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?
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.
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.