Medicaid applicants must prove that they have limited income and assets in order to be eligible for long-term care services. Before beginning the application process, it is helpful to understand what information you will be required to provide to prove your eligibility.
Medicaid is a state-run program, so the rules can vary from state to state, but in general, applicants are not eligible for Medicaid benefits if the applicant’s income exceeds $2,523 a month (for 2022). Applicants can also have no more than $2,000 in assets in most states. Different income limits apply for applicants who are in nursing facility care at the time of application. In effect, if the applicant’s monthly income is less than the private pay rate to the nursing facility, they can be found eligible for Medicaid.
States require Medicaid applicants to provide the necessary information to prove that they are eligible for benefits. The burden of proof is on the Medicaid applicant—not on the state. In addition to needing to provide identifying information such as a birth certificate and proof of citizenship, following are some of the documents that you may have to provide to the Medicaid agency when you apply for benefits:
- Proof of income. A copy of any pay stubs, Social Security statements, and/or pension checks; income tax returns for the past five years; and verification of any other sources of income, for example, rental income or dividends.
- Bank records. Copies of bank statements for the past five years.
- Property. A copy of the deed to any property owned within the past five years and a copy of the most recent property tax bill.
- Retirement accounts. Statements for the past five years of retirement accounts.
- Investment accounts. Statements for the past five years of brokerage or investment accounts.
- Savings bonds. Copies of any U.S. Savings Bonds owned by the applicant.
- Insurance. Copies of any insurance policies, including health insurance, life insurance, and/or long-term care insurance. Copies of your Medicare and private insurance cards, and verification of premiums paid for premiums for any such policies of insurance. As a practical matter, it’s rarely necessary in Virginia to provide copies of health or life insurance policies.
- Car registration. Registration information for any cars owned by you, and current market value of such vehicles.
- Burial arrangements. Copies of any prepaid funeral contracts or deeds to burial plots.
- Property transfers. Documentation explaining any transfers of assets that occurred in the five years preceding the filing of the Medicaid application.
The state may use an electronic database to verify some of the information. Intentionally giving false information is a serious offense.
The state looks back five years to determine whether you transferred assets for less than market value within five years of applying for Medicaid. Applicants who gave away assets may be subject to a period of ineligibility. In practice, although it may be necessary to produce copies of financial accounts and transactions that may have occurred during the last five years to help explain an asset transfer, it’s rarely the case that the Medicaid eligibility worker will require that level of documentation absent evidence of transfers for less than fair market value. Moreover, not all transfers from the Medicaid applicant are penalized, and some transfers may even be required.
Not all assets will be counted against you for the purposes of Medicaid eligibility. Personal possessions, one vehicle, your principal residence (as long as you or certain family members continue to reside there), and prepaid funeral plans are “noncountable” assets. However, the state will likely still request information about these assets. Moreover, just because assets may be “noncountable” doesn’t mean they won’t be subject to Medicaid estate recovery after your death.
After you begin receiving benefits, you are not done. Medicaid reviews your income and assets every year to ensure that you remain eligible. This could involve electronic verification or submitting more documentation.
The Medicaid application process is complicated, and submitting an application without an attorney’s help, particularly if you are applying for nursing home benefits, is not a good idea. The process generally takes several months, as Medicaid keeps asking questions and demanding further documentation for the answers provided. Before applying, contact your attorney. An attorney may also be able to advise if there are steps that you can take to reduce the risk of Medicaid estate recovery after your death.