Applying for Medicaid Benefits

Because Medicaid is administered by the states, each state has its own eligibility requirements and available benefits. Considerable variation can exist.

To apply for Medicaid, you or your representative must use a written application on a form prescribed by your state and signed under the pains and penalties of perjury. Give the application to your state Medicaid office.

What Information Must You Disclose?

The Medicaid application process will require the disclosure of certain personal information, including:

• Proof of age, marital status, residence, and citizenship (or lawful alien status).
• Social Security number.
• Verification of receipt of other government benefits, such as Social Security, SSI, AFDC, and veterans’ benefits.
• Verification of all sources of income and assets for you and spouse. (Regarding assets, an indication as to how title is held (jointly, etc.) should be required.)
• A description of any interest you or your spouse has in an annuity (or similar financial instrument) regardless of whether the annuity is irrevocable or is treated as an asset.
• Lists of all transfers of income and assets within the applicable look-back period. This should include dates of transfer, name of transferee, consideration (if any) for transfer, and purpose of transfer.

For transfers made on or after February 8, 2006 (the date of enactment of the Deficit Reduction Act of 2005), the look-back period is 60 months for all transfers. The waiting period begins on:

1. The first day of the month during or after which assets have been transferred, or
2. The date of first possible eligibility for Medicaid (but for the penalty period), whichever is later.

Federal law generally requires state agencies to determine an applicant’s eligibility for Medicaid within 90 days for those who apply on the basis of disability and within 45 days for all other applicants. State agencies must send each applicant a written notice of its decision. If the application is approved, the applicant will be notified of the effective date of his or her Medicaid eligibility (which can cover a retroactive period of up to 90 days from the date of the application), as well as a calculation of the applicant’s “patient paid amount” or the amount of the monthly medical expenses that the applicant will be responsible for paying from his or her own income. If eligibility is denied, the reasons for the denial must be outlined, the relevant regulation cited, and an explanation of appeal rights outlined.

What Are Your Appeal Rights?

Federal law requires states to provide an opportunity for a fair hearing before the state Medicaid agency to any individual whose claim for medical assistance is denied or not acted upon with reasonable promptness or to any recipient who believes the agency has acted erroneously. To appeal, you must sign the request for a fair hearing within the time stated on the notice of denial. The time frame is generally anywhere from 30 to 90 days.

Hearings are handled by administrative officers, with review authority in state courts of appeal, federal circuit courts of appeal and, ultimately, the U.S. Supreme Court.

If the hearing decision is favorable to the applicant, the state Medicaid agency must make corrective Medicaid payments retroactive to the date an incorrect action was taken. If you have questions, contact the Experts at Henssler Financial:

• Experts Request Form
• Email: experts@henssler.com
• Phone: 770-429-9166.