The LTC Medicaid Process
JG Medicaid Consulting LLC
Jul 07, 2021
Colorado - Western Slope
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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.
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