Medicaid Application Summary

When applying for Medicaid or other public benefits, it is crucial 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 or county office fails to meet a deadline or erroneously renders a disposition on an application, the applicant must be prepared to exercise his or her Constitutional and state statutory rights.

Following is a list of Medicaid application issues which should be addressed 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 for children. Many states, including Colorado have dual institutional Medicaid programs which have different income and asset standards.

2. Timeliness of Filing - Although families have the opportunity to expedite their Medicaid eligibility through asset protection planning under the guidance of an elder law attorney, it is extremely 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 to wait to file an application may be more or less than three years, filing an application during a period of ineligibility could potentially cause a significant delay in the applicants eligibility approval status.

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 allows a relative, or a professional such as an attorney to apply on the applicant's behalf.  Because the Medicaid eligibility laws and policies are rapidly changing, 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. Substantiating the Data - The Medicaid application form 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.

6. Enforcing Your Rights. The Medicaid Technician will not tell you how to protect your property. The Medicaid Technician’s job is to review the application for completeness and to investigate all cases for fraud.  You should never rely on the advice of the person processing the application. In addition, not all Medicaid Technicians know the law or correctly apply the law.  A denial or delay in public benefits can be appealed 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.