how does medicaid in new jersey work
1. What is Medicaid in New Jersey?
Medicaid is a joint Federal and State program that will pay for an individual's Long Term Care costs. The Medicaid program will pay for a person’s long‑term care costs in a nursing home, assisted living or even at home care if he/she qualifies. Medicaid is administered by a New Jersey state agency known as the Department of Human Services.
Medicaid is a joint Federal and State program that will pay for an individual's Long Term Care costs. The Medicaid program will pay for a person’s long‑term care costs in a nursing home, assisted living or even at home care if he/she qualifies. Medicaid is administered by a New Jersey state agency known as the Department of Human Services.
2. What is the difference between Medicare and Medicaid?
Medicare, is a government benefit program that covers medical expenses such as hospital bills and doctors’ fees for seniors who are 65 years of age or older. Medicare is not a means-tested program. If a person is disabled or over 65 then regardless of how much money that person has he or she can still qualify for Medicare benefits. Medicaid, is the government benefit program that will cover nursing home, assisted living or at-home care costs. However, Medicaid is a strict means-based and asset-based program. Any person who is applying for Medicaid must complete an application, and also pass asset and income requirements established by the New jersey state Medicaid program.
Medicare, is a government benefit program that covers medical expenses such as hospital bills and doctors’ fees for seniors who are 65 years of age or older. Medicare is not a means-tested program. If a person is disabled or over 65 then regardless of how much money that person has he or she can still qualify for Medicare benefits. Medicaid, is the government benefit program that will cover nursing home, assisted living or at-home care costs. However, Medicaid is a strict means-based and asset-based program. Any person who is applying for Medicaid must complete an application, and also pass asset and income requirements established by the New jersey state Medicaid program.
3. Why seek the legal advice before applying for Medicaid?
It is extremely important to obtain qualified legal advice if you or an aging loved one is or will be applying for Medicaid in New jersey. Prior to applying for Medicaid is best. The cost to pay for nursing homes or assisted living is rising at an astronomical rate. The bottom line is that most people simply can’t afford to pay for nursing homes. Many people are forced to wipe out their entire life savings in only a year or so to pay for nursing home care. Thankfully, the New Jersey Medicaid Program exists to help the middle class. Basically, Medicaid is the long term care insurance for the middle class. However, There are many complicated requirements that must be satisfied before a person will become eligible for Medicaid. To qualify for Medicaid an applicant is required to pass certain tests on the amount of income and assets they have. The main legal concept of Medicaid is that the applicant must use the bulk of his own assets to pay for a nursing home before Medicaid will begin paying. Therefore, it is very important to undertake careful Medicaid planning to try to save as much of your family’s savings as possible. In addition, the Medicaid rules are a maze of confusion and consist of endless legalities. In most instances an experienced lawyer will be able to save your family the majority of your hard earned savings and eliminate the aggravation by providing you with legal counseling on Medicaid planning. In summary, legal advice of an attorney that specializes in New Jersey Medicaid planning will allow you to:
It is extremely important to obtain qualified legal advice if you or an aging loved one is or will be applying for Medicaid in New jersey. Prior to applying for Medicaid is best. The cost to pay for nursing homes or assisted living is rising at an astronomical rate. The bottom line is that most people simply can’t afford to pay for nursing homes. Many people are forced to wipe out their entire life savings in only a year or so to pay for nursing home care. Thankfully, the New Jersey Medicaid Program exists to help the middle class. Basically, Medicaid is the long term care insurance for the middle class. However, There are many complicated requirements that must be satisfied before a person will become eligible for Medicaid. To qualify for Medicaid an applicant is required to pass certain tests on the amount of income and assets they have. The main legal concept of Medicaid is that the applicant must use the bulk of his own assets to pay for a nursing home before Medicaid will begin paying. Therefore, it is very important to undertake careful Medicaid planning to try to save as much of your family’s savings as possible. In addition, the Medicaid rules are a maze of confusion and consist of endless legalities. In most instances an experienced lawyer will be able to save your family the majority of your hard earned savings and eliminate the aggravation by providing you with legal counseling on Medicaid planning. In summary, legal advice of an attorney that specializes in New Jersey Medicaid planning will allow you to:
