Of course, you’ve heard of the 10 commandments, the 11th commandment is:

Never, ever file a Medicaid application until you are sure that you qualify or it is strategically beneficial to be denied!

Once you apply for Medicaid, you will lose the opportunity to protect your assets. Do not throw away the flexibility that exists prior to an application! If your assets show that you have more than the allowable amount, you will be required to spend-down those assets. Call a medicaid lawyer first before completing any Medicaid application! They can tell you whether or not we can save you money. You will lose money and flexibility if you file for Medicaid too soon or too late. Let the lawyers calculate when the Medicaid application should be submitted.

They can usually determine the amount of money that you will save and the appropriate date that the Medicaid application should be filed. Attorneys normally submit the Medicaid application 60 days or more prior to the date that they believe the MA will be eligible for benefits, given the current delays in the Medicaid approval process.

A Medicaid application requires a mountain of paperwork, and is then submitted to an overwhelmed and adverse government processing system, which makes filing an application for public benefits an enormous project. Consultants and attorneys have developed systems to make your life easier. Their teams know how to present the information in a way that it can be easily understood by Medicaid officials. They will detail all of the strategies that our clients have used to qualify for governmental benefits while safeguarding assets. They will highlight and justify with appropriate legal support the reasons why our recommendations are appropriate.

When applying for Medicaid or other public benefits, there are often many hidden potholes, obstacles, and dangerous curves in the road. Attorneys understand these problems, as they have driven this road before — and we are prepared to address them and solve them. They will represent you through the application and all face-to-face meetings with Medicaid caseworkers or higher-level officials.

General Information on Applying for Medicaid

Medicaid Applications

The pile of paperwork required and an often inefficient government processing system can make filing an application for public benefits an enormous project. Although the federal government shares the cost of funding the Medicaid program with the states and requires the state government to uphold certain standards with respect to efficiency and the granting of Medicaid applications, it is not uncommon for a state or county office to fail to meet the federally imposed guidelines.

Therefore, when applying for Medicaid or other public benefits, it is crucial for applicants to be well prepared and well versed in the legal implications of all information to be supplied in support of the application. Also, when the state or county office fails to meet a deadline or erroneously renders a disposition on an application, the applicant must be prepared to exercise his Constitutional and state statutory rights.

Following is a sample list of Medicaid application issues which should be addressed to avoid unnecessary delays and denials.

1. Selecting a Program

Applicants for public benefits must decide the programs for which they wish to apply. The choice of programs may depend on the applicant's living situation, physical condition, and financial status. Certain benefits programs are also specifically geared to victims of traumatic brain injuries or Alzheimer’s Disease. Many states, including New Jersey have dual institutional Medicaid programs which have slightly differing income and asset standards and offer different coverage with respect to hospital stays.

2. Timeliness of Filing Your NJ Medicaid Application

Although families have the opportunity to expedite their Medicaid eligibility through asset protection planning under the guidance of an Elder and Disability Law attorney, it is vitally important that applicants do not apply for Medicaid prematurely. Strategies for Medicaid planning often include triggering a penalty period for Medicaid eligibility purposes. While the time in which to wait to file an application may be more or less than five years, filing an application during a period of ineligibility could potentially cause a significant delay in the applicants eligibility approval status. It is, therefore, important to check with a qualified professional as to the date after which the application may be filed.

3. Authorization to Apply

In most cases, the applicant himself or herself is unable to visit the County social services office and offer detailed information on his/her financial status. The law, therefore, specifically provides that a relative, welfare agency staff member, staff member of the institution in which the applicant resides, or a professional such as a doctor or attorney may apply on the applicant's behalf. In cases where an attorney has been retained to apply on behalf of an applicant, the attorney must acquire an authorization from the applicant or his/her attorney-in-fact to obtain, discuss and submit financial data in support of the Medicaid application. Because the Medicaid eligibility laws and policies are rapidly changing, subject to shifts in politics and lobbying by advocates for the elderly, applicants are well advised to retain individuals with comprehensive knowledge of the Medicaid eligibility rules and all strategies that may be legally employed to expedite eligibility.

4. Physical Criteria for Medicaid Eligibility

Qualifying for Medicaid involves not only financial criteria, but also physical requirements. Therefore, applicants must demonstrate through a physical exam that he or she is unable to perform the activities of daily living, including feeding, dressing, bathing, toileting and continence. If it cannot be shown to Medicaid that the care is medically necessary, the Medicaid application will be denied.

5. Intake Procedures for Filing a Medicaid Application

In some counties, the applicants or families themselves are required to complete the paperwork. While some counties are more lenient as to what types of documents may be submitted by mail, the initial filing of a Medicaid application generally requires a face to face interview with a Medicaid caseworker.

6. Substantiating the Data Needed for Approval of a Medicaid Application

The Medicaid application itself is several pages, and the answers to each question must be substantiated by legal or financial documentation. These supporting documents include: social security cards, Medicare cards, health insurance cards, birth certificates, marriage certificates, death certificates, life insurance policies, deeds, car registrations, household expense bills, funeral arrangement documents, pay or pension stubs, and financial statements typically dating back five years prior to the time the Medicaid application is filed. If certain documents are missing, such as financial records, proof of birth or marriage, etc., a paralegal can help you obtain certain documents from the Registrar of Vital Statistics in your area.

Each Medicaid office has a computer program to verify social security numbers, employment history, or other personal information. Likewise, if any financial information is not disclosed to a county social service office, the office may deny the application based on information it periodically receives from the Internal Revenue Service. Intentional failure to disclose relevant financial data is considered Medicaid fraud. Even in cases where Medicaid eligibility has initially been granted, the county welfare office may revoke the approval upon receiving the IRS records.

7. Additional Documentation and County Verification for Medicaid Eligibility

In addition to personal and financial data, applicants who have been able to protect assets through planning for benefits may have to submit additional supporting information to the county social services office. The treatment of these additional supporting documents may vary from county to county. For instance, both a husband and wife may present prepaid funerals as non-countable assets. Both Care Agreements and Caregiver Affidavits which help applicants protect assets without triggering penalties, must also be submitted to support an application, but their treatment may vary with other financial data and the county accepting the application. Trusts that have been established must also be submitted to the welfare office since they may affect benefits eligibility, depending upon their provisions.

The requirement that financial statements dating back five years prior to the filing of the application be submitted also varies from county to county. Depending on the circumstances, some counties have been known to request as little as forty-two (42) months of statements.

8. Enforcing the Applicant's Rights for Eligibility to Receive Medicaid

Applicants should be aware of their federal rights to a prompt disposition of their application. Enforcing the federally mandated deadline of 90 days found in the Code of Federal Regulations, and the state deadlines can be done through a fair hearing, which is an informal proceeding before an administrative law judge. These hearings are often used to expedite the decision making process of the county and state welfare agencies. Individuals who do not exercise their federal and state rights to a prompt decision on their Medicaid applications might otherwise find themselves waiting over a year to learn whether their nursing home bills, which had been accruing, will be covered by the benefits programs.

About Ingvar Grimsmo

Ingvar writes about Medicaid and other law related fields. He is a consultant to Medicaid Law firms.