Lisa notices her mother’s health and mental capacities start to decline rapidly after the holidays. When she discusses it with her mother, Gale, things are worse than Lisa imagined. She realizes her mother will need long-term care soon, maybe even a nursing home, but the family can’t afford that. So, Lisa learns what she can about Medicaid and helps her mother submit an application as soon as possible. But when that’s done, all Lisa can do is wait and worry.

She’s worried about her mother’s health and safety because Gale might need care before her application is approved. If that’s the case, Lisa doesn’t know how she’s going to pay for it, and she has no idea how long Medicaid approvals usually take. She’s also worried that she didn’t have Gale apply for the right program, or she didn’t fill out the application correctly, because everything was rushed. If they don’t get the benefits they need, or they get denied, Lisa’s worries will explode.

If she had connected with Eldercare Resource Planning, our team of professionals could have eased some of Lisa’s concerns. We know how long Medicaid offices usually take to approve or deny applications because we’ve submitted thousands of them. We could have advised Lisa and Gale on how to use Medicaid programs that are specifically designed to help applicants cover healthcare costs while they wait for approval. And we could have helped them correctly complete and submit Gale’s application so there would be no worries about getting denied because of a simple mistake.

Connect with one of our Certified Medicaid Planners to learn more about approval times and Medicaid long-term care, or keep reading.

Average Approval Times for Medicaid Applications

States are required by federal law to approve or deny Medicaid applications within 45 days, or 90 days for applications that require a disability determination. However, data we’ve compiled from more than 500 of our clients nationwide show that states take longer than 45 days to respond. We have found that:

• From the day our organization submits an application to the state’s Medicaid office to the day our clients received a determination letter (either an approval or denial) takes an average of 83 days.

Here are a few other interesting tidbits we found while we were analyzing all that data:

• Nursing Home Medicaid applicants were approved, on average, in 79 days.
• Home and Community Based Services (HCBS) Waiver applicants were approved, on average, in 89 days. HCBS Waivers cover long-term care benefits in the beneficiary’s home, the home of a family member or other places in the community.
• Single applicants were approved, on average, in 81 days.
• Married applicants were approved, on average, in 87 days.

There are a number of things that might lead to a delay in approval time. Offices might be temporarily understaffed. Documents could be lost or misplaced. Automated decision-making systems might make denials without adequate reasons.

We have noticed consistent delays during certain months of the year. Here are the Medicaid approval times (in days) broken down by month. Notice the 40% increase from May to June, when many people take vacation time. Or the 29% increase in wait time from October to November, the start of the holiday season.

While Medicaid rules and regulations vary by state, we did not find a statistically significant difference in average application approval times by state.

Approval Does Not Guarantee Immediate Assistance

Just because a Medicaid application is approved does not mean Medicaid benefits will be immediately available. This is an important distinction, and the Medicaid program a senior is applying for impacts how soon care is available. For example, a senior may be approved for long-term care benefits at home through a Home and Community Based Services (HCBS) Waiver, but there might not be any available in-home caregivers in the senior’s area. What’s more, many HCBS Waivers programs have a limited number of enrollment spots, and once those spots are full additional applicants, even if they are qualified, will be placed on a waitlist.

Nursing Home Medicaid is an entitlement, which means all eligible applicants are guaranteed coverage without wait. However, not all nursing homes accept Medicaid, and those that do may not have any available spaces when you or your loved one is looking for one. So, even though eligible applicants are guaranteed nursing home coverage, they are not guaranteed a spot in any nursing home they want. They may have to wait for a spot to open up or move into a different facility that does have open spaces.

Average Time to Prepare a Medicaid Application

Families considering Medicaid long-term care coverage should also know how long it takes to complete a Medicaid application, which includes gathering official documents that clearly illustrate the applicant’s financial situation and prove they meet Medicaid’s financial eligibility requirements – the asset limit and the income limit. Our data shows that from the day we start working with our clients to the day we submit their Medicaid application takes an average of 79 days. So, on average, it takes a total of 162 days for our clients to be approved for Medicaid: 79 days to complete the application + 83 days waiting for approval = 162 days, which is about five and a half months.

However, anyone attempting to complete a Medicaid application without the help of a professional should expect it to take longer than 79 days. Our team has completed thousands of applications and we are experts in all areas of Medicaid, which is one of the most complex government systems ever created. Trying to navigate it for the first time will likely add weeks if not months onto the time it will take an amateur to complete an application.

The most time-consuming part of the application process is gathering all of the required financial paperwork. Some seniors and their families may have a complete understanding of their financial situation and can find the right documents without delay. What’s more typical, however, is that the senior and their family doesn’t have a complete grasp of the situation. There might be forgotten bank accounts or investments, or maybe an irregular IRA withdrawal. It’s not uncommon for the adult child of an applicant to need Power of Attorney in order to collect the right paperwork, but they don’t have it and so another time-consuming step is added to the process.

