Washington Elder Law Practice Report (#19) / Applying to Medicaid for long-term care

July 16, 2014

Medical LawThis is #19 in a continuing series of Washington Elder Law Practice Reports.

Applying for Medicaid-funded long-term care in Washington State has not been substantially affected by the Affordable Care Act (ACA).

As a result of the ACA, online applications can start with the Washington Health Benefit Exchange at www.wahealthplanfinder.org. However, for long-term care it is necessary to then link to a supplementary application at www.WashingtonConnection.org.

And even this does not trigger a real-time eligibility determination for long-term care. Extensive additional information and materials must be provided and then analyzed by a financial worker, who applies detailed procedures for the evaluation of such materials.

The criteria for eligibility have remained unchanged by the ACA.

If such an online approach is followed, additional materials may have to be scanned in and emailed (which may be time consuming and lead to various review issues), mailed, or delivered. Insurance policies, financial statements, and various types of legal documents are typically required for the eligibility review.

Thus, fundamentally, eligibility for Medicaid long-term care coverage still requires a paper trail in most cases.

Alternatively, for aged, blind and disabled applicants (who are known as “Supplemental Security Income (SSI)” related), Form 18-005 may be downloaded and completed, and mailed in or delivered to a Home and Community Services (HHS) office of the Department of Social and Health Services (DSHS), along with supporting materials.

These supporting materials must include details regarding all financial accounts (assets), income, and all types of financial transfers over the preceding five years.

In most cases, the paper approach may be the most-efficient and lowest-cost approach to submitting an application. Arrangements for an in-person application can also be made at an HCS office.

Long-term care eligibility further requires a special evaluation of the need for care by a social services worker for HCS. An assessment may be scheduled by calling in on a DSHS intake line.

In many cases, it is desirable to schedule such an evaluation as soon as possible, to establish the need for care. Social workers make use of detailed review procedures that are included on a laptop computer. An applicant has a right to have his or her attorney present at such an evaluation.

The continuing complexity of Medicaid applications for long-term care stands in distinct contrast to an online application for health care coverage through insurance or Medicaid, which is based only on income using the Modified Adjusted Gross Income (MAGI) standards.

Thus, a Medicaid application for long-term care services remains very restrictive. Those who need assistance with paying for such care and are SSI-related still have to face much more restrictive criteria (as well as potential application of the lien law to “pay back” the program for such assistance).

Relative “social values” have been placed on those needing health care coverage and those needing long-term care coverage. Those in the former category have had care made more available by the ACA, while those in the latter category have not. At some point, these differences may give rise to new political pressures.

More on Elder Law in Washington may be found in the “Elder Law” volumes of Washington Practice by Cheryl and Ferd Mitchell: Washington Elder Law and Practice (Vol. 26), the associated Elder Law Handbook (Vol. 26A), and the Washington Probate volume (Vol. 26B). These materials are available at www.legalsolutions.thomsonreuters.com under the tag Mitchell and Mitchell elder law. Additional updates may also be found on this blog under the tag Washington Elder Law Practice Reports.