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Medicaid Recertification

community nurse make a house call to seniorQuestion:
My mom is currently approved for Community Medicaid. I received a notification that her benefits need to be recertified. Is this something I should go back to my attorney to handle or can I fill it out myself?

Answer:
Once someone has been approved for Community Medicaid (home care benefits) or Chronic Medicaid (nursing home benefits) they will need to recertify with the local Department of Social Services each year. The recertification notice comes with an application that must be completed and sent in prior to the due date. The application should be sent in with supporting documentation showing income and asset verification for the Medicaid recipient and spouse. This is the way the Department of Social Service ensures that the Medicaid recipient is still entitled to the benefit.
Retaining an attorney to prepare and submit the recertification is typically advisable. If the application is not filled out correctly or documentation is missing the recertification could be denied for failure to provide information. This would result in a loss of benefit for the Medicaid recipient and the possibility of a gap in coverage if a new application is not timely filed and approved.
Another reason to have the attorney prepare the recertification documents is that this will be another opportunity for the attorney to review the entire file and make sure that all of the estate planning is also in order. For example, in the case of a Community Medicaid application, the homestead (primary residence) is an exempted asset for the purpose of eligibility. Even though the property will be exempted from the calculation during the life of the applicant, under New York State law, costs of services provided under Medicaid to an individual over the age of 55 are subject to estate recovery at the time of the Medicaid recipient’s death, this would include the house. In order to prevent estate recovery, the Medicaid recipient should engage in proper estate planning during his or her life in order to make sure that no assets will be subjected to recovery after the Medicaid recipient’s death. Another reason for a thorough review is to make sure that the proper calculation is being used for any retirement accounts in pay-out status. Where the Medicaid recipient has a retirement account that is set up for a systematic monthly distribution, that distribution is based on the value of the account and the life expectancy of the Medicaid recipient. The value of the account can change over time and as the Medicaid recipient gets older, the monthly distribution may need to be changed. If the attorney prepares the recertification, the monthly distribution can be recalculated and adjusted if necessary.
For most Medicaid recipients the benefits received under the Medicaid program are invaluable. Engaging your attorney to handle the recertification can ensure that the recertification application is prepared correctly and review all aspect of the recipient’s file to ensure no adjustments are necessary.

Filed in: Ask Nancy

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