Don't file a Medicaid application until you are qualified or it is strategically beneficial to be denied!

Once you apply for Medicaid, you often lose the opportunity to legally protect your assets. Why?  Because that's the law.  Do not throw away the flexibility that exists prior to filing an application! If your financial disclosure(s) show that you have excess resources (commonly referred to as assets) above what NJ law allows, you will be required to spend-down those assets on your long-term care before Medicaid will pay your expenses.

Call us first before completing your Medicaid application! We can tell you whether or not we can save you money. Don't risk unnecessarily losing money and choices if you file for Medicaid too soon or too late. Let us calculate when the Medicaid application should be submitted. We can usually determine the amount of money you will save and the appropriate date that the Medicaid application should be filed. We normally submit the Medicaid application 60 days or more prior to the date that we believe the individual will be eligible for benefits, given the current delays in the Medicaid approval process. 

The Maze Called the "Medicaid Application Process"

A Medicaid application generally requires hundreds of pages of paperwork.  It is submitted to an overwhelmed and adverse government which makes the application process an enormous project. We have developed systems to make the process easier. Our team knows the how to present the information in a way that it can be easily understood by Medicaid officials. We try to make their job easier so you can get an approval sooner.  We detail the strategies that our clients use to qualify for government benefits while safeguarding assets. We highlight and justify (with appropriate legal support) the reasons why our positions are appropriate.

When applying for NJ Medicaid or other public benefits, there are often many hidden landmines, obstacles, and dangerous curves in the road. We understand these problems. We will represent you throughout the application and in face-to-face meetings with Medicaid caseworkers or higher-level officials.

If you consent, you will have the assurance that we will represent you through any and all necessary appeals subject to the terms of our engagement agreement. As experienced trial and appeal lawyers, we are not afraid of the courtroom like many attorneys and law firms are.

If you would like to discuss your matter in a confidential meeting with a caring and sensitive attorney who knows NJ Medicaid law, contact Fredrick P. Niemann, Esq. toll-free at (855) 376-5291 or e-mail him at fniemann@hnlawfirm.com.

Additional Information About Applying for Medicaid

The pile of paperwork required and an often inefficient government processing system can make filing an application for public benefits an enormous project. Although the federal government shares the cost of funding the Medicaid program with New Jersey and requires the state to recognize federal law and regulations with respect to approvals of Medicaid applications, it is not uncommon for the state or the County Board of Social Services to fail to meet the federally imposed guidelines.

Therefore, when applying for Medicaid or other long-term care benefits, it is crucial for applicants to be prepared and well versed in the legal implications of all information supplied in support of their application. Also, when the state or county office fails to meet a deadline or erroneously rejects an application, the applicant must be prepared to exercise his Constitutional and state statutory rights of appeal in what is known as a "Fair Hearing Appeal".

The following is a sample list of Medicaid application issues which should be addressed to avoid unnecessary delays and denials.

1. Selecting a Program

Applicants for public benefits must decide the programs for which they wish to apply. The choice of programs may depend on the applicant's living situation, physical condition, and financial status. Certain benefit programs are specifically geared to victims of traumatic brain injuries or Alzheimer’s Disease. Many states, including New Jersey have dual institutional Medicaid programs which have slightly differing income and asset standards and offer different coverage with respect to hospital stays. If you have any questions on selecting the appropriate Medicaid program for you, contact Fredrick P. Niemann toll-free at (855) 376-5291.

2. Timing the Filing of Your NJ Medicaid Application

Although families have the opportunity to expedite their Medicaid eligibility through asset protection planning under the guidance of an Elder and Disability Law attorney, it is vitally important that applicants do not apply for Medicaid prematurely. Strategies for Medicaid planning often include triggering a penalty period for Medicaid eligibility purposes. While the time in which to wait to file an application may be more or less than five years, filing an application during a period of ineligibility can potentially cause a significant postponement in the applicants eligibility and approval status. It is, therefore, important to check with a qualified professional as to the date after which the application may be filed.  You may contact Fredrick P. Niemann toll-free at (855) 376-5291 or email him at  fniemann@hnlawfirm.com to discuss the timing of a Medicaid application.

