Five Ways to Mess Up Your Application for Medicaid Home Care

“I called my Department of Social Services and Medicaid for FOUR YEARS and asked to apply for a Medicaid Waiver for my daughter. Every time they discouraged me and told me my daughter would not qualify. Finally, I insisted on an appointment with a nurse for a home screening. After the interview, the nurse told me my daughter definitely qualified, and she should have applied years ago.” – Peony

“When I called I was told that I needed to have Medicaid to apply, and since I had been turned down for Medicaid, I could not be in this program. I gave up for a year. Then my friend gave me the number of my local area agency on aging. They explained the rules to me and I was approved three months later.” – Rose

Sometimes people get turned down for Medicaid home care because they apply for the wrong program or their application gets processed the wrong way. Tips from readers for avoiding problems with your application:

Tip # 1: Apply for the Medicaid Program Not the Medicare Program 

Some of our readers report that they accidentally wound up applying for the Medicare program instead of the Medicaid one. The Medicare program only gave them a few hours per week of care, wouldn’t let them choose their own aide, and then ended after a few months.

You want the Medicaid program. The Medicaid program typically offers 10-30 hours per week, allows you to choose your own aide if you wish, and provides ongoing care. Even if you are not on Medicaid now, you can still apply for the Medicaid program.

Tip # 2: Check the Box

The Medicaid application and the doctor’s forms may have a question about “nursing level of home care” or “institutional level care” or “longterm care” or “services to avoid institutionalization.”

Many people are (understandably) afraid to check this box and many doctors are (understandably) afraid to check the box for their patients. However, this box is not going to put you in a nursing home.

This box is a way to request to be screened for “nursing home level of need.” This box means you need to get services to avoid going into a nursing home.

If you are applying for a waiver, and you don’t check this box, you will be automatically denied. If it appears on doctor’s forms, your doctor does not check the box, you will be automatically denied.

Tip # 3: Learn The Criteria Before You Call 

Some of our readers report that they started out by answering a few questions about their needs on the phone. Then the person on the phone told them they weren’t eligible.

Then months or years later they learned more about the rules and discovered they really were eligible all along. They called back and requested a full at-home assessment, gave much more details about their care needs, talked with their doctor about their application, and got approved. How to Apply for a State Home Aide Program

Tip # 4: If You are on QMB or SLMB You Are Not Really On Medicaid

QMB is a Medicaid program that pays for your Medicare premiums and co-pays. Even though it is a Medicaid program, it’s not full-scope Medicaid. To qualify for home care, you’ll need to also apply for full-scope Medicaid.

Tip # 5: If You Have Too Much Money for Medicaid, You May Still Qualify

If you are not already on Medicaid, you’ll need to apply. But wait! There’s a bunch of reasons why you might get (incorrectly) denied. Learn more below.

Medicaid may be called something different in your state. It might be called Denali Care or Badger Care or Medi-cal or Medical Assistance. What’s medicaid called in my state? 

Still Having Problems?

You have the right to request an assessment. If you have an assessment and get a formal denial letter.  Having Problems Applying for a State Home Aide?

Five Bonus Tips for People Not on Medicaid

Exclude Spousal Income. Exclude Parental Income. 

For most waiver programs: If you are married, your spouse’s income does not count. If you are a parent applying for your child, your income does not count. If you live with other people, their income doesn’t count. (Exception: If your spouse is also applying for Medicaid home care, rules change).

One common reason for denials is the person at the Medicaid office doesn’t realize they need to exclude parental and spousal income. If this happens to you, you can appeal the decision.

Another option is to check with a supervisor or the person who handles waivers at your local Medicaid office. In many states, they will tell you to leave out all spousal and parental income off your application to avoid this problem.

For example: Parent applies for child. Medicaid worker says to leave out parental income. Parent does not include their own income, but lists child support and child’s SSI income only.

Apply for a Medicaid Waiver Not Standard Medicaid

Some of our readers report that they tried applying by contacting Medicaid. They were turned down for having too much income.

Then months or years later, they learned more and discovered they really were eligible all along. They applied again, this time making sure they were not applying for regular medicaid. They were applying for “medicaid longterm care” or a “medicaid waiver.” Then they got approved.

Example: In many states, the income limit for disability medicaid is $800 per month, but the income limit for medicaid waivers is $2,300 per month. Big difference!

If You Apply Online

Some states let you apply for medicaid waivers online.

Once again, make sure you are applying for Medicaid waiver, or Medicaid longterm care. The online system should show you how to do this. If it doesn’t, you may wish to apply in person or on paper instead.

Tips from Readers: Some readers apply on paper and at the top of every page they write the name of the waiver program they are applying for in large red letters. Then they call and ask to speak to a supervisor or to the person in charge of Medicaid waivers to make sure it is processed correctly.

If You Call Medicaid

If you contact Medicaid, try telling them the name of the waiver program you are applying for. Ask to speak to the person who handles eligibility for that specific program. Whenever possible, talk to that person, not the person who answers the phone.

Don’t be surprised if the person who answers the phone tells you something that sounds crazy! It might be Medicaid Workers Can Say Weird Things

Azalea was told she couldn’t apply unless she was already approved for Social Security disability. Turned out not to be true! Do I Need to Be On Disability to Get Medicaid Home Care?

If All Else Fails

If it turns out you really do have too much money or too many assets for a Medicaid waiver, you still might have some options. How to Apply If You Have Too Much Income