- Preserve as much of your family's savings and assets as possible
- qualify faster
- lessen the chance of a penalty
- eliminate the high cost of nursing home or assisted living care
4. If a person is going into a nursing home should he/she have their estate plan reviewed?
Absolutely. If you are going into a nursing home or assisted living facility then you must have your estate plan carefully reviewed. Some important areas to review are as follows:
Absolutely. If you are going into a nursing home or assisted living facility then you must have your estate plan carefully reviewed. Some important areas to review are as follows:
- Review Your Will: If a couple has joint wills that leave their respective estates to each other, then their wills should be redrawn. The spouse who is entering the nursing home should be disinherited. It may sound harsh but If the spouse who is at home should die first, then the entire estate will then be inherited by the spouse in the nursing home which will then be used to fund the nursing home. Therefore, it is imperative that the wills be redrawn so that the nursing home spouse does not receive any part of a married couple’s estate.
- Power of Attorney is Updated: It is very important that a person should have his powers of attorney(s) updated before he goes into a nursing home. It is my experience that financial institutions are now being very picky when it comes to dealing with old and dated powers of attorneys. Therefore, up to date power of attorneys should be obtained before any person goes into the nursing home. These documents will make your loved ones lives much easier, and it will enable them to carry on your affairs.
- Living Will: It is critically important to have a valid living will before you go into a nursing home. Don’t rely on the living wills prepared by the senior center or obtained via the internet. Go to an experienced lawyer and have a current and “proper” living will prepared. Keep in mind that the costs to prepare a living will be deducted from your countable Medicaid estate.
5. How are the costs for a nursing home paid?
The cost to live in a nursing home is outrageous! The cold hard reality is that the relatives of the person who has to go into the nursing home become furious sometimes at the prospect of seeing their inheritance, or if your spouse is going to the nursing home, your hard earned savings wiped out to pay for the nursing home.
There are basically four ways that you can pay the cost of a nursing home;
The cost to live in a nursing home is outrageous! The cold hard reality is that the relatives of the person who has to go into the nursing home become furious sometimes at the prospect of seeing their inheritance, or if your spouse is going to the nursing home, your hard earned savings wiped out to pay for the nursing home.
There are basically four ways that you can pay the cost of a nursing home;
- Long Term Care Insurance: In the ideal world a person should have long term insurance before he goes into a nursing home. However, the premiums for long term care insurance very high and many people can’t afford it or even qualify and the policy will only cover a portion of the costs.
- Payment With Own Money/Funds: Most middle class Americans have to use their own money and funds to pay for a loved one’s nursing home. Basically, most middle class people have to pay for their own long term care. Unfortunately, the cost to pay for a nursing home can quickly wipe out many middle class families’ savings. Most nursing home bills average between $10,000 to $12,000 per month in our area. Therefore, many families in New Jersey quickly wipe out their savings by paying for a loved one's nursing home bills.
- Medicare: Medicare is basically a national health insurance program primarily for people 65 years of age or older. Medicare will only pay nursing home bills for the 1st 20 days [only after a qualifying stay at a hospital], after that Medicare will only pay a portion of the next 80 days.
- Medicaid: Ordinarily once a senior wipes out most of his or her savings, then he or she must apply for Medicaid. The rules that govern qualifying for Medicaid are like a maze and they will make your head spin. However, we will try to break it down for you in a simple and real world manner.
6. What are the rules that determine when a person can qualify for Medicaid?
A person can only apply for Medicaid to pay for nursing care when they meet the financial and medical needs. For financial, it's when the countable assets of the person applying for Medicaid have been reduced to $2,000. However, the “at-home” spouse is entitled to an allowance called the CSRA or Community Spouse Resource Allowance. As of July 2015, the amount of the CSRA is $119,220. Another key concept is that any transfers that are made for less than the fair market value consideration, within five years of the Medicaid application, may trigger a Medicaid penalty. These transfers don’t apply if the property is the primary residence and it was transferred to a spouse, a caretaker child, or a disabled child.
