Applicants can often wait months to learn whether their Medicaid application for long-term care in a nursing home was approved or denied. An approval notice can bring great relief to the applicant and their family. But even so, the family may not know what to expect upon application approval.
This article explains what to expect and what the applicant and their family may need to do after their Medicaid application is approved. It also offers other helpful bits of information to help you understand what will happen during the Medicaid application process and beyond.
How will you know if your Medicaid application for long-term care has been approved?
You will know if your Medicaid long-term care application has been approved when you receive a determination letter from your state’s Medicaid office. This letter will state whether your application has been approved or denied.
If you have been approved for Medicaid’s long-term care benefits, the letter will also outline the services you are eligible for and any additional steps you must take in the process.
Depending on your state, the Medicaid long-term care benefits approval process generally takes between 45 and 90 days. In the time between submission and approval or denial, you are considered to be in a “Medicaid pending” status, meaning that you have applied for benefits but have not yet received a final determination.
What Medicaid long-term care beneficiaries and their families need to do after approval
Once your Medicaid application for long-term care benefits has been approved, your state’s Medicaid office will generally inform your chosen nursing home of your approval. They also typically will coordinate with the nursing home to begin payments.
For eligible individuals, Medicaid will pay the nursing home directly for services rendered, including room and board and any necessary medical supplies. However, you may be required to contribute most of your income toward the nursing home costs, with a small personal needs allowance left for your personal expenses. The amount can change from year to year and depends on the state you live in.
Medicaid will continue to monitor your eligibility for coverage and the services you receive from the nursing home to ensure compliance with the program’s rules and regulations. This includes an annual recertification process, which we will discuss next.
How to recertify for Medicaid long-term care benefits
After your Medicaid application for long-term care benefits has been approved, it will be necessary to ensure that you continue to be eligible going forward. Medicaid recertification (also referred to as Medicaid redetermination or Medicaid renewal) is a necessary process that determines whether or not you are still qualified to receive Medicaid-funded nursing home benefits.
In this case, you must continue to meet the health requirements and financial limits. Therefore, you must report any changes in your health, income, or assets. Failure to report any such changes to Medicaid — including situations like the receipt of an inheritance — can result in the loss of Medicaid benefits, as well as possible penalties such as fines or repayment of the benefits you have already received.
There are several documents that Medicaid beneficiaries or their families must provide on their behalf for the recertification process. These include:
- Proof of income: Several items are relevant for proof of income, such as Social Security benefit statements, pay stubs from employment, and income tax returns.
- Proof of assets: Proof of assets can be shown via documents like bank statements, investment account statements, and property deeds.
- Medical documentation: Medicaid may require you to provide medical records, doctors’ statements, or other documents verifying your need for long-term care services.
- Verification of residency: You must also verify your residency. You can do this using cell phone statements or other similar documents.
Depending on your state and your specific situation, you may be required to provide additional documents. It is important to inquire with your state’s Medicaid office to ensure that you have provided all the pertinent information.
Your benefits will be discontinued if you do not complete the Medicaid redetermination process in time. However, under federal law, you will have 90 days from the date your case was closed to provide Medicaid with all the required information for renewal. Provided that you do so, your Medicaid long-term care benefits may be reinstated without needing to go through the entire application process again as long as you meet all the necessary eligibility criteria.
Other considerations for Medicaid long-term care benefit recipients
The Medicaid long-term care application process for benefits can be somewhat overwhelming, even if you have already qualified for coverage. It is also important to note that Medicaid long-term care qualification criteria can differ from state to state. With that in mind, it is highly recommended that you discuss your options with a specialist familiar with the Medicaid long-term care benefits application process in your area.
