(FAQ) FREQUENTLY ASKED QUESTIONS ABOUT

MEDICAID APPLICATIONS

IN NEW JERSEY

 

Medicaid in NJ FAQBy Frederick P. Niemann, a NJ Medicaid Application  Law Firm

Where are Medicaid Applications 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 office.

New Jersey Medicaid applications may not be filed by mail.

What documents are required to be filed in connection with an application?

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

What do I do if I am unable to locate a birth certificate, marriage certificate, death certificate or divorce decree?

This can be a real problem.  Medicaid is a bureaucracy; it’s government processing of paperwork. Often times, 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.  If you’re hitting a roadblock, then consult with an experienced NJ Medicaid application attorney or if in doubt about the completeness of your documentation to reduce the chances of denial.

Must applicants prove that it is medically necessary that he/she be receiving the long-term care being provided?

Yes.  A PAS must be ordered by the facility. Once received, 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.  Medical eligibility is determined by a document called a “pre-admission survey”.

Does Medicaid examine your financial information to know that the information being provided is complete?

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

 

Actual Client Testimonial – Cindy Rygiel- Sayreville, NJ

The Hanlon Niemann law firm took my case when others wouldn’t. They worked hard to get my Mom the Medicaid Insurance that she deserved. My mom is handicapped and at only 75 years of age too young to be placed in a nursing home. Now, thanks to the hard work done by Fred and Diane, she can remain at the place she has called home for the past 4 years.. If it wasn’t for them, her time at The assisted living facility would have been limited. Both mom and I can sleep better these days and I feel like a huge weight has been lifted off of my shoulders. Thanks again, Fred and Diane!

 

How long does it take to process a Medicaid Application?

The length of time necessary to process a Medicaid Application varies.  It is dependent on the quality of the financial information being submitted. An application can be approved within 60 – 90 days. In other counties, it takes 6 months or more to a year. In special cases, the application must be approved in Trenton.  This can take 18 months or longer.  During the application process, it is not uncommon for the case worker to request duplicative information many times; information is lost, so you keep duplicates of all documents sent in connection with your application.

Must I pay the nursing home while the Medicaid application?

Only pay a portion of the bill.  At the time of approval of the Medicaid Application, Medicaid will inform the applicant of the applicant’s future monthly share of costs. The applicant should generally 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.

Is the Medicaid Application process time consuming in New Jersey?

You bet it is!  Medicaid demands proof of every financial transaction going back five full calendar years prior to the application. Complete and detailed records should be obtained and furnished to the County Board of Social Services.  This makes the processing simpler. If records are incomplete or if a Medicaid application package is disorganized, the County Agency will insist on additional information.  They will cause the application to be delayed indefinitely. A Medicaid Application takes approximately 25-40 dedicated and undisturbed hours to assemble and organize. 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 (including an attorney) in preparing and filing a Medicaid Application is 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.

What do you mean when you say “the applicant must spend down”?

To qualify for Medicaid, an applicant’s non-exempt resources must be spent down to the calculated amount. However, with proper planning there are often ways to preserve some or all of these resources.

Similarly, for married couples, the rules are even more complex. The community spouse, (i.e. the at-home spouse) may generally keep roughly one-half of the couple’s assets up to a maximum of about $104,400. Depending upon their resources, the couple may have a substantial amount of money which needs to be spent before the nursing home spouse qualifies for Medicaid.

A person pursuing Medicaid eligibility may want to purchase a new car, pre-pay nursing home expenses, clothing, wheelchair, make home improvements, purchase household goods, consolidate debt repayment or even purchase a vacation for a spouse living at home.

A pre-paid funeral plan is often another good item to purchase during the spend down process. However, the rules regarding funerals differ so you should only deal with a funeral home knowledgeable in this type of planning.

These are, of course, not the only appropriate items for a spend-down. There are other expenses, which would also qualify. The main thing to keep in mind is that whatever goods or services are purchased must be done at fair market value. In other words, giving the money away or paying outrageous amounts for less than the real value of the services can cause Medicaid disqualification.