A person can only apply for Medicaid to pay for nursing care when they meet the financial and medical needs. For financial, it's when the countable assets of the person applying for Medicaid have been reduced to $2,000. However, the “at-home” spouse is entitled to an allowance called the CSRA or Community Spouse Resource Allowance. As of July 2015, the amount of the CSRA is $119,220. Another key concept is that any transfers that are made for less than the fair market value consideration, within five years of the Medicaid application, may trigger a Medicaid penalty. These transfers don’t apply if the property is the primary residence and it was transferred to a spouse, a caretaker child, or a disabled child.
7. What are the Medicaid rules on exempt and countable assets?
To qualify for Medicaid, a person must pass several strict and confusing tests to assess the amount of assets that he can retain. To understand how the Medicaid system works, it is imperative that one understands what is considered to be as exempt and nonexempt or countable assets. Basically, if an asset is considered exempt then Medicaid will not take it into account when determining if the applicant is eligible.
What are some assets that can be considered to be exempt?
Thankfully, there are many assets that are considered to be exempt. This means that the applicant can keep many of his assets even if he qualifies for Medicaid. These exempt assets include:
The value of life insurance if the face value is $1,500 or less. If it does exceed $1,500 in a total face amount, then the cash value in these policies is considered to be a countable asset.
To qualify for Medicaid, a person must pass several strict and confusing tests to assess the amount of assets that he can retain. To understand how the Medicaid system works, it is imperative that one understands what is considered to be as exempt and nonexempt or countable assets. Basically, if an asset is considered exempt then Medicaid will not take it into account when determining if the applicant is eligible.
What are some assets that can be considered to be exempt?
Thankfully, there are many assets that are considered to be exempt. This means that the applicant can keep many of his assets even if he qualifies for Medicaid. These exempt assets include:
- The applicant may keep his home. However, the home must be the principal place of residence.
- Personal belongings and household goods.
- Any income‑producing real estate.
- One car or truck.
- Burial spaces and certain related items for applicant and spouse.
- Up to $1,500 designated as a burial fund for applicant and spouse.
- An irrevocable prepaid funeral contract.
The value of life insurance if the face value is $1,500 or less. If it does exceed $1,500 in a total face amount, then the cash value in these policies is considered to be a countable asset.
8. What are considered countable assets for Medicaid purposes?
If the applicant has any other assets besides after going through the list, then these assets are generally nonexempt and are countable. The applicant and his family may be required to liquidate these assets and then use the proceeds or cash to pay for the nursing home care.
Some common examples of countable Medicaid assets are as follows;
There is no doubt that the New Jersey Medicaid laws are a complex maze of confusion and may of the above "countable assets" can be moved to a "non-countable" status by an experience New Jersey Medicaid planning attorney.
If the applicant has any other assets besides after going through the list, then these assets are generally nonexempt and are countable. The applicant and his family may be required to liquidate these assets and then use the proceeds or cash to pay for the nursing home care.
Some common examples of countable Medicaid assets are as follows;
- Cash, savings, and checking accounts, credit union shares and draft accounts.
- Certificates of Deposit
- U.S. Savings Bonds
- Individual Retirement Accounts (IRA), Keogh plans (401K, 403B)
- Nursing home accounts.
- Prepaid funeral contracts which can be cancelled.
- Trusts (depending on the terms of the trust).
- Real estate (other than the residence).
- More than one car.
- Boats or recreational vehicles.
- Stocks, bonds or mutual funds.
- Land contracts or mortgages held on real estate sold.
There is no doubt that the New Jersey Medicaid laws are a complex maze of confusion and may of the above "countable assets" can be moved to a "non-countable" status by an experience New Jersey Medicaid planning attorney.
9. How does Medicaid classify a joint account(s) that is held with children?
A very common issue that arises is parents that share their bank accounts with their children. therefore, the legal issue arising is how Medicaid classifies joint bank accounts when the children’s names are also listed on their parents bank accounts. Unfortunately, Medicaid will consider any joint bank account with a child(s) name also listed on it as a countable asset and the entire bank account as part of the applicants total resources.
