The legal basis for Medicaid is found in federal law and in the Oklahoma statutes.
In order to protect your assets from nursing home costs, the Medicaid secrets can start to be deciphered by the study of the legal basis for the Medicaid program.
Federal authority is found at Title XIX of the federal Social Security Act, title 42 of the United States C
ode, sections 1396, et seq. SOURCE WEBSITE The Oklahoma legislature established the legal framework for Medicaid at 56 OS 1981, Section 328, et seq. OKLAHOMA SUPREME COURT NETWORK The Oklahoma Administrative Code contains the rules adopted by the State of Oklahoma for the administration of the Medicaid program. They are found in the Oklahoma Administrative Code at Title 317. OKLAHOMA SECRETARY OF STATE WEBSITE Each state is required to adopt a state plan to implement the Medicaid program. The state must financially participate by not less than 40% in the cost of the program. The state plan must provide for an appeal right to applicants, called a fair hearing. It must designate a state agency to administer the program. This is the Oklahoma Health Care Authority. But it may use a local agency to determine eligibility for Medicaid benefits. That agency is the Department of Human Services. Each state is required to maintain a consumer-oriented website providing useful information to consumers regarding all skilled nursing facilities and all other nursing facilities in the state.
One Medicaid secret is that Medicaid is available for nursing home long term care expenses for anyone who is blind or disabled or is 65 or older (aged) and is blind or disabled. This is called categorically related. The Department of Human Services uses the same criteria used by the Social Security Administration for the disability determination. The means if the individual who is to apply is already on Social Security Disability or Supplemental Security Income, they meet the disability requirement for Medicaid. Being 65 or older is all that is required to be aged under Medicaid. If you know that you or your spouse, or your parent, is likely to need nursing home care at some future time, the time to protect your assets from nursing home costs is now. Don’t wait. Medicaid planning is best when started early. Contact Brent D. Coldiron, an expert in protecting assets from nursing home costs. BRENT’S WEBSITE He knows how to have Medicaid pay for nursing home costs.
Disability means that the individual needing nursing home care is unable to engage in an substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death, or which has lasted , or can be expected to last, for a continuous period of not less than 12 months. This is the same definition used for Social Security Disability.
Proof of disability under Social Security or Supplemental Security Income is established by producing the notice of award letter of benefits. If an applicant has applied and been denied under these programs, he will be denied under Medicaid, unless it can be shown the medical condition has worsened.
An applicant for Medicaid benefits to pay for long term nursing home care costs must prove he or she is a citizen to receive Medicaid nursing home benefits. Hopefully the applicant has received expert legal advice from an elder law attorney, such as Brent D. Coldiron, on how to protect the family’s assets from nursing home costs. Brent D. Coldiron has years of experience in elder law. He knows how to protect you.
According to the regulations the most reliable forms of citizenship verification are: (i) A U.S. public Birth Certificate showing birth in one of the 50 states, the District of Columbia, Puerto Rico (on or after 1/13/1941), Guam (on or after 4/10/1899), the U.S. Virgin Islands (on or after 1/17/1917), American Samoa, Swain’s Island, or the Northern Mariana Islands after 11/4/1986. For Puerto Ricans whose eligibility is being determined for the first time on or after October 1, 2010 and using a birth certificate to verify citizenship, the birth certificate must be a certified birth certificate issued by Puerto Rico on or after July 1, 2010; (ii) A Report of Birth Abroad of a U.S. citizen issued by the Department of Homeland Security or a Certification of birth issued by the State Department (Form FS-240, FS-545 or DS-1350); (iii) A U.S. Citizen ID Card (Form I-179 or I-197); (iv) A Northern Mariana Identification Card (Form I-873) (Issued by the INS to a collectively naturalized citizen of the U.S. who was born in the Northern Mariana Islands before 11/3/1986); (v) An American Indian Card issued by the Department of Homeland Security with the classification code “KIC” (Form I-872); (vi) A Final Adoption Decree showing the child’s name and U. S. place of birth; (vii) Evidence of U.S. Civil Service employment before 6/1/1976; (viii) An Official U.S. Military Record of Service showing a U.S. place of birth (for example a DD-214); (ix) Tribal membership card or Certificate of Degree of Indian Blood (CDIB) card, without a photograph of the individual, for Native Americans; (x) Oklahoma Voter Registration Card; or (xi) Other acceptable documentation as approved by the Oklahoma Health Care Authority. It might be possible in certain cases where the above documents are not available to use less reliable forms of citizenship verification such as: (i) An extract of a hospital record on hospital letterhead established at the time of the person’s birth that was created five years before the initial application date and that indicates a U.S. place of birth. For children under 16 the evidence must have been created near the time of birth or five years before the date of application; (ii) Life, health, or other insurance record showing a U.S. place of birth that was created at least five years before the initial application date and that indicates a U.S. place of birth; (iii) Federal or State census record showing U.S. citizenship or a U.S. place of birth (generally for persons born 1900 through 1950). The census record must also show the applicant’s/member’s age; or (iv) One of the following items that show a U.S. place of birth and was created at least five years before the application for Medicaid. This evidence must be one of the following and show a U.S. place of birth: (I) Seneca Indian tribal census record;
(II) Bureau of Indian Affairs tribal census records of the Navajo Indians; (III) U.S. State Vital Statistics official notification of birth registration; (IV) An amended U.S. public birth record that is amended more than five years after the person’s birth; or (V) Statement signed by the physician or midwife who was in attendance at the time of birth. Other documents which will be helpful are: (A) A driver’s license issued by a U.S. state or territory with either a photograph of the individual or other identifying information such as name, age, sex, race, height, weight, or eye color; (B) A school identification card with a photograph of the individual; (C) An identification card issued by Federal, state, or local government with the same information included on driver’s licenses; (D) A U.S. military card or draft record; (E) A U.S. military dependent’s identification card; (F) A Native American Tribal document including Certificate of Degree of Indian Blood, or other U.S. American Indian/Alaska Native Tribal document with a photograph of the individual or other personal identifying information; or (G) A U.S. Coast Guard Merchant Mariner card.
Medicare and SSI recipients do not have to verify their citizenship and identity because they have been previously verified by the Social Security Administration.
The establishment of the applicant as a citizen who is disabled, blind or aged is the first Medicaid Secret that must be complied with to qualify for Medicaid benefits to pay for nursing home care costs. If you may need Medicaid to pay for nursing home costs, you should contact an expert in elder law. Brent D. Coldiron may be reached at (405) 478-5655. He knows how to protect assets from a nursing home in Oklahoma and qualify an applicant for Medicaid under the rules and regulations of Oklahoma.