Of course, you’ve heard of the 10 commandments. In this office, the 11th commandment is: Do not file a NJ Medicaid application until you are sure that the applicant qualifies or it is strategically beneficial to be denied!
And beware of the many Medicaid planning services that advertise application services… we have cleaned up many of their messes over the years after the families have been denied benefits or frustrated by the lack of knowledge concerning NJ Medicaid laws, rules and regulations. These companies are not law firms and have no lawyers involved in your application. Get denied and you’re on your own!
It’s All About Understanding the Medicaid System and The Application Process
Do you want to know how to apply for Medicaid and what the eligibility qualifications are? Once you apply for Medicaid, you risk losing the opportunity to protect your assets. Do not throw away the flexibility that exists prior to filing the application forms! If your application shows that you have more than the allowable amount of assets or your application has been filed prematurely, you will be denied approval and required to spend down your assets. It’s a devastating outcome.
May I encourage you to call us first before completing a Medicaid application! We may be able to tell you whether or not we can save you money. Let us help you calculate the date when you should file a Medicaid application. Together we can determine the amount of money you can save and the appropriate date that a Medicaid application should be filed.
Generally speaking, our office normally assembles the Medicaid application 90-180 days (or more) prior to the date we believe a person will be eligible for Medicaid benefits, given the current delays in the approval process. A Medicaid application in New Jersey requires a mountain of paperwork. It is then submitted to an overwhelmed and adverse government agency, which makes filing an application an enormous project. At Hanlon Niemann & Wright we have developed systems to make the process easier. Our team knows how to package and assemble the information expected by the assigned caseworker in a way that can be better understood and evaluated by Medicaid officials. We highlight and justify with appropriate legal support the reasons why your application should be approved for coverage. When applying for Medicaid, there are often many hidden obstacles and dangerous curves in the road. We understand these obstacles, as we have driven this road before — and we are prepared to address them and solve them. We will represent you throughout the application process and all face-to-face meetings with Medicaid caseworkers or higher-level officials. We want to give you added peace of mind knowing we can represent you through any and all necessary appeals if the government treats you unfairly, subject to the terms of our engagement. If the County wrongfully denies your application, we can appeal that decision to the Administrative Law Court sometimes at no additional cost to you. No Medicaid application service can do this for you, only an experienced and licensed Medicaid attorney in New Jersey can.
Applying for Medicaid in NJ Video, Part I
Applying for Medicaid in NJ Video, Part II
General Information on the NJ Medicaid Application Process
In New Jersey Medicaid Applications are filed with each of the 21 County Boards of Social Services. Some counties maintain outreach offices at different municipalities in the county, otherwise the application must be filed at the county’s home office. In some counties, Medicaid applications can be filed by mail. There has been a recent trend of allowing filings by mail so each county must be contacted.
Many types of documents are required to be submitted in connection with filing a NJ Medicaid an application.
Required documentation begins with a birth certificate. A marriage certificate must be produced if the applicant is or has been married and a death certificate of the spouse or divorce decree if the marriage has been dissolved by death or divorce. In addition, five years of complete and detailed financial records are required.
All applicants must prove that it is medically necessary that he/she be receiving a nursing home level of care.
Medical eligibility is determined by a document called a “pre-admission survey” (PAS). A PAS is ordered by the applicant or nursing home or residential health care facility, including assisted living. Medicaid sends a nurse to examine the applicant to determine whether or not the 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 timely secure a PAS will result in a denial. They key word is “timely”.
Medicaid eligibility often centers on the existence of ADL’s. ADL’s are known as “the Activities of Daily Living”. They are the most crucial link between the individual and medical eligibility for Medicaid. Regardless of the medical diagnosis of any condition (Alzheimer’s, Dementia, Parkinson’s, ALS, etc.), the effect of that condition requires that the individual either (1) need assistance with at least three (3) ADL’s every day of the calendar week and/or (2) be a safety risk to himself or herself because of the impact of the condition on his/her ability to perform their Activities of Daily Living independently and without constant cueing by another person present.
The word “assistance” seems straightforward but in actuality it is not because New Jersey Medicaid requires that an applicant for institutional and home based care need “hands-on assistance” with such things as dressing, bathing, toileting, ambulation, transferring, eating, etc. Hands on assistance means that another individual must be present to physically put his or her hands on the individual in order to accomplish those tasks.
The process Medicaid has selected to validate the need for assistance of daily needs is a pre-admission screening (commonly known as a PAS). The state will send out a nurse or other medical professional to perform this assessment usually at the place of the residence or current facility placement of the applicant. Often your physician completes a PA-4 form which is essentially a preliminary screening tool attesting to the fact that the applicant requires a nursing facility or assisted living residence in the immediate future. If the PAS is denied, then notwithstanding financial eligibility, the application will be denied. Note, a denial triggers an immediate right to a Fair Hearing Appeal, as discussed elsewhere on this site.
The take away from this discussion is to alert you to make an objective assessment of your loved one’s ability to independently perform his or her ADL’s. It’s the first test in a series of medical tests to qualify for Medicaid.
Medicaid examines your financial information to know that the information being provided is complete.
Medicaid has a computer match with the I.R. S. Medicaid will receive information concerning 1099’s sent by all financial institutions.
