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Where are Medicaid Applications filed?
In New Jersey Medicaid Applications are filed at the County Board of Social
Services. The counties maintain outreach offices in major hospitals otherwise
the application must be filed at the county office.
May applications be filed by mail?
New Jersey applications may not be filed by mail.
What type of documents are required in connection with
an application?
Required documentation begins with a birth certificate for the Medicaid
Applicant, a marriage certificate if the applicant is or has been married and a
death certificate of the spouse or divorce decree if the marriage has been
dissolved by death or divorce. In addition, three years of complete financial
records may be required.
What if I am unable to locate a birth certificate,
marriage certificate, death certificate or divorce decree?
All of these items can be obtained from the Registrar of Vital Statistics or
from court records. If it is absolutely impossible to obtain these records,
other forms of evidence may be accepted.
How does the applicant prove that it is medically
necessary that he be receiving the care being provided?
A PAS is ordered by the facility. Medicaid sends a nurse to examine the
applicant to determine whether or not the care is medically necessary. The
applicant or the applicant's representative must be sure that the facility
orders the PAS. New Jersey has an unwritten rule that the examination will take
place within 30 days from the date the PAS is ordered.
How does Medicaid know that the information I am
providing is complete?
Medicaid has a computer match with the I.R. S. Medicaid will receive information
concerning 1099's sent by all financial institutions.
How long does it take to process a Medicaid
Application?
The length of time necessary to process a Medicaid Application varies from
county to county and is dependent on the nature of the financial data being
submitted. In some counties, an application can be approved within 45 - 60 day.
In other counties, it takes 6 months to a year. In special situations, the
application has to be approved in Trenton and this can take 18 months or longer.
Who pays the nursing home while the Medicaid
Application is pending?
At the time of the Medicaid Application, Medicaid will inform the applicant of
the applicant's monthly share of cost. The applicant must pay this share to the
facility while the application is pending. When the application is approved,
Medicaid will pay the nursing home retroactively to the date of eligibility.
Is the Medicaid Application process time consuming?
Medicaid demands proof of every financial transaction for 3 years prior to the
application and in some instances Medicaid goes back for 5 years. Accurate
records should be gathered and a complete Medicaid application furnished to the
Board of Social Services to make processing simpler. If records are inaccurate
or incomplete or if a Medicaid application package is in disarray, the Medicaid
Agency will continue to insist on additional information and the application
will be delayed inordinantly. Submission of a complete Medicaid Application
requires many hours of time. It is estimated that a professional assembling a
Medicaid Application spends approximately 20 hours assembling and organizing the
information. A person unfamiliar with the process will spend many times that
amount of time.
Is the cost of paying a professional such as a law firm
to prepare and file a Medicaid Application a legitimate spend down for Medicaid
eligibility purposes?
Yes. The cost of professional assistance in preparing and filing a Medicaid
Application is paid by the Medicaid applicant as part of the spend down process.
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