A very common issue that arises is parents that share their bank accounts with their children. therefore, the legal issue arising is how Medicaid classifies joint bank accounts when the children’s names are also listed on their parents bank accounts. Unfortunately, Medicaid will consider any joint bank account with a child(s) name also listed on it as a countable asset and the entire bank account as part of the applicants total resources.
10. Why can’t I just give my assets away to my family members before I go into the nursing home?
This is a very common question. The Medicaid laws have many severe and complicated penalties for people who simply give away their assets with the purpose make themselves immediately eligible to receive Medicaid benefits. In New Jersey every $9,977 given away during the five years prior to a Medicaid application creates a one month period of ineligibility. Therefore, if you gift your assets away before you apply for Medicaid, then you will be penalized by Medicaid and be ineligible for a certain period of time. A gift of $13,000 to a person will not trigger any gift tax implications by the IRS, however, these gifts will trigger a review by a Medicaid auditor.
This is a very common question. The Medicaid laws have many severe and complicated penalties for people who simply give away their assets with the purpose make themselves immediately eligible to receive Medicaid benefits. In New Jersey every $9,977 given away during the five years prior to a Medicaid application creates a one month period of ineligibility. Therefore, if you gift your assets away before you apply for Medicaid, then you will be penalized by Medicaid and be ineligible for a certain period of time. A gift of $13,000 to a person will not trigger any gift tax implications by the IRS, however, these gifts will trigger a review by a Medicaid auditor.
11. My husband is going into the nursing home. How much of our savings and assets can I keep?
The Spousal Impoverishment provisions of the Medicare Catastrophic Act of 1988 answer this question. It applies only to married couples. This law recognizes that it is unwise to impoverish both spouses when only one needs to qualify for Medicaid assistance to go into a nursing home care. When a spouse must enter a nursing home or assisted living facility in New Jersey and wants to apply for Medicaid, the couple must complete many forms at the local County Board of Social Services. Medicaid will then make a determination as to the “division of assets” between the spouses.
Basically, in a division of assets, the married couple will gather all of their countable assets and list them in the Medicaid application, the countable assets are then divided into two. The at‑home or “community spouse” is legally permitted to keep one half of all countable assets. The community spouse can keep up to a maximum of $119,220 of countable assets as of July 2015. The remaining one half of countable assets must be “spent down” until $2,000 remains. The amount of the countable assets which the community spouse or at-home spouse gets to keep is called the Community Spouse Resource Allowance (CSRA). This fancy term simply means that the spouse who is not going into the nursing home may keep a certain amount of the countable assets to help ensure that they can continue with their lifestyle.
The Spousal Impoverishment provisions of the Medicare Catastrophic Act of 1988 answer this question. It applies only to married couples. This law recognizes that it is unwise to impoverish both spouses when only one needs to qualify for Medicaid assistance to go into a nursing home care. When a spouse must enter a nursing home or assisted living facility in New Jersey and wants to apply for Medicaid, the couple must complete many forms at the local County Board of Social Services. Medicaid will then make a determination as to the “division of assets” between the spouses.
Basically, in a division of assets, the married couple will gather all of their countable assets and list them in the Medicaid application, the countable assets are then divided into two. The at‑home or “community spouse” is legally permitted to keep one half of all countable assets. The community spouse can keep up to a maximum of $119,220 of countable assets as of July 2015. The remaining one half of countable assets must be “spent down” until $2,000 remains. The amount of the countable assets which the community spouse or at-home spouse gets to keep is called the Community Spouse Resource Allowance (CSRA). This fancy term simply means that the spouse who is not going into the nursing home may keep a certain amount of the countable assets to help ensure that they can continue with their lifestyle.
12. What is the minimum monthly maintenance needs allowance?
Medicaid also establishes monthly income limits for the at‑home spouse. This is called the Minimum Monthly Maintenance Needs Allowance [MMMNA]. The at-home spouse is permitted to keep a monthly income ranging from $1,991 to $2,980 [As of July 2015]. To summarize, if the community spouse does not receive at least $1,991 of their own income, then he or she is allowed to use the income of the spouse applying for Medicaid to help support them. The at-home spouse is also entitled to allowances for utilities. The community spouse can also file an appeal/application to receive more than the MMMNA. The community spouse can request an additional MMMNA on the grounds of certain living allowances and utility allowances.
