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Applying for Medicaid

Although Medicaid is a joint federal and state program the states operate the program on a day-to-day basis, including taking applications and making determinations of eligibility.  That means you must contact a local office in your state to apply for Medicaid.

To apply for Medicaid you will have to:

  1. Fill out an application form
  2. Provide documentation to verify general and financial requirements

Once the state finds you eligible for Medicaid, you will have to go through a functional eligibility assessment if you want to receive long-term care services.

You may apply for Medicaid coverage yourself, or you may designate another person, such as a family member, your attorney, or a friend, to apply for you. If someone else apples for you, that person should be familiar with your situation, be able to answer all eligibility questions, and have access to your financial records. The state may also require a face-to-face interview.

If you own a home, the state may ask you to document the current fair market value of the home and any loans for the home, such as mortgages or equity loans. The state may ask for these documents:

  • A current tax bill
  • A real estate appraisal
  • Copies of your mortgage

The state may ask for this documentation because, while your home is not counted as an asset when determining your eligibility for Medicaid, how much equity you have in your home can affect whether Medicaid will pay for your long-term care services.  See the section on “Limits on Home Equity” for more information about this.

If the value of your assets went down a lot within the past five years, the state may ask you to explain what happened to the assets.  In particular, the state will want to know whether you gave away any of your assets in the past five years.

If you are married and in a nursing home, you will also be asked to document your assets when you first entered the nursing home—this can help establish how much of your assets your spouse is able to keep.  See the section on “Considerations for Married People” for more information about this.

Where to Apply for Medicaid:

All states have local Medicaid eligibility offices where you can file applications. Many states also provide applications at different locations in your community, including Aging and Disability Resource Centers (ADRCs). Your can also apply by phone by calling your local Medicaid office.  In most states, you can also apply online, or find an application online that you can complete and mail to the local office.

Contact your State Medical Assistance Office to find out where and how you can apply for Medicaid benefits.

When to apply for Medicaid:

The best time to apply depends on your medical situation, your marital status, and the complexity of your finances. If your finances are straightforward, the state may be able to process your application faster. If you find that you need long-term care, you should apply as soon as possible because it may take some time for the state to process your application and make an eligibility determination.  For the most part, the date you become eligible is based on the date you apply for Medicaid, assuming you meet all of the eligibility requirements when you apply.  The longer you wait to apply, then, the later your date of eligibility will be.

The Medicaid agency usually has 45 days to process your application. If the application requires a disability determination, the agency can take 90 days.  But, it may take longer for the state to determine your eligibility if you do not provide the required documents on time. If Medicaid thinks that you are not cooperating, it can deny your application for failing to cooperate.  If this happens, you may have to start your application over again once you have your documents in hand.  This will delay the date you become eligible for Medicaid even longer.

If the Medicaid agency determines that you are eligible, you will receive a letter with your date of eligibility and the amount you must pay toward the cost of your care.  This could be your spenddown liability if you are eligible as medically needy, or your share of cost if you are eligible on some other basis. See the sections on “Medically Needy – Spenddown” and “Share of Cost” for more information about this.

Medicaid will review your eligibility status every year. During the yearly review, you may need to document your income and assets again, especially if either your income or assets have changed much in the last year. The review process is usually simpler than the original application process.

If the Medicaid agency determines that you are not eligible, you will receive a letter that explains the reason for denial. The notice will also explain how you can appeal the decision.