Jay J. Sangerman, PLLC
171 East 84th Street, Suite 21B
New York, New York 10028
212-922-0711
212-439-0056 - facsimile
PLEASE NOTE THAT THE RULES SET FORTH BELOW ARE ABOUT TO CHANGE.
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New York State Medicaid Documentation Checklist
Calendar Year 2006
© Jay J. Sangerman, PLLC
A SUCCESSFUL MEDICAID APPLICATION REQUIRES THE FOLLOWING:
PERSONAL DOCUMENTATION
1. PROOF OF AGE AND CITIZENSHIP:
One of the following - applicant only:
! Passport
! Birth Certificate
! Naturalization papers, if applicable
2. VERIFICATION OF MONTHLY INCOME:
(i.e., Social Security, pensions - applicant and spouse)
! Copy of the actual check that is received
! Copy of Social Security Award Letter (issued by SocialSecurity Administration)
! Copy of letter from payor stating amount of pension benefits, etc.
! Copy of bank statement showing direct deposit
3. VERIFICATION OF RENT & RELATED EXPENSES:
(from current legal residence or last legal residence if applicant is in nursing home - applicant only)
! Rent -one of the following:
Rent Bill or Receipt
Canceled check
Statement from landlord
Copy of lease
! Copy of recent Gas/Electric bill
! Copy of recent telephone bill
4. HEALTH INSURANCE:
(i.e., Blue Cross/Blue Shield, AARP, HIP, HMO, etc. - applicant and spouse)
! Copy of insurance card(s)
! Proof of Premium(s) - one of the following:
Copy of premium notice(s)
Copy of canceled check showing payment of premium(s)
Bank statement showing direct deduction
! Long Term Health Insurance- copy of policy
5. MEDICARE:
! Copy of card - applicant only
! proof of enrollment in Part A and/or Part B (can order
TPQY form from Social Security Administration,
if necessary) (Social Security Award Letter)
6. SOCIAL SECURITY CARD (applicant and spouse)
7. PROOF OF MARITAL STATUS:
Copy of Marriage Certificate - if the following do not apply:
! Copy of Divorce Decree
! Copy of Separation Decree
! Copy of Death Certificate of spouse
8. SPOUSAL REFUSAL -
Original letter from spouse of applicant.
PLEASE NOTE THAT MEDICAID MAY SUE THE WELL SPOUSE FOR RECOVERY OF THAT WHICH MEDICAID PAYS FOR SPOUSE ON MEDICAID.
FINANCIAL DOCUMENTATION
Please note that financial documentation is needed for 60 months for a nursing home application, but only for ONE month for a homecare community application. The documentation set forth below requiring 60 months of information and transaction explanations is only for nursing home Medicaid.
For married applicants, documentation must include all information, whether it pertains to the Medicaid applicant or the spouse and whether in joint name with another or sole name.
In some instances, if the family goes to the financial institutions to request documentation, there will be no charge to obtain the documentation.
For all accounts, open or closed, during past 36 (60) months, applicant must provide the following:
9. CHECKING, SAVINGS, CD, MONEY MARKET AND OTHER ACCOUNTS:
! Copies of all monthly statements for the relevant period or copy of passbooks
! Documented explanation of withdrawals/deposits of $500 or more (sometimes starting with a threshold of $1,000 or more) (i.e., copies of checks and withdrawal slips)
10. STOCKS & BONDS: (anything owned and/or sold within the last 36 (60) months)
! Stock & bond certificates (copies)
! Statements from financial institution(s) (monthly, quarterly, etc.)
! Copies of other statements for the relevant period
(monthly, quarterly, etc.)
! Documented explanation of transactions of $500 or
more (sometimes starting with a threshold of
$1,000 or more)
! Letter from financial institution/broker stating value
of account as of "pick-up" date and the "approximate annualized interest income" projected for the account.
11. REAL PROPERTY: (house, condo, land, etc.)
! Copy of deed showing ownership
! Copy of deed showing transfer of ownership of property if transferred within last 36 (60) months
! Copy of a recent appraisal of market value.
