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!
Do you know how to apply for Medicaid and what the coverage qualifications are? Do you know that 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 a Medicaid application form! If your application shows that you have more than the allowable amount of assets, you will be denied approval and required to spend down your assets. Call us first before completing a Medicaid application! We may be able to tell you whether or not we can save you money and achieve quicker eligibility for long term care benefits at home, in assisted living or a nursing home.
Let us help you calculate 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. We normally assemble the Medicaid application 90 – 120 days or more prior to the date that we believe a person will be eligible for Medicaid benefits, given the current delays in the approval process and the tremendous amount of information that needs to be assembled prior to filing.
The Medicaid Application Process
A Medicaid application requires a mountain of paperwork, and is then submitted to a government processing system that is overwhelmed, under resourced and often under trained, which makes filing an application for public benefits an enormous project. Although the federal government shares the cost of funding the Medicaid program with the states and requires the state government to uphold certain standards with respect to efficiency and the granting of Medicaid applications, it is not uncommon for the state or county office to fall behind many months when meeting the federally imposed guidelines.
Therefore, when applying for Medicaid or other public benefits, it is essential for applicants to be well prepared and well-versed in the legal implications of all information to be supplied in support of the application. Also, when the state of county office fails to meet a deadline or erroneously renders a disposition on an application, the applicant must be prepared to exercise his Constitutional and state statutory rights.
Following is a sample list of Medicaid application issues which should be addressed in an effort to avoid unnecessary delays and denials.
1. Selecting a Program
Applicants for public benefits must decide which programs for which they wish to apply. The choice of programs may depend on the applicant’s living situation, physical condition, and financial status. Certain benefits programs are also specifically geared to victims of traumatic brain injuries or Alzheimer’s Disease. Many states, including New Jersey have dual institutional Medicaid programs which have slightly differing income and asset standards and offer different coverage with respect to hospital stays.
2. Timeliness of Filing
Although families have the opportunity to expedite their Medicaid eligibility through asset protection planning under the guidance of an Elder and Disability Law attorney, it is vitally important that applicants do not apply for Medicaid prematurely. Strategies for Medicaid planning often include triggering a penalty period for Medicaid eligibility purposes. While the time in which to wait to file an application may be more or less than five years, filing an application during a period of ineligibility could potentially cause a significant delay in the applicants eligibility approval status. It is, therefore, important to check with your planning advisor as to the date after which the application may be filed.
3. Authorization to Apply
In most cases, the applicant himself is unable to visit the welfare office and offer detailed information on his financial status. The law, therefore, specifically provides that a relative, welfare agency staff member, staff member of the institution in which the applicant resides, or a professional such as a doctor or attorney may apply on the applicant’s behalf. In cases where an attorney has been retained to apply on behalf of an applicant, the attorney must acquire an authorization from the applicant or his/her attorney-in-fact to obtain, discuss and submit financial data in support of the Medicaid application. Because the Medicaid eligibility laws and policies are rapidly changing, subject to shifts in politics and lobbying by advocates for the elderly, applicants are well advised to retain individuals with comprehensive knowledge of the Medicaid eligibility rules and all strategies that may be legally employed to expedite eligibility.
4. Physical Criteria
Qualifying for Medicaid involves not only financial criteria, but also physical requirements. Therefore, applicants must demonstrate through a physical exam that he or she is unable to perform the activities of daily living, including feeding, dressing, bathing, toileting and continence. If it cannot be shown to Medicaid that the care is medically necessary, the Medicaid application will be denied.
5. Intake Procedures
In some counties, the applicants or families themselves are required to complete the paperwork. While some counties are more lenient as to what types of documents may be submitted by mail, the initial filing of a Medicaid application generally requires a face to face interview with a Medicaid caseworker.
6. Substantiating the Data
The Medicaid application itself is several pages, and 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 three years prior to the time the Medicaid application is filed. If certain documents are missing, such as proof of birth or marriage, your professional can help you obtain certain documents from the Registrar of Vital Statistics in your area. Each Medicaid office has a computer program to verify social security numbers, employment history, or other personal information. Likewise, if any financial information is not disclosed to a county welfare office, the office may deny the application based on information it periodically receives 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 the approval upon receiving the IRS records.
7. Additional Documentation and County Variation
In addition to the personal and financial data, applicants who have been able to protect assets through planning for benefits may also have additional supporting information to submit to the welfare office. The treatment of these additional supporting documents may vary from county to county. For instance, both a husband and wife may present prepaid funerals as non-countable assets. Both Care Agreements and Caregiver Affidavits which help applicants protect assets without triggering penalties, must also be submitted to support an application, but their treatment may vary with variations in other financial data and the county accepting the application. Trusts that have been established must also be submitted to the welfare office since they may affect benefits eligibility, depending upon their provisions.
Some county welfare offices require such individuals to complete a plan of liquidation of assets in certain situations. Such cases may necessitate professional advice to protect the applicant’s rights, to protect a portion of the proceeds for his or her family members or to enhance his or her institutional care.
The requirement that financial statements dating back five years prior to the filing of the application be submitted also varies from county to county. Depending on the circumstances, some counties have been known to request as little as four months of statements.
8. Enforcing the Applicant’s Rights
Applicants should be aware of their federal rights to a prompt disposition of their application. Enforcing the federally mandated deadline of 90 days found in the Code of Federal Regulations, and the state deadlines (in New Jersey, the recommended processing time is 30 days) can be done through a fair hearing, which is an informal 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 over a year to learn whether their nursing home bills, which had been accruing, will be covered by the benefits programs.
Actual Client Testimonial – 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.
Here’s a real life testimonial – Mike Price – Plainfield, IN
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.
Visit our other related web pages for additional information about New Jersey Medicaid Law: