FinanciallyEligible but Still No Medicaid (Part 2)

In my post last week, I told you that, while our focus in achieving Medicaid eligibility tends to be on the financial part, there are some non financial requirements we must also pay attention to.  One is medical eligibility.

Another is residency.  Medicaid is a combination federal and state program.  Federal funds are provided but the programs are applied for and administered on the state level.  This means that if I apply for Medicaid in New Jersey I must reside in New Jersey.  There is, however, no “waiting period” to establish residency.  In other words, if I move to New Jersey today and can prove I intend to remain here as a resident, I can apply for Medicaid today in New Jersey.

When an applicant is in a long term care facility – whether a nursing home or an assisted living facility- establishing residency is easy.  If applying for home care, one must prove residency by home ownership, a lease or other proof that New Jersey is now their legal residency.  Changing a driver’s license, voter registration, utility bills addressed to the applicant at their New Jersey residence all can be proof.

There is, however, another aspect to the residency requirement.  That is legal residency.  An applicant must be living in this country legally to be eligible for Medicaid.  One does not have to be a U.S. citizen but must be here legally.  Over the years, we have received calls from families and health care providers about individuals who were not eligible because they were not in the country legally.  It would appear to be straight forward but at times it can be tricky.

In some cases a potential applicant may be here legally as a refugee for some period to time, however, that status can change based on changes in immigration and refugee laws.  There must be legal status at the time of the Medicaid application.

These non financial eligibility requirements do not arise in a majority of cases but when they do, meeting the financial tests will do no good because the application will be denied for failure to meet one of these other requirements.