Apply for Medicaid: 5 Important Decision Points

When you decide to apply for Medicaid, the Area Agency on Aging, or if you’re at a nursing home or hospital, the social worker of the facility or a patient advocate should tell you how to begin the process. It's not difficult to apply for Medicaid but you need to have some understanding of the process.

Apply for Medicaid: What documents will I need?

When you or your loved one apply for Medicaid, you will need to provide proof of your (or loved one’s) identity and citizenship (birth certificate or passport), proof of address (lease, cancelled rent checks, utility bills), proof of income (letter from Social Security, pay stubs, retirement benefits), proof of your assets (bank statements, financial statements, bank books), proof of living expenses (rent, utility bills, etc.) as well as copies of medical bills.

When I apply for Medicaid, will they pay me or the nursing home?

Medicaid pays the nursing home directly. For the portion of the bills that you will need to pay, Medicaid may collect directly from you or from a surrogate, usually a relative who handles your personal finances. In many cases, Medicaid will also arrange for your Social Security checks to be sent directly to the nursing home. The nursing home must keep your personal needs allowance in a special account for you.

Because the rules governing the Medicaid program are often complicated and change frequently, nursing home social workers and personnel are not always up-to-date with the latest requirements of the Medicaid law. Even state officials may not always be up-to-date on the most recent changes in the Medicaid law or regulations. So, if you or your family member has been told that you are ineligible for Medicaid by a nursing home administrator or other personnel because you have set up a trust or transferred assets, you should probably seek the opinion of another person knowledgeable about Medicaid or a Medicaid lawyer.

Apply for Medicaid: Key Decision Points

If you want to preserve some assets for your spouse or children, you should probably consult with a Medicaid attorney long before you are in need of a nursing home.
If you think you have a nursing home placement coming in the near future, and will probably need to spend down, you should probably consider converting assets that Medicaid will count toward a spend down (bank accounts, CD’s and other investments) into assets (such as home improvements) that Medicaid won't count in determining your eligibility.
You should consider applying for Medicaid home care coverage if your state allows for a reasonable package of these services. If you don't qualify, or if services are not available, then you'll have to consider your own resources to pay for this care.
You may consult your Medicaid attorney about transferring title to your house to your spouse to make sure that they have a place to live if you go into a nursing home and you think that Medicaid will be paying for your care.
If you don't want to spend down and transferring assets is out of the question, you may consider a long-term care insurance policy, if you believe you can comfortably pay the premiums now and into the future.

Some information from How to Care for Aging Parents by Virginia Morris and Consumer Reports Complete Guide to Health Services for Seniors by Trudy Lieberman

Additional Information and webpage by Paul Susic MA Licensed Psychologist Ph.D. Candidate