The pile of paperwork required and an often inefficient government processing system can make filing an application for public benefits an enormous project for even experienced professionals. Although the federal government shares the cost of funding the Medicaid program with the states 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 for applicants to 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 Constitutional and state statutory rights.

Following is a sample list of Medicaid application issues that should be addressed to avoid unnecessary delays and denials.

1. Selecting a Program - Applicants for public benefits must decide which 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 that have slightly differing income and asset standards and offer different coverage with respect to hospital stays.

2. Timeliness of Filing - Although families have the opportunity to expedite their Medicaid eligibility through asset protection planning under the guidance of an elder law attorney, 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 three years, filing an application during a period of ineligibility could potentially cause a significant delay in the applicant's eligibility approval status. It is, therefore, important to check with your planning advisor as to the date after which the application may be filed.

3. Authorization to Apply - In most cases, the applicant is not able to visit the welfare office and not prepared to offer detailed information on his financial status. The law, therefore, specifically provides that others, such as a relative or a professional such as an attorney, may apply on the applicant's behalf. Because the Medicaid eligibility laws and policies are rapidly changing, applicants are well advised to retain individuals with comprehensive knowledge of the Medicaid eligibility rules and strategies that may be legally employed to file application and expedite eligibility.

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

5. Intake Procedures - Counties often differ with regard to their procedures for the intake of benefits applications. For example, many counties will not permit the applicants themselves to complete the Medicaid application. In such counties, the caseworker must complete the Medicaid application based on financial data submitted. In other counties, the applicants or 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 generally requires a face to face interview with a Medicaid caseworker.

If you are interested in filing a Medicaid application or learning more about the process, please contact our office to schedule an appointment.

6. Substanting the Data - 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 three years prior to the time the Medicaid application is filed. If certain documents are missing, such as proof of birth or marriage, your professional 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 welfare 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 Variation - In addition to the personal and financial data, applicants who have been able to protect assets through planning for benefits may also have additional supporting information to submit to the welfare 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 noncountable 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 variations in other financial data and the county accepting the application.

Some county welfare offices require such individuals 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 three years prior to the filing of the application be submitted also varies from county to county. Depending on the circumstances, some counties have been known to request as little as four months of statements.

8. Enforcing the Applicant's Rights - Certain annuity and trust provisions must not only be reviewed by the county welfare office in which the Medicaid application is filed, but in New Jersey, must be submitted to the Division of Medical and Health Services, located in Trenton. While this second review of the paperwork may cause a delay in the processing of the application, applicants must be aware of their federal rights to a prompt disposition of their application. Enforcing the federally mandated deadline of 90 days found in the Code of Federal Regulations, and the state deadlines (in New Jersey, the recommended processing time is 30 days) can be done through a fair hearing, which is an informal proceeding before an administrative law judge.

If you are interested in filing a Medicaid application or learning more about the process, please contact our office to schedule an appointment.