What to do when a Medicaid Application is wrongfully denied
The process to apply for MLTSS/Medicaid to pay for in-home care, nursing home care and assisted living is grueling. There’s no denying that. Producing all the records to the County Board of Social Services, and explaining every single financial transaction that occurred during the 60 month look-back period, can be brutally difficult, if not downright impossible. As you can imagine,...
Update on Irrevocable Funeral Trusts and Medicaid Eligibility
Earlier this year I wrote about problems that are cropping up for Medicaid applicants who purchased irrevocable funeral trusts. The problem is that certain County Boards of Social Services were/are counting some of the dollars in the irrevocable funeral trust as if they are available resources (assets). The theory was that the items are ‘for the living,” and not “for the...
Continuous residence in USA not prerequisite for Medicaid eligibility for previously-qualified alien
One of the threshold eligibility requirements for Medicaid has to do with legal status. N.J.S.A. 30:4D-3(q)(1)(a). If a person is an alien (non-citizen) with the status of a Legal Permanent Resident (LPR) (“green card holder”) who was present in the United States prior to August 22, 1996, s/he is eligible to apply for Medicaid (and receive “full Medicaid benefits” if...
Watch out for the Rules of Evidence in Medicaid appeal hearings
The first level of appeal when the State Medicaid Agency issues an adverse decision is called a “Fair Hearing” and takes place at the NJ Office of Administrative law (OAL). The Judge is referred to as an Administrative Law Judge or “ALJ.” That Judge issues an initial decision that is subject to review and final decision by the NJ Division of Medical Assistance and...
Burden to provide all verifications sits with Medicaid applicant
The Medicaid application process for MLTSS services in nursing homes, assisted living facilities or in the community requires a tremendous amount of documentation. Numerous documents pertaining to personal status, income, and finances must be produced. Filing an incomplete application increases the risk of a denial. Failing to produce the required documentation frequently leads to denials, as...
Medicaid Applicant is Entitled to Actual Notice of Deficiencies of Application
As my readers know by now, a Medicaid application is comprised of five years’ of financial records for every single asset and transaction that occurred during the 5-year “look-back” period preceding the application, along with a host of “personal identifiers” and proofs pertaining to income, marital status, legal residency, birthdate and more. If an application is...
Medicaid applicant must prove that funds in Joint account were contributed by other co-owner
An applicant for Medicaid to pay for nursing home care is not eligible if the available resources exceed a certain level. The regulations for New Jersey Medicaid specify how joint accounts are treated: “All funds in the account are resources to the individual, so long as he or she has unrestricted access to the funds (that is, an “or” account) regardless of their source. When...