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The LTC Medicaid Process
The Long Term Care Medicaid application process requires various facets be completed.
When an individual applies for Long Term Care Medicaid to help pay for Nursing Home Care, Assisted Living Care, or in-home care, a financial application is completed by (or for) the client. The application initiates a process to determine the client’s financial AND functional eligibility.
A functional assessment will be scheduled, after the financial application is submitted, in which a case manager assigned by the county will meet with the person-in-need. The applicant must meet a “nursing home level-of-care” to qualify for Long Term Care Medicaid, but this DOES NOT mean that he or she be admitted to a nursing home. The case manager gathers information from the client, the family, and the client’s doctors to help make the functional determination. A case manager’s level-of-care approval is required for the financial technician to move forward with a Long Term Care approval.
During the financial process of the client’s application, all assets and income for the individual, or both spouses, will be reviewed. Assets may include (but are not limited to); checking, savings, certificates of deposit, stocks, bonds, promissory notes, real property (such as: homes, cabins, bare land, time shares, etc.), mineral rights and vehicles (i.e.: cars, trucks, ATV’s, boats, trailers, campers, RV’s, etc.) Proceeds from the sale of a home within the last five years must also be disclosed and a spend down of these funds provided. Please note that gifting of any kind is NOT allowed by Medicaid and will create a penalty period if one occurs. Any types of trusts with the client’s and/or spouse’s names on them must also be disclosed, copied, and submitted by the county technician to the State of Colorado for an official review. Trust types may include; Family, Irrevocable, Revocable, Disability, Special Needs, or Income. The State’s review may take several weeks, so it’s imperative that the document along with an upto-date asset list be submitted early in the process to allow the State sufficient time. The State’s
approval is required for the technician to move forward with a Long Term Care approval.
The financial technician may review assets for the client/spouse looking back over the last five years, so records requested as verification may be required. The State of Colorado has set a 5-year look back period in it’s rules and regulations, so if the county technician deems it necessary, records may be required for this time period. While this doesn’t happen all the time, it can happen so a new applicant should be prepared to gather the information upon request.
Being adequately prepared when a financial application is submitted is half the battle of getting positive results for the application. Responding timely to verification requests from the technician is the other half of the battle. Most times, applications are not as complicated as what is listed above and the process can move along swiftly. The county technician is required to process a financial application to completion within 45 days, whether it’s with an approval or denial. ~
Editor’s Note: This article was submitted by Joell Gray, owner of JG Medicaid Consulting, LLC. She can be reached at 970.216.4999, or by email at jg.ltc. med@gmail.com. See ad on page 45.
Specializing in Long Term Care for the Elderly & Disabled
• Assist with Medicaid application • Complete additional documentation as needed • Supply an itemized list to client for verifications required • Guidance on how to proceed and what to expect from county • Act as the liaison between client and county office
Guidance provided for clients currently not eligible due to resources. We can outline potential spend down options.
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