The COVID-19 pandemic public health emergency is scheduled to expire as of May 11, 2023. https://www.cms.gov/About-CMS/Agency-Information/Emergency/EPRO/Current-Emergencies/Current-Emergencies-page. As a result, Medicaid recipients need to remain focused to protect their benefits from termination.
What are Medicaid Benefits?
Medicaid is a federally funded health care program which can pay for long-term care. https://www.medicaid.gov/medicaid/long-term-services-supports/index.html. The MLTSS Medicaid program in New Jersey provides benefits for long-term care in nursing homes and assisted living facilities, as well as in the home.
Participation in the Medicaid program is means-tested and strictly regulated. Only people with low assets and low income qualify for MLTSS Medicaid. https://www.nj.gov/humanservices/dmahs/clients/medicaid/#:~:text=To%20be%20eligible%20for%20New%20Jersey%20Medicaid%2C%20a,meet%20specific%20standards%20for%20financial%20income%20and%20resources.
In Burlington County, where my elder law office is located, and throughout New Jersey, a single individual cannot have more than $2,000 in countable assets and qualify for MLTSS Medicaid. Having even one dollar over the $2,000 countable asset limit on the first day of the month can disqualify an individual ineligibility for Medicaid for the entire month. Surprisingly, retirement account balances are included in the $2,000 countable resource limit.
Under federal law, New Jersey (and other states which have opted to receiving Medicaid funding) must follow certain requirements. One of those requirements is processing periodic Medicaid eligibility redeterminations.
What is a Medicaid Eligibility Redetermination?
A Medicaid redetermination is a review by the county Medicaid office of a Medicaid enrollee’s finances. The purpose of the redetermination is to re-confirm that despite the passage of time, the Medicaid enrollee’s resources are still below the $2,000 Medicaid eligibility threshold.
Fortunately, a Medicaid redetermination may involve only a review of one month of financial statements, unlike the Medicaid application, which takes into account sixty months of bank statements.
In a Medicaid redetermination, the Medicaid enrollee (or his or her authorized agent) completes the Medicaid eligibility redetermination form. They provide one month of bank statements for the enrollee. The agency scrutinizes the statements for changes like an inheritance, a death of a spouse, bank balances over $2,000 and large gifts during the period reviewed.
It’s a good idea to take care in completing a Medicaid redetermination, because an increase in the bank balance on the first day of the month can trigger a termination of the entire month of Medicaid eligibility. This can translate into liability for thousands of dollars of medical expenses for someone with very limited assets and income.
What Has Changed
During the public health emergency, the government recognized that there were significant disruptions in living situations, and employment. As a policy matter, health insurance coverage needed to be kept in place until the pandemic ended. New rules curtailed Medicaid terminations during the public health emergency. Now that the end of the public health emergency is drawing near, some of those protections are being lifted.
What You Need to Do
In Marlton, New Jersey and the surrounding counties where I practice elder and disability law, I have noticed that redetermination packets are being sent out to many Medicaid enrollees. https://fearnzimmerelderlaw.com/The redetermination forms must be completed and returned promptly. If you moved during the pandemic, this can be a problem, because you may not receive the forms if they are sent to an old address.
If you receive Medicaid and you have moved since January 2020, contact your county Medicaid office with your new address and email.
Check your mail for the Medicaid redetermination form. Be sure to complete and submit the form promptly, using a delivery method that allows you to confirm receipt by the county Medicaid office. It is a good idea to consult an attorney if you have questions about the Medicaid redetermination form or if you receive a termination notice.
Contact your attorney right away, in the event of a Medicaid termination notice. Medicaid terminations can jeapardize important benefits, leaving you or your spouse responsible for thousands of dollars in long term care and other medical bills, with limited funds to pay them.
