Of course, you’ve heard of the 10 commandments.

In this office, the 11th commandment is:

If possible, do not file a NJ Medicaid application until you are sure that the applicant qualifies or it is strategically beneficial to be denied!

Once you apply for Medicaid, you risk losing the opportunity to protect your assets. Do not throw away the flexibility that exists prior to filing an application! If your assets show that you have more than the allowable amount, you will be required to spend-down those assets. Call us first before completing any Medicaid application! We may be able to tell you whether or not we can save you money. Let us help you calculate when you should file a Medicaid application. Often times together we can determine the amount of money that you can save and the appropriate date that the Medicaid application should be filed. We normally assemble the Medicaid application 90 days or more prior to the date that we believe a person will be eligible for benefits, given the current delays in the Medicaid approval process.

A Medicaid application in New Jersey requires a mountain of paperwork, and is then submitted to an overwhelmed and adverse government agency, which makes filing an application for public benefits an enormous project. We have developed systems to make your life easier. Our team knows the how to present the information in a way that it can be better understood and organized by Medicaid officials. We highlight and justify with appropriate legal support the reasons why an approval is appropriate.

When applying for NJ Medicaid or other public benefits, there are often many hidden obstacles and dangerous curves in the road. We understand these problems, as we have driven this road before — and we are prepared to address them and solve them. We will represent you through the application process and all face-to-face meetings with Medicaid caseworkers or higher-level officials.

If necessary, you will have the peace of mind knowing we will represent you through any and all necessary appeals subject to the terms of our engagement agreement.

General Information on Filing Your NJ Medicaid Application

Where are Medicaid Applications in New Jersey filed?

In New Jersey Medicaid Applications are filed in each of the 21 County Board of Social Services. The counties maintain outreach offices in certain locations, otherwise the application must be filed at the county's home office.

New Jersey Medicaid applications may not be filed by mail.

Many types of documents are required in connection with filing a NJ Medicaid an application.

Required documentation begins with a birth certificate for the NJ Medicaid Applicant, a marriage certificate if the applicant is or has been married and a death certificate of the spouse or divorce decree if the marriage has been dissolved by death or divorce. In addition, five years of complete and detailed financial records are required.

Many people ask what to do if they are unable to locate a birth certificate, marriage certificate, death certificate or divorce decree.

Often times all of these items can be obtained from the Registrar of Vital Statistics or from court records. If it is absolutely impossible to obtain these records, other forms of evidence may be accepted. You should consult with an experienced NJ Medicaid application attorney if in doubt about the completeness of your documentation to reduce the chances of denial.

All applicants for NJ Medicaid must prove that it is medically necessary that he/she be receiving a nursing home level of care.

Medical eligibility is determined by a document called a "pre-admission survey”. (PAS)

A PAS is ordered by the nursing home or residential facility. Medicaid sends a nurse to examine the applicant to determine whether or not the care is medically necessary. New Jersey has an unwritten rule that the examination will take place within 30 days from the date the PAS is ordered. Failure to secure a PAS will result in a denial.

Medicaid examines your financial information to know that the information being provided is complete.

Medicaid has a computer match with the I.R. S. Medicaid will receive information concerning 1099's sent by all financial institutions.

It can take an extremely long time to process a Medicaid Application

The length of time necessary to process a Medicaid Application varies from county to county and is dependent on the nature of the financial data being submitted. In some counties, an application can be approved within 90 – 150 days. In other counties, it takes 6 months to a year. In special situations, the application has to be approved in Trenton and this can take 18 months or longer. During the application process, it is not uncommon for the assigned case worker to re-request duplicative information, lost information, so it is critical that you keep duplicates of all documents sent in connection with your application.

While the Medicaid Application is pending, the nursing home bill continues to mount up

At the time of approval of the Medicaid Application, Medicaid will inform the applicant of the applicant's monthly share of cost. The applicant must pay this share to the facility while the application is pending. When the application is approved, Medicaid will pay the nursing home retroactively to the date of eligibility.

