Medicaid Planning - Application & Submission

Navigating the Medicaid Application

The Long Term Care Medicaid application process involves several detailed steps, requiring careful attention to ensure eligibility and proper documentation. Here’s an overview of the Medicaid Planning Consultants’ process from start to finish:

Pre-Application

Preparation:

Assessment of Eligibility: We determine if the applicant meets the basic requirements for Medicaid, including age, disability status, and medical necessity for long-term care.

Financial Review: We will conduct a thorough review of the applicant’s financial situation, including income, assets, and any transfers of assets within the past five years (look-back period). This helps identify if any planning is necessary to meet Medicaid’s strict financial criteria.

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Gather Documentation:

Personal Information: We will collect personal identification documents such as birth certificates, Social Security cards, and proof of citizenship or legal residency.

Financial Records: We will gather financial statements, proof of income, tax returns, and documentation of assets, such as property deeds and vehicle titles.

Medical Records: We may need to obtain documentation that demonstrates the need for long term care services.

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Medicaid Planning Process

Spend Down and Planning (if necessary)

Asset Restructuring

If the applicant’s assets exceed Medicaid’s limits, we will engage in spend-down strategies such as paying off debt, making home improvements, or purchasing exempt assets like a primary residence or a funeral plan, to name a few examples.

Strategies and Transfers

We may need to establish Medicaid-compliant strategies or transfer assets in a manner that complies with Medicaid regulations to protect assets while meeting eligibility requirements.

Application Submission

Complete Application Forms

We will fill out the Medicaid application forms accurately and completely. Include all required documentation.

Submit to State Agency

We will submit the completed application and supporting documents to the appropriate state Medicaid office. Some states may offer online submission options, while others require paper application submissions.

Verification and Interviews

Verification Process

The state Medicaid office reviews the application and verifies the provided information. This may involve cross-checking financial records.

Interviews

Some states may require an interview with the applicant or their representative to clarify details and ensure all information is accurate.

Approval and Notification

Approval Decision

Once the review process is complete, the state Medicaid office makes a decision on the application.

Notification

The applicant receives a notification letter detailing the approval or denial of benefits. If approved, the letter will include information on the level of benefits and the start date.

Appeals (if necessary)

Filing an Appeal

If the application is denied, we will file an appeal. This involves submitting a request for a hearing and providing additional documentation or clarification to support the case.

Hearing Process

We will attend the hearing, either virtually or by phone, to present the case to a Medicaid hearing officer. A decision will be made based on the evidence presented.

Post-Approval Management

Care Coordination

Once approved, work with the Medicaid program to coordinate long term care services, whether in a nursing home, assisted living facility, or through in-home care.

Regular Reporting

Continue to report any changes to the Medicaid office as required to maintain eligibility.

Navigating the Long Term Care Medicaid application process can be complex and time-consuming. Working with our Certified Medicaid Planners at Medicaid Planning Consultants can help ensure all steps are completed accurately and efficiently, increasing the chances of a successful application. Contact us today!