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.

If you are given a choice about applying for Medicaid in person or through another means such as on line or through the mail, experts who have helped people apply recommend appying in person. When you apply in person, there is a clerk who can help you through the process. There is also less likelihood that things will get lost.

If you need help completing forms, 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.

For more information, see:

• What To Take With You When Applying For Medicaid  
• How To Prepare Before Applying For Medicaid  
  
• Where To Apply For Medicaid 
  
• Best Days And Times To Apply For Medicaid  
  
• How To Prepare For The Interview When Applying For Medicaid  
  
• At The Interview When Applying For Medicaid
  
• The Medical Review  
  
• The Consultative Exam (Examination By A Doctor)
  
• Medicaid: Appeals

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.

Although each state has its own Medicaid application procedure, they all require information about you, your financial situation and your medical condition in order to determine whether you are eligible for Medicaid.

Following are items that are typically needed when applying directly for Medicaid. It's advisable to take the time to assemble all that you will need. It will save you time in the long run.

Proof of Identity

• Birth certificate.
  • Preferably an original or certified copy.
  • If you were not born in this country, the state may accept other early documentation such as a baptismal certificate, entry in family bible, school records or other documents from your childhood.
• Proof of citizenship or legal status if not born in the U.S.
• Military discharge papers, if there are any.

Proof of Residency

• If you rent the premises you live in:
  • Documents that show the amount of your rent. This can be a lease, a rental agreement, rent receipts, notices of rent increases, or similar documents.
  • Documents that show your address to prove that you are a resident of the state and county and are using the right office. In addition to the above documents, you may also use: utility bills with both your name and the residence address, official documents from other government agencies such as Social Security or the Department of Motor Vehicles that show your address.
• If you're a homeowner:
  • Proof of ownership, such as deed or trust documents, as well as the location of the home. In addition to proof of ownership, it may be helpful to take utility bills with both your name and the residence address or official documents from other government agencies such as Social Security ore the Department of Motor Vehicles that show your address.
  • Documents such as a loan agreement, receipts, canceled checks, or other documents that show your housing costs. Medicaid uses this to crosscheck the reasonableness of the other information you give. For example, if you report your income is $500 but you pay $750 for your mortgage, there are going to be questions about how you're able to do that.

Proof of Income

Medicaid needs to know what you're living on. Take with you:

• Paycheck stubs. Include stubs for the past three months in case you are applying for retrospective payment of past bills.
• Copies of checks you receive from Social Security or take the Social Security award letter which shows you are entitled to receive Social Security Disability Insurance (SSDI) benefits.
• Award letters or check copies from the Veterans Administration or other pensions and disability programs that pay you income.
• Any document that shows other income you receive. Information about your current and past resources.

Documentation of What You Own

• Auto registration and loan or lease agreement for all autos and other vehicles you own or lease.
• Life insurance policies.
• Deeds or other documentation of other property you may own besides the home in which you live.
• Proof of ownership of stocks, bonds, mutual funds, CDs or other similar assets.
• Monthly statements of bank accounts, checking accounts, money market accounts, and other liquid cash type funds. NOTE: Medicaid will require such statements for at least the last three months, and sometimes as much as six months.
• If you transferred any substantial assets within the last five years, be prepared to discuss the transfers and to show documentation if the transfer was made for a reason other than becoming eligible for Medicaid. There may be costs and delays if you need to contact financial institutions and order copies of any missing records. (The reason for the request relates to the penalty Medicaid imposes if you need custodial care and transffered assets within the last 5 years to qualify).

Medical Bills if you want to backdate Medicaid coverage.

Medicaid rules permit backdating coverage for up to three months prior to your applying. If you want Medicaid to pay for medical bills incurred before you apply, pull together a copy of each bill you want covered.

Make sure you take documentation to show that your income and resources were limited enough to make you financially eligible during those months.

Proof of Medical Condition if you are applying for Medicaid based on disability

Proof of a disability can come solely from your medical records. However, to speed the medical review process, also consider obtaining medical statements, and third party testimony. Also take a copy of your logs indicating the impact of your health condition on your work and activities of daily living. •

• Medical Records. Although Medicaid doesn't request or require it initially, you can substantially speed up the process if you obtain copies of all your medical records from your various doctors and other health care providers and take them with you to the interview.
  • This would include all medical records from any professional whose record would support your claim of disability including primary care physicians, specialists, a psychiatrist or psychologist, even chiropractors and podiatrists if their records relate to your claim.
  • Review the record to make sure every symptom, infection, pain and complaint is thoroughly documented.
• It will also speed the medical review process if you take:
  • A detailed disability statement from your doctor(s), listing all of your symptoms and stating how the symptoms keep you from working. NOTE: This is generally required if you intend to apply for Presumptive Medicaid.
  • Your daily log. A copy of your Symptoms Diary and/or Work Journal which show the changes in your health and how it impacts your ability to do your job.
  • Third party testimony. Letters and written statements from friends, co-workers, family, or any one who knows about your condition and has observed its effects on your day-to-day functioning can be very helpful. See sample letters below. One of the most helpful letters could come from your supervisor or employer who has observed, and perhaps even written up, the decline in your performance at work. For samples, see the next two sections. Also see: Social Security

NOTE: Submit photocopies - not originals.