3. Authorization to Apply

In most cases, the applicant himself or herself is unable to visit the County Board of Social Services and provide the detailed information on his/her financial status. The law, therefore, specifically provides that a relative, welfare agency staff member, staff member of the institution in which the applicant resides, or a professional such as a doctor or attorney may apply on the applicant's behalf. In cases where an attorney has been retained to apply on behalf of an applicant, the attorney must acquire an authorization from the applicant or his/her attorney-in-fact to obtain, discuss and submit financial data in support of the Medicaid application. Because the Medicaid eligibility laws and policies are rapidly changing, subject to shifts in politics and lobbying by advocates for the elderly, applicants are well advised to retain individuals with comprehensive knowledge of the Medicaid eligibility rules and all strategies that may be legally employed to expedite eligibility. Don’t hesitate to contact Fredrick P. Niemann toll-free at (855) 376-5291 or email him at  fniemann@hnlawfirm.com to learn more.

4. Medical Criteria for Medicaid Eligibility

Qualifying for Medicaid involves not only financial eligibility but also medical eligibility. Therefore, applicants must demonstrate that he or she is unable to perform the activities of daily living, including feeding, dressing, bathing, toileting and continence through a physical exam . If it cannot be shown to Medicaid that the proposed care is medically necessary, the Medicaid application will be denied.

5. Intake Procedures for Filing an Application

In some counties, the applicants or families themselves are requested to complete the paperwork. This is not always possible.  With proper guidance, there are ways around this rule.  While some counties are more lenient as to what types of documents may be submitted by mail, the initial filing of a Medicaid application always requires a face to face interview by a representative with a Medicaid caseworker.

6. Substantiating the Data Needed for Approval of an Application

The Medicaid application itself is several pages, and the answers to each question must be substantiated by legal or financial documentation. These supporting documents include: social security cards, Medicare cards, health insurance cards, birth certificates, marriage certificates, death certificates, life insurance policies, deeds, car registrations, household expense bills, funeral arrangement documents, pay or pension stubs, and financial statements typically dating back five years prior to the time the Medicaid application is filed. If certain documents are missing, such as financial records, proof of birth or marriage, etc., a paralegal at Fredrick P. Niemann’s office can help you obtain certain documents from the Registrar of Vital Statistics in your area.

Each Medicaid office has a computer program to verify social security numbers, employment history, and other personal information. Likewise, if requested financial information is not disclosed to the County Board of Social Services, the office may deny the application based on information it periodically receives from the Internal Revenue Service. Intentional failure to disclose relevant financial data is considered Medicaid fraud. Even in cases where Medicaid eligibility has initially been granted, the county welfare office may revoke the approval upon receiving the IRS records.

7. Additional Documentation and County Verification for NJ Medicaid Eligibility

In addition to personal and financial data, applicants who have been able to protect assets through planning may have to submit additional supporting information to the county social services office. The treatment of these documents will vary from county to county. For example, both a husband and wife may present prepaid funerals as non-countable assets. Care Agreements and Caregiver Affidavits which protect assets without triggering penalties may be requested to support an application, but their treatment may vary with other financial data. Trusts that have been established may also have to be submitted to the County Board since they may affect benefits eligibility, depending upon its provisions.

Some county Board of Social Service offices require each individual to complete a plan of liquidation of assets in certain situations. Such cases may necessitate professional advice to protect the applicant’s rights, to protect a portion of his/her assets and income for his or her family members or to enhance his or her institutional quality of care.

The requirement that financial statements dating back five years prior to the filing of the application may also vary from county to county. Some counties have been known to relax the rules.

8. Enforcing the Applicant's Rights for Eligibility to Receive NJ Medicaid

Applicants should be aware of their federal rights to a prompt decision on their application. Enforcing the federally mandated deadline of 90 days is found in the Code of Federal Regulations.  New Jersey's deadline processing time is 30 days, which if not finalized can be challenged through a fair hearing appeal which is an informal proceeding before an administrative law judge. These hearings are often used to expedite the decision making process of the county agency. Individuals who do not exercise their federal and state rights to a prompt decision on their Medicaid applications may find themselves waiting up to a year to learn whether their nursing home bills, which had been accruing, will be covered by the benefits programs.

Medicaid 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