Medicaid also establishes monthly income limits for the at‑home spouse. This is called the Minimum Monthly Maintenance Needs Allowance [MMMNA]. The at-home spouse is permitted to keep a monthly income ranging from $1,991 to $2,980 [As of July 2015]. To summarize, if the community spouse does not receive at least $1,991 of their own income, then he or she is allowed to use the income of the spouse applying for Medicaid to help support them. The at-home spouse is also entitled to allowances for utilities. The community spouse can also file an appeal/application to receive more than the MMMNA. The community spouse can request an additional MMMNA on the grounds of certain living allowances and utility allowances.
13. Will I lose my home if I have to go into a nursing home?
Most likely not. Medicaid cannot force you to sell your home if the at-home spouse still lives there, or if caretaker children live there. Even when the home is occupied by some non-owner family members other than the spouse, most County Board of Social Services are still reluctant to force the sale of the home. The county practices vary as to whether the property must be listed for sale. There are many strategies to protect the house for your family if you need nursing care. Under the Medicaid laws, the home is in most cases considered to be exempt, and it is not considered to be a countable asset and in most cases, a home is not forced to be sold to pay for nursing home costs. However, Medicaid may ultimately try to file a lien on a home after both spouses die. In 1993, Congress passed a law that permitted Medicaid to pursue estate recovery to recover Medicaid costs after both spouses die. This law requires each state including NJ to attempt recover the cost paid to the Medicaid recipient by filing a lien. This legal concept is called estate recovery. Thankfully, any estate recovery does not take place until the Medicaid recipient dies. Federal law then requires that New Jersey try to recover the Medicaid benefits paid from the recipients’ probate estate. If the Medicaid recipient still owns property at time of death, then the property will be subject to a Medicaid lien if there is no surviving spouse and none of the other limited exceptions apply. In the majority of the cases, the amount of the Medicaid lien can be negotiated down to a much lower amount. The Medicaid lien is paid from the sale proceeds. A discharge of a lien must be filed before any prospective buyer can purchase the home.
Most likely not. Medicaid cannot force you to sell your home if the at-home spouse still lives there, or if caretaker children live there. Even when the home is occupied by some non-owner family members other than the spouse, most County Board of Social Services are still reluctant to force the sale of the home. The county practices vary as to whether the property must be listed for sale. There are many strategies to protect the house for your family if you need nursing care. Under the Medicaid laws, the home is in most cases considered to be exempt, and it is not considered to be a countable asset and in most cases, a home is not forced to be sold to pay for nursing home costs. However, Medicaid may ultimately try to file a lien on a home after both spouses die. In 1993, Congress passed a law that permitted Medicaid to pursue estate recovery to recover Medicaid costs after both spouses die. This law requires each state including NJ to attempt recover the cost paid to the Medicaid recipient by filing a lien. This legal concept is called estate recovery. Thankfully, any estate recovery does not take place until the Medicaid recipient dies. Federal law then requires that New Jersey try to recover the Medicaid benefits paid from the recipients’ probate estate. If the Medicaid recipient still owns property at time of death, then the property will be subject to a Medicaid lien if there is no surviving spouse and none of the other limited exceptions apply. In the majority of the cases, the amount of the Medicaid lien can be negotiated down to a much lower amount. The Medicaid lien is paid from the sale proceeds. A discharge of a lien must be filed before any prospective buyer can purchase the home.
14. What exactly are the Medicaid “look back” rules?
Basically, Medicaid will “look back” at the entire financial situation o f the applicant and spouse for up to five years prior to the date when the person is institutionalized, or the date of the Medicaid application.
Basically, Medicaid will “look back” at the entire financial situation o f the applicant and spouse for up to five years prior to the date when the person is institutionalized, or the date of the Medicaid application.
15. What is the process to complete a Medicaid application for nursing home care?
Individuals who no longer have or do not want to use their resources to pay for the costs of nursing home or assisted living care may apply for Medicaid through their local County Board of Social Services if they meet specified financial criteria. Timing is critical, as retroactive eligibility is limited to three months.
