An individual or if the individual is incapacitated due to dementia or Alzheimer’s Disease then his agent pursuant to his power or attorney or his guardian must apply for Medicaid benefits at the County Board of Social Services. This is something that you – the person in need of benefits or the person helping a mentally incapacitated loved one – must do. It doesn’t happen automatically and no one does it for you. There is very little free help available so it is something that you either do yourself or pay for assistance.
The Medicaid application process begins by calling the County Board of Social Services and scheduling an appointment if necessary (some counties don’t require appointments but you have to call to check whether they do or not). Once you schedule an appointment you will probably receive something in the mail confirming the appointment and telling you what documents to bring with you when you go in to complete the Medicaid application. The required documents include identifier information – birth certificate, social security card, marriage certificate, insurance cards, etc. – and also financial records – bank statements and other financial records going back as far as five years in the past.
When you go in for your appointment you will sit with the Medicaid caseworker and answer a lot of questions about the Medicaid applicant. You will hand in the materials you brought with you. The caseworker will make note of everything and create a list of additional information that is needed to supplement the application. The Medicaid caseworker will give you a deadline to submit the additional materials they need. Please respect the deadline provided – if you don’t submit them in time the application will probably be denied for failure to submit the materials. Many times when you submit the requested materials you will be sent another list of even more documents and a new deadline to submit them. Again, pay careful attention to the deadline. Medicaid is very unforgiving if you don’t follow their instructions and adhere to their deadlines. They are quick to deny applications and that could cost your loved one and potentially those helping him or her many thousands of dollars.
Medicaid will review the materials and get back to you with their findings sometime in the future. Some of the frequent results are outright approval, approval but for penalties, outright denial or pending status meaning they need more materials to complete their review. It can take weeks or, more frequently, months, before you hear back from them with information about the application (they have been known to take a year or more depending on the facts in the application and the backlog of applications).
Hopefully, if you have done everything in keeping with the Medicaid rules and requirements you loved one will be approved for Medicaid benefits. If your loved one is not approved then you might need to take an appeal or, depending on the circumstances, re-apply for benefits. Medicaid is difficult, confusing and time consuming but if you are diligent, responsive and follow instructions your loved one will probably receive benefits. You may, however, want to see help from an elder law attorney knowledgeable about the Medicaid application process. The attorney can usually help you avoid problems with Medicaid and work with you to make sure you do everything right during the Medicaid application process.