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By John M. Bigler One of the difficult realities facing older people is high costs they may incur if they need medical care for any extended period of time. One means of meeting those costs is Medicaid. But people who want to have their medical bills paid by Medicaid must apply for benefits and prove that they qualify for the program. It's much more complicated than merely filling out and submitting a form.
Reprinted with permission of the Suffolk Times © 2002
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One of the first tasks must be to determine whether the person is currently eligible benefits or can become eligible with Medicaid planning. If assets have been transferred to another individual or to a trust, or if the applicant has a spouse or owns resources in excess of the allowed amount to be eligible for benefits, the attorney must decide the best timing for filing the Medicaid application that will lead to the best outcome in terms of eligibility for the applicant. Submission of a Medicaid application before the necessary planning has taken place can result in a determination of ineligibility for a significantly longer period of time than would otherwise been necessary.
The Medicaid application is 16 pages long. There are two versions of the form, one for applications to be filed in New York City and another for all other counties outside of New York City. If the form for the wrong place of filing is submitted, the application will be rejected.
The form asks for a lot of basic information about the applicant, such as name, address, phone number, description of other household members, income for the applicant and other household members, available resources for the applicant and other household members, employment, education and medical history. One of the he most important questions on the application in determining whether benefit will be granted is this: Have any assets or resources been transferred to an individual in the last 36 months or to a trust in the last 60 months?
The Medicaid application itself is not that complicated to fill out. However the documentation that must be and presented along with the application can and often does cause problems. Documentation includes proof of identity and citizenship such as a birth certificate, passport or other papers establishing citizenship status. Other information about the applicant will need to be provided with the application such as proof of residence, marriage certificates, death certificates for deceased spouses or divorce judgments, and military discharge papers.
Supporting documentation of financial information will also be required, such as: a letter from an insurance company stating surrender value and ownership of a policy, copies of stock or bond certificates, copies of real estate deeds, or any other source of income. In short, documentation for anything owned by or providing income to the applicant or a member of the applicant's household.
This includes both open accounts and closed accounts of all kinds that were open during the past three year in either the applicant's name or spouse's name. Pages of each monthly bank statement for the period must be provided. Also, any withdrawals and deposits of $1,000 or more for an application outside of New York City or $500 or more for an application in New York City must be documented and verified. Proof in the form of copies of check and deposit tickets must be submitted. Income tax returns filed for the last three years, or proof that none were filed during that period, must be submitted with the application. Information must be provided about the finances of both spouses, even when only one is applying for Medicaid.
If the documentation provided with the application was incomplete, the applicant will receive a list of any additional documentation needed and the deadline for submission. It's important to respond within the time allotted to avoid a denial for failure to document. If the requested information isn't provided in a timely manner, the application will be denied and there are very few denials more difficult to overcome than "failure to document".