Understanding the First Steps in Filing a Medicaid Application for Home-Based Services

HNWApplying for Medicaid Long Term Care Benefits

MedicaidA client came to me contemplating applying for Medicaid for services at home.  There were two issues needing attention.

The first issue was financial.  How much income could the “institutionalized” spouse keep each month (for taxes, food, utilities, etc.)?

Federal law at 42 CFR 435.726 indicates she can keep “an amount for her maintenance needs.”  Is there a fixed dollar number ($$) or will the family need to prove actual expenses at the time of the application? If the family needs to prove actual expenses, do those expenses get divided by the number of people living in the house (in this case, husband and wife)?

The second issue was how does one initiate the snapshot date for the community spouse’s right to keep assets? Do we contact the state to request a PAS? Will the snapshot date be the first day of the month in which the PAS is issued?

In this case, the “institutionalized” spouse has been receiving assistance from an aide and attending a daycare program, but the family has been paying privately thus far. Also, the goal is to help them increase the countable resources before the Medicaid snapshot date is taken.

A snapshot date in the community is tricky.  I’ve heard different answers from different Medicaid officials.  It seems to be one of either the date the PAS is done, the date the Medicaid application is submitted, or the first day of the month when one or the other is done.  To be safe, many attorneys recommend clients keep snapshot date assets until both PAS is done and application is submitted.

The HCBS institutionalized spouse can keep all income up to $2313 ($2382 in 2021/2022), plus medical insurance premiums.  Amounts above this amount must be turned over to the state as his/her private pay contribution.

We often contact the county Office on Aging to start the screening process for in-home HCBS.  We then follow up with the Office of Community Choice Options to confirm that the PAS has been ordered.  But the key is the date of filing the Medicaid application so a financial assessment is initiated.

During Covid, the counties have suspended all clinical/medical eligibility requirements.

To discuss your NJ Medicaid matter, please contact Fredrick P. Niemann, Esq. toll-free at (855) 376-5291 or email him at fniemann@hnlawfirm.com.  Please ask us about our video conferencing or telephone consultations if you are unable to come to our office.

By Fredrick P. Niemann, Esq. of Hanlon Niemann & Wright, a Freehold Township, Monmouth County, NJ Medicaid Attorney

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