Medicaid Application Finish Line Shortened

In the past several years, especially since COVID, the Medicaid application process has become more lengthy and time consuming.  More documents are now required in order to achieve Medicaid approval than ever before.  The 16 page application is the easy part but I always tell people that you must have your ducks in order before filing, meaning you need to have the majority of the documents needed, ideally included with the application.

A new Medicaid Communication issued by the State of New Jersey puts a 45 day limit on the time to process Medicaid applications, beginning with the date the application is received. When an application has a discrepancy or insufficient information, a Request for Information (RFI) letter will be sent detailing the documentation needed.

The applicant then has 14 days to comply or the application will be denied.  The State does allow for extensions of time in the case of what it terms, but does not define, as “exceptional circumstances”. The MedComm does also state that if the applicant requests additional time and continues to cooperate in good faith, an additional amount of time may be granted.

A few counties have operated under a 45 day time limit for some time before this MedComm was issued.  Now it appears that every county must do the same which  will likely increase the frequency of denials.  While one can always reapply, remember that a request for benefits can only be made up to 3 months back from the month of application.   Repeated denials for failure to provide documentation will eventually result in lost benefits.  In monetary terms, that could mean out of pocket nursing home costs in the tens or even hundreds of thousands of dollars if Medicaid won’t cover the cost.

The message is clear.  Take the application process lightly at your own risk.