First, monthly income from all sources is examined. Examples of income are Social Security, Pensions, and monthly annuity payments that are received. Next, the resources are divided into “countable” and “non‑countable” categories. If the applicant is unmarried, the countable resources cannot exceed $2,000. The house is generally “non-countable” if it is listed for sale or if there is a child or a sibling co‑owner living there. All resources that can be liquidated within 30 days are considered to be “countable” as long as they are also “available.” There are certain exceptions for cases where assets are unavailable.
If the applicant is married, then the house will be “non‑countable” if the community spouse is living in it. One car and personal possessions are also considered to be non‑countable. All of the rest of the marital resources are generally considered countable, whether owned by one member of the couple or jointly‑owned. The general rule is that 401K’s, IRAs, bank accounts, stocks and bonds, cashable life insurance policies, vacation property etc. are countable. The countable resources are then added up as of the 1st day of the month of entry into institutional care, and then they must be reduced to a specific level. The community spouse may retain the lesser of one‑half or $119,220 of these countable resources. This is called the “CSRA,” or Community Spouse Resource Allowance. There are certain exceptions for cases where the combined assets, or the community spouse’s income, is very small.
The Medicaid application is filed after the assets have been reduced to the required level. It is required in most counties of New Jersey that a authorized representative of the applicant meet with the caseworker at the County agency. A complete Medicaid application must also be supported by up to five years of documentation. Moreover, each Medicaid application must disclose every single financial transaction which took place with the individual’s or couple’s income and resources during the 5‑year look‑back period. Proof of citizenship or legal status, marital status, birth date, insurance, and other items must be supplied. Accounts that are closed must be verified with proof of where the money went.
The application will also be scrutinized by the County Board of Social Services to ascertain if any transactions were payments for goods and services or “gifts.” All transactions during the look‑back period that are categorized as “gifts” or “uncompensated transfers” will result in a period of disqualification (“penalty period”) starting when the nursing home Medicaid applicant is spent‑down, receiving care, and is “otherwise eligible” for Medicaid. Careful planning requires legal advice to avoid this problem and to be able to deal with if it occurs.
Once the application has been filed, then the applicant is considered “Medicaid pending” and is protected against involuntary discharge. It can take many months for the application to be processed, and often a great deal of follow‑up is required. During that time, the applicant’s income should be paid to the facility each month.
Individuals who no longer have or do not want to use their resources to pay for the costs of nursing home or assisted living care may apply for Medicaid through their local County Board of Social Services if they meet specified financial criteria. Timing is critical, as retroactive eligibility is limited to three months.
First, monthly income from all sources is examined. Examples of income are Social Security, Pensions, and monthly annuity payments that are received. Next, the resources are divided into “countable” and “non‑countable” categories. If the applicant is unmarried, the countable resources cannot exceed $2,000. The house is generally “non-countable” if it is listed for sale or if there is a child or a sibling co‑owner living there. All resources that can be liquidated within 30 days are considered to be “countable” as long as they are also “available.” There are certain exceptions for cases where assets are unavailable.
If the applicant is married, then the house will be “non‑countable” if the community spouse is living in it. One car and personal possessions are also considered to be non‑countable. All of the rest of the marital resources are generally considered countable, whether owned by one member of the couple or jointly‑owned. The general rule is that 401K’s, IRAs, bank accounts, stocks and bonds, cashable life insurance policies, vacation property etc. are countable. The countable resources are then added up as of the 1st day of the month of entry into institutional care, and then they must be reduced to a specific level. The community spouse may retain the lesser of one‑half or $119,220 of these countable resources. This is called the “CSRA,” or Community Spouse Resource Allowance. There are certain exceptions for cases where the combined assets, or the community spouse’s income, is very small.
The Medicaid application is filed after the assets have been reduced to the required level. It is required in most counties of New Jersey that a authorized representative of the applicant meet with the caseworker at the County agency. A complete Medicaid application must also be supported by up to five years of documentation. Moreover, each Medicaid application must disclose every single financial transaction which took place with the individual’s or couple’s income and resources during the 5‑year look‑back period. Proof of citizenship or legal status, marital status, birth date, insurance, and other items must be supplied. Accounts that are closed must be verified with proof of where the money went.
