A colleague of mine recently won a Medicaid appeal that highlights an increasingly common problem: excessive delays in processing applications. Medicaid, the joint federal and state health program, has been in the news due to proposed reforms, including those in the Trump Administration’s pending legislation that would impose work requirements on some beneficiaries.
Medicaid law is extraordinarily complex, with many different programs administered differently by each state. The proposed bill targets Medicaid recipients who use it as private health insurance, imposing work conditions; however, the clients I help are elderly individuals seeking assistance with long-term care—such as nursing homes or assisted living facilities—and are unaffected by these work requirement changes.
Long-term care is extremely expensive. A nursing home in this area can cost in excess of $15,000 a month. An assisted living residence can cost in excess of $12,000 a month. Few people could afford to pay for these costs for a sustained period of time without bankrupting themselves, but long-term care—as the name implies—can last a long time. Assume that Mrs. Smith were eighty years old and required long-term care in a nursing home. Including incidental costs (medications, diapers), the cost of her care is $250,000 a year. If Mrs. Smith had an estate worth $500,000, which is a nice estate, she would be bankrupt after two years of care.
I’ve been helping clients qualify for Medicaid for over twenty-five years and have filed thousands of applications; so many, in fact, that I’ve lost count. Medicaid applications are submitted to the county board of social services where the applicant resides. So, if Mrs. Smith lives in Brick Township but is now residing in a nursing home in Wall Township, she would file her application with the Monmouth County Division of Social Services because that is where the nursing home in which she resides is located.
By federal and state law, the County has forty-five days to process Mrs. Smith’s application for benefits. In my experience, this legal deadline is almost never met. The County often requests additional information from an applicant and grants extensions for the applicant to respond. For instance, the County might want an explanation of checks Mrs. Smith wrote years before she filed her application for benefits, and Mrs. Smith may need time to obtain the information and provide an explanation of the financial transactions that occurred years earlier. How many of us can remember the checks we wrote three or four years ago? Applying for Medicaid is no easy task because none of us lives our lives as if we are going to have to undergo a five-year forensic accounting.
And the County has a difficult job too. It has to review thousands of these applications a year. The work is tedious and monotonous. But in recent years, the County has fallen way outside the pale of what is an acceptable timeframe for processing applications. Most applications sit untouched for months. These delays hurt applicants, who may not learn of issues until nearly a year after filing their applications, by which point tens of thousands of dollars in long-term care costs may have accumulated.
A recent hearing decision held that a county’s delay in processing an application should not be used to deprive the applicant of benefits. This decision is a critical reminder that administrative delay should not come at the expense of vulnerable citizens. Justice, especially in the context of life-sustaining care, must be timely—or it risks becoming meaningless.