What Is The Medicaid Application Process In New York?

A Medicaid application does not end with a simple submission. It is the responsibility of the applicant to report and provide all the facts and information necessary for the determination. The onus is on the applicant to establish, or prove to the Medicaid agency that they are in fact qualified, or have met the requirements for Medicaid eligibility, so the nursing home can be paid for by the Medicaid program, and that a penalty period should not be imposed, forcing an individual to have to pay for that facility. Such requirements are the responsibility of the applicant, and the applicant is required to obtain the necessary documentation to verify the eligibility requirements.

The Medicaid application allows an individual to allow Medicaid to conduct a collateral investigation to obtain the relevant information and documentation to verify factors for eligibility. However, very often, local Medicaid agencies are quick to deny an application for failure to provide documentation or verification necessary to establish eligibility, which was not necessarily available to the applicant when the agency required such documentation.

It has become common practice for the local Medicaid agency to make a claim and or sue the community spouse to recover Medicaid benefits paid on behalf of the institutionalized spouse, even if the community spouse signed a spousal refusal, and had assets in excess of the community spousal resource allowance limit at the time of the Medicaid approval.

The local Medicaid agency may seek a judgment and recover against the excess assets as reimbursement for Medicaid expenses paid on behalf of the institutionalized spouse. If an individual has a spouse that is applying for Medicaid, and submits a spousal refusal and has resources in excess of approximately $120,000, there is a right of recovery against that community spouse. That is in the community for the amounts of monies expended for the nursing home care that Medicaid approved and paid to the nursing home. This sometimes becomes a very big shock or a concern to an applicant when they filed. For instance, with the nursing home and the nursing home provided the services, or some outside agency that is not familiar with how this all works, the spouse is happy that the individual got accepted for Medicaid, but they become horrified when they get that collection notice from HRA saying, “We need to be reimbursed or when they get sued in Court”.

In a lawsuit, where the spouse is then sued, HRA would be looking for those resources that the individual has. This is where receiving proper advice from the Law Offices of Michael Camporeale becomes important, because proper planning mandates that you not only apply for the Medicaid, and implement spousal refusal, but the bigger issue is what to do with the excess resources after an individual has been accepted for institutional Medicaid in order to protect the community spouse’s excess resources and how to deal with a claim made for excess resources.

That is a big issue in addition to getting the spouse the community benefits that they are entitled to. As indicated above, if that is not put into place, the community spouse is a primary target for Medicaid recoveries, because there are no limitations, or restrictions by virtue of age, or survival of the spouse in order for them to collect or pursue recovery for all, or a portion of the assistance paid for the community spouse if an individual does have excess resources.

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