Our own Michael Steinberg was featured in a Huffington Post article earlier this month. He offers information and advice on the two eligibility categories related to Medicaid applications: clinical eligibility and financial eligibility.
Individuals over 21 can be deemed eligible for Medicaid services related to skilled nursing, rehabilitation, and long-term care. Clinical or medical Medicaid eligibility and reimbursable services are determined by individual state criteria. Michael explains that proof of clinical eligibility is not a complicated process.
On the other hand, proving an individual qualifies for Medicaid services based on their financial standing is a daunting task. Applicants must gather financial documentation for five years – which is known as the five year look back. Every cash-value asset must be reported to show proof of financial eligibility.
What does this mean to skilled nursing facilities? If a patient is having trouble obtaining Medicaid approval, the facility is no doubt having trouble getting paid. About 55 percent of nursing home patients are on Medicaid, delays in reimbursements based on eligibility could be a big financial hardship to the nursing home business.
Michael advises that the best way to prepare for what’s ahead is to be well versed in Medicaid rules and guidelines. An even better idea is to leave it to the experts, such as the team at Senior Planning Services.