When it comes to Medicaid, timing is essential. One day can make the difference between saving and losing thousands.
There are two essential timing issues:
- Being financially eligible by the end of the month, and
- Getting your application submitted by the end of the month.
Medicaid benefits are determined month-to-month
The deadline for these issues is the last day of the month. This is because Medicaid benefits are determined month-to-month. If you are nonfinancially and financially eligible as of the last day of the month, Medicaid will cover that entire month. This is a core principle when it comes to Medicaid.
This rule means that you can receive money at the start of the month—an inheritance of $20,000, for example—and, by doing various allowable things with that money, be under your Medicaid asset limit by the end of the month, meaning you keep your benefits without interruption. This money might have caused you to go over the asset limit and lose your benefits, but because you spent it down by the end of the same month, it’s no longer an issue. On the other hand, if you miss that end-of-the-month deadline, you’ll lose benefits for that month.
Note: Whatever you do with the money in an example like this, you must report receiving it within 10 days. This is an obligation of everyone who receives Medicaid benefits.
Also, elder law attorneys know the detailed rules and strategies for spending down or setting aside excess assets without creating problems. In a situation like this, you should always get professional advice.
Being financially eligible by the end of the month
For any month of long-term care you want Medicaid to cover, you must meet all requirements for eligibility as of the last day of that month. That means you must be nonfinancially eligible and financially eligible—including being below the applicable asset limit, which is usually the sticking point.
Once that month is over, there is no going back. Either you met the requirements on the last day of the month or you didn’t. This is why timing makes such a big difference. If you are close to the asset limit already, a transaction posting on July 1 instead of June 30 might mean you have to pay the nursing home another $9,000.
Submitting your application by the end of the month
Although there’s no going back when it comes to financial eligibility, the same rule doesn’t always apply to getting the actual Medicaid application submitted.
In general, you must submit your application for long-term care Medicaid by the end of the month. However, sometimes—not always—you can “backdate” your application. Backdating means asking for retroactive Medicaid benefits.
Here’s the key: in Wisconsin, backdating is only possible when applying for institutional long-term care Medicaid. That means you want Medicaid to pay for care in a nursing home or hospital. You still have to meet all the requirements for eligibility as of the last day of those past months. But if you do, and it’s to pay for a nursing home, you can go back up to 3 months. That means you can submit an application in July, backdate it, and potentially get coverage for June, May, and even April (if, again, you were financially eligible as of the last day of those months).
Note: You probably paid out-of-pocket for those backdated months. If your application is approved, the nursing home will actually owe you a refund. Usually, you have to contact the nursing home yourself, ask them to bill Medicaid for those months now that Medicaid will cover them, and ask for a refund.
Unfortunately, you cannot backdate Medicaid for assisted living, memory care, or in-home care. For these Medicaid programs, you must apply by the end of the current month. (Note: You also need something called a functional screen for these types of Medicaid.)
Finally, don’t overlook what counts as “submitting” an application by the deadline. You can apply for Wisconsin Medicaid by mail, fax, phone, in person, or online. The application is considered submitted (or, technically, “filed”) when it is actually received by the county agency in charge of benefits, or the next business day if it is received after the agency’s regularly scheduled business hours. The only exception is for online applications, which are considered filed the date the application is electronically submitted (meaning it can be submitted up to 11:59 p.m.).
Note: Also don’t overlook signing the application. This includes a spouse’s signature, too. The agency won’t consider the application valid unless it is properly signed.