Notices of Proof Needed

After you submit your Medicaid application, the county agency has 30 days to process it and either approve or deny. (This can be extended by 10 days if you ask for extra time.) Almost always, the first thing you’ll get is a piece of mail from the State titled “Notice of Proof Needed.” This usually comes 1-2 weeks after submitting your application.

This means that a county worker has begun reviewing the application and needs additional documentation. Usually, what’s requested is a document verifying an asset—its value on a certain date, the account number, the owner, or another important fact. Because Medicaid is a government benefit, it’s up to you to prove you’re eligible for it. That includes providing the correct documentation. Even if you’re otherwise eligible, if you fail to provide the needed documents before the deadline, your application can be denied.

So it is essential to respond to any Notice of Proof Needed, and to do so promptly. The problem is that these notices can be hard to comprehend. They are automatically generated and sent, and are often unhelpful or misleading in the example documents given. That’s why I always give my clients this advice: whenever you get a Notice of Proof Needed, call the consortium’s phone number. Once you’re talking to a person, they will generally be helpful and able to tell you what’s really needed. They will be able to cut to the chase.

Even once you know exactly what you need to get, it can be surprisingly tricky to get it in some cases. Getting a bank statement is easy (though even there, I’ve seen issues like a bank only putting the last 3 digits of an account number on the statement, when the county has to see the last 4). But getting the right life insurance statement that shows cash value on a specific date in the past, plus face value, owner, and original policy date? Navigating the customer service phone line to get that—if, by the way, you don’t need to send in a copy of the POA first and wait for them to process it before they’ll even talk to you—well, that can be a pain. Not always—but frequently enough to be a common problem.

That’s why one of the most common reasons Medicaid applications are denied is lack of proper documentation. It’s not always clear exactly what information the county needs, and it’s not always clear what hoops you have to jump through to get it.

This is one of many areas where an elder law attorney can help. A lawyer experienced in Medicaid applications will be able to anticipate the documents needed before a notice is sent, and also be able to know exactly what the issue is when looking at a notice. He or she will know what hoops to jump through to get the correct information—sending in a POA, asking the right questions, talking to the right people, filling out the right form—and to get it the first time. An elder law attorney will also know if the county is wrong about what it’s requesting. Sometimes county workers make mistakes (Medicaid is complicated, after all) that only a professional could catch.