HomeMEDICAID FOR NURSING HOME CAREMEDICAID PAYS FOR NURSING CARE. THE TRICK IS TO QUALIFY.

The Supremacy Clause of the United States Constitution, Article VI, Clause 2, invalidates state laws that interfere with or are contrary to federal law. Therefore the federal Medicaid program is supervised by federal law. Where the federal law allows, each state may enact its own law. Medicaid is a medical assistance program established by Title 19 of the Social Security law. It provides that there shall be joint federal and state funding of medical care for poor individuals who meet income and resource standards. Under Medicaid the states must follow the federal law by providing medical services for eligible individuals. The carrot is the federal government pays between 50% to 83% of the costs. The state pays the difference. The states must follow the federal guidelines for making eligibility determinations, collecting and maintaining information, and program administration. See In re E.B., 229 W. Va. 435, 729 S.E.2d 270 (W.Va., 2012).

U S Constitution

U S Constitution

Title 56 of the Oklahoma Statutes is the section for poor persons. The Department of Human Services is in charge of carrying out the granting or denial of applications for Medicaid through local county offices. The Department is responsible for taking in writing and investigating all Medicaid applications. Each county office has the forms needed. During the investigation the case worker will usually request that the applicant sign an authorization for the case worker to contact the banks, etc. to obtain records. The financial is required to provide the records at no cost. Refusing to sign the authorization is not an option. If the applicant refuses, the application is summarily denied for lack of cooperation. After the local case worker’s investigation, he or she must notify in writing the applicant of the decision. If Medicaid is granted the date when assistance begins must be given. If Medicaid is denied the applicant must be notified of his or her appeal rights.

If Medicaid is denied, the applicant has the right to appeal. The appeal is a request for a fair hearing. This hearing is required to comply with the Administrative Procedures Act. The case worker is required to prepare a record for the fair hearing. It must be all applications and other documents submitted, rulings, evidence in the form of photos, statements, affidavits, documents, financial records, letters, and the like. The Department will assign the appeal to a hearing officer. At present there is only one hearing officer responsible for the entire State of Oklahoma. All hearings are telephonic. A recording is made. A transcript will be prepared upon request.

The hearing officer decides the evidence which is to be admitted and what evidentiary weight is to be given to it. The normal evidential rules are relaxed. Statements in letters and affidavits will be admitted, even though this type of evidence is hearsay. And copies of documents, instead of the originals, will be admitted. But privilege rules apply. Such as self incrimination (5th Amendment), confidential communications between attorney and client, confessions made to the clergy or priest, doctor patient communications, federal rules of confidentiality are also enforced. The applicant can bring witnesses. The applicant is allowed to cross examine anyone testifying against him. Either party, the applicant or the Department may request the rule of exclusion at the beginning of the hearing. This means that the hearing officer will instruct the witnesses to leave the room during the hearing. Each witness will only be permitted to be present when they testify. The hearing officer may take judicial notice of facts that are well known and not subject to dispute. The hearing officer is allowed to conduct a fair but efficient hearing. Thus incompetent, irrelevant, immaterial or repetitious evidence and documents can be excluded or ignored by the hearing officer. Objections may be made by the applicant or his attorney. Each applicant is entitled to be represented by the attorney of his choice. Wise applicants will obtain the services of an experienced elder law and Medicaid attorney. Brent D. Coldiron is an experienced elder law and Medicaid attorney. He may be reached through his website Brent’s Website by telephone (405) 478-5655 or 737-2244. He knows how to protect applicants during the application process. He is an expert in qualifying an applicant for Medicaid under the rules and regulations of Oklahoma.

If the applicant loses the fair hearing, he or she may appeal further to the Director of the Department. Finally, an adverse decision by the Director may appeal to the District Court of the County of the applicant’s residence. The review by the District Judge is a paper one only. No more evidence may be submitted.

Section 165 provides that an applicant for Medicaid shall receive assistance after consideration of their resources and income. An applicant shall receive no more than what is necessary to meet reasonable subsistence compatible with decency and health. Or if the applicant is blind. Or if the applicant, regardless of age is permanently and totally disabled Any needy person over the age of 65, when authorized under federal law shall be eligible for assistance. Also some assistance may be obtained under the Oklahoma law, not federal, when the needy individual is age 62. The needy applicant must be a state resident and must intend to remain a state resident. The applicant must not have sufficient income and resources to provide for himself or herself. The applicant cannot qualify for Medicaid while they are an inmate in prison or jail. The applicant must not have made an assignment, transfer or encumbrance of their property for the purpose of rendering himself or herself eligible for Medicaid assistance at any time within the previous 5 years. A blind recipient is also prohibited from soliciting alms.

The cash or loan value of all life insurance policies, and all revocable prepaid funeral contracts, and all monies set aside in a separate account specifically designated for funeral expenses is a countable resource. But life insurance policies or designated accounts, or any combination of the two, owned by the applicant which have a cash surrender or loan value of $1,500 or less are exempt. And $10,000 cash plus accrued interest in an irrevocable contract, and not more than $1,500 in designated account or cash value in a life insurance policy is exempt. The total can not exceed $10,000. If $1,500 is exceeded, an irrevocable prepaid funeral contract must be used.

There are many more Medicaid rules and regulations that may adversely affect an applicant. Wise applicants will obtain the services of an experienced elder law and Medicaid attorney. Brent D. Coldiron is an experienced elder law and Medicaid attorney. He may be reached through his website Brent’s Website or by telephone (405) 478-5655 or 737-2244. He knows how to protect applicants during the application process. He is an expert in qualifying an applicant for Medicaid under the rules and regulations of Oklahoma.


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