The LTC Medicaid Process

Author

JG Medicaid Consulting LLC

Posted on

Jul 07, 2021

Book/Edition

Colorado - Western Slope

Share This

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 clients 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 clients doctors to help make the functional determination. A case managers 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 clients 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, ATVs, boats, trailers, campers, RVs, 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 clients and/or spouses 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 States review may take several weeks, so its imperative that the document along with an up-to-date asset list be submitted early in the process to allow the State sufficient time. The States 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 its rules and regulations, so if the county technician deems it necessary, records may be required for this time period. While this doesnt 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 its with an approval or denial.


Editors 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.


Other Articles You May Like

These 3 Experts Help Seniors With Long-Term Care Options

Older adults can seek financial guidance from a range of well-known types of professionals, but when it comes to making long-term care decisions, it can be difficult to know who can help. The senior care services a person needs and can receive are greatly influenced by their health conditions, their health insurance coverage, community resources and programs, and the types of senior care services appropriate for them. It can be challenging to know how to navigate all these factors. Here, we explain three types of experts who can help seniors understand their options for long-term care, including State Health Insurance Assistance Program specialists, social workers, and senior living advisors. State Health Insurance Assistance Program (SHIP) specialistEvery state has a State Health Insurance Assistance Program (SHIP), a free and unbiased information resource that educates state residents aged 65 and over and their families and caregivers about Medicare, Medicaid, and other assistance programs. The Omnibus Budget Reconciliation Act of 1990 required the Centers for Medicare and Medicaid Services to create state-level advisory programs that help the public better understand these complex programs. Because every state runs its own Medicaid program and may have varying rules about other programs and insurance, each operates its own SHIP with volunteers to educate residents. SHIP specialists must provide unbiased information about health insurance programs. For example, they can help explain how to enroll in Medicare, but they cannot enroll someone in Medicare. SHIP specialists can help older adults by: Explaining Medicare enrollment, including penalties associated with late enrollments.Explaining the options for Medicare coverage.Describing services that Medicare does and doesnt cover.Defining Parts A, B, C, and D of Medicare, including supplemental plans.Explaining Medicare Savings Programs.Explaining the Low-Income Subsidy program.SHIP counselors can also refer seniors to the state Medicaid office or the Social Security Administration if they meet eligibility requirements for certain programs.Older adults with questions about insurance and other assistance programs can find their local SHIP counselor at shiphelp.org.Social workerA social worker is a highly trained professional with a masters degree who helps individuals cope with issues and access supportive programs. Social workers who work with older adults are often employed in hospitals, skilled nursing facilities, home health agencies, and geriatric doctors offices.These professionals often have knowledge of state programs like Medicaid and Medicare, PACE programs, and other programs that older adults may need to access. They have contact information for local and state offices that can help older adults with these programs as well. Because social workers have a holistic view of older adult medical conditions, long-term care needs, senior living facilities, and public programs, they are a great liaison for helping older adults access the help they need. Senior living advisorA senior living advisor is a professional with in-depth knowledge about the common care needs of older adults, long-term care options, and financial options to fund care services. A senior living advisor can also obtain the Certified Senior Advisor (CSA) designation, though it is not required. The CSA designation requires the individual to pass an exam and background check. The exam tests knowledge of the aging process, needs for care, financial matters related to retirement and long-term care, and other pertinent topics.A senior living advisor can be a great help to an older adult who needs care and assistance in deciding the best way to obtain that care. These professionals typically offer their services to older adults and get paid by the community or the provider where the older adult moves in or contracts services. Some of the services and assistance a senior living provider will offer to their senior clients and their families include:Educating the senior and family on long-term care options, including home care, so they can decide which option is best for them.Providing suggestions for senior living or long-term care facilities based on the senior clients care needs.Acting as the liaison between the community and the senior and family in scheduling the community tour.Accompanying the senior and family on each community tour.Connecting the senior and family with individuals who can assess financial ability and needs to pay for care services.The senior living advisor deals with many communities and home care providers in their area and can objectively discuss each, helping seniors and their families navigate selecting the right long-term care option. Because senior living options and prices vary depending on the location, working with a local senior living advisor is the best way to learn the most about long-term care options in a seniors area.Get help understanding your long-term care optionsWhen it comes to making a decision about long-term care services, many factors must be considered. While elder law attorneys, estate planners, accountants, and other financial professionals can help older adults assess their financial means to cover senior care costs, individuals like SHIP specialists, social workers, and senior living advisors can help seniors understand their options for care. Through the collaboration of financial professionals and long-term care experts, older adults can more easily access the long-term care services they need.

