she has proven that she will get herself only so well then when out of a facility she just stops progressing and regresses. Does this mean that she is now stuck in a nursing home until her passing?
  11. Our Mom is in a skilled nursing facility on a “Medicaid pending ” . My question is her Medicaid was approved in March and now two months later , they are saying her “nursing home medicaid” has expired ,and we need to reapply. I was sure it was good for a year. I’m confused.
  12. Hi, my mother has dementia and has lived with me for 4 years. When she came to live with me her finances were in very bad shape due to previous care giver and checking account was overdrawn and bank closed it. I never tried to open another checking account just had her SSI deposited into my checking account. Now I need to apply for help with her dementia, assisted living long term care and not sure how Medicaid will validate / accept her income? Will I just send closed account details and my checking, I have been her caregiver and also work from home full time. Will we be denied?
    1. Having her SSI deposited into your account is not a good idea if you don’t want Medicaid to include your income. They will ask you for the last three months of bank statements as well as her SSI paperwork. Get a separate checking account for your mom and pay all of her bills out of that checking account so Medicaid has a very clear picture of her expenses. After getting a separate account for her, if you don’t want your income included in your Mom’s Medicaid decision then be sure to explain to them that she is a tenant in your home and that she pays for both room and board each month. If her income is over the limit, then have a Qualified Income Trust set up and she will still be eligible. Medicaid is very particular and doesn’t give you the rules so be sure to get an elder attorney if you need one. If she owns her own home get a ladybird deed on it asap as Medicaid has a 5-year look back period in which they can take her assets at the time of her passing. I’ve been doing this with my Mom for years and it’s been a rollercoaster with Medicaid at times. If you have a lot of trouble or it’s dragging out for months on end, then call Senior Resource Alliance (if you are in Florida) or whichever senior agency in your state can help and just explain that your Mom is having trouble with Medicaid and you need help getting someone to advocate for your mom. Be very careful with what you do and how you put things. If you’re saying that she is paying rent, make sure you can back it up with receipts, etc. Thankfully for our loved ones, they take fraud and neglect very seriously. However, innocent people can fall into that pit if they are not careful. Getting an on-call elder attorney is invaluable if you can swing it. Its like insurance, most the time we don’t need it but when we need it, we really need it. Hope this helps. Dee
  13. My Mother is in frail health, currently living on her own, rents, lives off her social security. I fully expect her to need a care facility of some type within the year. What can I do to help her get on Medicaid and find some sort of care for her before it happens?
    1. First, get her finances in order (see my reply to the above post). Contact Medicaid to get an application. Medicaid will pay for an aide to come out to your Mom’s home and care for her. Make sure she is eating, cook her meals, help her bathe, whatever she needs. If she is taking medication they can remind her to do so but if they are not a nurse they can’t administer it for her. Remember that Medicaid always looks at the past three months and will ask for bank statements for those months so if her income is more than the limit, get a QIT set up in order to qualify. See the above post for details. God Bless you and your Mom, Dee
  14. I need to know how to apply for a medical extension to delay Medicaid. Here’s what I want to do: Mom is in nursing home. We have a letter from the doctor saying that our goal, in the next 6 months, is to have her go home. Our private pay money is running out. I have been told that you can delay Medicaid for 6 months while mom is healing. If she does not go home, house is sold and then Medicaid gets the money from the sale from the 6 month of mom’s recovery. Any information on this?
    1. I live in Florida so everything I’m saying is based on Florida law. However, as I understand it, Medicaid does not touch her assets until after her passing this sounds more like it may be the nursing home. Medicaid, won’t kick in if the nursing home does not file. Be careful when talking to the nursing home though. Always check with an attorney about your options because if your plan and their plan to make money conflict they often don’t give you all the information. If you have trouble with the nursing home working with you, be sure to ask very pointed questions such as; “Ok I understand, what can we do to resolve this?” My mom was in a nursing home once and they would not let her go. They threatened me with all sorts of things saying that I wouldn’t be able to care for her at home. I finally let them know that I would be recording our conversations for Mom’s attorney and asked them very specific questions about what needed to happen to get my mother home with family and loved ones again. She was released that week.
    1. First of all, is your loved one already on Medicaid? If the answer is no, move your loved one prior to the application. It’s easier that way. If the answer is yes, you need to move your loved one a specific way. Medicaid in one state doesn’t mean medicaid in another state. All states have different qualifacations. Get answers from your local job and family services on qualifications for nursing home medicaid. A person cannot qualify for medicaid in one state for the same month as another state and this will not be as easy as transferring a case. It’s a new application process. You will need to get the medicaid end dated in the current state which happpens at the end of a month. The new month begins and first day should be the admission date to new facility. You will need to find a facility to take in a Medicaid pender. Ensure that bank accounts for the loved one aren’t at a bank that’s local to the area you moved that loved one away from unless you are able to travel within a week or two to gather documents. This will delay the application process. If the bank is local to that area, best to close it and open a new one at a bank that is local to the new area. You will need proof of that closed account by a statement from the bank. Remember that if the nedicaid isn’t end dated in the old state, the new state will not open Medicaid. This means the facility will not get paid. This is why out of state transfers for medicaid are scary for facilities to take on. I can tell you from experience, many people don’t handle these correctly and facilities bring in these people thinking one state they qualified so they’ll qualify in new state. But then old state never end dated Medicaid until renewal time or expired date. These people have the largest write off amounts I’ve ever seen. If your loved one owns a home, be sure to ask questions in the new state about the qualifications regarding this. Life insurances same thing. Like I said before qualifications vary state to state.
