What You Need to Know Before You File for New Jersey Medicaid
In New Jersey, Medicaid Applications are filed by mail or in some cases electronically with the County Board of Social Services. Some counties maintain outreach offices within the county, otherwise the application must be filed at the home office of the County Board of Social Services. You should contact your County Board of Social Services for their current policy on filing Medicaid applications. You file the application in the county where the applicant resides whether in their personal residential home or in a long-term care facility.
Many documents are required to be filed in connection with a Medicaid application.
You don’t just file a simple Medicaid application, oh no, much more information is demanded. Mandatory documentation begins with a birth certificate to establish proof of US citizenship. A marriage certificate must be produced if the applicant is or has been married or a death certificate or divorce decree if the marriage has been dissolved or ended by death or divorce. In addition, five years of complete and detailed financial records are required.
Recent Medicaid Changes Demanding Increased Proofs of Eligibility
Many people ask what to do if they are unable to locate a birth certificate, marriage certificate, death certificate or divorce decree.
Often, all or most of these documents can be obtained from the Registrar of Vital Statistics or from court records. If it is impossible to obtain these records, other forms of evidence may be accepted. You should consult with an experienced NJ Medicaid attorney if you are missing important submission documents or if you are in doubt about the completeness of your application to reduce the chances of a denial months after you’ve filed.
All applicants must prove that it is medically necessary that he/she be receiving a nursing home level of care, even if that care will be provided at home. Medicaid eligibility is mandatory before Medicaid approval will be given.
Medical eligibility is established by a document called a “pre-admission survey” (PAS). A PAS is ordered by the nursing home or residential facility, or by the family if home care is being applied for. Medicaid sends a nurse or other medical professional to examine the applicant to determine whether nursing care is medically necessary. New Jersey has an unwritten rule that the examination will take place within 30 days from the date the PAS is ordered. Failure to secure a PAS will result in a denial. Coordination and follow up of the PAS is essential.
Medicaid examines and may verify that the financial information you submit going back five years is truthful and complete.
Medicaid has a computer match with the IRS. Medicaid receives information concerning 1099’s, K-1’s, etc. sent by all financial institutions. The state is looking for cheaters and others who transfer assets and then claim “poverty” to qualify for Medicaid. Innocent individuals who are unable to produce requested information are threatened with penalties and denial by the state without justification and legal authority. Be careful! Know your rights!
Understanding the Medicaid Application Process
Actual Client Testimonial
My aunt is 80 years old and a widow. She’s in good health and lives alone. My cousin and I are very close to her, but I live in North Carolina and my cousin in California. That makes it hard for us to help her as much as we would like to. She wanted to do some estate planning and asked us to help her find an elder law attorney. I did some homework and research and after many inquiries, found Mr. Niemann. He came recommended to me by several sources. Mr. Niemann was the perfect match for my aunt. He demonstrated a kindness and sensitivity that made us feel welcomed and comfortable. He met with us right away and was caring and patient with my aunt and answered all our questions. He even called my aunt to make sure she was following up on his advice. Mr. Niemann offered us ideas and solutions we hadn’t even thought of. We very much appreciated that. My aunt truly values having Mr. Niemann as her attorney. So do I…
– Robert Newell, Raleigh, NC
It can take an extremely long time to process a Medicaid application and receive approval
The length of time necessary to process a Medicaid Application varies from county to county and is dependent on the quantity and quality of the financial information being submitted. In some counties, an application can be approved within 90 – 150 days. In other counties, it takes 6 months to a year. In special situations, the application must be approved in Trenton and this can take many months or longer. During the application process, it is not uncommon for the assigned caseworker to request duplicative information or lose information you previously supplied so it is critical that you keep copies of all documents submitted in connection with your application and the date(s) it was submitted. Establishing a “paper trail” should be a high priority.
While the Medicaid Application is pending, the nursing home or assisted living bill continues to mount up so then what happens and how does the facility get paid?
At the time of approval, Medicaid will inform the applicant of his/her future monthly obligation to share in the costs of their care. This is called the personal “cost share.” But before approval, and while the application is being processed, an applicant must generally pay all of his/her income to the facility in which he/she resides minus health insurance premiums and their monthly spending allowance called a personal needs allowance. However, for home-based care under MLTSS home care application, an approved applicant gets to keep a reasonable amount of their monthly income. As mentioned in the prior paragraph, an MLTSS Medicaid home care application allows a person to keep substantially more income to pay for the costs of living at home and not at a facility. However, there is no retroactive eligibility for home care. I’ll explain this later on this page.
