Medicaid Applications and Medicaid Appeals Attorney
I. Medicaid Applications
For each client, the Law Office of Donald D. Vanarelli prepares a comprehensive evaluation of the client's unique family and financial situation and provides planning recommendations designed to ensure that the client obtains all needed care, that there are funds available to pay for all needed care, and that the client's estate is preserved for his/her loved ones to the maximum extent possible. In addition, the Law Firm is available to prepare the Medicaid application itself and represent the client's interests through the often lengthy process. At the client's request, we also handle all communications with the Medicaid agency, thereby removing the client as far as possible from the tedious and often frustrating application process.
The process of properly completing a Medicaid application and providing all necessary information and documentation to the Medicaid agency is extremely labor intensive. The process is deceptive, in that it often may appear to be much simpler than it actually is. By assisting the client with this arduous task, and by coordinating efforts with the nursing home, the Law Office of Donald D. Vanarelli can help the client avoid being denied Medicaid benefits and obtain a quicker approval from the Medicaid office. A quick approval after the Medicaid application is filed is very important, because the applicant and his or her family will continue to pay catastrophic nursing home costs (which may exceed $8,500 per month in northern New Jersey) until Medicaid eligibility is attained.
Filing the Application
Federal and state laws regulate the Medicaid application process. The federal law of Medicaid applications is found in the Code of Federal Regulations, 42 C.F.R. §435.900. The state regulations concerning Medicaid applications is found in the New Jersey Administrative Code, Title 10, Section 71. Internal agency memoranda, called Medicaid Communications, from the state agency to the county welfare board must also be consulted.
Extensive documentary evidence and information is required by the Medicaid agency to file an application. Because the evidence required is so extensive, the Law Firm often visits the client's house to assist with the procurement of the required information. If requested by the client, the Law Office of Donald D. Vanarelli can also assist the client in obtaining the necessary information from the client's financial institutions, CPAs, financial planners, insurance providers, health care managers, and other relevant representatives. We can also help in obtaining appropriate documentation from the Registrar of Vital Statistics and other necessary investigations, including reviewing the past 60 months of financial accounts and transactions.
The application must be in writing on a form prescribed by the Medicaid agency. The application must be filed in the Department of Social Services of the county in which the applicant resides. The applicant's agent or family member may file the Medicaid application on the applicant's behalf. However, the applicant (or his or her agent) should avoid filing a Medicaid application during the look-back period if gifts were made which would result in a penalty, or a period of ineligibility for Medicaid. Further, the applicant should avoid any possibility of committing a criminal offense through incorrect timing of the filing of the Medicaid application.
In the usual Medicaid application case, the following information and documents are required, and must be provided to the agency along with the application:
Verifications Required for Medicaid Applications
Personal Information
1. Birth Date/Citizenship Information
Birth certificate, baptismal record, passport, voter's registration card, naturalization papers, or alien registration card.
2. Marriage Certificate/Divorce Papers/Death Record
Copy of marriage certificate
Copy of divorce papers, if divorced
Copy of death record, if spouse is deceased.
3. Social Security Card
4. Health Insurance Card
A copy of the Medicare Card, front and back, is needed in addition to any supplemental coverage such as AARP, prescription cards, Blue Cross, major medical, etc. A copy of medical coverage premium invoice is also required.
Finances
5. Bank Statements
Submit the following for all bank accounts (checking, savings, CDs, IRAs, etc.) that were open at any time during the past 36 months (even accounts now closed) and that were in the names of either spouse or held jointly with someone else:
- Bank statements for each month for the past 60 months
- Passbooks covering the past 60 months
- Canceled checks for $1,000.00 or more for the past 60 months
- Provide an explanation for all transactions of $1,000.00 or more
- Continue to provide statements received between the application date and the date your case is granted by the state.
6. Records of Stocks, Bonds or other Assets
Verification of ownership and current value of any stocks or bonds you own alone or with another, including 60 months of statements for any stock or mutual funds.
7. Sources of Income
Written verification of all sources of income such as Social Security benefit statement, earnings, pensions, retirement benefits, Veterans benefits, SSI benefits, IRAs, 401K plans, interest income, income from rental property. GROSS AMOUNTS are required.
Property
8. Deeds
Deeds for all property owned by applicant, such as residence and burial plot, including property the applicant owns but on which the applicant does not live. If property is on the market to be sold, a copy of the Listing Agreement is needed and a Plan of Liquidation must be completed.
9. Copy of Tax Bill for all real estate.
10. Property sold in the past 60 months
A copy of the settlement sheet is needed to verify date of sale and amount received.
11. Vehicles
Registration and Fair Market Value for all vehicles, even exempt vehicles, and amount owed, if any. Include automobiles, boats, trucks, camper trailers, etc.
Life Insurance
12. Life Insurance Policies
All life insurance policies, preferably a copy of each policy itself to use as written verification of the face value. The applicant will also need written verification from the company of the current cash value of all policies. If the policy has been surrendered, the applicant must provide written verification that the policy is no longer in force.
Legal Documents
13. Trusts
Documents pertaining to any Trust of which the applicant or the applicant's spouse is the beneficiary or that the applicant or the applicant's spouse have established for the benefit of any other person.
14. Guardianship/Conservatorship
A copy of the Court Order if a Guardian or Conservator has been appointed for the applicant.
15. Power of Attorney
A copy of any existing power of attorney for the applicant.
Transfers/Gifts
16. Gift/Transfer Documentation
Written documentation of all gifts or property transfers within the past 60 months. This should include a statement of date of transfer, the name of the person receiving the transfer, type of resource transferred, and resource value at time of transfer. If a transfer of real property has occurred, the applicant must provide the deed or other transfer documents and an appraisal of the property as close to the time of transfer as possible.
Miscellaneous
17. Safe Deposit Boxes
Listing of all contents of all safe deposit boxes.
18. Funeral Arrangements
Copy of funeral arrangements, if any. This must be an Irrevocable Trust Fund.
19. Income Tax Returns
Copies of income tax returns for last three years with 1099s.
20. Nursing Home Statements
Statement from nursing home verifying personal needs account balance.
Follow-up requests by the Medicaid agency for additional information and documents are common. An applicant's timely response to agency requests is essential.
Post-Filing Issues
After the application is filed, the agency verifies the information provided by the applicant by matching the information on the Medicaid application with I.R.S. data, and contacting financial institutions and other third parties. Although the verification process may take years to complete, applicants must be aware that this process will occur and, as a result, must be scrupulously honest on the application and the verifications provided to support the application.
The Medicaid application takes 2 to 3 months to process in the usual case. However, it is not unusual for applications to take much longer to process if the application is complex or the local agency is backlogged at the time the application is submitted. During the time the application is being processed, the applicant is not required to continue paying the nursing home the entire private pay rate. However, the applicant must pay the nursing home the amount that the applicant will be required to pay after the application is approved. Failure to do so may result in the application being denied by the agency.
To ensure that the application is processed smoothly, it is advisable to keep the nursing home advised of the progress of the Medicaid case file. Further, it is important to coordinate certain events with the facility, such as ordering Medicaid to schedule a medical review of the applicant by the pre-admission screening ("PAS") nurse. Without being medically approved by the PAS nurse, the applicant cannot be found eligible for Medicaid, and the application may be denied.
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