written by
lucinda koza

Sponsored Blog Post: Long-Term Care – The 5 Biggest Roadblocks When Applying for Medicaid

Partners 3 min read , April 7, 2022

Medicaid is America's primary payer for long-term and eldercare services. It can make life a lot easier for both caregivers and the person in need, and covers the costs of ongoing healthcare and medical needs, but Medicaid is often misunderstood.

The application process is complicated. Since Medicaid is a program supported by both federal and state governments, the federal guidelines are designed to weed out ineligibilities, and state requirements are not all the same.

Here are the 5 Biggest Roadblocks When Applying for Medicaid, according to NavigAid:

1. Not getting approved due to medical ineligibility

To be "clinically eligible" for Medicaid to cover the costs of long-term care, the recipient must need help with some "activities of daily living." Activities of Daily Living (ADL) include getting dressed by yourself, walking on your own, "transfer" or moving from a sitting to standing position or vice versa and getting from a chair to a bed, bathing or showering, being able to feed yourself and using a toilet unassisted.

2. Not getting approved due to financial ineligibility

Unlike Medicare that is generally available to every American age 65 and older, Medicaid is a need-based program. Proof of financial need is established through numerous forms of documentation that must be submitted as part of the application process. An individual must have extremely limited assets in order to receive Medicaid benefits; these limits vary by state. A house, car, bank account, pension, stocks, and life insurance policy are all considered assets. Many times, people apply before their resources are fully spent down. It's important to know your specific resource limit and begin the spend-down process simultaneously or prior to submitting the application. Focus on ensuring that financial requirements are met before actually submitting the Medicaid application.

Even if a person is financially eligible, an application that is filled out incorrectly or incompletely will be denied. It is possible to reapply. The goal, however, is for the application to be accepted the first time to start receiving benefits as quickly as possible when needed.

3. Not knowing what documents to provide to Medicaid

Mortgage or lease statements, bank statements, medical records, proof of citizenship, marriage certificates, divorce decree or death certificate of spouse are just some of the documents required when applying for Medicaid. If the proper documents are missing or improperly submitted, benefits may be denied or delayed until corrections are made.

4. Knowing what documents you need, but not knowing how to find them

How do you locate the deed to a house purchased 45 years ago? Where do you find the death certificate of a former spouse from whom the beneficiary is divorced? How do you prove that a car was "gifted" to an adult child more than five years ago? Finding the answers, and then tracking down the documents is both time-consuming and immensely frustrating without guidance or support. It is not unusual for the Medicaid office to request documents within a very tight deadline, which doesn't always give the applicant enough time to get the information from the proper institution. Knowing what you need ahead of time can eliminate much of this stress.

5. Not knowing the specific state income and asset limitation requirements

If you live in New York and are filling out an application on behalf of someone who lives in Pennsylvania, for example, you can't assume that the requirements are the same in both states. Having the state-specific information at your fingertips would make the Medicaid application process go more smoothly at a time that is emotionally charged and financially stressful.

People who want to take the DIY approach to a Medicaid application can get assistance from the NavigAid online tool. NavigAid's step-by-step assistance helps you keep track of your application progress. This organized approach lets you stay in control at your own pace. For more information about NavigAid, visit mynavigaid.com, or call 844-344-3802.

Please note that assessing and obtaining eligibility for Medicaid sometimes requires legal advice and the assistance of an attorney. NavigAid does not provide any legal advice or services. You may wish to consult with an attorney concerning your Medicaid eligibility and application.

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family caregivers