It is best to submit photocopies of documents - not originals. (If you make a copy of each document, you can take both the original and copy with you. The representative can see that the copy is a duplicate of the original. You can then keep the original while handing over the copy).

If you don't have access to a copier, take the original and ask the representative to make copies and give you back the originals.

Ask for proof that shows what documents you gave to Medicaid and when. Proof may be as easy as a simple date stamp.

See the next section below: How To Prepare For The Interview

Whether you need Medicaid for general medical care or for "custodial care" in a nursing home, every state has income and asset requirements. If either your income or assets exceed those requirements, you will be denied Medicaid.

To prepare for applying for Medicaid, take the following steps:

Step 1. Check the rules in your state for eligiblity for Medicaid.

• What is the maximum amount of income the rules allow?
• What is the maximum amount of countable assets you can have and still qualify for Medicaid? (Assets such as your house generally don't count).

Step 2. Check your income and assets against the rules.

• When thinking about your income, include Social Security and other disability benefits you may be entitled to receive.
• Note that even if you have more income than allowed, you may still become eligible for Medicaid if you incur enough medical expenses each month to bring your income below the maximum allowed in your state (this is known as "Spending down" or "Medically Needy"). Be aware that you will be expected to spend down your income each month before Medicaid takes over coverage.
• Assets and income can be transferred to someone else in order to become eligible financially for Medicaid. There are different transfer rules depending on whether or not the care you need is "custodial care" such as in a nursing home.  (In most states you can transfer income and/or assets and qualify immediately for Medicaid for non-custodial care. There is a 5 year look back period for custodial care). 

Step 3. Pull out copies of old medical bills for at least the last three months. Medicaid may reimburse you for these bills. Generally, you have to attach the bills to your application. If you don't follow the rules about submitting old medical bills, they will not be paid for.

• Be sure to take copies of old bills with you when you apply for Medicaid. 
• Take older bills as well if they are available. Let the representative tell you whether the state pays for them or not. 

Medicaid is applied for in the state in which you live. In some states, you can apply for Medicaid as part of the process of applying for Supplemental Security Income (SSI).

When you are ready to apply for Medicaid, find out which entity processes Medicaid applications. In some states a state agency processes Medicaid applications. In others, each county is responsible for processing the Medicaid applications of its residents. To find the correct place in your state, see: http://covertheuninsured.org/stateguides/ or call Medicare at 800.633.4227. Ask for the Medicaid office in (name of your state.)

 Where To Apply For Medicaid If You're Not Confined In An Institution.

Contact the state agency that handles Medicaid in your state and ask for the following information:

• The location of the office that you should use. NOTE: Many states require you to use the office in the area in which you reside. (This is unlike Social Security which allows you to pick which office to use).
• Do they accept appointments for an application or must you simply walk-in and wait your turn? 
• What are the office's hours?
• What documents should you bring to the appointment?
• Whether you can apply online - and if so, how. (Individual stories indicate you have a better chance of getting Medicaid if you go to the office instead of applying online.)
• Are there public clinics at which you can apply? If so, ask whether applications taken at the clinic take longer and/or have more problems than applications filed at a Medicaid office. There are some parts of the country where this seems to be the case. 

NOTE: If Medicaid in your state pays health insurance premiums, contact the health insurance companies that offer such plans and ask if the company will apply for you or at least help you through the application process.

Where To Apply For Medicaid If You Are Confined In An Institution.

Ask your facility administrator about seeing a Medicaid eligibility worker. Medicaid workers will usually make visits to hospitals and nursing homes to enroll people at their bedside.

Many nursing homes will apply for Medicaid for you for free because it's in their interest to get you approved.

If You Qualify For SSI

If you qualify for SSI, apply for it first - then Medicaid. See the Supplemental Security Income ("SSI") and Medicaid section of Medicaid for a list of which states will automatically give you Medicaid if you are approved for SSI. In states that require you to apply directly for Medicaid, having been approved for SSI will make the process easier. This is especially so in those states which apply SSI criteria to their Medicaid.

Agencies that handle Medicaid applications are not usually pleasant places. The waits are long and there are usually lots of people waiting for assistance.

