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The cost of long-term care can quickly add up for seniors and their families. Some people reach a point where they need assistance and apply for Medicaid long-term care benefits. The Medicaid application process is complex and takes time, but once you’ve submitted your application, what should you do? This article explains what a family can do while they wait for a long-term care Medicaid application to be reviewed and approved or denied.
What should I do while I wait?
There will likely be several weeks if not months between the submission date of your Medicaid application and the day you receive a decision letter. While waiting through this period between submitting your application for long-term care and receiving an answer, you are considered Medicaid-pending. Consider taking the following action steps during the Medicaid-pending period.
Check the status of your Medicaid application
You’ll want to stay updated on your application’s status while it is pending. You can do so by:
- Checking your state’s online Medicaid portal.
- Calling your state’s Medicaid agency or visiting a local Medicaid office.
You can find contact information for your local Medicaid agency here.
Make sure you have submitted everything
It is crucial to ensure that you have properly completed your application and submitted every required document. Important documents needed for a Medicaid long-term care application include bank statements, other proof of income, medical records, and identification, among others.
Federal law requires states to evaluate Medicaid applications within 45 days of the submission date. While states must comply with time limits, applicants are not guaranteed an answer within that timeline. While waiting for a decision on your application, you can review the documents you submitted to ensure you didn’t accidentally omit any important information.
Research long-term care facilities
Ideally, you’ve already been accepted to a facility prior to submitting your Medicaid application for long-term care. That’s an important factor to consider, as some facilities might not accept new residents who are in Medicaid-pending status. Also, not every long-term care facility accepts Medicaid. If you aren’t already living in a facility, you’ll need to visit the ones you are considering and ask about their Medicaid payment policies. While your application is pending, confirm that the facilities are Medicaid-certified.
Important documents to keep during Medicaid-pending
There are various documents that applicants should keep during Medicaid-pending. The following documents can help as you review your determination letter and move forward with the application process.
- Funeral trust document.
- Durable power of attorney.
- Proof of life insurance assignment.
- Proof of health insurance coverage and costs.
- Income verification letter or tax forms.
- Social Security Administration letter.
- Financial account statements.
If your application is denied or you are subject to a penalty period but want to appeal it, you might need to provide some of the above documentation. In some cases, you might need to resubmit documentation like the information above even if you’ve already submitted it.
You’ll also want to keep detailed records of any money the applicant spends or receives during the Medicaid-pending period. Even if you’ve collected all the receipts from the last five years to cover the look-back period, remember that the time between the date you submitted your application and the date the Medicaid caseworker reviews your application is also part of that look-back period. This means that your Medicaid caseworker will likely ask for the following documents during the Medicaid-pending period:
- Checking account bank statements.
- Copies of any checks or documentation of payments made with cash or checking account funds.
- Receipts for purchases.
These are important to keep because you may need to prove that the transactions are not gifts to others or income that pushes the applicant over the Medicaid asset or income limit.
Who pays for housing while my Medicaid application is pending?
While you’re waiting for your Medicaid application to be reviewed, you need to pay as much of the costs as you can. Then, when your application is reviewed, you will find out whether Medicaid pays the costs moving forward or not.
If Medicaid approves the application for long-term care assistance, it will pay the rent for the long-term care facility where the senior currently resides (assuming the facility accepts Medicaid for payment). Medicaid will pay the monthly rent retroactively to the date you filed the application at the Medicaid rate minus the resident’s share of the cost.
If the long-term care application is denied, the senior is responsible for paying the cost of housing and all associated future costs at the private-pay rate.
Medicaid long-term care application results
After a complete review of your application, Medicaid will inform you of their decision. The Medicaid office will decide whether you are eligible for benefits and what your benefits will cover. Potential results for your application can include:
Approval
If your application is approved, you will receive a notice of approval from Medicaid, which will contain important details, including:
- The date that your long-term care benefits begin.
- How long Medicaid will cover your care and when you must submit a renewal application for continued eligibility.
- The services covered.
In some cases, applicants are approved but incur a Medicaid penalty period for improperly transferring assets during the five-year look-back period. This penalty is determined by the amount of money transferred and the state’s penalty divisor. If you are given a Medicaid penalty, you will be responsible for paying for your care out of pocket until the end of the penalty period, after which you will receive Medicaid long-term care benefits.
Denial
Medicaid sometimes denies long-term care applications. If Medicaid has decided you are not eligible for benefits, you will receive a denial letter stating why you were not afforded coverage. Some common reasons that applicants are denied coverage are missing documentation, exceeding the income and asset limits, not meeting the health criteria to receive long-term care, or failing to meet residency or citizenship requirements.
You have the right to appeal a decision if you are denied. Applicants typically have 30 to 60 days to file an appeal with Medicaid. Appealing a Medicaid long-term care application denial can be challenging. It can be helpful to consult an elder law attorney if you have questions regarding your right to an appeal.
Conditional approval
Medicaid sometimes approves applications with conditions. If your Medicaid application has issues that need to be resolved, you will be required to resolve the issues before full approval can be granted. Most conditional approvals are because of problems with asset spend-down, or you might be required to pay a portion of your income toward your care. You must resolve the condition and follow up with Medicaid for your application to be reassessed and receive coverage.