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Medicaid Long-term Care Coverage – The Problem of Where to Apply

Aug 20, 2015

The rules for where to apply for Medicaid are complicated. A filing in the wrong jurisdiction can delay eligibility and force the filer to incur significant care expenses.

This article is a short introduction to jurisdictional filing rules.

The application itself is filed with the local county or city Department of Human Services or Family Services. Every Department has a person or office of eligibility staffed by workers whose job it is to determine eligibility for long-term care.

If the filer has lived in more than one place, jurisdictional issues must be addressed when filing. Below are some examples of filings with complicated jurisdictional issues.

First, a simple scenario: if the applicant lives in Fairfax County and moves to a nursing facility in Fairfax County, the application is filed with the Fairfax Department of Family Services.

But if the applicant lived in Fairfax County but enters a nursing home in Arlington County, the application is still filed in Fairfax County. The Virginia Medicaid Manual, states: “the responsibility for processing the application rests with the department of social services in the locality in Virginia in which the person last resided outside of an institution.”

Suppose the applicant did not reside in Virginia before becoming institutionalized in Virginia. The manual states: “if the individual did not reside in Virginia prior to entering an institution, responsibility for processing the application rests with the department of social services in the locality in which the institution where the person receiving care is located.”

But how about this scenario: applicant moves from Maryland to a care home in Fairfax for one week. Then the applicant moves to a Sunrise facility in Arlington for two years. Now the applicant needs Medicaid for nursing home care. Where should the application be filed? Arlington will reject the application stating the person first lived in Fairfax (even for only a week) when first moving to Virginia and that is where the person should apply. That person then moved out of the Sunrise facility in Arlington and moved to his daughter’s residence in the City Alexandria. Now if he moves to a nursing facility and requires Medicaid coverage the application is processed in the City of Alexandra no matter where he moves because that is the locality the applicant resided outside an institution.

When applying for Medicaid long-term care coverage even the simple process of where to apply can be complicated and requires expertise.

Update on the Individual and Family Support Program

The Individual and Family Support Program assists individuals with intellectual and developmental disabilities and their family members currently on the waiting list for the Intellectual Disability Waiver (ID Waiver) or the Individual and Family Developmental Disabilities Supports Waiver (DD Waiver)

The Individual and Family Support Program has announced the Funding Period for FY 2016. $3,000,000 has been provided by the General Assembly for this funding period.

This year there is only one funding period for FY2016

(a) All money will be distributed during this round.

(b) The maximum amount of funds per person will be $1000 for the entire year.

(c) The application must be postmarked on or after Sept. 15, 2015.

(d) Applications will be accepted on a first-come, first serve basis.

(e) To be eligible for this program, an individual must be on either the ID Urgent or Non-Urgent Waiver Wait Lists or the DD Waiver Wait List.

The Application and Directions will be posted on the Family Support Website by August 21st. Go to http://www.dbhds.virginia.gov/individuals-and-families/developmental-disabilities/community-support-services.

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