Knowing how much you must pay each month is tricky. For example, a facility will tell you to pay 100% of all income, less a personal needs allowance, to them but this is not accurate. You are entitled to deductions and to withhold some income for yourself.
As mentioned in the prior paragraph, a MLTSS Medicaid home care application allows a person to keep substantially more income to pay for the cost of living. However, there is no retroactive eligibility for home care. I’ll explain this further later on this page.
When the application is approved, Medicaid will pay the nursing home or assisted living residence retroactively to the date of eligibility which is generally the date the application is filed with the county agency.
The preparation of a Medicaid Application process is very, and I mean very time-consuming in New Jersey
As mentioned earlier on this page, Medicaid demands proof of almost every financial transaction of the applicant going back 5 full calendar years prior to the date of filing the application. Accurate and complete financial records are a must to make processing simpler and quicker. Do NOT file an incomplete application except in limited circumstances. If records are inaccurate or incomplete or if the application package is disorganized, the caseworker at the county will continue to insist on additional information thereby delaying the application indefinitely, or he/she will deny the application. Submission of a complete Medicaid Application requires many hours of time. It is estimated that a professional assembling such an application spends approximately 35 dedicated and undisturbed hours organizing the information. A person unfamiliar with the process will spend many more hours, often in excess of 100 hours.
The Costs Paid for Filing A Medicaid Application Are A Permissible Spend Down in New Jersey
DID YOU KNOW THAT THE COST OF HIRING PROFESSIONAL ASSISTANCE IN PREPARING AND FILING A MEDICAID APPLICATION IS PERMITTED AS PART OF THE SPEND DOWN PROCESS? THE LEGAL FEE PAID TO OUR OFFICE, FOR EXAMPLE, IS CREDITED TOWARD THE APPLICANT’S ELIGIBILITY. SINCE A PERSON CAN KEEP ONLY $2,000/$4,000 IN RESOURCES TO BECOME MEDICAID ELIGIBLE, IT SELDOM MAKES SENSE FOR THE FAMILY TO ASSUME THE RESPONSIBILITY FOR FILING THE APPLICATION. THE MONEY WILL ONLY GO TO THE NURSING HOME OR OTHER PARTIES WHO WILL BE PAID BY THE STATE ONCE ELIGIBILITY IS ESTABLISHED.
Beware of the Big Medicaid Application Companies!
BEWARE OF MEDICAID APPLICATION COMPANIES. THEY ARE NOT STAFFED BY ATTORNEYS. OFTEN TIMES THEY MAKE MANY MISTAKES AND/OR GIVE POOR AND/OR GROSSLY INACCURATE LEGAL ADVICE THAT CAN COST YOU ELIGIBILITY. THESE COMPANIES ARE “IN BED” WITH THE LARGE NATIONAL AND REGIONAL NURSING HOMES AND ASSISTED LIVING COMPANIES. THEY ARE NOT OUT TO PROTECT YOU. THEY DO NOT OFFER STRATEGIES AND LEGAL ADVICE TO ASSIST FAMILIES IN PROTECTING A LIFETIME OF SAVINGS AND INCOME FROM LONG-TERM CARE COSTS. THEY ARE RECOMMENDED BY THE BUSINESS OFFICE OF THE LARGER NURSING HOME AND ASSISTED LIVING CHAINS BECAUSE THEY WILL MAXIMIZE THE $ SPENT BY FAMILIES AT THESE FACILITIES. THEY ARE NOT YOUR FRIENDS!
Contact Fredrick P. Niemann, Esq. of Hanlon Niemann & Wright on any questions concerning eligibility for NJ Medicaid or applying for Medicaid approval. Call toll-free (855) 376-5291 or email him at firstname.lastname@example.org. His team of experienced medical lawyers and paralegals have filed many hundreds of applications throughout New Jersey.
The following is a sample list of Medicaid application issues that should be addressed to avoid unnecessary delays and denials.
1. Select the Program Right for You Before You File
Applicants for long-term care assistance must decide which care program(s) is best for him/her. The choice of programs depends on the applicant’s living situation, physical condition, and financial status. Certain benefit programs are specifically geared to victims of traumatic brain injuries or Alzheimer’s Disease. Many states, including New Jersey, have dual institutional Medicaid programs including MLTSS which have slightly differing income and resource standards and offer different coverage with respect to hospital stays and community setting. If you have any questions on selecting the appropriate Medicaid program for you, contact Fredrick P. Niemann toll-free (855) 376-5291.
