Follow up & Follow Through on Paperwork
Once Medicaid eligibility is established, it has to be maintained. If a recipient no longer meets the medical screen, receives too much income, or accumulates too much in countable assets, they are no longer eligible for Medicaid and benefits can and will be terminated.
An applicant has the obligation of reporting any such changes to the county, i.e., inheritance, additional income, etc. If benefits are not terminated, either due to the applicant’s failure to timely report such changes or due to the county’s failure to timely terminate benefits, an overpayment will occur.
The applicant will be responsible for repaying the State for such benefits improperly paid.
Medicaid benefits are also now being terminated based on the recipient’s failure to pay the patient payment to the nursing home. This obligation needs to be stressed to the client.
Medicaid regulations allow an applicant’s spouse to retain a certain amount of assets in the spouse’s own name, i.e., bank accounts, cars, investments, etc. This allowance is known as the “community spouse resource allowance” or CSRA. Once Medicaid benefits are approved, the spouse is required by Medicaid regulations to retitle all such assets into the spouse’s name alone. This retitling is required to occur within one year of the date Medicaid is approved.
Once the assets are separated between the spouses, the “household” then consists of the Medicaid recipient only. The spouse’s assets are no longer relevant. Despite this, the counties usually will request this information in the annual redeterminations. The spouse’s income and expenses continue to be relevant in order to determine the spouse’s income allowance from the institutionalized spouse, if any.
The counties are required to do an annual “redetermination” of eligibility. They will typically send out a form listing the applicant’s information, which is usually quite inaccurate. They will likely also request additional documentation as proof of continuing eligibility. The applicant needs to note the corrections and return it to the county along with any requested documentation. If the redetermination paperwork is not completed and returned, the county can terminate benefits. The counties are also able to request a redetermination at any time they deem it necessary. Usually, it is done only annually.