If you or a loved one are in a Nursing Home and need Masshealth coverage be careful to fill out the right application because there are many different coverage types and programs for Masshealth (Medicaid) and many different application forms. The Application for Health Coverage for Seniors and People Needing Long Term Care (SACA-2 (Rev 03/17) is the proper form.
This application must be completed and signed by the applicant or an Authorized Representative Designee (ARD). Along with the application you must submit all supporting verifications to determine your financial eligibility. The application and all supporting verifications should be filed by mail, fax, or in person to the Central Processing Unit in Charlestown.
MassHealth Enrollment Center Central Processing Unit P.O. Box 290794 Charlestown, MA 02129-0214
The Central Processing Unit will assign your application to an Intake worker at one of the four Masshealth Enrollment Centers across the commonwealth (Taunton, Chelsea, Tewksbury, or Springfield.) I have found that the Intake worker is usually highly trained in the Masshealth regulations for eligibility (130 CMR 520.000) Upon receipt of the application the Intake worker will review your application and supporting verifications and then usually within a few weeks mail out an Information Request letter (VC-1) to the applicant or his ARD. On this information request will be a list of documents that were not provided with the original application that are needed to verify the applicants eligibility. Additionally on the VC-1 will be four documents that are required to be submitted by the applicants Long Term Care facility so it is important to share the Information Request with the Business office manager of the facility. The information request usually allows the applicant 30 days to provide the requested verifications.
It is often because of the complexity of the document require as far back as 5 years from the date of application that the applicant is not able to get the verifications filed with the Caseworker. They do not issue extension rather it is their procedure to issue a denial notice for failure to verify. The denial notice for failure to verify will allow the applicant 30 days to provide some or all of the additional information. The date you re-log the application is your new application date. The denial notice also allows the applicant an opportunity to file an appeal with the Division of Medical Assistance Board of Hearings. It is imperative that this appeal be filed within 30 days, especially if you are seeking retroactive coverage beyond 90 days. I file appeals on almost all of denials my office receives.
Denials are also received sometimes when all of the information Masshealth has requested is provided timely however the applicant still has in excess of the $2000 single person eligibility limit or the $122,900 Spousal eligibility limit. With a denial for excess assets you are required to provided new financial information within 30 days to the Intake worker to verify you have spent assets down to below the limit within the allowable rules of 130 CMR 520.000. I also file appeals of almost all denials for excess assets my office receives.