How Does the Medicaid Application Work for Nursing Home Care?

What could be easier? Go down to your local Medicaid office, pick up and fill out an application, turn it in, and you’re qualified. Not exactly. While there are medical, asset, and income qualification issues, other aspects come into play when a caseworker evaluates your application. Here we will discuss some of those issues and highlight the need to understand exactly what the application is asking and how answers will be evaluated.

“Do you intend to return to your home?” Eight simple words that we all understand. But answering that question incorrectly can convert the home from an exempt asset that does not count against the applicant, into a countable asset that will need to be sold and the money spent on nursing home and medical care. Why?

The home of a Medicaid applicant only retains its exempt status if the person intends to return to the home. But let’s be honest. Unless a person is discharged to a nursing home to receive a short period of therapy and rehabilitation, that person is not likely to come out of the nursing home. In other words, the applicant knows, the family knows, and the caseworker knows, that the person is not likely ever to return home. Nonetheless, the question needs to be answered with a “yes” or the home loses its exempt status.

When to file the Medicaid application can be a difficult issue as well due to the convoluted Medicaid laws and regulations. During recent years, rules have changed for qualifying for Medicaid. The two most commonly discussed are the look-back period and the calculation of the penalty period. The look-back period is the time frame during which Medicaid can “look back” at your finances to ensure that you meet all the rules for qualifying for Medicaid. The look-back period is nothing more than the length of time for which Medicaid can require you to provide your financial information.

An elder law attorney in your state will have a complete list of information that the state requires to be submitted with the Medicaid application. Download our article on why it may make sense to hire an elder care attorney to assist you with the Medicaid application.

At a minimum, an applicant has to provide proof of citizenship; marital status; death certificate for deceased spouse; a photo ID; copies of social security, Medicare, and health insurance cards; information on any pre-paid funeral or burial plans; and complete and comprehensive financial information for the entire look-back period. This information includes all open or closed bank accounts, all investments, life insurance policies, income information, annuities, and literally everything to do with your finances that occurred during the look-back period.

People sometimes ask, “How does Medicaid find out about my finances?” The answer is simple: you have to tell them. Failing to do so or hiding assets or income are violations of federal law and, when discovered, will be penalized with fines and possible time in jail. No applicants for Medicaid should do anything other than make full and proper disclosure of all required information. And remember, sometimes it’s best to get help from a professional to plan for Medicaid.

Additional Information on North Carolina Medicaid Assistance for Nursing Home Care:

Download a free copy of Jackie Bedard’s book, The Ultimate Guide to Paying for Nursing Home Care in North Carolina, to learn the nursing home and Medicaid secrets you need to know to avoid going broke in a nursing home and leaving your family penniless.

Jackie Bedard
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