  15. My sister is currently in a nursing home in Uniondale, New York. I would like to transfer her to Florida near Boca raton, Ft Lauderdale, or Boyton Beach areas.
  16. I have applied for a Medicaid for my Mom and Dad 6 times with 6 denials. It is a very difficult process. They have very little assets and only bring in less than a thousand each a month. The most important advice you should have before you apply is about life insurance. Make sure to cash it in or get a paper signed by the insurance company saying it is irrevocable. If cashing it in it will need to be several years before you apply no gifting is allowed. It is best to seek legal help in this matter. The cash in value of the policy will count against you. My parents had one for 3000.00 and what a headache it was to make it go away. Always appeal your denial it is looked into more closely and takes less time.
    1. Lisa, I’m so sorry to hear about your struggle to get your parents on Medicaid. What a nightmare. Would you be willing to share your experience with me? I’m currently building an organization to help solve the life insurance problem in particular, and would be very interested in your insight. I can be reached via email: epg *at* leapanalytic.com Best, Elaine
    2. Easiest thing to do with life insurances with cash out values is to sign these over to a funeral home for prepaid funeral which in most states is an allowed way to spend down. Cashing them out takes too much time but signing over is a simple document notarized. I have seen hang up on a life insurance with a cash out value of 400 combined with money in bank put person over total allowed assets. Also, spousal cases are very different than single person applications. It’s ALWAYS best to seek legal counsel due to this fact. It doesn’t matter the asset amount. Elder care lawyers know the Medicaid laws better than you and a facility. Your application process will go smoother
  17. Hello, I have an authorized representative working on my behalf to apply for Medicaid for my dad. It has been a very lengthy process and I have not been happy with the answers I am getting with respect to the delays. It seems like there is delays an excuse. Anyway, it has been over 16 months since we applied. Am I being unreasonable to think that it shouldn’t take this long?
    1. Hi Sue My mom is currently in a home as well and I paid her other rent up until Dec 2018 but couldn’t afford to cover both expenses. I applied for Medicaid in Kentucky and it is the first time applying. I was told that it would take 30 days to find out if approved or not and it is coming up but I haven’t heard anything as yet. I have been reading about denials and such so I am just waiting to see how this works. The home will take mom’s ss check except for $40.00/month for personal items and what it cost for her supplemental insurance premiums.
    2. Really depends on the case and the state/county applied in. Typically the longer a case means they’re waiting on documents. If they aren’t, in the mean time call the case workers supervisor. Get them to see the urgency. Also ensure that if you signed over a life insurance policy to funeral home, that the insurance policy actually did the paperwork. Ensure that for all months your loved one had under the allowed amount for total assets. Also if you were given time to sell home, vehicle, etc. Ensure you’ve done so. Remember the facility isn’t getting paid by medicaid in this time frame so they want it approved just as much as you do. I have seen cases go on as long as yours and be denied because the insurance policy, while signed over, proper paperwork from the insurance policy wasn’t completed. I have also seen them approved by simply calling the supervisor to make them aware how long this has gone on.
  18. how far in advance would you have to apply if the person is already in a home and their money would only last them about another year or two
    1. The month you spend the amount that puts them under that limit amount, that’s the month you file the application unless that amount covers the current month. Then the following month for application. In the meantime keep all reciepts. Also ensure you’ve done funeral planning prior to spending all money at the nursing home. You can upgrade services you’ve already paid for as well.
  19. Friend in nursing home past 6 mos is applying for long term care. Nursing home wants his social security check amounts sent to them now for past two months. Is that correct? Also he has continued to pay his old rent up until now (he might go home eventually). Must he stop paying the old rental and send all money to nursing home? Can nursing home request what has been paid to the rental for the two months too? Thank you
    1. This is correct. Medicaid is known as the payer of last resort. This means they’ll always pay last. When in a long term care facility, medicaid guidelines set forth a dollar amount to be the person’s patient liability. This is the person’s income minus the dollar amount Medicaid says you can keep per month. (Spousal cases are different.) This patient liability is like rent and medicaid picks up the rest of the bill. So if the PL is 2000 and it cost 6000 to live there Medicaid is only paying 4000. Medicaid doesn’t take into consideration outside bills because you’ve applied for medicaid for nursing home. By doing this you’ve said you intend for this to be their home. Therefore they wouldn’t need appartment, utilites, etc. All expenses are covered in the nursing home. So yes, that person owes that amount to the nursing home. If it’s already spent, choices are to allow that small dollar amount that is kept monthly to go towards back bill, family come up with the money to pay, or do nothing which will end result in a write off for the facility or if the person owns a home, upon death and depending in dollar amount, facility will do a lien.
  20. Thank you for all the information about Medicaid. My parents have been wondering about Medicaid and how they can get it. That is good to know that they have to fill out an application before they get Medicaid. I will have to let them know.
      1. Once you start the medicaid process can it be stopped? We are not sure we will go that route but were considering starting the process.
        1. Hi Patricia, Thats a great question, I would ask the state agency you will be working with, they will be able to give you the correct info based on your specific state laws, etc…

  21. Thanks for sharing the application process. It is of great help. Medication for seniors is a long and complex process, that’s true. Most of the people have no idea about the age in which a senior citizen becomes eligible for Medicaid. This blog is very useful for people who are looking to help their loved one through Medicaid. The whole process may keep you busy but it has tons of benefits too.
  22. I never realized how in depth the process was to get long term Medicaid. It was helpful to know that the first step in the process is to fill out the application, and give it to the appropriate state department. If I am ever in need of Medicaid, although a long process, I’m sure it’ll benefit me more than I could imagine.

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