How do I apply for Medicaid?

Medicaid applications may be made with the Department for Medicaid Services. Following this process, it may take up to 45 days for your eligibility to be determined. The process can be easier if you are prepared prior to your meeting. Please bring the following items, as the Medicaid caseworker will request from you:

• Social Security card.
• Medicare card.
• Birth Certificate or other record of birth; if not a citizen your legal residency card.
• Bank statements on all accounts for the last 3 months (checking, savings, CD, money market).
• All health and life insurance policies that cover you, your spouse, and your children. If you are paying for insurance that covers another family member (ex. grandchildren), also bring those policies.
• Insurance premium books that list the policy numbers for all of those that you pay premiums.
• All hospital, cancer or accident policies and their identification cards as well as the proof of payment for the premiums (such as canceled checks or receipts).
• Tax records and deeds to property; fair market value of property will be requested.
• Motor vehicle titles or registration cards for any vehicles listed in your name; proof of the amount you owe on each vehicle.
• Original documents for stocks, bonds, or trust funds.
• Prepaid burial contracts.
• Benefit award letters for social security, VA, retirement pensions or supplemental securing income (SSI).
• If currently employed, pay stubs for the last eight weeks. If applying for a retroactive coverage (regular Medicaid only), you will need the stubs for all pay received during the months of the medical expenses you are seeking coverage for.
• All medical bills and receipts for expenses incurred in the last 3 months, paid or unpaid.
• If you have recently been in the hospital, the itemized bill.
• If you have become disabled and have not applied for social security benefits or SSI, an application must be made with the social security office. Proof that you have applied for those benefits will need to be provided.
• Power-of-attorney document, if someone else is completing the application for you.
• Please note, other items may be needed in order to make an accurate assessment of resources and income. These will be determined at the time of the interview. Direct deposit on bank statements cannot be accepted as verification of income because the gross monthly income must be initially verified.

What is Medicaid?

A state-funded program that helps individuals pay for medical costs such as doctor’s care, hospital stays, medications and skilled nursing facility care. You may be eligible for Medicaid benefits if you meet the eligibility requirements, which varies by state.

Individuals are currently allowed to have cash reserves or other assets totaling a set maximum set by the state-specific program, and excludes a non-revocable prepaid burial contract, subject to limitations set by the Medicaid Program Office. If you have a spouse living at home, he or she may be able to keep a portion of your income and your savings to meet his or her living expenses and needs. Further, your spouse can request an assessment to determine the extent of non-exempt resources at the time of admission.

A representative from the Department for Medicaid Services can review your financial information to determine and/or explain the eligibility for enrolling in the Medicaid benefit program. The date you qualify for benefits can also be determined. An application must be made. If you are unable to submit this application on your own, a family member, legal representative or another person who knows about your circumstances may assist you.

The facility, if certified by the state Medicaid program, cannot refuse to admit you, nor may the facility discharge you solely because you receive Medicaid to help pay for the cost of your care. Please let the Business Office Manager know if you have applied for Medicaid or if you decide to apply at a later date. Once your Medicaid application has been approved, the facility will review your past statements to refund any overpayments made during the approval process.

There are some supplies and services that are not covered. Please contact the Business Office Manager or the Social Services department for the most current information. The below are examples of some items and services that may not be covered:

• Barber/Beautician services (those services not routinely covered by facility staff)
• Flowers and plants
• Newspapers and other reading materials
• Physical & Occupational Therapy Services (unless part of a physician-ordered program, meeting certain regulatory requirements)
• Personal clothing and comfort items (including smoking materials, if not prohibited)
• Private room, unless deemed medically necessary
• Privately hired nurses, nursing assistants, or sitters
• Telephone service
• Cable/Satellite service
• Transportation by ambulance to a physician’s office (unless part of your plan of care under the Medicare Program)

What is Medicare Part A / Hospital Insurance?

Part A assists in paying for an inpatient stay in a skilled nursing facility. Part A has deductibles and co-insurance requirements. Most covered individuals do not have to pay premiums for the Part A benefits.

Medicare Part A will only pay for skilled nursing care in a facility certified to participate in the Medicare program, and will cover up to 100 days per spell of illness. To be eligible for utilizing the Medicare benefits for skilled nursing care, your care needs must meet certain criteria, such as:

• Daily skilled nursing or skilled rehabilitation services which can only be provided in a skilled nursing facility (SNF); and
• You have been in the hospital, as an inpatient stay, for at least three consecutive days and nights; and
• You are admitted to a SNF within 30 days following your hospital discharge or last covered SNF stay; and
• Your care in the SNF is for a related condition that was treated in the hospital and a physician certifies that you need the services provided.
• A 60 day wellness period is required by Medicare to begin a new 100-day skilled benefit period.
• There are some supplies and services that are not covered. Please contact the Business Office Manager or the Social Services department for the most current information.

What is Medicare_Medicaid?

Information regarding benefits under Medicare and Medicaid is available from our Admissions team, the Administrator or Social Services. The information below is general, and the programs are subject to change.

Medicare – a Federal health insurance program for individuals who are 65 years or older, have been disabled for at least two consecutive years, have been diagnosed with End-Stage Renal Disease or meet eligibility based on other criteria set by the Medicare program.

How much does Medicare pay?

Medicare Part A will only pay for skilled nursing care in a facility certified to participate in the Medicare program, and will cover up to 100 days per spell of illness. To be eligible for utilizing the Medicare benefits for skilled nursing care, your care needs must meet certain criteria. (Read the complete article below for further information.)

Who is generally eligible for Medicaid?

You may be eligible for Medicaid benefits if you meet the eligibility requirements, which varies by state.

(Read the complete article below for further information.)

What happens when the patient’s funds run out?

When private pay residents come close to exhausting their own resources, they generally become eligible for Medicaid. Our business office staff will assist you and your family with options and process.