Remember that the Medicaid application process is just that….a process. It is important for any SNF provider to establish and implement a Medicaid application process that incorporates the following:

• Information for residents and family members about the Medicaid program for residents of a SNF
• Assistance by facility staff to applicants
• Follow up with the applicant for any reviews, meetings with caseworkers, etc. to help ensure that the facility is aware of any potential problems.
• Sending private pay statements each month to applicants until the application is approved AND the facility receives vendor payment

Help Educate Residents and Family on the Medicaid Program

Residents and family members may be unfamiliar with the Medicaid program. The local caseworker for the SNF as well as the state agency can provide informative brochures, flyers, etc. to help educate potential applicants. Keep a supply of these items on hand as well as any websites, weblinks etc. Here is a helpful Medicaid Guide one from the CMS.

Written information should be made available by the Admissions, Business Office and/or Social Services Office at the appropriate time. Some of the items are downloads from a state website. They are often written in large font and in multiple languages.

To help educate residents and family members about the Medicaid program, the SNF provider should consider the following:

• Provide information in a brochure rack, in admission packets or on the SNF website as a downloadable resource
• Schedule a “Family Night” on a quarterly basis to help families learn more about the process. The SNF social worker can host the event and it offers an opportunity to invite in additional speakers such as the Medicaid caseworker assigned to the SNF, a local elder law attorney and even the LTC Ombudsman.
• Include information about Medicaid in every facility/community newsletter. “Need information about Medicaid?  See X in Social Services”
• Include information in the same manner on any facility bulletin board or resources area… “Need information about Medicaid?  See X in Social Services”

Specific departments should have specific responsibilities to help manage the Medicaid application process:

• Admissions

• Work with inquiries to determine the potential for a need for Medicaid and when it may be needed.
• Indicate that the SNF wants to help all residents with the application process, if needed. Request that when a resident is within 3-6 months of the income threshold that they let you know. Remember that some new admits/families may believe the SNF stay is short term. If a resident is admitted as a short term stay but remains after thirty days, check back and revisit the conversation about the financial expectations regarding a long term admission.
• Have Medicaid 101 information (referenced above) available and offered.
• Be sure to introduce all new residents/family members to the Business Office and Social Service staff members so that they will know who to ask and where to go for more information.

• Social Services

• Offer to assist the resident/family with the application process
• Assist the resident/family with completion of the actual application, either hard copy or online. Offer to help review the application prior to submission to help ensure that all questions are answered.
• Make any copies to save the expense and difficulty that applicants may have in getting copies made
• Offer transportation for any meetings with caseworkers or others involved in the application review.
• Offer to write letters or use online services to obtain evidentiary documentation such as  bank records, etc.

• Business Office

• Establish a Medicaid Pending log and update it at least weekly.
• Review every account monthly to help ensure that any accounts that are not timely can be monitored as potentially in need of Medicaid application information. Make referrals to other departments such as Social Services, as appropriate.
• Continue to send private pay statements to Medicaid applicants until the decision regarding the application has been rendered. Medicaid pending does not mean Medicaid approved.
• Become authorized representative for the applicant in order to help facilitate the application process and to be able to receive any information regarding the status of the application.
• Become Rep Payee to ensure that the monthly income due the resident and the facility is received at the SNF and not at the home address.
• Complete the Resource Assessment for the applicant as appropriate when a resident’s spouse remains in the community.
• Notify the county Medicaid office by sending the request for Resource Assessment Notice.
• Ensure that the pending and approved account is monitored to ensure that the proper resource amount is paid to the SNF each month, even during the application process.
• Follow up with the applicant/family on a monthly basis to offer any assistance and also to monitor the timeline and progress or lack thereof.

In summary, it is important for a SNF to establish and follow a process to manage the Medicaid application process. A pending application is just that….pending. There is no guarantee that a Medicaid application will be approved. If a SNF has just five pending applications, that equates to revenue of $25-30K that is uncollected. Managing the application process is part of the Revenue Cycle Management process. But it is also just good business. SNFs provide care and assisting residents and families in the Medicaid application process is part of providing good care.