- Pamela E. Crohan, Esq. and Kathy L. McNair
7 Tips for a Smoother MassHealth (Medicaid) Application Process
If you or a loved one need nursing home care, you may find yourself navigating through the often-overwhelming MassHealth application process for long-term care benefits. Often clients must spend down money before they will qualify for MassHealth benefits. Hiring an elder law attorney is an allowable way to spend down the excess money. In many cases, we are able to help clients by recommending the best way to spend down excess assets and protect assets for any spouse remaining at home. Often the costliest mistake is not meeting with an elder law attorney.
Applying for MassHealth is a complicated maze. Whether you are woking with an elder law attorney or not, here are some tips that will make the application process smoother for you:
1. MassHealth is also called Medicaid, but Medicare is different
It is helpful to understand that MassHealth and Medicaid mean the same thing. MassHealth is the term used in Massachusetts to describe the federal program called Medicaid. This is a need based program for those that meet certain financial requirements.
Medicare is a different program. It is a federal program provided to seniors over 65 and certain younger disabled people. You do not need to have limited assets to receive Medicare. Medicare will not pay for more than 100 days in a nursing home, and only if you are making progress toward your rehabilitation. You cannot count on getting the full 100 days, and unless you have supplemental insurance, there is a co-pay after the first 20 days.
2. Apply at the appropriate time
You should not submit an application for long term care benefits if you are not clinically financially eligible. If you are in a nursing home and have been screened as clinically eligible, you must also meet the asset requirements before requesting benefits. Again, assuming proper planning and spend down of your assets occurred, you have ninety (90) days to submit your application and request an effective date of coverage back to the initial date of eligibility.For instance, if you were clinically and financially eligible on January 1st, and need benefits starting on that date, you must submit your application by March 31st. However, since it can take several weeks (even months) to obtain a final approval for retroactive benefits, it is best to submit your application as soon as you are eligible.
3. Submit a completed application with all necessary verifications
It is tempting to skip a section of the lengthy application because you don’t have the information at your fingertips or you are not even sure what it is asking. Procrastinating will not make the question go away.
When you first submit an application, you will be assigned a caseworker, who you will deal with throughout the entire process. You do not want to get off on the wrong foot with your caseworker. If an application is incomplete, your caseworker will list all missing information on a “Request for Information” with a deadline to submit the information. This will delay the process, and may lead to additional requests that were not necessarily on the initial application, or even requests for copies of documents you already submitted.
While MassHealth can ask for five (5) years of financial statements (especially if there were large transfers within that 5 years), in many cases an applicant will include only 2-3 years of statements and wait for the caseworker to request more if necessary. These statements should include the check images or other verification showing the payee for all checks/debits over $1000. Otherwise, your caseworker cannot determine if the expenses/spenddown were “allowable”. You do not want to receive a denial based on missing verifications. Again, this will delay the process by leading to an otherwise avoidable lengthy appeal. You need to organize your information in a way that easily explains the financial steps you took to obtain financial eligibility. If this includes, for instance, a large payment to a funeral home (an allowable expense) you should include a copy of the check, receipt from the funeral home, and copy of the contract for funeral and burial services. This will allow your caseworker to easily verify this expense and move onto an approval.
4. Stay organized
I always include a table of contents with an application, with numbered sections, and corresponding tabs. It is a little more effort, but will make it easier and quicker for the caseworker to review and respond. It is also important to keep a copy of everything you submit, because you may need to submit it again, or may need it for an appeal, etc.
5. Confirm your information was (timely) received
Whether you drop it off in person, fax, or mail it in, always obtain a date-stamped confirmation verification.I typically use certified mail with a return receipt request/tracking. Try to respond to information requests as soon as possible, so you are not in panic mode— finding yourself staring at a broken fax machine at 4pm the day your response is due. Deadlines matter, and a late or missing response will likely lead to a denial of benefits.
6. Appeal immediately
Despite your best efforts to get approved for benefits with your initial application, it is not uncommon to receive a denial. File for your appeal hearing immediately. You have 10 days, but do not risk forgetting or missing the deadline. Even if you are convinced the reason is wrong, or you don’t understand the reason for the denial—sign and return the appeal request. Once you submit the request it could take a while to receive your hearing date, and you can work out appeal issues during that time. Filing your request for a fair hearing should preserve the initial effective coverage date you requested.
7. Be patient and expect the process to take at a minimum several months
Even if you follow all of the tips above, the application takes months to get approved. In the best case scenerio, it will take a few months, but I have had cases drag on for over one year.
Applying for MassHealth can be stressful and you may find yourself losing your patience with all the paperwork. However, keep in mind that your caseworker is dealing with dozens of other applicants, attorneys, and nursing home administrators, who are not all pleasant to deal with. Likewise, the bank tellers helping you obtain 5 years of bank statements, and the social workers expediting your clinical screening forms, may also be swamped with their more routine duties. So be courteous and respectful and you may find this simple act alone makes the process just a bit smoother.
At Senior Solutions our focus is on meeting the needs of seniors and their families. Whether you are planning in advance or facing a crisis. We are here to help you with all of your elder law and estate planning issues from qualifying for Medicaid/ MassHealth, to setting up a smart estate plan.
Senior Solutions is an Elder Law and Estate Planning Law Firm serving the Boston, Massachusetts area. We meet with clients in either our Belmont or Hingham offices. Take the first step and call us at 617-489-5900 or email firstname.lastname@example.org.
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