2. Make Sure Your Medicaid Application is Timely Filed
Although families can expedite their Medicaid eligibility through asset protection planning under the guidance of a New Jersey Medicaid lawyer, it is vitally important that applicants do not apply for Medicaid too soon and prematurely. Strategies for Medicaid planning often include triggering a penalty period for Medicaid eligibility purposes. You read me correctly. Sometimes we want to be denied so we can start a penalty period, the effect of which is to protect gifts and other transfers made within the prior 5 years. But, filing an application during a period of ineligibility will cause either a significant setback in eligibility and approval or result in a denial. It is, therefore, important to obtain a qualified professional to determine the precise date the application should be filed. You may contact Fredrick P. Niemann at (855) 376-5291 or email@example.com to find out more.
3. Authorization to Apply for NJ Medicaid
In most cases, an applicant is unable to visit the County social services office to provide detailed information about his/her financial status. The law, therefore, specifically provides that a relative, personal friend, designated representative of the institution in which the applicant resides, may apply on the applicant’s behalf. In cases where an attorney or designated representative has been retained to apply on behalf of an applicant, the attorney must obtain authorization from the applicant or his/her attorney-in-fact to obtain, discuss and submit financial data in support of the Medicaid application. Because Medicaid eligibility laws and policies are rapidly changing, applicants are well-advised to meet with professionals with comprehensive knowledge of the Medicaid eligibility rules and all strategies that may be legally employed to expedite eligibility.
4. Medical Criteria for Medicaid Eligibility
Qualifying for Medicaid involves not only financial criteria but also physical and medical eligibility requirements. Therefore, applicants must undergo a medical evaluation to establish that he or she is unable to perform a certain number of daily activities commonly referred to as “ADL’s”, including feeding, dressing, bathing, toileting and continence. If it cannot be proven to Medicaid that a nursing home level of care is necessary, the Medicaid application will be denied.
5. Intake Procedures for Filing a Medicaid Application
In some counties, the applicant or the family is required to complete and file the paperwork in person. Other counties are more lenient and will allow the application and supporting documents to be filed by mail or electronically. You must confirm with your county if the initial filing of a Medicaid application requires a face-to-face interview with a Medicaid caseworker in each county, or can be done electronically or by mail.
6. Substantiating the Data Needed for Approval of Your Application
The Medicaid application itself is not overly long but 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 at Fredrick P. Niemann’s office can help you obtain certain documents from the Registrar of Vital Statistics in your area.
In addition to personal and financial data, applicants who attempt 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 documents varies from county to county. For instance, both a husband and wife may present prepaid funerals as non-countable assets. Care Agreements and Caregiver Affidavits which help applicants protect income and savings without triggering penalties must also be submitted to support an application, but each may be treated differently as with other financial data by the county accepting the application. Trusts that have been established in prior years may also have to be submitted since they may affect benefits eligibility, depending upon their terms.
Each Medicaid office has a computer program available to them to verify social security numbers, employment history, and other personal information. Likewise, if any financial information is not disclosed to a county social service office, the office may deny the application because it obtained the omitted information 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 approval upon receiving IRS records.
Some County Board of Social Services requires everyone to complete a plan of liquidation of assets in certain situations. Such cases may necessitate advice to protect an applicant’s rights and to protect a portion of their savings for a family member(s) or to enhance his or her institutional care.
The details and complexity of the financial statements dating back five years prior to the filing of the application also vary from county to county. You must be diligent and cautious with what you file and how much disclosure you make. Remember, a Medicaid agency is not your friend.
7. Enforcing the Applicant’s Rights for Eligibility to Receive NJ Medicaid
Applicants should be aware of their federal right(s) to a prompt decision of their application. Enforcing the federally mandated deadline of 45 days found in the Code of Federal and State Regulations, (in New Jersey, the recommended processing time is 45 days) can be done through a fair hearing, which is a 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 up to one (1) year to learn whether their nursing home bills, which had been accruing, will be covered by the benefits programs.
Applying for Medicaid Eligibility For Long Term Care in NJ (Part I)
Applying for Medicaid Eligibility For Long Term Care in NJ (Part II)
Do you think you may need help with your Medicaid application? If so, I encourage you to contact Fredrick P. Niemann toll-free at (855) 376-5291 or firstname.lastname@example.org to set up an office consultation at your convenience. Fred will tell you honestly and directly if you can go it alone when filing your Medicaid application, or if help is needed.
Written by Fredrick P. Niemann, Esq. of Hanlon Niemann & Wright, A New Jersey Medicaid Attorney