! If the property is out-of-state, must be sold in order to obtain Medicaid eligibility unless spouse or disabled child lives in property.
12. COOPERATIVE APARTMENTS:
! Copy of stock certificate showing ownership
! Copy of re-issued/new stock certificate showing change of ownership, if transferred within 36 (60) months
! Copies of assignment and acceptance of assignment
of Proprietary lease and/or stock, if transferred
within 36 (60) months
! Copy of a recent appraisal of market value.
! If the cooperative apartment is out-of-state, must be sold in order to obtain Medicaid eligibility unless spouse or disabled child lives in cooperative apartment.
13. LIFE INSURANCE: (choose one)
Please note that life insurance is counted as an asset when determining Medicaid eligibility.
! Copy of insurance policy (cash surrender value must be stated)
! Statement from insurance company stating current cash surrender value.
14. IRS FEDERAL TAX FORM 1040 AND ALL RELATED SCHEDULES FOR THE PRIOR THREE YEARS (not required for homecare community application)
15. REPARATIONS: (i.e., German, Austrian, Japanese-American, Agent Orange Payments)
Exempt as income/resource (calculations must be done)
Should be kept in separate account
! Copy of check
! Affidavit of Receipt of Reparations
! Proof of total amount received
16. PROOF OF TRANSFERS OF MONEY OUT OF APPLICANT'S NAME:
(not required for homecare community application)
! Copies of statement(s) for account(s) in which transfer was deposited, showing deposit/transfer
! Copies of deposit slips into other accounts (s), if available.
! Copies of checks indicating to whom paid
OTHER IMPORTANT INFORMATION
1. The Medicaid applicant/recipient is allowed to have the following resources for the year 2005, in addition to exempt assets:
Please note that all amounts may change yearly
! Allowable Resources as of pickup month: $4,000.00
! Irrevocable Pre-Needs Funeral Agreement and possibly, a Burial Fund o f $1,500.00, a maximum, reduced by certain Pre-Needs Funeral Agreement payments (must be separate account so designated, and may grow with interest).
! Spouse living in the community when applicant/spouse is in a nursing home is allowed to keep $74,820 (and in certain cases more, up to
$95,100.00 or greater) plus Pre-Needs Funeral Agreement and, in certain instances, a Burial Fund to a maximum of $1,500; and income of 2,378.00/per month.
2. Documentation must be for 36 (60) months prior to "pick up" date (i.e., the date as of which the applicant's resources were within the allowable limits prescribed by Medicaid - see note no. 1). Documentation need only be for ONE month for homecare community Medicaid.
3. Applicable documentation must be provided for all assets in applicant's name, including all assets held jointly with any other person. A joint account is generally counted as a resource by Medicaid.
4. If there is a long-term asset divestment plan for Medicaid eligibility, check the current rules at least once a year.
5. Medicaid Applicants, or responsible parents, with excess funds, might be sued by Medicaid for reimbursement of that which Medicaid expended.
6. For individuals who last resided in New York City, for every $9,132 transferred, there is one month of Medicaid penalty for nursing home care. Rates are different in counties outside of New York City and change annually. See our Website for current regional rates.
7. Be sure, if possible, that Medicaid recipient's remaining account(s) is accessible either as a joint account or by means of a power of attorney with one or two additional people (e.g., spouse in the community and a child) so there will be no problem in accessing the account in the future. The spouse in the community should have a power of attorney so the assets can be accessed in the event the community spouse becomes incapacitated.
8. Please note that the Medicaid recipient's excess income will need to be paid to the homecare agency or to the nursing facility, even though a bill has not been issued during the pendency of the Medicaid application process.
9. We submit Medicaid Applications from our office; however, clients may check with the nursing home or community agency to see if they will submit the application for no charge.
Jay J. Sangerman, PLLC
171 East 84th Street, Suite 21B
New York, New York 10028
212-922-0711
212-439-0056 - facsimile