What Is The Process To Apply For Medicaid?
The process of applying for Medicaid begins by getting the applicant’s assets and income below the resource and income levels. Then there is an application that needs to be filled out in excruciating detail. Once that application is done, it has to be accompanied by dozens of documents regarding any trusts that are in place, real estate, investment accounts, bank accounts, insurance cards, and more. A passport, a copy of the driver’s license, utility bills, marriage licenses, birth certificates, and a variety of other documents are usually required as well.
Once all of the necessary documents have been collected, the application is sent to the local Department of Social Services (DSS). Every county in New York has a local DSS that is responsible for administering Medicaid within that county. New York City has a human resource administration (HRA), which is the equivalent of a local DSS outside New York City. They will review the application and may request additional documentation. A case worker will be assigned to help open the application, and ultimately a decision will be made to determine whether or not the person qualifies for Medicaid. They will then send out a neutral medical evaluator (usually this person is a nurse) to determine whether or not the applicant actually meets the threshold medical requirement for Medicaid.
So long as the applicant qualifies on the asset level, if the evaluator determines that they do meet the medical need requirements, then the person will be accepted into Medicaid. However, that doesn’t determine exactly what level of services they’re going to receive. The next step requires the person to join one of the several managed long-term care programs. Each program has different doctors and different advantages and disadvantages. A person has to analyze the program to see what kind of services it provides. Oftentimes, the programs differ in terms of the nursing services that are in that particular network. So, a person might want to find a certain nursing service that they will likely need is available in that network.
The managed long-term care programs are evaluated on an individual level on the star system, and they’ll usually get between two and five stars. Some people just want to go with the five star program, but if a five star network does not have their doctor or some of the services that they need, then they might need to choose a three or four star program. Some people don’t even use that evaluation. I try to guide my clients into making the overall best choice that they need under their particular circumstances. If someone has a nurse who they would like to be a part of the long-term care program, then that might be the best choice. If there is a physician that they’ve used for many years, then they may be limited by the networks in which that physician works. Once the applicant has joined a long-term healthcare program, that program sends out another nurse to evaluate them. That nurse makes a determination as to how many hours of service they’re entitled to, which is usually quantified in terms of hours per day and days per week.
A person might qualify for one hour a day if they just need a little bit of assistance getting up in the morning, for instance. If they need assistance getting up in the morning, brushing their teeth, using the bathroom and getting dressed, then they may need three hours a day, for instance. They might need assistance for 12 hours a day if, for instance, they need help with all their daily tasks and there is a concern that they may wander off, forget their medications or otherwise put themselves or others in danger. Care can be ordered up to 24 hours per day, seven days a week. When a person needs 24-hour care, a nurse will need to stay with them 24 hours a day. If the client can stay in the community (at home) as opposed to going to a nursing home, then that may be preferable. If there are no available alternatives to at-home 24-hour care, then the person will have to see if they are qualified for a nursing home.
The process of applying for Medicaid starts with the gathering of information and an application. It leads all the way through approval on the financial level, to approval on the medical level, to assignment of the managed long-term care program, to an approval at the number of hours that the individual is going to qualify for on a daily basis. The managed long-term care program is actually incentivized to give fewer hours, so they might not give the client as many hours as they need. If a client is not approved for as many hours as they need, they can have a fair hearing. At that fair hearing, they would go before an administrative judge within the Medicaid process and present the case as to why they need more hours. If the case is made properly, then they will receive an order that tells the managed long-term care program that they have to give more hours.
What Happens If Someone Needs Medicaid Faster Than the Process Allows?
If someone needs Medicaid faster than the process allows, there is a mechanism for dealing with that within Medicaid. It normally takes about two to three months to get Medicaid approved. Once approved, Medicaid will give the applicant a retroactive date from the beginning of the month in which they applied. During the two or three months while the person is waiting, the cost of their nursing care has to come out of pocket without any guarantee of reimbursement. Because of this, until recently, a lot of people were simply going without care. In response, Medicaid instituted an Immediate Need process. This means that a person can have their doctor fill out an Attestation of Immediate Need, which is supported by medical history and certain information. Using this process narrows the approval window to just a few weeks in most cases. It’s not necessary for everyone, but it is necessary for those who definitely have an immediate need.
Akiva Shapiro, A Personal Attorney for Your Life, Business & Legacy
I call myself a personal attorney for your life, business and legacy. This is because I look to get a clear understanding of the client’s entire life from a holistic legal perspective. It’s important to understand where the client is coming from, where they’re headed, where they want to go, what they have and what they want to protect.
It’s about protecting your rights, assets, what you own and what you are entitled to. If an attorney doesn’t understand a client’s overall situation, then they won’t be able to protect their assets or properly represent them. It’s very important to look for an attorney who the client can relate to and feel comfortable with. If a person can find the type of attorney who has the skills to do the job, as well as the individual personal skills, then they are going to be happy with that attorney.
For more information on Application Process for Medicaid in New York, Long Island, Nassau or Suffolk County, a free phone consultation is your next best step. Get the information and legal answers you are seeking by calling (516) 806-0762 today.
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