What Happens After I Qualify for Medicaid

I have applied for Medicaid benefits for clients over a thousand times.  I have a lot of experience with applying for Medicaid benefits.

Medicaid is a health payment plan for needy individuals.  In order to qualify for Medicaid benefits, an individual must have very limited assets and insufficient income with which to pay for her care.  For the program of Medicaid for which I help clients—a Medicaid program known as Managed Long Term Services and Supports or MLTSS—the potential Medicaid beneficiary must also require hands-on assistance with three of the basic activities of daily living.

The basic activities of daily living are clothing, bathing, toileting, transferring, eating, and mobility. Since a potential Medicaid beneficiary must require hands-on assistance with three of these basic activities, the individual must be in dire need of assistance, both financially and physically, in order to qualify for Medicaid benefits.

Most of my clients are residing in a nursing home or an assisted living residence. Some require long-term services at home, such as an adult day care center or a home health aide.

Over the years, I have been successful in helping my clients qualify for Medicaid, but sometimes, qualifying for Medicaid is only half the battle. If the Medicaid beneficiary is living at home, a care manager from Medicaid will come visit the beneficiary and arrange for the appropriate services given the beneficiary’s care needs.  For instance, the Medicaid care manager might arrange for some services from a home health aide and some services through an adult day care center.

If the Medicaid beneficiary is residing in a nursing home, then a Medicaid bed in the facility is almost a guarantee. Most every nursing home in New Jersey accepts Medicaid.  Probably fewer than ten nursing homes in this state do not accept Medicaid, and I don’t know of any facility in Monmouth or Ocean Counties that does not accept Medicaid.

Once a person qualifies for Medicaid in a nursing home, the nursing home must treat the resident exactly the same as they would treat her if she were privately paying for her care. Some nursing homes might try and tell you once you qualify for Medicaid that they don’t have a “Medicaid bed” for you and that you have to find another facility with an available Medicaid bed.

The truth is, in most nursing homes, every bed in the facility is dual certified for Medicare and Medicaid eligibility, so every resident already is in a Medicaid bed. Even if the resident weren’t in a Medicaid bed, the truth is, it is incumbent on the nursing home—not the resident or her family—to find another facility with an available Medicaid bed.  In all the years that I’ve been practicing, I have never had a nursing home find another facility for a resident.  All of the facilities have eventually accepted the resident as a Medicaid beneficiary, though some have tried to put up a fight.

Assisted living residences are different animals. Most every assisted living residence in New Jersey requires, at least, two years private payment before they would accept an individual as a Medicaid beneficiary.  After the two years private payment is satisfied, the facility will tell you that if you qualify for Medicaid and if the facility has a Medicaid bed available, the facility will accept the resident as a Medicaid beneficiary.

In my experience, most every assisted living residence in New Jersey will make room for the resident if the resident qualifies for Medicaid, after the resident has private paid for two years. One facility, which shall remain nameless, often gives residents a very, very hard time about a Medicaid bed even if the resident has private paid for two, three, and even five years.

Qualifying for Medicaid benefits is a process. Implementing those benefits can be a process as well.

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