The State Medicaid system is complex and at times overwhelming. Here are some of the most common issues that Medicaid caseworkers look for that can result in a denial of nursing facility benefits.
1. Giving Things Away. Transfers for less than fair market value within five (5) years before the filing of an application for Indiana Medicaid benefits. This includes outright gifts and sales for less than full value. If an applicant or their spouse makes transfers for less than fair market value that are not permitted by Indiana, then Medicaid benefits can be delayed. This can cause a large nursing facility bill at a time when there are no funds available due to the gift.
2. Missing Deadlines. The Indiana Medicaid process is driven by a series of deadlines. If an applicant misses any of them, then they may have their application denied.
a. Filing the Application. Nursing facility benefits under Indiana Medicaid are only available at the most for three (3) months before the month in which the application is filed. Delay in filing can result is missed months of eligibility and benefits.
b. Notice of the Initial Interview. Once an application is filed, Indiana Medicaid will set an initial interview on the application and send a notice. Unfortunately, the notice will sometimes arrive after the interview is scheduled. If the applicant or their agent misses the interview, the application may be closed.
c. Response to a Document Request. After the initial interview, the Medicaid caseworker will usually send out a request for additional documents. A response to this request is required within thirteen (13) days of the date of the request. With delay due to the mail, this often leaves about a week to collect and provide the required documents. This can be a hectic time or even practically impossible if the request is extensive.
d. Appeal. If the caseworker reaches a decision that the applicant does not accept, the window to file an appeal is very short. A failure to timely appeal usually results in the loss of the right to appeal the caseworker’s decision.
3. Confusing Resources and Income. Eligibility for Indiana Medicaid in the nursing home requires passing three tests: level of care, income, and resources. Applicants need to identify all assets and income sources and properly classify them in order to understand whether they are eligible and when.
4. Thinking That the Process Is Easy. It is relatively straightforward to fill out an online Indiana Medicaid application. However, that is only the first step out of many. Even the most straightforward application involves considerable work and documents to collect. Delay compresses this large amount of work into less and less time. This adds stress and expense. Moreover, it is important to understand an applicant’s rights and the process as a whole.
5. Thinking That You Do Not Qualify. People often hold off on an application for Indiana Medicaid benefits because they assume that they or their loved one does not yet qualify. This delay can be expensive. The only way to know whether and when an applicant qualifies for Indiana Medicaid is a complete review of the applicant’s unique situation.
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