Also, don’t let anyone tell you that anything spent must be done solely for the benefit of the nursing home spouse. On the contrary, virtually anything that benefits the community spouse will also benefit the nursing home spouse and therefore may be an appropriate spend down item.

Finally, keep in mind that while some of the spend-down strategies will not work as well for a single person qualifying for Medicaid, there are other strategies that can work equally well, no matter whether you are dealing with a single person or a married couple. Consult an experienced Medicaid planning attorney for guidance. Contact Fredrick P. Niemann, Esq. toll-free at (855) 376-5291 or email him at fniemann@hnlawfirm.com.

Can I give my assets away in order to qualify for Medicaid? 

Generally no.  We frequently counsel clients who are under the impression that they are allowed to give away $14,000 as a gift based upon the federal gift tax rules. Federal gift and estate tax rules allow gifting of up to $14,000 per person per year without any gift tax consequence. However those gifts may still result in a period of ineligibility for someone applying for Medicaid benefits. That does not mean gifting can’t be done. You just need to learn the rules.

Can I gift certain amounts of money to my family and still be eligible for Medicaid?

There are ways to do some gifting; however, this must be done in strict conformance with Medicaid rules and regulations.

Since my childrens’ names are on my bank accounts, will those assets still count against me for Medicaid purposes? 

Simply placing a child’s name on a bank account does not transfer the account to your child. This is true even if the child’s name has been on those accounts for several years. The state says when you add your child’s name to an account, you are doing so for ‘convenience purposes.” Generally, the entire amount will be counted for Medicaid purposes unless it can be proven the monies in those accounts were contributed by the child. This rule applies to savings and checking accounts, credit union and share draft accounts, certificates of deposit, and other similar financial accounts.

All of my assets are in a Revocable Living Trust. Are these assets exempt from Medicaid? 

Medicaid considers all assets in a revocable trust to be countable for Medicaid. Therefore, they are not protected and may need to be spent down.

Will I lose my home? 

Oftentimes, people are concerned that they will have to forfeit their home to qualify for Medicaid benefits. When an individual is applying for Medicaid benefits, the home can be a non-countable resource. However, there is a federal law requiring each state to have a plan in place to recover the costs Medicaid paid for long-term care. This is called Estate Recovery. In other words, after an individual who has received Medicaid benefits passes away, it is the State’s responsibility to recover the value of Medicaid payments from the recipient’s estate, including a home.

New Jersey’s Estate Recovery Acts attempts to recover the money paid for benefits through the estate of the individual who received the benefits. For a married couple, however, this typically does not occur until both spouses have passed away. Once that happens, (or upon the death of a single Medicaid recipient) the Estate Recovery Act will lay claim to the value of the house up to the cost of benefits provided by Medicaid. Of course, estate recovery planning should not be left until the individual passes away. It should be part of an overall plan prior to application.

My husband is 53 and has just been diagnosed with early onset Alzheimer’s disease, can you explain some of the unique legal issues that will arise due to this? 

In future years, more individuals will be accurately diagnosed at younger ages due to the increase in productive diagnostic procedures. Alzheimer’s disease is considered to be early onset if an individual is age 55 or younger when symptoms first appear. Early onset individuals may not necessarily be in the early stage of Alzheimer’s when diagnosis is made. Individuals with early onset Alzheimer’s will experience similar symptoms as early stage Alzheimer’s, but there are other issues that may also be present. These individuals may experience issues due to their younger age (e.g. children still living at home, employment issues).

Fredrick P. Niemann, Esq. NJ Medicaid Lawyer

Fred Niemann, NJ Medicaid Lawyer

To learn more about Alzheimers and Dementia, please visit our website,

www.alzheimersdementialawyer.com.

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 fniemann@hnlawfirm.com.

His team of experienced lawyers and paralegals have filed many hundreds of applications throughout New Jersey.