Of course, you’ve heard of the 10 commandments. In this office, the 11th commandment is: Do not file a New Jersey Medicaid application until you are sure that the applicant qualifies, or it is strategically beneficial to be denied!
Beware of the many Medicaid companies that advertise their Medicaid application services. Our firm has rescued many families from Medicaid “screw-ups” over the years, after they had been denied benefits or frustrated by a lack of knowledge of NJ Medicaid laws, rules, and regulations. These application companies have little, if any, experienced advisors or attorneys involved in preparing or assisting with your application. Get denied, and you’re on your own!
It’s All About Understanding the Medicaid System and the Application Process
Do you want to know how to apply for Medicaid and what the eligibility qualifications are? Do you know that once you apply for Medicaid, you risk losing the opportunity to protect your assets? Do not throw away the many planning and asset-protection options available to you before applying! If your finances disclose you have more income and/or resources above the legal limit, your application is premature, and you will be denied approval and required to spend down your assets. It’s a devastating outcome.
May I encourage you to call us first before completing a Medicaid application? We may be able to help save all or a portion of your assets that would otherwise be lost by prematurely filing. Let us help you calculate the date when you should file a Medicaid application. Together, we can determine how much you can save and the appropriate date to file a Medicaid application.
Our office normally assembles the required financial information and supporting documents for Medicaid 90-180 days (or more) before the date we believe a person will be eligible for Medicaid benefits, given the current delays in the approval process. A Medicaid application in New Jersey requires a mountain of paperwork. It is then submitted to an overwhelmed and adversarial government agency, making the application process an enormous undertaking. At Hanlon Niemann & Wright, we have developed systems to streamline the process. Our team knows how to package and assemble the information expected by the assigned caseworker in a way that is easier for Medicaid officials to understand and evaluate. We highlight and justify, with appropriate legal support, the reasons your application should be approved for coverage. When applying for Medicaid, there are often many hidden obstacles and dangerous curves in the road. We understand these obstacles, as we have driven this road before — and we are prepared to address them. We will represent you through the application process and communications with Medicaid caseworkers or higher-level supervisors. We can also represent you through any necessary appeals if the government treats you unfairly, subject to the terms of our engagement. If the County wrongfully denies your application, we can appeal that decision to the Administrative Law Court. No Medicaid application service can do all of this for you; only an experienced and licensed Medicaid attorney in New Jersey can.
Applying for Medicaid in NJ Video, Part I
Applying for Medicaid in NJ Video, Part II
General Information on the NJ Medicaid Application Process
In New Jersey, Medicaid Applications are filed in each of the 21 counties through the County Board of Social Services. Some counties maintain outreach offices at different municipalities in the county; otherwise, the application must be filed at the county’s home office. In some counties, Medicaid applications can be filed by mail, even electronically. There has been a recent trend of allowing filings by mail or electronically, so each county must be contacted.
Many types of documents and financial disclosures are required for filing a NJ Medicaid application.
Required documentation begins with a checklist. Included in this checklist are requests for a birth certificate, a marriage certificate if the applicant is or has been married, and a death certificate of a deceased spouse, or a divorce decree if the marriage has been dissolved by divorce. In addition, five years of complete and detailed financial records are required.
You Must Prove You Are Medically Eligible for Medicaid
All applicants must prove that it is medically necessary for him/her to receive a nursing home level of care.
Medical eligibility is determined by a document called a “pre-admission survey” (PAS). A PAS is ordered by the applicant, nursing home, or residential health care facility, including assisted living. Medicaid may send a nurse to examine the applicant to determine whether the care is medically necessary. Sometimes, a video medical evaluation will be done instead of an in-person examination. New Jersey has an unwritten rule that the examination will take place within 30 days of the date the PAS is ordered. Failure to secure a PAS in a timely manner will result in a denial. The keyword is “timely”. Your physician must complete a PA-4 form, which is essentially a preliminary screening tool attesting that the applicant requires a nursing facility (or assisted living residence) level of care in the immediate future. If the PAS is denied, the application will be denied, notwithstanding financial eligibility. Note, a denial triggers an immediate right to a Fair Hearing Appeal, as discussed elsewhere on this site. The takeaway from this discussion is to alert you to make an objective medical assessment of your loved one’s ability to independently perform his or her ADLs. It’s the first test in a series of medical tests to qualify for Medicaid.
Medicaid eligibility often centers on ADLs. ADLs are known as “the Activities of Daily Living”. They are the most crucial link between the individual and Medicaid eligibility. Regardless of the medical diagnosis of any condition (Alzheimer’s, Dementia, Parkinson’s, ALS, etc.), the effect of that condition requires that the individual either (1) need assistance with at least three (3) ADL’s every day of the calendar week and/or (2) be a safety risk to himself or herself because of the impact of the condition on his/her ability to perform their Activities of Daily Living independently and without constant cueing by another person present.
The word “assistance” seems straightforward. Medicaid requires that an applicant for institutional and home-based care needs “hands-on assistance” with activities such as dressing, bathing, toileting, ambulation, transferring, and eating. Hands-on assistance means that another individual must be present to physically put their hands on the individual to accomplish those tasks.
