EC DSS: Medicaid - Medicaid Long Term Care Eligibility

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Medicaid

Medicaid Long Term Care Eligibility

The Nursing Home Units is a specialized Medicaid Unit that determines financial eligibility for Medical Assistance for persons in Skilled Nursing Facilities, Intermediate Care Facilities, or in Hospitals with a discharge plan that requires placement in a Skilled Nursing Facility.

How to apply for Medicaid at the Medicaid Long Term Care Eligibility Division:

The application process begins by calling [716] 858-1901 to schedule an appointment for an interview. Most interviews are conducted with the legal representative of the person in need of nursing home care.

Interviews are scheduled primarily at 9:00 A.M. with a limited number at 10:30 A.M. at The Rath Building 158 Pearl Street Buffalo, New York 14202 - Room 230.

In addition to verification of gross monthly income and outstanding medical bills, the representative must supply the last 60 months of financial records. This may include bank statements and statements from brokerage houses. It is helpful if you can have photocopies available for us to retain in our records. We require documentation of the source of all deposits and withdrawals of $2,000 or more.

The Interview:

Certification interviews may last several hours. Normally, the more prepared you are and the less complicated the financial situation, the shorter the interview.
It is in your best interest to bring as much verification as possible with you to the interview.
A request for more verification may come up during the course of the interview, or be generated by information submitted after the interview. At the interview, you will be provided a list of essential missing information and a deadline date to send in this information. If you are unable to meet the deadline, please contact the examiner to request an extension.

Necessary Verification to bring to the interview:

All applicants and their spouse must provide the following verifications:

Birth Certificate
Social Security Card
Verification of address
Marriage Certificate

You must also provide verification for any of the following items that may pertain to your situation. Please note, if you are married, verifications for both husband and wife must be presented:

Naturalization Papers or Alien Registration Card.
Medicare Card.
Proof of Blue Cross/Blue Shield and/or private health insurance; plus a premium bill or other proof of cost and proof of last premium paid.
Proof of residence prior to admission to a Long Term Care Facility [nursing home].
Armed services discharge papers or other proof of service for applicant and spouse.
If separated or divorced - proof of separation or divorce.
If spouse is deceased - copy of the Death Certificate.
All bank and credit union account transactions for the past 60 months to date: savings, checking, Certificates of Deposit [CDs], and Individual Retirement Accounts [IRAs] - verification must be passbook or account statements. This applies to both open and closed accounts.
Explanation and proof [including receipts and cancelled checks] of all large withdrawals and deposits from bank/credit union accounts.
The last eight [8] pay stubs/statements from your employer.
Letter from appropriate agency or photocopy of most recent check for:
- Social Security
- Pension or Retirement
- Veteran's Benefits
- Railroad Retirement
- Union Benefits
- Workman's Compensation
- NYS Disability Insurance
- Court Ordered Support Payments
  NOTE: If any of the above benefits are deposited directly into a bank/credit union account, indicate most recent deposit on bank statement/book.
Letter from hospital verifying Alternative Level of Care [ALC] date and Medicare cut-off dates.
Letter/bill from nursing home verifying the 'paid through' date.
Stocks, bonds, and/or securities owned by the applicant during the previous 60 months to date and any transactions made within this period.
Face and cash values of all life insurance policies.
Trust and annuity contract(s) showing the amount of principal and income. All transactions for the past 60 months to date.
If applicant sold or transferred property within the previous 60 months, present closing statement of sale/proof of transfer.
If applicant has tenant(s): tenant(s)' statements/rent received; book showing amount of rental income, maintenance and repair costs.
Current proof of: mortgage/escrow, tax bills, homeowner's insurance premium, water bill.
Deed(s) to all property [real estate] owned.
If applicant's representative [or other individual] has Power of Attorney for applicant, documentation for this.

IMPORTANT: If you are unable to obtain Birth Certificate, Social Security Number, and/or Social Security Award amounts, request a TPQY [Third Party Query System] form for the applicant by calling the Social Security Administration at 1-800-772-1213. The TPQY does not verify citizenship, however a medicare card does verify citizenship.

Links to Internet sites with interesting and beneficial information:

Selecting a Nursing Home: New York State Department of Health - "Guide to Finding a Nursing Home in New York State"
http://www.health.state.ny.us/nysdoh/hlthcare/hlthcare.htm

New York State Department of Health - Nursing Home Facility Characteristics and Survey Summary Reports:
http://www.health.state.ny.us/nysdoh/nursing/main.htm

'The Official U.S. Government Site for Medicare Information provides detailed information about the performance of every Medicare and Medicaid certified nursing home in the country'
http://www.medicare.gov/nhcompare/home.asp

A Personal Account:
http://www.therubins.com/aging/homes.htm

Long Term Care Insurance: NYS Partnership for Long Term Care [Long Term Care Insurance]
http://www.nyspltc.org

For information on New York State's Medicaid program: http://www.medicaidinstitute.org

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Erie County Department of Social Services

Medicaid

Medicaid Long Term Care Eligibility