Medicaid is a program of medical assistance to persons with financial need. It is jointly funded and administered by the federal government and the states. In order to obtain Medicaid assistance, an application must be filed at the local office of the state Medicaid agency. Certain documents must be produced. The agency then makes a determination of eligibility and notifies the applicant.

Applying for Medicaid

In order to obtain Medicaid assistance, a written application on the government form should be filed at the local office of the state Medicaid agency. The applicant or the representative should bring the following documents:

  • Birth certificate or church record of baptism
  • Social Security number
  • Verification of wages or pensions, such as a pay stub with the employer's name and address
  • Verification of resources, such as bank books
  • Verification of other government benefits, such as Social Security or veteran's benefit checks or identification number
  • Proof of citizenship, such as a passport, a certificate of naturalization or citizenship and a driver's license

Although the applicant has the burden to establish eligibility, a caseworker may assist an applicant who is physically or mentally unable to gather the required documentation to prove eligibility.

Eligibility

Applicants who are institutionalized are eligible for Medicaid as of the first day of any consecutive 30-day period of institutionalization, provided their incomes do not exceed 300 percent of the Supplement Security Income (SSI) payment level.

If the applicant dies before eligibility is approved, the person is still entitled to coverage of medical care and services rendered before death. If an individual dies before submitting an application, a representative of the deceased may submit an application on the deceased's behalf up to three months after the person's death. Benefits are paid retroactively for medical care given to the deceased during the three months prior to his death, provided the deceased applicant would have been eligible for Medicaid when care was provided.

In all cases, the effective date of eligibility for Medicaid is the third month before the month of application if the applicant received covered benefits at any time during those months. The state also can move eligibility back further to the first day of the third month before the month of application.

The Department of Health and Human Services interprets the current federal regulations to mean that retroactive payment to providers of medical care and services prior to the month of application is required only when the person's bill is unpaid. Medicaid also pays the provider if the provider is willing to refund the applicant's payment to him and bill the State for that service.

People who are potential applicants for Medicaid should do the following:

  • Delay payment of medical bills as long as possible
  • If it is necessary to pay bills during the three month period prior to applying for benefits, keep accurate records and receipts
  • List all paid medical expenses on the application form and claim reimbursement for them

Eligibility Determinations

State Medicaid agencies are required by federal law to follow certain procedures in making eligibility determinations. The agencies must:

  • Reach a decision on an applicant's eligibility and notify the applicant of the decision within 45 days after the application date or 90 days after that date for an application based on disability
  • Mail written notice of the decision to the applicant, stating the reasons for the decision and the person's right to request a hearing in cases of denial of eligibility
  • Make a redetermination of a recipient's Medicaid eligibility at least every 12 months for circumstances in the person's condition likely to change

Questions for Your Attorney

  • Where do I go to apply for Medicaid?
  • Do I need to bring anything with me when I apply for Medicaid?
  • When should I hear from the state agency about whether I will receive Medicaid?

Tagged as: Elder Law, medicaid service, elder law lawyer