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THE CALIFORNIA MEDICAID (Medi-Cal) APPLICATION PROCESS
How to apply for medi-cal in CA
Note: This information is general, and may or may not apply to your area.
Although practice differs slightly from county to county, the basic format is relatively the same.
An application for Nursing Home Medicaid is filed with the County Office in the county where the loved one is receiving his/her long-term care. Some counties may have more than once office located in their jurisdiction. Other counties may have their Nursing Home Medicaid applications overseen by an adjacent county. Among other the things, the family is requested to list the loved one’s assets and liabilities.
When the application is submitted, the family also needs to supply additional documentation to corroborate the asset and liability values stated on the application.
Married Couples With An At-Home Healthy Spouse:
Note that when there is an at-home community spouse, the Nursing Home may have the family complete a Resource Assessment prior to the filing of the Medicaid Application. This enables the family to determine how much the at-home spouse will be allowed to keep. Anything over and above that amount will have to be spent down pursuant to CA Medicaid guidelines.
A person must be financially eligible to qualify for Nursing Home Medicaid. It is for this reason that the Nursing Home forwards a form entitled: “Long Term Care Admission and Discharge Transmittal Form MA-103” to the County Assistance Office. This form also enables the Medicaid caseworker to determine the admission date and the requested effective date sought by the Nursing Home.
In order to verify the applicant’s resources, the County Assistance Office will require the loved one to sign PA-4 (Authorization for Release of Information).
In addition to being financially eligible to receive Medicaid, one must also be “medically eligible.” It is for this reason that the County Office on Aging obtains a medical evaluation (Form MA-51) from the loved one’s doctor. Upon receipt of this information, the County Office on Aging will prepare an OPTIONS DETERMINATION REPORT. This report evaluates whether or not the loved one’s needs could realistically be met by “at-home care”. If such is the case, Pennsylvania has a Medicaid Waiver program which may provide certain subsidies for caring for a loved one in their own surroundings. If the report indicates that the loved one’s needs can only realistically be met in a skilled nursing facility, the County Assistance Office is alerted accordingly.
Gifts Given During Previous Five Years:
During this process, the family will also be asked to complete another form. This form ask the family to divulge any gifts (or uncompensated transfers) for the previous 60 months. Unless the transfers can be legally justified, this may postpone the approval of the application.
Notice of Eligibility or Rejection:
After the County Assistance Office has had the opportunity to scrutinize the application and supporting materials, they issue a determination. This is known as NY 162 (Notice of Eligibility or Rejection). If the Nursing Home Application is approved, the family will be so advised. If additional information is needed for the County to make a determination, that will be revealed as well.
If the application is rejected, the family has the option to supply any additional documentation or ask for an appeal. The appeals process is known as a “Fair Hearing.”
Assets and Income Transferred to the At-Home Healthy Spouse:
When there is an at-home “healthy” spouse, Medicaid will allow certain assets or monthly income to be transferred to such person.
What can be transferred is set by guidelines set forth the New York Department of Public Welfare (DPW). The family must complete a certification as to what assets and income will be shifted to the community spouse. This must be done within certain time guidelines established by the department.
CA Medicaid Application Process | California Medicaid Applications
CALIFORNIA MEDICAID APPLICATION
Medicaid application in CA