The application will also be scrutinized by the County Board of Social Services to ascertain if any transactions were payments for goods and services or “gifts.” All transactions during the look‑back period that are categorized as “gifts” or “uncompensated transfers” will result in a period of disqualification (“penalty period”) starting when the nursing home Medicaid applicant is spent‑down, receiving care, and is “otherwise eligible” for Medicaid. Careful planning requires legal advice to avoid this problem and to be able to deal with if it occurs.
Once the application has been filed, then the applicant is considered “Medicaid pending” and is protected against involuntary discharge. It can take many months for the application to be processed, and often a great deal of follow‑up is required. During that time, the applicant’s income should be paid to the facility each month.
16. Where do I apply for Medicaid in New Jersey?
You must apply for Medicaid in New Jersey through your county board of social services. You have the right to an interpreter if you speak a language other than English, and you have the right to bring someone with you to help you with the application or represent you during the application process. If you are bedridden, you may request that a Medicaid caseworker come to your home to take your application.
You must apply for Medicaid in New Jersey through your county board of social services. You have the right to an interpreter if you speak a language other than English, and you have the right to bring someone with you to help you with the application or represent you during the application process. If you are bedridden, you may request that a Medicaid caseworker come to your home to take your application.
17. What proof do I have to show when I apply?
You must show proof of identity, residency, household income and, for some Medicaid programs, proof of disability and amount of resources. You also must show proof of citizenship status and provide your Social Security number. Household members who are not applying for Medicaid, including parents of children, do not have to furnish their Social Security numbers.
You must show proof of identity, residency, household income and, for some Medicaid programs, proof of disability and amount of resources. You also must show proof of citizenship status and provide your Social Security number. Household members who are not applying for Medicaid, including parents of children, do not have to furnish their Social Security numbers.
18. How long does the Medicaid application process take?
Medicaid must process your application within a reasonable amount of time and give you a written explanation if there is a delay. You also have a right to a copy of your completed application if you ask for it. If you are determined eligible for Medicaid and you have unpaid medical bills from the three‑month period immediately before the month of your Medicaid application, the state will pay for those services if you were eligible for Medicaid at the time of the service. This is called “retroactive eligibility,” and you must apply for this coverage within six months of the date of your Medicaid application.
Medicaid must process your application within a reasonable amount of time and give you a written explanation if there is a delay. You also have a right to a copy of your completed application if you ask for it. If you are determined eligible for Medicaid and you have unpaid medical bills from the three‑month period immediately before the month of your Medicaid application, the state will pay for those services if you were eligible for Medicaid at the time of the service. This is called “retroactive eligibility,” and you must apply for this coverage within six months of the date of your Medicaid application.
19. What if Medicaid decides that I am not eligible?
Medicaid must provide you with a written denial that describes the legal basis for Medicaid’s decision. This document must also inform you of your right to appeal this decision by requesting a fair hearing within 20 days of the date of the written denial. If you ask for a fair hearing, you have the right to see your case file, review the Medicaid manual that Medicaid used to make their decision, submit evidence, and bring witnesses to the fair hearing. You also have the right to hire legal counsel. You also have the right to appeal the judge’s decision if you do not agree with it.
Medicaid must provide you with a written denial that describes the legal basis for Medicaid’s decision. This document must also inform you of your right to appeal this decision by requesting a fair hearing within 20 days of the date of the written denial. If you ask for a fair hearing, you have the right to see your case file, review the Medicaid manual that Medicaid used to make their decision, submit evidence, and bring witnesses to the fair hearing. You also have the right to hire legal counsel. You also have the right to appeal the judge’s decision if you do not agree with it.
20. Can I appeal a Medicaid eligibility decision?
Yes, you certainly can. If the Board of County Services/Medicaid makes a determination that you believe is unfair and erroneous, then you can appeal to the New Jersey Office of Administrative Law [OAL]. If you lose your case you will then be given a notice that details the reason for the Medicaid’s decision, and you will be notified that you have a right to an appeal. When you appeal you are requesting a “fair hearing.”
