Individuals seeking Medicaid Long Term Care services must meet specified technical, medical, and financial eligibility requirements. The technical criteria includes proof of US citizenship, Maryland residency, and suffering from a defined disability (i.e. if you are over the age of 65 you are deemed disabled in the eyes of Medicaid). Eligibility is determined through an application and assessment process in accordance with medical criteria established by Federal law and implemented by the State of Maryland. The Medicaid application includes a five-part test. A critical factor in the Medicaid application is determining if the candidate needs “skilled nursing care.” Financial eligibility is determined by examining the “countable assets” of both the Medicaid applicant and community spouse. The applicant can have no more than $2,500 in “countable assets” and the community spouse no more than $109,540 in “countable assets.” The issue of determining if an asset is countable or non-countable (or exempt) requires a thorough knowledge of the ever-changing arena of Medicaid law. The area of Elder Law, and especially Medicaid law, is what many consider to be the “wild west” of the legal world. It is not fully developed, it changes rapidly, it is full of dangers and most importantly, there are big opportunities.

How medical eligibility will be determined: Clinical determination of Nursing Facility Level of Care and eligibility for waiver participation will be determined by an in-person assessment by a registered nurse or physician, typically associated with the nursing home. The nurse or physician will use a comprehensive, objective assessment instrument approved by the Department of Health and Mental Hygiene, and is normally be scheduled shortly after it is known that the family will applying for Medical Assistance. Assessments will be conducted at the applicant’s current location. The exam itself is relatively inexpensive and there usually is a quick turnaround time between assessment and determination of medical eligibility.

Medicaid Appeals in Maryland

Medicaid Fair Hearings can be a very confusing and intimidating process. Although traditional court rules of procedure and evidence are followed, the hearing officer will frequently allow both sides the latitude to enter all relevant evidence into the record. The appeals representative will use all available information and county resources to support their finding of non-Medicaid eligibility. It is absolutely critical that an experienced elder law attorney address the complex Medicaid Rules in a straightforward and convincing way to the administrative law judge. The ruling of the administrative law judge is limited to whether or not the Medical Assistance denial complied with Federal and state rules and regulations.

When it comes to Medicaid law in Maryland, the appeal process does not end with the ruling of the administrative law judge. If appealed, this ruling goes before the Board of Review. Here, the appeals are almost universally denied. The next step is the appeal to the Circuit Court or Federal District Court. Our office handles all levels of Medicaid appeals to assist clients who have been denied Medicaid or other public benefits. Our work includes both appeals at the administrative level, and more formal proceedings in state or Federal court. While some cases are settled without court intervention, we have the experience to take cases to the highest levels of review if necessary.