The Medicaid application process is complex, document-intensive, and unforgiving of errors. We guide families through every step — from the initial review through final approval.
We offer a free initial consultation for this practice area. Contact us today.
The Medicaid Application Challenge
Medicaid is the primary payer for long-term care in the United States, but accessing its benefits is far from simple. The application process is complex, document-intensive, and unforgiving of errors. A single mistake — a missing document, an incorrect asset calculation, or a misunderstood transfer — can result in a denial or a penalty period that delays benefits for months. At Shober & Rock, we guide families through the Medicaid application process from start to finish, ensuring that every form is completed correctly and every piece of documentation is in order.
What the Process Involves
A successful Medicaid application requires a thorough review of the applicant's financial history — typically covering the past five years — along with documentation of all assets, income, and any transfers that have been made. For married couples, the process also involves calculating the community spouse's resource allowance and income protections. We gather the necessary records, prepare the application, communicate with the County Assistance Office, and respond to any requests for additional information. We stay with you through the entire process, not just the initial filing.
When to Call Us
The best time to contact us is before a Medicaid application is needed — ideally when a family member's care needs are becoming apparent and long-term care may be on the horizon. Early planning creates options. But we also regularly assist families who are in crisis — where a loved one has just entered a nursing facility and benefits are needed immediately. In either situation, we can help.
Frequently Asked Questions
When applying for Medicaid long-term care benefits, the County Assistance Office reviews all financial transactions made by the applicant during the five years prior to the application date. Any transfers of assets for less than fair market value during this period may result in a penalty — a period of ineligibility for Medicaid benefits. The length of the penalty depends on the amount transferred. Understanding the look-back rules is critical to proper planning.
Pennsylvania Medicaid allows applicants to retain certain exempt assets, including a primary residence (subject to conditions), one vehicle, personal belongings and household goods, prepaid funeral arrangements, and a small amount of cash. For married couples, the community spouse — the spouse who is not in the nursing facility — is entitled to keep a protected amount of the couple's assets, known as the Community Spouse Resource Allowance, as well as a minimum monthly income. The specific amounts change annually.
The Pennsylvania County Assistance Office is required to process a Medicaid application within 45 days for non-disability applications and 90 days for disability-based applications. In practice, the process often takes longer due to requests for additional documentation. Having all documentation organized and complete at the time of filing significantly reduces delays. We work to ensure applications are complete before submission.
Transfers of assets to children or others within five years of a Medicaid application are subject to the look-back rules and may result in a penalty period. However, there are important exceptions — transfers to a spouse, a disabled child, or a caregiver child who has lived in the home and provided care may be permissible. Transfers must be carefully planned and documented. We strongly advise consulting with us before making any transfers.
Ready to get started?
Facing a Medicaid application? We can help you navigate the process.