Medicaid Application

From the date of application, the caseworker has 45 days in which to process the application.  At the time the application is completed, the caseworker will generate several forms that the applicant will have to sign.  One of the forms is acknowledgment regarding DSS’s use of the applicant’s Social Security number, one of the forms is the Estate Recovery Notification, and the last is the application itself.  The caseworker will also issue a Form 5097.  This form is completed by the caseworker, and sets forth the information that the applicant must provide to the caseworker before the caseworker is able to complete the application.  If this information is not provided within 45 days (with certain exceptions), the caseworker will deny the application and the applicant will have to reapply.  

Does Medicaid provide any retroactive coverage? 

Medicaid will provide up to three months of retroactive coverage for those seeking Long Term Care Medicaid.  For those seeking Special Assistance Medicaid, there is no retroactive coverage beyond the month of application.  Retroactive coverage is dependent upon the applicant’s eligibility.  For example, if a person were eligible for coverage in January, but did not apply until March, Medicaid would make payments on the applicant’s behalf back to January.  If the applicant had paid the facility for those months (or if someone had made payments on the applicant’s behalf), the applicant would be reimbursed for those amounts paid by the facility.  If you are considering making payments on behalf of an applicant but are expecting to be reimbursed once Medicaid provides retroactive coverage, you must have the proper documentation in place to ensure that the applicant repaying you does not cause qualification problems. 

Medicaid Eligibility 

Medicaid’s eligibility requirements vary depending on the Medicaid program you are seeking assistance from.  The program is determined by the applicant’s level of care, which is determined by the applicant’s doctor, who completes an FL-2.  The FL-2 sets out the applicant’s care needs, diagnoses, medications, and recommended level of care.  Once this form is completed, the applicant or their designated representative will know whether they are seeking Special Assistance or Long Term care.

For long term care overview, click here.  And for special assistance overview, click here.


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