Medicaid Application Process

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Step by Step Guide for Now/Comp Waiver Application

Step 1: Apply for Social Security

Being eligible for social security determines eligibility for Medicaid Waiver

  • There is no age requirement to apply for social security, so apply as soon as possible
  • Apply for Social Security using this link
  • For getting started on the application process keep in mind the paperwork you will need for Social Security is the same paperwork you will need for Medicaid Waiver.
  • Key to success is having all your medical records together
    • Psychological evaluations (not required for Social Security but required for waiver)
    • Inventories the schools are performed
    • All appointment documentation with family physician
    • Specialist appoint documentation if any
    • MRIs (Include dates and doctors that performed)
    • Bloodwork (Include dates and doctors that performed)
    • Prescriptions
    • Care Team information

Step 2: Apply for Medicaid Waiver

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Once you receive your eligibility letter for Social Security you are eligible to apply for Medicaid Waiver. Because the wait list is so long it is recommended to begin this process when your child is 15

  • Call your region field office
    • Be consistent if you do not get an answer. Call back weekly until you can speak with someone
  • After speaking with your regions office expect them to direct you to the waiver application either through mail or online
    • Be diligent about sending in all paperwork asked for by your regions office
  • Things you will need: Gather a list from your region rep of exactly what you will need. Keep in mind most tests will have to have been conducted in the past 12 months.
    • Annual Physical
    • Medical records for past year
    • Psychological evaluations (THIS MUST BE COMPLETED IN THE PAST YEAR)
    • Psychiatrist evaluations (if using a psychiatrist)
    • Photo ID
    • Birth Certificate
    • History of Medications
    • TB Test

Step 3: Assessment Process

Once Eligibility is determined assessment process begins

  • You will receive a letter if you are deemed eligible or not. If you are not there will be information regarding an appeals process
  • If deemed eligible the next phase is the assessments. Keep in mind this might involve people coming to your house and this process could take 6 months to even get scheduled
    • Nursing assessment
    • Behavioral assessment
    • Psychological assessment

Once the assessment process is complete, keep in mind the entire process could take years, you will receive notification if you have been awarded a waiver. Just because you have been awarded a waiver does not mean it has been funded so it still could be a long wait until the waiver is funded for services to begin.

Step 4: Waiver Eligibility and Approval

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Once you have been approved for a waiver keep in mind the waiver is not funded, it could still take years for your waiver to be funded.

  • Things to keep in mind
    • If you are in crisis let's say something changes and a caregiver dies, you know that's something you immediately want to get on the phone to the regional office and say, you know, we've started this process, but things have changed.
    • Communicate changes in behavior
    • Follow up and be diligent. At minimum follow up once a month
    • Make sure to quickly communicate any changes in behavior, caregiver, etc
    • If they come speak with you about how things are going keep in mind your worst day, not your best. You want to effectively communicate how much you are assisting them and if you were gone would they be able to fully take care of themselves?

Once your waiver has been funded you will be notified.

Checklist

  • Psychological evaluations (not required for Social Security but required for waiver)
  • Inventories the schools are performed
  • All appointment documentation with family physician
  • Specialist appoint documentation if any
  • MRIs (Include dates and doctors that performed)
  • Bloodwork (Include dates and doctors that performed)
  • Prescriptions
  • Care Team information
  • Annual Physical
  • Medical records for past year
  • Psychological evaluations (THIS MUST BE COMPLETED IN THE PAST YEAR)
  • Psychiatrist evaluations (if using a psychiatrist)
  • Photo ID
  • Birth Certificate
  • History of Medications
  • TB Test

Helpful Tips

  • Keep all medical records and documentation on hand
  • Be responsive regarding requests for your regions office
  • Be consistent in reaching out to your regions office regarding follow up and original reach out. Once a month at minimum
  • Get phone number and name of RSA when first speaking with Regions Office. You will use this if you ever need to file a complaint
  • Ask your regions office exactly what you will need for the application process.
  • Don’t get psychiatric evaluation until directed by region representative
  • Be comfortable with people coming into your home
  • Always keep in mind your worst day when being interviewed. Think to yourself if you were not there would your child or loved one be able to survive on their own...?
    • Example: If asked could they pay for a movie ticket on their own, are you telling them to pull out their wallet or telling them to input their pin number or sign if using a credit card?
    • When answering questions consider if you were not there at all, are you verbally prompting them for anything?

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