The preparation of a Medicaid Application process is very, and I mean very time consuming in New Jersey

Medicaid demands proof of every financial transaction going back to January 1, 2006 or 5 full calendar years prior to the application. Accurate records should be gathered and a complete Medicaid application furnished to the County Board of Social Services to make the processing simpler. If records are inaccurate or incomplete or if a Medicaid application package is disorganized, the Medicaid Agency will continue to insist on additional information and the application will be delayed indefinitely. Submission of a complete Medicaid Application requires many hours of time. It is estimated that a professional assembling a Medicaid Application spends approximately 25-40 dedicated and undisturbed hours assembling and organizing the information. A person unfamiliar with the process will spend many times that amount of time, often in excess of 100 hours.

Is the cost of paying a professional such as a law firm to prepare and file a Medicaid Application in New Jersey a legitimate spend down for Medicaid eligibility purposes?

Yes. The cost of professional assistance in preparing and filing a Medicaid Application if paid by the Medicaid applicant is permitted as part of the spend down process. The legal fee paid to our office, for example, is credited toward the applicant’s eligibility. Since a person can retain only $2,000/$4,000 in resources to become Medicaid eligible, it seldom makes sense for the family to assume the responsibility for filing the application. The money will only go to the nursing home or other parties who could be paid once eligibility is established.

Contact Fredrick P. Niemann, Esq. on any questions concerning eligibility for NJ Medicaid or applying for Medicaid approval. Call toll free (855) 376-5291 or email him at fniemann@hnlawfirm.com. His team of experienced lawyers and paralegals have filed many hundreds of applications throughout New Jersey.

MORE INFORMATION ON APPLYING FOR NJ MEDICAID BENEFITS

Medicaid Applications

The pile of paperwork required and an often inefficient government processing system can make filing an application for public benefits an enormous project. Although the federal government shares the cost of funding the Medicaid program in New Jersey and requires the state government to uphold certain standards with respect to efficiency and the granting of Medicaid applications, it is not uncommon for a state or county office to fail to meet the federally imposed guidelines.

Therefore, when applying for Medicaid or other public benefits, it is crucial that you be well prepared and well versed in the legal implications of all information to be supplied in support of the application. Also, when the state or county office fails to meet a deadline or erroneously renders a disposition on an application, the applicant must be prepared to exercise his or her federal and state statutory rights.

The following is a sample list of Medicaid application issues which should be addressed to avoid unnecessary delays and denials. 

1. Selecting a Program to Qualify for NJ Medicaid

Applicants for public benefits must decide the programs for which they wish to apply. The choice of programs may depend on the applicant's living situation, physical condition, and financial status. Certain benefits programs are also specifically geared to victims of traumatic brain injuries or Alzheimer’s Disease. Many states, including New Jersey have dual institutional Medicaid programs which have slightly differing income and asset standards and offer different coverage with respect to hospital stays. If you have any questions on selecting the appropriate Medicaid program for you, contact Fredrick P. Niemann at 855-376-5291.

2. Timeliness of Filing Your NJ Medicaid Application

Although families have the opportunity to expedite their Medicaid eligibility through asset protection planning under the guidance of New Jersey Medicaid lawyer, it is vitally important that applicants do not apply for Medicaid prematurely. Strategies for Medicaid planning often include triggering a penalty period for Medicaid eligibility purposes. While the time in which to wait to file an application may be more or less than five years, filing an application during a period of ineligibility could potentially cause a significant delay in the applicants eligibility approval status. It is, therefore, important to check with a qualified professional as to the date after which the application may be filed. You may contact Fredrick P. Niemann at (855) 376-5291 or fniemann@hnlawfirm.com.

3. Authorization to Apply for NJ Medicaid

In most cases, the applicant himself or herself is unable to visit the County social services office and offer detailed information on his/her financial status. The law, therefore, specifically provides that a relative, welfare agency staff member, staff member of the institution in which the applicant resides, or a professional such as a doctor or attorney may apply on the applicant's behalf. In cases where an attorney has been retained to apply on behalf of an applicant, the attorney must acquire an authorization from the applicant or his/her attorney-in-fact to obtain, discuss and submit financial data in support of the Medicaid application. Because the Medicaid eligibility laws and policies are rapidly changing, subject to shifts in politics and lobbying by advocates for the elderly, applicants are well advised to retain individuals with comprehensive knowledge of the Medicaid eligibility rules and all strategies that may be legally employed to expedite eligibility. Don’t hesitate to contact Fredrick P. Niemann at (855) 376-5291 or fniemann@hnlawfirm.com.