To keep stress and frustration to a minimum, try to:

• Go early in the morning. If you've been past these offices early in the morning, you have probably seen groups of people showing up even before they're open.
• Avoid Mondays, Fridays, and the first week of the month. Many Medicaid offices handle welfare and other public assistance programs that draw larger crowds before and after a weekend and when monthly checks are due.

Before going to the Medicaid office for your interview:

• Read about the documents to take with you in the section above.
• Read Making a Friend Given the reputation of eligibility workers at Medicaid agencies, this could be your greatest challenge - or opportunity. You will hopefully not be put off by an unfriendly attitude and will try to make the interview as pleasant as possible for both of you. It is worth an attempt to be understanding of the thankless job the interviewer must do. Keep in mind that this person is a government employee who is encouraged to follow the rules and not think too creatively. The person works in an environment that can be unpleasant, and is frequently put upon by a demanding and less than truthful public.

When you are ready to to the Medicaid office:

• Take plenty of reading material and food to sustain you. Expect to spend the day. Although you probably won't be there the entire day, you don't want to have another appointment pressuring you while you wait.
• Don't work too hard to look sick. It's not necessary. This appointment is with the Eligibility Worker or Claims Representative or whatever your state calls the intake person. Whatever the title, this is not the person who is going to determine if you are medically disabled. That's a whole different agency in another location. On the other hand, you shouldn't be dressed to run in a triathlon either because the worker you see will be talking with the Analyst who reviews your medical records.
• Dress comfortably with "sensible" shoes, as Mother used to call them. This is not an occasion where you need to dress to impress.
• No matter what the weather, it's best to wear layers since you don't know whether the heating (or the air conditioning) will be working overtime or barely working at all.
• Be on time if you have an appointment. If you are late, you have a long delay, or even have to return another day.

The information requested by all Medicaid offices is similar. If you review the section above What to Take With You To Apply for Medicaid, you will be prepared for the kinds of questions that will come up during the interview.

About one to two weeks after your interview, your file will be sent from Medicaid to the state agency that processes the medical portion of the applications for all Medicaid disability claims as well as Social Security disability claims.

 At the state agency, a Disability Evaluation Analyst will be assigned to handle your file. The analyst will obtain your medical records if you have not already provided them and will use them to determine whether or not you are disabled according to their standard. The Representative who helped when you submitted your Medicaid application should be able to give you the Analyst's name and phone number if you don't hear from her directly.

Check in occasionally with the Analyst:  

• Don't check in so frequently that you become a bother. It's best to wait three to four weeks after applying for Medicaid to call for the first time. It takes about a week to get your file from Medicaid, and another ten days to two weeks for the doctors to reply to requests or questionnaires. .
• Ask if the analyst is waiting for any records or information. If so, help the analyst obtain the required data. Call the doctor or the doctor's office manager to push the office to get the records promptly. If necessary, offer to go to the doctor's office and photocopy the records yourself.

Send the Analyst any new information such as new lab reports, or new or worsening symptoms. Make sure the Analyst gets the medical records that show any changes in your health condition.

While the Disability Evaluation Analyst's workload is such that you may have trouble making a friend, it still will help if you try to make a friend with the Analyst during this process. See Make A Friend.  

The analyst may also ask you and/or your doctor to complete additional forms. For an understanding of those forms, as well as tips for completing them, see: Medicaid: Forms An Analyst May Ask You To Complete ("Supplemental Questionnaires")

If the Analyst is unable to make a decision based on your medical record, or if your records are believed to be too incomplete, you may be requested to see a doctor or psychiatrist for a Consultative Exam. The Exam will be paid for by Medicaid and performed by a doctor who contracts with Medicaid.

You will receive a letter, usually about a month after the interview, giving you the name, address and date and time of your appointment with a doctor. While it is not a written rule, the experience of many people who deal with the eligibility process leads them to believe that Medicaid requests a Consultative Exam when it is leaning toward denying a claim. The Consultative Exam can be useful in helping document in the file a reason for the denial.

You can imagine how little helpful information a doctor can provide if he or she has never seen you before and only spends fifteen to twenty minutes or less examining you.

You have the right to request that a Consultative Exam be conducted by your own doctor (called a Treating Physician Consultative Exam) at Medicaid's expense. In fact, the Social Security regulations, which Medicaid is a part of, state that it is preferred that your own doctor conduct the exam (at Medicaid expense), but different Medicaid offices interpret that differently.

If you receive a letter ordering you to an exam by a Medicaid doctor, immediately contact the Analyst assigned to your case and ask if your own doctor can conduct the physical or if additional information from your doctor, or from your therapist, would be sufficient (instead of the exam). Experience has shown that it is much better for such exams to be conducted by a doctor who has been treating you and knows you and your condition.

If your request to use your own doctor is refused, ask for a supervisor to press your argument that a doctor who sees you once for only a few minutes cannot possibly understand the true state of your condition.