What’s more, the number of required documents is multiplied by Medicaid’s Look-Back Period. In order to prevent applicants from simply giving away their assets to meet the asset limit for eligibility, Medicaid uses the Look-Back Period. In most states, the Look-Back Period is five years. This means applicants must supply documents that illustrate their financial history for the five years before prior to their application date. To learn more about the Look-Back Period and the two states where it’s not always five years long (California and New York), click here.

Required Documents and Information for a Medicaid Application

The following assets must be documented for Medicaid applications:

• Cash
• Stocks
• Bonds
• Investments
• Promissory notes
• Savings, checking and credit union accounts
• Real estate in which one does not reside
• Non-primary vehicles
• All other assets easily converted to cash

The following income sources must be documented for Medicaid applications:

• Employment wages
• Pension payments
• Social Security Income
• Supplemental Security Income
• Social Security Disability Income
• IRA withdrawals
• Stock dividends
• Alimony payments
• Veteran’s benefits

Gathering financial documents be the biggest delay in the Medicaid application process, but it’s not the only one. Because Medicaid’s financial rules are complicated, families often submit applications for individuals who have too much income or too many assets, so the application is denied and they have to start the process again. They may make a mistake when calculating finances. They may not respond to a question from the state Medicaid office in a timely manner. These are all problems that would most likely be avoided by connecting with one of our Certified Medicaid Planners.

Functional Eligibility Requirements for Medicaid

In addition to meeting Medicaid’s financial requirements, and having the paperwork to prove it, Medicaid applicants must also be sure they meet the functional (medical) requirements to avoid delays in their approval. For Nursing Home Medicaid and most Home and Community Based Services (HCBS) Waiver applicants, this means requiring a Nursing Facility Level of Care (NFLOC). However, how a NFLOC is defined and measured can change depending on the state.

In some states, a NFLOC might mean needing help with three of the Activities of Daily Living: mobility, bathing, dressing, eating and toileting. In some states, a NFLOC might mean needing help with four of those activities. During the evaluation process some states may place a greater emphasis on mental health or behavioral issues than other states.

Most Nursing Home Medicaid applicants, however, are already residing in a nursing home when they apply for Medicaid and do not require a functional evaluation. Most HCBS Waivers applicants, however, will need a functional evaluation. How that is handled will depend on the state. Some may use a local Area Agency on Aging, others will rely on the Department of Human Services. Still others have independent nursing organizations that administer the level of care evaluations.

Medicaid Pending and Retroactive Medicaid

Seniors can sometimes receive long-term care coverage while they’re waiting for their application to be approved via Medicaid Pending. They can also be reimbursed for care they received just prior to submitting their application through Retroactive Medicaid.

Medicaid Pending
When a senior has applied for Medicaid but is still waiting for approval, they have “Medicaid Pending” status. Some nursing homes and caregivers will provide services to seniors who are Medicaid Pending. They are assuming the individual will be approved for Medicaid and they will be reimbursed for their services by Medicaid. Some facilities may try to charge Medicaid Pending seniors with the promise of paying them back if their Medicaid application is approved, but we do not recommend entering that type of an agreement.

Retroactive Medicaid
In some states, Retroactive Medicaid can help cover the cost of long term care for up to 3 months prior to the date an application has been submitted. However, the applicant must be approved for Medicaid and must have also met Medicaid eligibility requirements for those 3 months. For example, Zoe moves into a nursing home in January, but doesn’t apply for Medicaid until April. Her application is also approved in April. Since she also met the asset and income eligibility limits for January, February and March, Medicaid will pay her unpaid nursing home expenses for those 3 months. In some states, Zoe would also get reimbursed for the expenses she paid for during those three months, while other states will only cover unpaid costs. Note that some states have eliminated or restricted Retroactive Coverage.

How a Certified Medicaid Planner Can Help with Approval Time

Knowing exactly what Retroactive Medicaid will cover and how to handle it can be tricky. But our Certified Medicaid Planners have utilized Retroactive Medicaid so many times they understand it inside and out. Same goes with Medicaid Pending.

In fact, when it comes to applying for Medicaid, waiting for approval and doing it all in a timely fashion, our team of professionals has the process locked down. We know which assets and which income sources will be counted toward your eligibility limits, and which ones can be exempt. We know what documents will be needed to clearly illustrate your finances, where to find those documents and how to submit them with the Medicaid application.

Knowing that a professional completed the application should ease your mind while you wait for approval, but if you get anxious during the wait our CMPs can help. We’ll be able to tell you average wait times for the program you or your loved one applied for. And we know who to contact, and how, if the wait is too long.

Once the wait is over and you or your loved one has been approved for Medicaid, our team will review the benefits package to make sure it’s correct. If you’re not getting everything you deserve, we will follow up and make sure that you do.

Applying for Medicaid can be challenge, and waiting can be the hardest part. We’d be happy to ease your burden, so connect with us now.