Nursing-facility Medicaid: care necessity and financial review

Nursing-facility Medicaid: care necessity and financial review Qualifications and requirements: Nursing-facility Medicaid requires medically necessary nursing-home care plus income, resource and other Medicaid criteria. A DHS LTSS caseworker determines eligibility through the current application and assessment process. Documents to prepare (confirm what is required): Facility and care assessment information; Income and resource records requested by DHS; Insurance and benefit information; Spousal information when relevant Exceptions and checks: Community-spouse protections or an income trust may affect financial screening. Obtain DHS or qualified legal review rather than assuming an amount above a published limit prevents applying. Questions to ask: Is the issue eligibility, admission, an unpaid bill or a denial?; Is a spouse living in the community? Next steps: Use the current DHS LTSS packet and county-office route.; Ask how financial and care assessments will be completed.; Keep decision notices and seek timely review help if denied. Limits: Application routing covers all counties. Applying does not guarantee admission, a bed, retroactive payment or every charge. Documents are preparation suggestions; DHS specifies actual verification.