4. Physical Criteria for NJ Medicaid Eligibility

Qualifying for Medicaid involves not only financial criteria, but also physical and medical  requirements. Therefore, applicants must demonstrate through a physical exam that he or she is unable to perform a certain number of activities of daily living, including feeding, dressing, bathing, toileting and continence. If it cannot be shown to Medicaid that a nursing home level of care is necessary, the Medicaid application will be denied.

5. Intake Procedures for Filing a New Jersey Medicaid Application

In some counties, the applicant or the families themselves are required to complete the paperwork. While some counties are more lenient as to what types of documents may be submitted by mail, the initial filing of a Medicaid application requires a face to face interview with a Medicaid caseworker.

6. Substantiating the Data Needed for Approval of a NJ Medicaid Application

The Medicaid application itself is several pages, and the answers to each question must be substantiated by legal or financial documentation. These supporting documents include: social security cards, Medicare cards, health insurance cards, birth certificates, marriage certificates, death certificates, life insurance policies, deeds, car registrations, household expense bills, funeral arrangement documents, pay or pension stubs, and financial statements typically dating back five years prior to the time the Medicaid application is filed. If certain documents are missing, such as financial records, proof of birth or marriage, etc., a paralegal at Fredrick P. Niemann’s office can help you obtain certain documents from the Registrar of Vital Statistics in your area.

Each Medicaid office has a computer program to verify social security numbers, employment history, or other personal information. Likewise, if any financial information is not disclosed to a county social service office, the office may deny the application based on information it periodically receives from the Internal Revenue Service. Intentional failure to disclose relevant financial data is considered Medicaid fraud. Even in cases where Medicaid eligibility has initially been granted, the county welfare office may revoke the approval upon receiving the IRS records.

7. Additional Documentation and County Verification for NJ Medicaid Eligibility

In addition to personal and financial data, applicants who have been able to protect assets through planning for benefits may have to submit additional supporting information to the county social services office. The treatment of these additional supporting documents may vary from county to county. For instance, both a husband and wife may present prepaid funerals as non-countable assets. Both Care Agreements and Caregiver Affidavits which help applicants protect assets without triggering penalties, must also be submitted to support an application, but their treatment may vary with other financial data and the county accepting the application. Trusts that have been established must also be submitted to the welfare office since they may affect benefits eligibility, depending upon their provisions.

Some county Board of Social Services offices require each individual to complete a plan of liquidation of assets in certain situations. Such cases may necessitate professional advice to protect the applicant’s rights, to protect a portion of the proceeds for his or her family members or to enhance his or her institutional care.

The requirement that financial statements dating back five years prior to the filing of the application be submitted also varies from county to county. 

8. Enforcing the Applicant's Rights for Eligibility to Receive NJ Medicaid

Applicants should be aware of their federal rights to a prompt decision of their application. Enforcing the federally mandated deadline of 90 days found in the Code of Federal Regulations, and the state deadlines of the State of New Jersey (in New Jersey, the recommended processing time is 30 days) can be done through a fair hearing, which is a proceeding before an administrative law judge. These hearings are often used to expedite the decision making process of the county and state welfare agencies. Individuals who do not exercise their federal and state rights to a prompt decision on their Medicaid applications might otherwise find themselves waiting over a year to learn whether their nursing home bills, which had been accruing, will be covered by the benefits programs.

Contact Fredrick P. Niemann, Esq. on any questions concerning eligibility for NJ Medicaid or applying for Medicaid approval.  Call toll-free (855) 376-5291 or email him at fniemann@hnlawfirm.com.

Medicaid Application Attorneys serving these New Jersey Counties:

Monmouth County, Ocean County, Essex County, Cape May County, Mercer

County, Middlesex County, Bergen County, Morris County, Burlington County,

Union County, Somerset County, Hudson County, Passaic County