My goal is to give you a brief description of the Utah Nursing Home application process, as practiced by me on a daily basis for my client families. It is not a step by step how to, but a practical explanation of what’s involved.
The long term care Medicaid application process is administered by a caseworker who is employed by the Utah Department of Work Force Services (DWFS). From point of the mountain south, down to St. George there are only 12 caseworkers (2 men and 10 women). Each caseworker is assigned a number of nursing homes to work with. Almost all of the Caseworkers work from home and don’t have offices. Essentially all of their interaction with an applicant is by phone. Unless they give you their direct number, you will always go through the state phone system and leave a message for a return call. Its frustrating, and the number one complaint I hear – “I can’t get anyone to call me back”
All the documents you submit to the caseworker are scanned to a central scanning facility in Salt Lake City where they are entered into the DWFS computer system. After scanning, they are returned to the caseworker and she will tell you to come pick them up – usually at the nursing home. A caseworker doesn’t review an application until it is scanned and entered into the system.
A number of years ago, DWFS spent millions of dollars to create a software program to “automate” the application process. It took a number of years to develop and work out the bugs, but has now been operational for the last 3-4 years. It is now the exclusive way applications are reviewed and processed. One of the consequences of a “computerized system” is that the caseworker is required to complete every box, line, description and verification in a ridged and unyielding manner – i.e. “dot every i and cross every t.”
Another consequence of the process being “automated” is the ease in which your caseworker can generate form letters covering a myriad of topics, problems, requests for more information, decisions and requests for explanations. As they go screen by screen entering information, if something is missing or in-congruent or unverified, or incomplete, I think all they do is push a button and boom, out goes a letter – well – I don’t know about a button, but they do send a lot of letters out to request additional documents or requests for an explanation. It would be much easier to pick up the phone and call you about it – but that isn’t usually how they do it. They send you a letter. I think one of the main reasons they contact you in writing, is to keep a paper trail of their actions. Medicaid is a joint Federal State program and the state is required to follow Federal laws and is subject to audit and oversight by the Feds. But it’s often frustrating and time consuming to do things through the mail.
Utah’s “Medical Application for Long Term Care” is a 5 page form that requests detailed information about the applicant, the applicants spouse and in some cases other family members. The Application includes a list 18 types of records/documents (“verifications”) that must be submitted with the Application. This “Check List” includes 5 years’ worth of monthly bank and savings statements, 5 years’ worth of investment, IRA, 401K, annuity’s statements, insurance policies, a current house tax notice, copies of any Trust Agreements, funeral plans, proof of income, contents of safe deposit box, settlement papers from the sale of a house or reverse mortgage, a completed monthly budget schedule, and all other supporting documents relating to a person’s assets, income and resources.
The application process is essentially a “mini-audit”. They won’t take less than 5 years, and while a few missing months are OK, they require complete records. Prior to 2006, only 3 years were required, but the law now is to scrutinize your finances for 5 years to determine if you made any “gifts.” Clients are always surprised and frustrated by the level of detail and amount of paperwork they must gather and submit to DWFS.
Complete information must be submitted. DWFS operates under the “verification” theory – which is simply that unless a piece of paper can be produced to verify a fact or position, it can’t be accepted or established. In short, a caseworker won’t (and actually can’t) take your “word” for it. There are exceptions, but they almost always require a piece of paper to verify a fact, statement or explanation.
Once the Application and all verification’s have been submitted to the satisfaction of DWFS, the agency has 30 days to issue its eligibility determination, which it sets forth in a “Notice of Decision” letter. If your application is denied, the Notice will state the reason.
Here is a link to the application.