We started Medicaid application 6 months ago & still no approval. Any suggestions?

It took six months before my dad was approved.

I stayed in touch with the case worker and touched base every week to see how things were progressing. Try giving your caseworker a call. Somewhere on your paperwork there should be a phone number.

I've never heard of Medicaid taking a year to be approved.

My LO's application was approved pretty fast. While I was waiting, I looked it up and in NC, they are required by law to provide a response within so many days.

Also, just re-read your post, one issue probably happening is that the documentation has been coming to Medicaid office in a series of items. Like last month, was a banking issue, then this month is an funeral policy ?, this is a real problem because each time the application has to be reviewed there is the opportunity for something to get lost, go amiss or……..for them to find something else for another set of ?'s. For others reading this post, doing the application as a "document dump" of everything at one time and the more pages the better is the way to go. The caseworker has about 10 minutes to do a review so if he has 100++ pages of supporting documents, the assumption is that it's there somewhere and they tend to look for a single item or two to double check on and assume the rest is there somewhere. A fat file means that it's there somewhere. I was told to take this approach after Hurricane Katrina and was dealing with FEMA, SBA, insurance and various governmental units. Just deluge (pun intended) whatever application's you do with supporting documents and it likely will get stamped approved because it's likely somewhere in there…….just as an FYI.

Cadi - your in TX correct? for what it's worth for my mom (also TX) it was 5 1/2 months before the state approved but once approved was retro'd to the month of the day of the application to pay. She went into the NH as "Medicaid Pending" from day 1 and did her co-pay (or her "SOC" - share of cost) based as a Medicaid resident also from day 1. So I'd suggest you go over with the NH as to just when they started the clock on your mom being a "Medicaid Pending" resident and then make sure that you have given them the exactly correct SOC from that day forward.

Now I had gotten the 1 page list of what NH wanted to see for them to accept mom "Medicaid Pending" a couple of weeks prior when I went NH shopping, so I had gotten that pile organized waaaay in advance & just held in the wings till mom got the "NH needed" doctors orders to move her from IL to NH. So I was able to give copies of all the supporting documents on the list from the NH all at the same time the day the Medicaid application was done @ the NH. Over 100 pages too but mainly due to mom's old-school life insurance policy which was easily over 2 dz pages front & back.

Now mom's first glitch was within the NH as the NH did not get the application and their bill to the state off immediately but waited a couple of weeks. This part of the Medicaid maze is out of your hands. So I would speak with the NH to find out what day they submitted all to TX HHS / TxDADs. Actually I sent over a fax to the NH and a certified letter to the NH corporate office on this, just as a cya. I've just found that the facilities are less than stellar in follow-though and the fax & certified mail provides for a paper trail that you have done what you supposedly need too.

Mom had issues with both the financial & the medical aspect of the application. Has anyone explained to you that they have to qualify for both or Medicaid to pay? I moved mom from being in IL to a NH and totally bypassed the AL stage so mom did not have the easy medical history showing need that a person discharged to the NH from a hospitalization would, so give some thought if that could be an issue for the delay. If they are private paying, they do NOT have to demonstrate the need for skilled nursing care but do if on Medicaid. For my mom, her Medical issue was - that has to have the NH take the lead on - was that when she was admitted some of her medications were left off so she did not easily show "need for skilled nursing care". It was finally added on BUT after the state RN had evaluated her application, so an appeal had to be filed. I had to do the appeal but the NH had to do whatever to change the chart in coordination with her doctor (who also was the medical director of the NH) to provide the medical supporting documentation . Medical appeals run about 4 - 5 months out from the date filed and the issue was resolved before that, but the appeal is important to be done as the NH has to continue to have them stay as a "Medicaid Pending" resident while on appeal.

For the financial, mom had to provide 3 years & 6 months of all banking plus all her insurance, etc. There was a problem with her life insurance policy - yeah the old-school one -as the older ones are many many pages and fine print. The caseworker called me (also sent letter) as to if it was whole life or term policy. It was term but my saying it was term was not enough either. What I did was get a broker with a TX insurance license to do a letter on the brokerage house letterhead that the policy was evaluated and was only term with NO CASH VALUE. I faxed to over to the caseworker (this one was local and had the NH within his assigned area) so that issue was resolved. Local caseworker was very nice about all this, but the program is very document driven and either it's there and application goes forward to TxDAD's HQ or goes into the documents not provided pile and after 30 day is declined. SO really you need to find out just when the application and all the supporting documents went to the local office for the program. Now the insurance issue was about at month 4. The state did their own 5 year lookback on her real property which I assume is a simple set of keystrokes to do as real property ownership is all in the state system. Mom had a transfer penalty issue on her car
which worked out OK but again had a flurry of documents faxed over to provide details on lower value and within the 2K in nonexempt assets required.

It just takes time. If the NH has sent you a "30 Day Notice" then I'd start to panic but otherwise I'd suggest to just check with the NH to get the exact date of the filing; contact the caseworker assigned as to the status of the receipt of the application and the supporting documents and when they will review of her application. You do need to make sure that all queries from the state are going to your mom but as a C / O to you at your address (not heaven forbid to her @ the NH - that is a clusterF for disaster). BTW the caseworkers I have dealt with are all very very nice and want to get your elder accepted BUT they have to have whatever documents needed and in quick order as per state regulations - otherwise the application will have to go into the decline pile. If mom gets declined, you have to file an appeal- it buys you time & NH has to keep them as long as the appeal process has been filed and a hearing date set too. Good luck.

Medicaid takes a year to approve. Most nursing homes will accept "Medicaid pending" patients. Getting an attorney now will only slow it down. As long as there are five good years of financial records and she did NOT transfer assets or give away cars/cash/real estate, etc. You should be fine. The biggest snag is when money cannot be accounted for.