You have the right to an appeal or a “fair hearing” if Medicaid makes the following findings:
At the fair hearing you are given full discovery. You will be given a copy of the Medicaid case file. Moreover, you will have the legal right to hire and lawyer. Most of these types of cases are settled. Therefore, in the majority of the cases it is cost effective to hire legal counsel.
Yes, you certainly can. If the Board of County Services/Medicaid makes a determination that you believe is unfair and erroneous, then you can appeal to the New Jersey Office of Administrative Law [OAL]. If you lose your case you will then be given a notice that details the reason for the Medicaid’s decision, and you will be notified that you have a right to an appeal. When you appeal you are requesting a “fair hearing.”
You have the right to an appeal or a “fair hearing” if Medicaid makes the following findings:
- Medicaid determines that you are not eligible to receive Medicaid benefits.
- Medicaid makes the decision to stop, suspend, or reduce or cut off your Medicaid benefits that you previously received.
- Medicaid fails to make a decision regarding on your Medicaid eligibility in a reasonable time.
At the fair hearing you are given full discovery. You will be given a copy of the Medicaid case file. Moreover, you will have the legal right to hire and lawyer. Most of these types of cases are settled. Therefore, in the majority of the cases it is cost effective to hire legal counsel.
21. What are the major mistakes that people make in the Medicaid application process?
- Thinking that Medicaid is only for poor people This is a major myth. Medicaid is essentially a long term care insurance program for the middle class. Medicaid now pays for 70% of the long‑term care expenses for the middle class.
- Having the belief that it is too late to undertake any Medicaid planning It is always advisable to undertake Medicaid planning as soon as possible. The sooner that you undertake Medicaid planning the more money and assets your lawyer will be able to save you. However, there are still many available types of Medicaid planning that you can take even if you wait too long.
- Gifting away your assets too early Gifting is the key asset planning strategy for Medicaid planning. However, there are two traps when you gift away your assets. First, you might need the money back. Your children could squander away the money. Second, if your gifts make create eligibility issues if you apply for Medicaid.
- Gifting away your assets too late It is important to emphasize that you can’t gift away your assets in the last minute. All of your transfers are subject to a five-year look back rule.
- Overlooking the “safe harbors” or loopholes in the Medicaid planning system There a many transfers that are permitted by the Medicaid systems that are perfectly legit and they won’t make you ineligible for Medicaid or trigger any penalty. The most important safe harbor are: a) You can transfer assets in trust or a home to disabled children; b) You can transfer your home a caretaker child; c) You can transfer your home certain siblings; and d) You can transfer some of your assets and into a trust for a child or other party who is a minor, blind, disabled and under age 65.
- Not requesting an increase of the Medicaid resource or income allowance There are many rules in the Medicaid system that will make your head spin. Currently, the stay at-home spouse can keep from $1,991 to $2,980 in monthly income, and he can keep $119,220 in assets. These amounts are commonly referred to as the MMMNA and the CSRA. Thankfully, the at home spouse can always appeal to the Administrative Law Judge and request an increase in the MMMNA or the CSRA. The majority of these types of cases are settled. Therefore, it is in your interest to file these types of appeals.
- Applying for Medicaid too early or too late The timing of the Medicaid application is of critical importance. If you apply too early, then the look back period may prevent you from making some Medicaid transfers to save you money. However, if you apply too late, then you may have to pay too much of your own nursing home care, and it may cost you thousands of dollars that you did not have to pay.
22. Can I be evicted from the nursing home if I apply for Medicaid?
Most nursing homes prefer to be privately paid. They can make more money on private pays instead of receiving payment from Medicaid. However, no nursing home or assisted living care center can discriminate against a person based simply on source of payment. If a person runs out of private funds to pay, then the nursing home simply can’t discharge a resident without finding a suitable and appropriate alternative placement.
Read our blog post about when a Nursing Home can discharge a resident
Most nursing homes prefer to be privately paid. They can make more money on private pays instead of receiving payment from Medicaid. However, no nursing home or assisted living care center can discriminate against a person based simply on source of payment. If a person runs out of private funds to pay, then the nursing home simply can’t discharge a resident without finding a suitable and appropriate alternative placement.
Read our blog post about when a Nursing Home can discharge a resident
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