Medical eligibility for long-term care Medicaid isn’t always clear. Perhaps a recent fall or an early-onset dementia diagnosis has occurred, but there is uncertainty if the individual would qualify for benefits medically. Uncertainty around such a critical component of eligibility often leads to hesitation or inaction, placing families in vulnerable situations unnecessarily.

In partnership with Callahan Care Solutions, a personalized life care planning service, we are proud to offer the Level of Care (LOC) Assessment as a preliminary step toward understanding medical eligibility. The Level of Care Assessment is designed to give individuals and families clarity when exploring long-term care Medicaid benefits or utilizing long-term care insurance.

Conducted by our partners at Callahan Care Solutions, Registered Nurses with Medicaid expertise gather critical medical information—similar to what state agencies require when applying for the highest level of Medicaid programs—helping to speed up the process and increase the likelihood of program qualification.

Whether you are preparing to apply for Medicaid, need clarity on timing, or want to understand when to file a long-term care insurance claim, the LOC Assessment ensures you have the necessary clinical documentation to navigate the system confidently.

● A clear, objective understanding of whether Medicaid benefits are appropriate now or later.

● A streamlined, virtual experience conducted via phone or video.

● An assessment that aligns with what state agencies look for when approving skilled nursing-level Medicaid, ensuring you are well-prepared before the state review.

● Increased likelihood of being prioritized correctly in states with waitlists for long-term care Medicaid

● Actionable insights for leveraging your long-term care insurance benefits effectively.

● A foundation for your Medicaid team to build a strong, well-documented application to avoid unnecessary denials or delays.

● Comprehensive medical necessity assessment covering diagnoses, medications (including high-risk medications), cognitive status, and comorbidities.

● A detailed overview of all active medications with insights on safety risks, medication oversight needs, and fall risk factors.

● Cognitive and functional assessments that document why the individual may be unable to self-manage medical conditions.

● Justification for skilled nursing care to strengthen Medicaid eligibility under the highest level of programs.

● Documentation that can be submitted with your Medicaid application to avoid missing critical details that state reviewers look for.

● Insurance policy alignment for individuals with long-term care insurance to determine the optimal timing for claims.

● Guidance on additional programs for which the individual may qualify based on their current medical condition and state program structures.

● Appeals support if an application is denied despite high eligibility, with assistance provided at no additional charge.

1. Scheduling the Assessment

● The assessment is conducted virtually over the phone or via video, making it accessible in all 50 states.

● A typical assessment takes approximately one hour.

2. Information Gathering

● Callahan Care Solutions collects detailed medical and cognitive information similar to what state agencies require, including a physician-confirmed diagnosis and medication list when possible.

3. Assessment Documentation

● Within seven business days, you will receive a completed Level of Care Assessment ready for review and submission with your Medicaid application or to guide your long-term care insurance claims.

4. Review and Recommendations

● Clear documentation outlining whether Medicaid is appropriate now or later, your likelihood of approval, and next steps is provided.

● If the assessment indicates a high likelihood of approval, we proceed confidently with your Medicaid planning.

● If the assessment suggests the individual will not qualify, we help save time, energy, and resources by advising on the appropriate timing for future applications.

5. Support Throughout the Process

● If your application is denied despite high eligibility, we will support you through the appeals process at no additional charge, serving as a form of “insurance” for your application.

The Level of Care Assessment ensures that your Medicaid planning or long-term care insurance claim is strategic, efficient, and grounded in clinical evidence, providing you peace of mind and maximizing your eligibility for benefits when they are needed most.

Fill out the contact form below and one of our benefits associates will be in touch soon. They will schedule the free, 20-minute phone call discussed above that will determine if this service is a good fit for your situation.