Applying for Medicaid benefits, particularly long-term care benefits, can be difficult and confusing. Yet, it is a necessary evil for many who rely on Medicaid to ensure that they can afford the room, board, care, and services they need to survive. While the Medicaid application process is certainly not easy, there are some ways to make it less painful. In this article, we will discuss some tips to make the Medicaid application process go as smoothly as possible.
Tip #1: Be Proactive
While the specific requirements for long-term care Medicaid benefits vary from state to state, you can be sure that the agency will request information and documentation regarding the applicant’s gross income and finances. Typically, the Medicaid agency will provide a very limited amount of time to provide the requested information and documentation. For example, in North Carolina, applicants typically have twelve days to submit this information, and, in Virginia, applicants typically only have ten days to provide the information.
Depending on the state, the Medicaid agency may request up to five years of records for financial resources, including bank accounts, retirement accounts, life insurance policies, vehicles, real properties, etc. Most of us probably do not maintain records for the last five years, and if we do, we may not remember exactly where we have them. If the Medicaid agency requests five years of documents, and you only have ten days to provide them, you may start to panic. Therefore, it is a good idea to start gathering these documents as soon as the need for Medicaid benefits arises.
The Medicaid agency will also always require medical documentation to establish that the applicant requires nursing home care. Rather than waiting for the agency to specifically request this documentation, go ahead and have the nursing home complete what is called a level of care assessment for the applicant. Depending on the state, this may be a full assessment by a nursing home medical provider or a written request for the assessment to be completed by the Medicaid agency.
In most states, an applicant’s request for assistance from the Medicaid agency will require that the agency take steps to obtain any requested information and documentation on behalf of the application. Consequently, it is important to always request that the Medicaid agency assist the applicant in all written communications with the agency, and to initially make this request when submitting the Medicaid application.
Tip #2: Always Submit the Application
You should always submit your Medicaid application even if you do not have all the information requested within the application. Depending on your state, you may be able to wait to submit your application until the last day of the month, but you should always confirm with the local Medicaid agency on which date you should submit the application to ensure you preserve the benefits coverage dates needed.
You should always submit an application even if you are unsure of whether you will qualify for Medicaid or if benefits will ultimately be needed. You can always choose to withdraw your application, but you may not be able to get the coverage you need without having submitted the application.
We often see situations in which a Medicaid applicant lacks capacity and is unable to submit a Medicaid application on their own. Federal Medicaid regulations ensure that, despite incapacity, any person seeking Medicaid benefits can have an application submitted on their behalf. Federal Medicaid regulations also require Medicaid agencies to accept verifications submitted by third parties on an applicant’s behalf, even if the third party is not the applicant’s Guardian, Power of Attorney, or relative. So, if the applicant lacks capacity and is unable to submit the application on their own behalf, do not let that stop you from submitting the application.
Prior to submitting the application, check the local Medicaid agency’s website to confirm the current contact information for the agency. This is to ensure that you submit the application correctly. Once the application is submitted, make sure to retain a copy of the submission confirmation in case the application is lost by the agency.
Tip #3: Notify the Medicaid Agency of an Applicant’s Incapacity
In many states, an applicant’s incapacitation or incompetency, terms that are used interchangeably by most Medicaid agencies, triggers specific regulations and procedures that the Medicaid agency must follow. For example, in North Carolina and Florida, once documentation supporting the applicant’s alleged incompetency is submitted to the Medicaid agency, the agency must typically exclude the applicant’s financial resources. This can lead to an approval of Medicaid pending Guardianship proceedings for the allegedly incompetent applicant.
In other states, such as Virginia, the Medicaid agency will typically keep the Medicaid application open while Guardianship proceedings are pending for the allegedly incompetent applicant rather than denying the Medicaid application for failure to provide the requested documents.
Therefore, it is always a good idea to notify the Medicaid agency of an applicant’s potential incapacity or incompetency as soon as possible. Notice to the Medicaid agency can be as simple as a note on the application itself or a written letter submitted to the agency at the time of application.