It can take an extremely long time to process a Medicaid Application
The length of time necessary to process a Medicaid Application varies from county to county and is dependent on the nature of the financial data being submitted. In some counties, an application can be approved within 90 days. In other counties, it takes 6 months to a year. In special situations, the application has to be approved in Trenton and this can take 18 months or longer. During the application process, it is not uncommon for the assigned case worker to re-request duplicative information or lose information so it is critical that you keep copies of all documents given in connection with your application. We’ll help you deal with the nursing home or assisted living business office during this processing time. We know how to handle the application process.
While a Medicaid Application is pending, the nursing home bill continues to mount up
At the time of approval, Medicaid will inform the applicant of his/her monthly share of the costs of care. The applicant must pay this cost share to the facility while the application is pending. When the application is approved, Medicaid will pay the nursing home retroactively to the date of eligibility for all eligible but unpaid expenses. Here again, Fredrick P. Niemann, Esq. and Hanlon Niemann & Wright will guide you on how to handle all payment issues while your application is pending and after it is approved.
The preparation of a Medicaid Application process is very, and I mean very time consuming in New Jersey
Medicaid demands proof of almost every financial transaction going back 5 full calendar years prior to the filing of the application. Accurate records should be gathered and a complete Medicaid application furnished to the County Board of Social Services to make the processing simpler. If records are inaccurate or incomplete or if a Medicaid application package is disorganized, the Medicaid Agency will continue to insist on additional information and the application will be delayed indefinitely. Submission of a complete Medicaid Application requires many hours of time. It is estimated that a professional assembling a Medicaid Application spends approximately 35-50 dedicated and undisturbed hours assembling and organizing the information. A person unfamiliar with the process will spend many times that amount of time, often in excess of 100 hours. If you’re working, have a family or are easily frustrated when dealing with large volumes of information or $$$, you do not want to file a Medicaid application alone.
The cost of paying a professional such as a law firm to prepare and file a Medicaid Application in New Jersey is a legitimate spend down for Medicaid eligibility purposes.
Did you know that the cost of 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 retain 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 third party who will be paid by the state once eligibility is established. It makes no sense to kill yourself only to have the money go to the nursing home.
We Can Help You Even If You’ve Filed on Your Own
Sometimes people file an application and realize they are over their heads. Maybe I’m speaking to you right now. If so, don’t worry. Come in and see us. I’ll assign a highly qualified Medicaid paralegal to assist you and finish up the application and we’ll work with you on fees based on how much work you’ve already completed.
Let an experienced Medicaid application attorney at Hanlon Niemann & Wright work for you today.
If you would like to discuss your medicaid application or the eligibility rules for medicaid long term care in a confidential manner with a caring and experienced New Jersey medicaid attorney, contact Fredrick P. Niemann, Esq. today!
Toll-Free at (855) 376-5291
or e-mail him at
Nick Alfano, Morganville, NJ I knew I needed an attorney, but could I afford one? Would he or she be experienced and someone I could trust and talk to openly and in confidence? I was referred to Fredrick P. Niemann. I was warmly greeted and my appointment promptly kept. I was given all the time I needed to ask questions and talk about my needs and concerns. I was quoted a fee that was appropriate and reasonable for my matter. My attorney gave me answers and advice. He was a counselor at law and in life. Calling Fredrick P. Niemann was the right decision..
My wife and I wanted to express our gratitude for the guidance and patience from you and your staff along this journey. Life is strange at times and the things that bring us together can be just as strange, if not more. I not only got to put a few bucks in the bank, but got to reconnect with my cousin Sarah, which was a great surprise for me. That alone was worth the journey for me. Getting to know her and the family has been really nice. I know it was a long day for all of us in mediation, but I really am blessed to have gotten to know you and talk with you. I admire your skills, work ethic and attitude regarding time and Patience. When the opposing attorney was running her big mouth and doing her thing, you never lost your composure, nor your position. I’m hoping it’s one of the nuggets I’m able to take and implement in my personal/professional life. The short version of this story is that you have a lot to offer people, you’re a true, trusted advisor. Your words and actions seem to align with your values, which is like common sense, very hard to come by now a days. Your staff does a great job as well. Please let them know that as often as you can..
-Mike Price – Plainfield, IN
I am a NJ attorney with 40+ years of experience in the practice of law. Medicaid applications are not my area of expertise. I consulted with three law firms who specialize in this area of law. Thankfully, I chose Hanlon Niemann & Wright. The firm is professional, knowledgeable, efficient and responsive. My sister received notice of enrollment into the Medicaid program within 40 days after the law firm filed the application. Lorraine Banach, my legal assistant contact at the firm, was excellent. I will recommend Hanlon Niemann & Wright to all my family, friends and clients who are in need of legal services concerning Medicaid law.
– Joseph Marrazzo, Jr. – Cherry Hill, NJ
Written by Fredrick P. Niemann, Esq. of Hanlon Niemann & Wright, a Freehold Township, New Jersey Medicaid Attorney
Medicaid Application Attorneys serving these New Jersey Counties: Monmouth County, Ocean County, Essex County, Cape May County, Mercer County, Middlesex County, Bergen County, Morris County, Burlington County, Union County, Somerset County, Hudson County, Passaic County