General Information on the NJ Medicaid Application Process

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Where are Medicaid Applications in New Jersey filed?

Written by Fredrick P. Niemann, Esq. of Hanlon Niemann & Wright,  A New Jersey Medicaid Attorney

In New Jersey Medicaid Applications are filed in person with each of the 21 County Board of Social Services. Some counties maintain outreach offices at different municipalities in the county, otherwise the application must be filed at the county’s home office.  New Jersey Medicaid applications generally may not be filed by mail, though in some counties this policy is changing and applications by mail are being accepted.  You should contact your county for their current policy on applications by mail.

Many types of documents are required to be filed in connection with filing a NJ Medicaid application.

Required documentation begins with a birth certificate to establish proof of US citizenship.  A marriage certificate must be produced 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 or most of these documents 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 must prove that it is medically necessary that he/she be receiving a nursing home level of care, even if that care will be provided at home.

Medical eligibility is determined by a document called a “pre-admission survey” (PAS).  A PAS is ordered by the nursing home or residential facility, or by the family if home care is being applied for. Medicaid sends a nurse or other medical professional 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.  Coordination and follow up of the PAS becomes essential.

Medicaid examines all financial information going back five years to confirm that the information being provided is complete.

Medicaid has a computer match with the I.R. S. Medicaid will receive information concerning 1099’s etc sent by all financial institutions.  The state is looking for cheaters and others who transfer assets and then claim “poverty” to qualify for Medicaid.  Innocent individuals who are eligible for approval are threatened with penalties and denials by the state without justification and legal authority.  Be careful! Know your rights!

Understanding the Medicaid Application Process

 

Actual Client Testimonial

My aunt is 80 years old and a widow. She’s in good health and lives alone. My cousin and I are very close to her, but I live in North Carolina and my cousin in California. That makes it hard for us to help her as much as we would like to. She wanted to do some estate planning and asked us to help her find an elder law attorney. I did some homework and research and after many inquires, found Mr. Niemann. He came recommended to me by several sources. Mr. Niemann was the perfect match for my aunt. He demonstrated a kindness and sensitivity that made us feel welcomed and comfortable. He met with us right away and was caring and patient with my aunt and answered all of our questions. He even called my aunt to make sure she was following up on his advice. Mr. Niemann offered us ideas and solutions we hadn’t even thought of. We very much appreciated that. My aunt truly values having Mr. Niemann as her attorney. So do I…

– Robert Newell, Raleigh, NC

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 quantity, quality and 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 or lose information so it is critical that you keep copies of all documents given in connection with your application.  Establishing a “paper trail” should be a high priority.

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 his/her monthly share of the cost.   But before approval, and while the application is being processed, an applicant must pay his/her income to the facility. Knowing how much you must pay each month is tricky.  The facility will tell you to pay 100% of all income to them but this is not accurate.  You are entitled to deductions and to withhold some of your income for yourself.

When the application is approved, Medicaid will pay the nursing home retroactively to the date of eligibility which is generally the date the application is filed with the county agency.

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

Medicaid demands proof of almost every financial transaction going back to 5 full calendar years prior to the date of filing the application. Accurate records should be gathered and a complete application furnished all at the same time to the County Board of Social Services to make processing simpler and quickly. If records are inaccurate or incomplete or if the application package is disorganized, the state 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 such an application spends approximately 35 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.

 

The Costs Paid for Filing A Medicaid Application Are A Permissible Spend Down in New Jersey

DID YOU KNOW THAT THE COST OF PROFESSIONAL ASSISTANCE IN PREPARING AND FILING A MEDICAID APPLICATION 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 WILL BE PAID BY THE STATE ONCE ELIGIBILITY IS ESTABLISHED.

Beware of the Big Medicaid Application Companies!

BEWARE OF MEDICAID APPLICATION COMPANIES. THEY ARE NOT STAFFED BY ATTORNEYS. OFTEN TIMES THEY MAKE MANY MISTAKES AND/OR GIVE POOR AND/OR GROSSLY INACCURATE LEGAL ADVICE THAT CAN COST YOU ELIGIBILITY. THESE COMPANIES ARE “IN BED” WITH THE LARGE NATIONAL AND REGIONAL NURSING HOMES AND ASSISTED LIVING COMPANIES. THEY ARE NOT OUT TO PROTECT YOU. THEY DO NOT OFFER STRATEGIES AND LEGAL ADVICE TO ASSIST FAMILIES IN PROTECTING A LIFETIME OF SAVINGS AND INCOME FROM LONG TERM CARE COSTS. THEY ARE RECOMMENDED BY THE BUSINESS OFFICE OF THE LARGER NURSING HOME AND ASSISTED LIVING CHAINS BECAUSE THEY WILL MAXIMIZE THE $ SPENT BY FAMILIES AT THESE FACILITIES. THEY ARE NOT YOUR FRIENDS!
Fred Niemann - Medicaid Lawyer in New Jersey

Fred Niemann, Medicaid Lawyer in New Jersey

Contact Fredrick P. Niemann, Esq. of Hanlon Niemann & Wright 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 medical lawyers and paralegals have filed many hundreds of applications throughout New Jersey.

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 which long term care program(s) 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 including MLTSS which have slightly differing income and asset standards and offer different coverage with respect to hospital stays and community setting. If you have any questions on selecting the appropriate Medicaid program for you, contact Fredrick P. Niemann toll-free (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 too soon and prematurely.  Strategies for Medicaid planning often include triggering a penalty period for Medicaid eligibility purposes.  You read me correct.  Sometimes we want to be denied so we can start a penalty period, the effect of which is to protect gifts and other transfers made within the prior 5 years.  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 and 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 to find out more.

3. Authorization to Apply for NJ Medicaid

In most cases, an applicant himself or herself is unable to visit the County social services office and offer detailed information about 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 obtain 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 commonly referred to as the ADL’s, 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 family is required to complete and file the paperwork in person. Other counties are more lenient as to what types of documents may be submitted by mail, however the initial filing of a Medicaid application generally requires a face to face interview with a Medicaid caseworker in each and every county.

6. Substantiating the Data Needed for Approval of Your Application

The Medicaid application itself is only several pages long but 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 Eligibility

In addition to personal and financial data, applicants who have attempted or successfully have protected 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. Care Agreements and Caregiver Affidavits which help applicants protect assets without triggering penalties, must also be submitted to support an application, but their treatment will vary as with other financial data and the county accepting the application. Trusts that have been established may also have to 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 details and complexity of the financial statements dating back five years prior to the filing of the application also varies from county to county.  You must be diligent and cautious with what you file and how much disclosure you make.  Remember, a Medicaid agency is not out to be your friend.

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.

Applying for Medicaid Eligibility For Long Term Care in NJ (Part I)

Applying for Medicaid Eligibility For Long Term Care in NJ (Part II)