What is Immediate Need Medicaid?
Immediate need Medicaid is an expedited application process to receive long term care at home paid for by Medicaid. Unlike the standard Medicaid application process, which can take approximately 6 months to receive services, those applying for immediate need Medicaid tend to receive care at home within one month of applying.
Both immediate need and regular Medicaid have the same eligibility requirements and fall within the Community Medicaid guidelines. A Community Medicaid applicant can have up to $15,750 in their sole name, own their primary residence with an equity value of less than $898,000 (equity limit disregarded if spouse or disabled child in the home), and continue to maintain all tax deferred retirement accounts so long as they are in payout status. Any additional assets must be transferred out of the applicant’s name, either to a spouse, third party, or an asset protection trust.
Do You Qualify for Immediate Need Medicaid?
Immediate need is a great option for those who have limited resources to cover the cost of care during the pending application process. Applicants, or their representative, must attest to the fact that the applicant is in immediate need of care, is not or will not continue to receive informal or professional homecare services, and that the applicant’s current insurances does not cover the cost of care. A determination of eligibility must occur no later than seven calendar days after a completed application is received, and a nursing assessment to determine the number of hours the applicant is entitled must occur within 12 calendar days. It is important to note that under immediate need Medicaid, the applicant is automatically assigned an agency to provide the care, whereas under regular Medicaid, an applicant can shop amongst various agencies to determine which agency is right for them.
After 120 days of receiving services, the applicant will receive a notice from Medicaid to either sign up with a Managed Long-Term Care plan (MLTC) or be auto-assigned a MLTC within 60 days of the date of the notice. If the applicant likes their aides and is looking for a smooth transition, it is a good idea to determine which MLTC contracts with their current agency so that the aides can continue the care. The MLTC must provide the same number of hours for at least 120 days, at which point they can re-assess the applicant and determine new hours.
Due to the complexity of the Medicaid process, families interested in long-term care planning should consult an Elder Law attorney to assist in navigating the system to ensure the get the right type of Medicaid in place.