It can take an extremely long time to process a Medicaid Application
The time required to process a Medicaid Application varies from county to county and depends on the complexity of the financial data submitted and the workload of the Medicaid staff. In some counties, an application can be approved within 90 days. In other countries, it takes 6 months to a year. In special situations, the application must be approved in Trenton, and this can take 12 months or longer. During the application process, it is not uncommon for the assigned case worker to re-request duplicative information or lose information, so you must keep copies of all documents given in connection with your application. We’ll help you deal with the nursing home or assisted living business office during this processing time. We know how to handle the application process.
While a Medicaid Application is pending, the nursing home bill continues to mount up. Don’t panic; that’s normal.
At the time of approval, Medicaid will also inform the applicant of his/her monthly share of the costs of care. We will guide you on how to handle all payment issues while your application is pending and after it is approved. While an application is pending, there are special rules concerning the payment of care costs to the facility. When the application is approved, Medicaid will pay the nursing home retroactively to the date of eligibility for all eligible but unpaid expenses.
The preparation of a Medicaid Application process is very, and I mean very, time-consuming in New Jersey
Medicaid has the right to demand proof of almost every financial transaction for the 5 full calendar years preceding the application filing. Accurate records should be gathered and a complete Medicaid application furnished to the County Board of Social Services, if possible, all at once to simplify processing. If records are inaccurate or incomplete, or if a Medicaid application package is disorganized, the Medicaid Agency will continue to insist on additional information, and the application will be delayed until received or denied. Denials for failure to provide requested information within short turnaround periods have become common within many counties. We are closely following this trend. Submission of a complete Medicaid Application requires many hours. It is estimated that a professional assembling a Medicaid Application spends approximately 35-50 dedicated, undisturbed hours gathering and organizing the information. A person unfamiliar with the process will spend many times that amount, often exceeding 100 hours. If you’re working, have a family, or are easily frustrated when dealing with large volumes of information or $$$, you do not want to file a Medicaid application alone.
The cost of paying a professional, such as a law firm, to prepare and file a Medicaid Application is a permissible spend down for Medicaid eligibility purposes.
Did you know that the cost of professional assistance in preparing and filing a Medicaid Application is permitted as part of the spend-down process? The legal fee paid to our office, for example, is credited toward the applicant’s eligibility. Since a person can keep only $2,000/$4,000 in resources to become Medicaid-eligible, it seldom makes sense for the family to assume the time and responsibility of applying. The money will only go to the nursing home or assisted living residence, and the state will pay it once eligibility is established. Don’t kill yourself only to have the money go to the nursing home.
We Can Help You Even if You’ve Filed the Application on Your Own
Sometimes people file a Medicaid application and realize they are over their heads. Maybe I’m speaking to you right now. If so, don’t worry. Come in and see us. I’ll assign a highly qualified Medicaid paralegal to work with me and you to finish up the application, and we’ll work with you on fees based on how much work you’ve already completed.
Let an experienced Medicaid application attorney at Hanlon Niemann & Wright work for you today.
If you would like to discuss your experiences with Medicaid confidentially with a seasoned and experienced NJ Medicaid appeals attorney, contact Fredrick P. Niemann, Esq. at (732) 863-9900 or e-mail him at fniemann@hnlawfirm.com. Our offices are conveniently located on South Street in Freehold, NJ.
Testimonial
I knew I needed an attorney, but could I afford one? Would he or she be experienced and someone I could trust and talk to openly and in confidence? I was referred to Fredrick P. Niemann. I was warmly greeted and my appointment promptly kept. I was given all the time I needed to ask questions and talk about my needs and concerns. I was quoted a fee that was appropriate and reasonable for my matter. My attorney gave me answers and advice. He was a counselor at law and in life. Calling Fredrick P. Niemann was the right decision.
-Nick Alfano, Morganville, NJ
Testimonial
I am a NJ attorney with 40+ years of experience in the practice of law. Medicaid applications are not my area of expertise. I consulted with three law firms who specialize in this area of law. Thankfully, I chose Hanlon Niemann & Wright. The firm is professional, knowledgeable, efficient and responsive. My sister received notice of enrollment into the Medicaid program within 40 days after the law firm filed the application. I will recommend Hanlon Niemann & Wright to all my family, friends and clients who need legal services concerning Medicaid law.
– Joseph Marrazzo, Jr. – Cherry Hill, NJ
Testimonial
My wife and I wanted to express our gratitude for the guidance and patience from you and your staff along this journey. Life is strange at times and the things that bring us together can be just as strange, if not more. I not only got to put a few bucks in the bank, but got to reconnect with my cousin Sarah, which was a great surprise for me. That alone was worth the journey for me. Getting to know her and the family has been really nice. I know it was a long day for all of us in mediation, but I really am blessed to have gotten to know you and talk with you. I admire your skills, work ethic and attitude regarding time and Patience. When the opposing attorney was running her big mouth and doing her thing, you never lost your composure, nor your position. I’m hoping it’s one of the nuggets I’m able to take and implement in my personal/professional life. The short version of this story is that you have a lot to offer people, you’re a true, trusted advisor. Your words and actions seem to align with your values, which is like common sense, very hard to come by now a days. Your staff does a great job as well. Please let them know that as often as you can.
-Mike Price – Plainfield, IN
Written by Fredrick P. Niemann, Esq. of Hanlon Niemann & Wright, a Freehold Township, New Jersey Medicaid Attorney
Medicaid Application Attorneys serving these New Jersey Counties:
Monmouth County, Ocean County, Essex County, Cape May County, Mercer County, Middlesex County,
Bergen County, Morris County, Burlington County, Union County, Somerset County, Hudson County, Passaic County