How to Apply for Long-Term Care Medicaid in Colorado

How to Apply for Long-Term Care Medicaid in ColoradoApplying for Medicaid can be a daunting task, especially when it comes to long-term care. However, with the right guidance and resources, the process can be much smoother. This guide is designed for seniors, caregivers, and Colorado residents to help them understand how to apply for long-term care Medicaid in Colorado. Understanding Long-Term Care MedicaidLong-term care Medicaid provides financial assistance to those who need help with daily living activities, such as bathing, dressing, and eating. It covers care provided in various settings including nursing homes, assisted living facilities, and even at home. Why You Shouldn't Apply AloneGiven the high volume of applications and the complexity of the process, we do not recommend submitting an application on your own. Mistakes can delay approval or result in denial. Should you choose to apply on your own, we will give you the information and tools you need during our free initial consultation with you. Schedule a free consultation here  - calendly.com/doinggoodforothers Steps to Apply for Long-Term Care Medicaid in ColoradoStep 1: Find The Applicants DHS OfficeThe first step in applying for Medicaid in Colorado is to find the applicants local Department of Human Services (DHS) office. This is where you will submit your financial application. Find the Applicants DHS office here - cdhs.colorado.gov/contact-your-county Step 2: Submit a Financial ApplicationOnce you have located your local DHS office, you will need to submit a financial application. This form will require detailed information about your income, assets, and expenses. Step 3: Determine Financial EligibilityBefore proceeding with the application, it's crucial to determine if you qualify financially for Medicaid or VA Aid & Attendance benefits. Strategies exist to access benefits while protecting your personal assets, and a Certified Medicaid Planner (CMP) can help you maximize your benefits. Find out if you qualify - doinggoodforothers.com/financialinformation Step 4: Schedule a Health AssessmentAfter qualifying financially, you will need to schedule a level of care assessment, also known as a health assessment, with the Applicants Single Entry Point. This evaluation will determine the level of care you require. Schedule a health assessment - hcfp.colorado.gov/case-management-agency-directory Step 5: Skip the Hassle of Applying Alone Schedule an AppointmentIf you find the application process overwhelming, you can skip figuring out how to apply on your own by scheduling an appointment with our experts.  Schedule an appointment with a Certified Medicaid Planner - calendly.com/doinggoodforothers Our 4-Step Process for Application AssuranceWe have developed a streamlined 4-step process to help you feel relief about your loved ones care and save money. 1. Schedule a Free Initial ConsultationLearn more about what we can do to preserve your assets by scheduling a free initial consultation. 2. Make a PlanThrough an assessment of your financial circumstances, we will create a roadmap of the best options for you. 3. Pick an OptionWe explore legitimate opportunities to preserve your assets. 4. Gain BenefitsSelect the best option, and we will complete a successful application for gained benefits. Applying for long-term care Medicaid in Colorado doesn't have to be stressful. By following these steps and seeking professional guidance, you can ensure a smoother application process and maximize your benefits.For personalized assistance, schedule a free consultation with one of our Certified Medicaid Planners (CMP) today. Learn more and schedule now! - calendly.com/doinggoodforothers

What is Medicare?

What is Medicare?Medicare is a federal health insurance program that gives you access to specific coverage and benefits. Medicare is different from health insurance you may have had before. It offers you a variety of coverage options and it has key enrollment dates and guidelines you need to follow. Were here to help you make sense of it all. How is Medicare Different From Other Health Insurance?You may be surprised at the differences between Medicare and other types of health insurance. If youve had health coverage through your employer, your plan likely included medical and prescription drug coverage, along with other benefits. It also may have covered both you and your spouse.Medicare only covers one person at a time. This means you and your spouse must enroll separately. In addition, Medicare gives you options that can make it possible to receive your benefits in a variety of different ways.You can:       Choose hospital and medical coverage delivered through the federal government.       Add prescription drug coverage delivered through a private company.       Purchase a supplemental insurance policy from a private insurer that can help cover some of the costs.       Choose coverage from a private insurer that combines hospital, medical and often prescription drug coverage into one plan.In short, with Medicare you can choose coverage that fits your needs, budget and lifestyle. We can help you take full advantage of that freedom. Who is Eligible for Medicare?      - Age 65+      - Under age 65 with certain disabilities      - Have End-Stage Renal Disease (ESRD) When and How Do I Apply?If youre like most people, youll enroll in Medicare around the time you turn 65. Your Initial Enrollment Period begins three months before your 65th birthday, includes the month you turn 65 and ends three months after that birthday.Keep in mind that if you dont get Medicare during this Initial Enrollment Period, you may have to pay Medicare Part B or Part D late enrollment penalties. Plus, you could be missing out on coverage and benefits that can help protect your health and finances. Thats why its generally a good idea to enroll as soon you can. How you enroll generally depends on if youre getting benefits from Social Security, the Railroad Retirement Board or the Office of Personnel Management.Contact me today at 724-554-7989 for a FREE consultation.