Nursing home Medicaid is a program funded by the Federal government and administered by Georgia that pays the cost of nursing home care for those who have a medical need for such care. Along with showing a medical need for nursing home care, applicants for nursing home Medicaid must also satisfy income and asset tests to qualify for Medicaid.
The income and assets of an applicant for nursing home Medicaid are listed on the applicant’s Medicaid application, which is usually filed using the online process on the DFACS website. Along with the application, detailed statements documenting the income and assets of the applicant, and applicant’s spouse if applicable, must be provided with the application. After the information is provided, the caseworker at DFACS will follow up, usually be mail, and request additional information be provided. It is important to answer such requests in the time frame provided by DFACS.
Recently, we have seen a number of cases in which a complete application is submitted, evidence of all income and assets is provided, all of the follow up questions from DFACS are answered, and the application is denied on the basis of failure to provide requested evidence. This common practice frustrates applicants, results in delay of medical care, and is contrary to Georgia Medicaid regulations. The answer when an application is denied improperly on the basis of a failure to provide documentation is to request a fair hearing. A fair hearing is an appeal before an administrative law judge. Cases that are appealed usually do not result in a hearing, as DFACS caseworkers will work to resolve the case before a hearing. By timely requesting a fair hearing, an applicant preserves their entitlement to Medicaid and reopens the case at which time a supervisor will review for any information the initial caseworker may have missed.
While it is possible for an applicant to successfully obtain nursing home Medicaid on their own, given the growing complexity of the area, it is advisable to seek the assistance of an attorney. An experienced elder law attorney can protect assets and assist a Medicaid applicant to obtain the benefits they need as soon as possible.