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Medicaid Application Processing

Taking the necessary steps for filling out a Medicaid application is important in order to get benefits. It requires those who apply to have a certain checklist of line items in place and be ready to submit them in order to qualify.  It is so much more than just filling out an application because there is an incredible amount of information that needs to go in before an applicant gets approved for benefits. Therefore, potential Medicaid candidates need to understand the challenges of applying for Medicaid and seeking eligibility.  

Reviewing the application

Prior to submitting a Medicaid application, prospective beneficiaries should review the Medicaid application guidelines. They will need to have a list of items ready in order to properly fill out the application. Knowing if you meet eligibility requirements and knowing how to best prepare your list of line items, is crucial when you begin your application. For example, those with incomes that are too high to qualify for Medicaid applications are allowed to spend it down in order to have their applications approved or set-up a Qualified Income Trust (Q.I.T.) depending on the state. Since applying for benefits can be very complicated and time consuming, it’s usually beneficial to have some expertise so it’s wise to hire a Medicaid specialist who will guide you through the entire process.

Medicaid Eligibility

To be eligible for Medicaid, you must meet the requirements for an eligibility group that your state covers under its Medicaid program. An “eligibility group” can be defined as individuals who meet certain criteria, such as an older adult or a person with a disability and having income and assets below certain levels. There are many different eligibility groups in the Medicaid program, and each one has its own set of requirements. States are required to cover some groups but also have the option to cover or not cover others. Regardless of the specific eligibility group, someone applying for Medicaid must meet at least four types of requirements to qualify for Medicaid.

  1. General Medicaid Requirements: You must be one of the following to be eligible for Medicaid – be age 65 or older, have a permanent disability as that term is defined by the Social Security Administration, be blind, be a pregnant woman, be a child, or the parent or caretaker of a child. It is also required for an applicant to be a U.S. citizen or meet certain immigration rules, be a resident of the state where you apply, and have a Social Security number. With the elderly, Medicaid has two types of eligibility requirements – functional and financial. For functional eligibility (depending on the type of Medicaid program) applicants must show they require the level of care provided in a nursing home or an intermediate care facility. For financial eligibility, Medicaid will look at both the applicant’s (and spouse’s if a married couple) total resources, which includes their income and assets.
  2. Income Requirements: You must also have limited income, as well as assets to be eligible for Medicaid. The amount of income you can have also varies by state and depending on which eligibility groups each state covers. When the state determines your financial eligibility for Medicaid, the state will count your income. Your income includes these sources – Regular benefit payments such as Social Security retirement or disability payments, veteran benefits, pensions, salaries, wages, interest from bank accounts and certificates of deposit, dividends from stocks and bonds. In 2019, a single individual 65 years or older must have income less than $2,313 monthly. This applies to nursing home Medicaid, assisted living (in the states which cover it) and in-home care typically provided through a state’s HCBS Waivers. Income limits are different if the applicant is married or if both spouses are applying for Medicaid. A married couple’s income is counted separately. In most states, each spouse is allowed $2,313 or a combined income of $4,626 monthly. If one spouse applies for Medicaid, the non-applicant can be allocated by some of the applicant’s income in order to help them continue living at home when their spouse enters a nursing home facility. This is called the Minimum Monthly Maintenance Needs Allowance (MMMNA). For this year, most states allow a non-applicant spouse to receive a maximum amount of $3,160.50 per month.
  3. Asset Requirements: The Medicaid asset limit also referred to as the “asset test,” can be complicated due to several rules that need to be considered prior to determining if an applicant would pass this test. First, there are “countable assets” and “exempt assets.” An applicant’s home and furnishings are usually exempt. Secondly, assets for married couples are counted as joint assets, in contrast to income, which is counted separately. Thirdly, asset transfers made by the applicant are counted up to five years preceding their application date (or 2.5 years in California). This is known as the “Medicaid Look-Back Period.” If there is a violation at any point during this period, it may render someone ineligible for Medicaid for a period of time. In 2019, most states permit a single applicant aged 65 or older up to $2,000 in countable assets in order to be eligible for nursing home Medicaid or HCBS Waivers. Also depending on the state, those who are aged, blind or disabled Medicaid usually have the same asset limit or permits just a few thousand dollars more in assets. For married couples, both who apply and are usually allowed to have $3,000 on countable assets to qualify for Medicaid.  With a married couple where only one spouse applies, the applicant is permitted to transfer assets to a non-applicant spouse, referred to as a Community Spouse Resource Allowance.  Also In 2019, community spouses are allowed to have countable assets valued at $126,420.  The home is excluded as long as the community spouse resides in it and the equity value of the home doesn’t exceed the maximum amount $878,000. This amount can also vary per state. Due to the complexity of the Medicaid asset test, sound planning is very important because there are ways to help applicants with Medicaid eligibility despite being over the limit.
  4. Medical Requirements: The medical or “level of care” requirement for Medicaid for seniors varies based on the type of Medicaid program one is seeking assistance from. For example, long-term care in a nursing home requires a high level of care need. “Aged, Blind or Disabled” (ABD) Medicaid requires that the applicant be over 65 years of age, blind or disabled. Rules for a nursing home’s level of care requirement changes per state. with program participants requiring a minimum of assistance with their Activities of Daily Living (ADL), which entails bathing, grooming, dressing, eating, toileting, and mobility. Most cases will require a medical professional to complete an assessment in order to determine the level of care someone would require in order to perform ADLs. Also, a medical diagnosis of Alzheimer’s Disease, Parkinson’s and other dementia doesn’t guarantee an individual will meet the requirement for Medicaid’s level of care. However, the conditions are serious enough to meet the criteria, or have a pending status to soon qualify, due to the individual’s progressive decline in health.

Callahan Financial Services Group helps individuals apply and get approved for Medicaid. Call today for a free consultation at (973) 325-7500.


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