25 Mar 2018
Created in 1965, the Medicaid program was designed to provide health coverage for low-income people. While the federal government establishes certain parameters for all states to follow, each state administers their Medicaid program differently, resulting in variations in coverage across the country.
In New York State, Medicaid for long-term care (nursing home care or care at home) is applied for a little differently than Medicaid as a form of health coverage (for young people).
Each county in the state has its own Medicaid office and applications are processed in the county in which you reside. Here in Westchester, long-term care applications are processed through the Medicaid office in Mt. Vernon. Outside of Westchester, your local social service office should be contacted. Applications can be mailed in. A face-to-face meeting is not required.
When filing for Medicaid, you use an application called Access NY Health Care. There are also a couple of supplemental forms that must be submitted with long-term care applications.
In addition to the Medicaid application, several documents are needed to support your eligibility. The documents most often required are listed below:
1. Proof of Identity: Two forms of identification. Ideally, one is a picture ID and one is proof of citizenship or legal status in the U.S.
2. Social Security Card/ Medicare Card/Supplemental Insurance/Rx plan: In addition to these cards, have proof of any premiums paid.
3. Veteran Status: Copies of Military Discharge Papers (i.e.; DD214) for the applicant or spouse
4. Proof of Marital Status: A marriage license; divorce papers if divorced; death certificate if widowed
5. Residence Information: Either a deed of owned property, tax or mortgage statement or a lease if renting
6. Income for the Current Year: Include current Social Security Award Letter; proof of pension
7. Deed to Burial Plot and/or Prepaid Burial Information:
Statements: For the three consecutive months prior to application for at home care or for the prior 60 months for nursing home care
9. Life Insurance: Showing face value and cash value of all policies
10. Power of Attorney and Any Trusts established by the applicant
Once you file, the state has 45 days to process the application. Presuming eligibility, applications that are completed properly and accompanied by all required documents are often approved within that time frame. If that’s not the case, your application will be kicked back for more information or denied.
When you are approved, you then need to seek long-term home care services or nursing home placement. The home care process is a bit complicated and includes two home assessments: one from NYS Medicaid Choice and one from a Managed Long Term Care Plan (MLTC) – that ultimately determine the number of hours of care and service provision.
Navigating all of these aspects of the application process is quite difficult. This can be compounded by caregiving responsibilities. With the help of a knowledgeable Medicaid specialist, the process of obtaining coverage and services can be much easier, quicker and less stressful.