Our Elder Law and Medicaid Planning Attorneys Discuss the Information Needed on Your Medicaid Application
Medicaid is a lifeline for millions of families across New York. Although it was originally designed to provide comprehensive coverage to individuals who can’t afford basic insurance, the rising cost of certain services can make Medicaid seem a more appealing alternative to private policies and self-pay. However, applying for Medicaid—whether to obtain basic care or to fund a long-term stay in assisted living—is a complicated process that is governed by an unusual combination of state law and federal statutes.
Here, the trusted elder law and Medicaid planning attorneys at Landskind & Ricaforte Law Group, P.C. discuss how to fill out a Medicaid application and the information you’ll need.
Table of Contents
Making Sense of Medicaid Requirements
Medicaid is federally subsidized health insurance available to U.S. citizens and lawful residents who meet certain income requirements. Depending on your coverage and circumstances, Medicaid can pay for services including, but not limited to, the following:
- Inpatient hospital services
- Outpatient medical services
- Nursing home and assisted living facilities
- Home health services
- Aging-in-place accessories, services, and facilities
Every state maintains its own Medicaid program, but baseline rules are set by the federal government. Since the U.S. Centers for Medicare and Medicaid Services define “low income” as a prerequisite for obtaining Medicaid coverage, states like New York are required to assess applicants’ finances before extending coverage. Many families begin by asking, “How much does nursing home care cost?” because these assessments help protect the integrity of Medicaid but often have the unintended consequence of forcing older adults to make difficult decisions about how best to afford the costs of assisted living.
What to Know Before You Apply for Medicaid
Medicaid is a government-run program. Applying for benefits, whether for yourself or for a spouse, typically requires some advance preparation. Before getting started, you’ll need to:
Collect Your Personal Information
Medicaid applications require a significant amount of information about yourself, your family, and your income. You’ll need to provide the following:
- Your basic biographical information (name, date of birth, etc.)
- The names, addresses, and basic biographical information of your spouse, children, and any dependents
- Family medical history
- Your current health insurance details
- Information about your finances, including the properties you own and the accounts you control
- Information about personal possessions, such as your car, recreational vehicles, and collectibles
- Estimates on your monthly expenses
- Any estate planning documents you may already have
Know the Types of Financial Documents You May Need
When you apply for Medicaid, it’s important to understand that there are many financial documents you’ll need to prove your financial status. It won’t be enough to simply provide bank and checking statements. Medicaid wants to verify your household income and assets, so that means you need to provide five years’ worth of financial documentation.
To meet Medicaid’s requirements, your documentation will need to comply with the state’s five-year look-back period and strict eligibility criteria, showing all past transfers of assets. Medicaid scrutinizes all financial transactions made during this look-back period and checks to see that you haven’t given away money or assets to someone to make it appear that you have less money than you’re reporting. They want to know that you haven’t made large financial gifts to friends or family; you haven’t transferred a house or property to someone in your family; and/or you haven’t sold assets for less than their current market value. If Medicaid finds you’ve tried to hide money or shield assets by giving them away or putting them in a Medicaid Asset Protection Trust (MAPT), you may be penalized, and Medicaid may delay coverage.
The documentation you’ll need will include monthly bank statements—even if you’ve since closed the account—as well as all other financial accounts. You may have to provide canceled checks or withdrawal slips for transactions made during these five years.
Additionally, you’ll need to gather five years of tax returns, closing documents for residence sales, and records of insurance policies, especially those with a cash value. Here, our elder law and Medicaid planning attorneys offer the types of financial documents you’ll likely need when applying for Medicaid benefits:
Accounts
- Checking Account Statements
- Savings Account Statements
- Money Market Accounts
- Certificates of Deposit
- Credit Union Accounts
- Stocks or Bonds
- Annuities
- IRA, 401K, 403B, Keogh Accts
Property
- Title to Automobiles, Motorcycle, Boats, Vacation homes, Rental Property
- Deeds to Property Owned and Listing Agreement, and Mortgage
- Property Proceeds
Income
- Most Recent Pay Stubs
- Pension Statement
- Unemployment Check Stub
- Social Security Award Letter
- Railroad Retirement Award Letter
- Temp. Disability Check or Award Letter
- Support/Alimony Checks or Court Order
- VA Award Letter
- SSI Award Letter
- Interest, Dividends, and Royalties
Other
- Special Needs Trusts
- Tax Returns
- Life Insurance Policies With Cash Value Statements
- Burial Plot Information
- Prepaid Funeral Contracts
Why Funeral and Burial Documents
You may wonder why you need to include your prepaid funeral information with your Medicaid application. Medicaid limits the amount of income and assets you can have when applying for benefits, but this amount doesn’t include the money you set aside for a funeral and burial costs and isn’t recognized when determining your eligibility. However, Medicaid does want to see the paperwork that verifies you’ve allocated your funeral funds in one of the two authorized ways:
Creating a Bank Account
One way Medicaid applicants spend down their wealth without being penalized is by creating a bank account that’s established specifically for their funeral and burial. Applicants are allowed to set aside up to $1,500 in a standard revocable burial account. When you provide the paperwork for your Medicaid application, it must include specific information about this bank account.
Signing a Contract With a Funeral Home
New York Medicaid doesn’t allow you to spend down your income and assets for Medicaid eligibility by putting as much money as you want into an irrevocable funeral trust (IFT). However, you can sign a pre-need funeral contract directly with a funeral home.
You make a pre-need funeral contract with the funeral home you want to manage your funeral service and burial. The contract spells out the specific services provided by the funeral home and the cost for all items. This contract must be irrevocable, which means once you sign the contract, you can’t cancel, change, or revoke it. Medicaid will exclude the money you’ve prepaid from your total asset amount when determining eligibility for benefits. If the funeral home goes out of business, the money you’ve paid can be transferred to another funeral home. Paperwork proving your contractual agreement with a funeral home will be needed when you apply for Medicaid.
Prepare Documents to Prove Your Eligibility
Every Medicaid application examines your eligibility with respect to citizenship, residency, and income. You’ll need to be prepared to submit the following types of documents before applying for Medicaid:
- Your passport, birth certificate, and other proof of citizenship
- Your Social Security card or other proof of Social Security coverage
- Proof of Medicare, if you are currently receiving Medicare benefits
- Proof of marital status, typically fulfilled by providing a copy of your marriage certificate, divorce degree, or death certificate
- Proof of income, including bank statements and a full accounting of any other assets you own or control
- Proof of residence
Some applications require additional documentation. This could include an estimate of your monthly housing costs or information about why your spouse has chosen to refuse Medicare.
L&R Medicaid Application Checklist and Questionnaire Forms
Here, you can view the Medicaid questionnaire our team at Landskind and Ricaforte P.C. uses to gather the needed information and a checklist of items necessary to submit a Medicaid application:
Applying for Medicaid benefits is a time-consuming process that requires extensive documentation of your physical and financial circumstances. Even if you do everything right, you’ll still have to:
- Present original documents for verification
- Authorize Medicaid to investigate years of your financial history
- Prepare for the possibility of having to file an appeal
Any mistake, omission, or oversight—no matter how seemingly minor—could have big repercussions if left uncorrected. In a worst-case scenario, your request for benefits could be denied, leaving you unable to try again for years.