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Medicaid: How To Apply For

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It is best to prepare for applying for Medicaid before actually applying.

All Medicaid programs have what is known as "Presumptive Medicaid." With Presumptive Medicaid, Medicaid coverage can start at the time of applying for Medicaid without waiting. This applies to some classes of applicants. While staff are supposed to check to see if you qualify for Presumptive Medicaid, it is always advisable to ask if you qualify to be sure it is considered in your case.

Medicaid can pay for old medical bills up to 3 months before the date of your application. 

It is best to prepare for the meeting by pulling together all the information Medicaid needs.

  • If you don't have all the information you need when you first apply, you face seeing a different person when you return with the rest of the documentation. Even if the person you see has all the old paperwork, you may basically be starting over. At least one person who helps people complete Medicaid applications finds that documents delivered later frequently don't make it into an applicant's file.
  • It is not advisable to try to fool Medicaid about the amount of your income or assets. Keep in mind that the agency will have your Social Security number which means agents can learn about bank accounts and other income or assets you may not disclose. Penalties can be severe.

Patient Navigators who specialize in financial matters help people complete Medicaid forms. Staff in your doctor's office or in a local treatment center can likely help you find a Patient Navigator who can help, usually at no cost. Navigators know the tricks to make applying for Medicaid easier. For instance:

  • If your rent is being paid by someone else, name that person as "Head of Household." Otherwise you have to at least put together a letter explaining the situation and deal with questions.
  • Resources are generally counted at midnight on the first day of the month for which eligibility is sought. Issue checks early enough in the previous month to assure they have cleared through your bank account by the end of the month.

There are some days and times better than others to apply for Medicaid. It is preferable to avoid Mondays, Fridays and the first few or last few days of the month. Those are generally very crowded days.

If you're also applying for Supplemental Security Income (SSI), it is advisable to apply for SSI before applying for Medicaid.

When the interview is complete, ask for a "Pending Letter." A Pending Letter is proof that you applied for Medicaid. It is proof that you filed in case your file is lost. It may also help you start getting medical care.

After the interview, a different Analyst will review your medical records to determine if you are "disabled" for purposes of Medicaid (this is known as the "Medical Review."). There may be additional forms for you to fill out. If the Analyst requests a Consultative Exam (a physical exam by a doctor), you have the right to request that your own doctor do it.

If your claim for Medicaid is denied, you have the right to appeal.

NOTE:

  • If you need medical expenses to reduce your income to qualify for Medicaid, you need to have medical bills every month for there to be coverage for the month. To learn more, see: Medicaid: Spend Downs.
  • Keep in mind that Medicaid has to be recertified every six months. Now is a good time to start keeping all the information Medicaid requires in one place.

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