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Medicaid Long Term Care Eligibility - Nursing Home Division (NHD)

The Nursing Home Unit is a specialized Medicaid Unit that determines financial eligibility for Medical Assistance for persons in Skilled Nursing Facilities, Intermediate Care Facilities, or in hospitals with a discharge plan that requires placement in a Skilled Nursing Facility.

How to apply for Medicaid Long Term Care Eligibility:

The application process begins by calling (716) 858-1901 to request an Access NY application. The date that a completed application is received by this agency is considered to be the application date.

When completing and returning the Access NY application for Long Term Care, please be sure to complete the Access NY Supplement A form and a notarized authorization to represent. Also include your choice of how we should contact you. Be sure to sign the application AND Supplement A.

Upon receipt of the completed Access NY application by our agency, the application will be assigned to an examiner who will contact you to discuss the application or arrange a face to face appointment. Face to face meetings are scheduled within two weeks of the agency’s receipt of your application. Meetings are scheduled between 8:00 a.m. and 2:00 p.m. at the Rath Building, 158 Pearl Street, Buffalo, NY 14202.

In addition to verification of gross monthly income and outstanding medical bills, the representative must supply the last 60 months of financial records. This may include all pages of bank statements and statements from brokerage houses. You will need to provide photocopies for us to retain in our records. We require documentation of the source of all deposits and withdrawals of $2,000 or more.

Certification process:

Normally the more prepared you are and the less complicated the financial situation, the shorter the contact/meeting.

It is in your best interest to provide as much verification as possible upon initial contact. A request for more verification may come up during the course of the contact/meeting, or be generated by information submitted after the contact/meeting. At this time you will be provided a list of essential missing information and a deadline date to send in this information. Extensions may be granted.

All applicants and their spouse must provide the following verifications:

  • Documentation for Power of Attorney, Guardianship and/or Authorization for applicant or sign-consent for a representative.
  • Birth Certificate.
  • Social Security Card.
  • Marriage Certificate.
  • Naturalization papers or Alien Registration Card.
  • Medicare Card.
  • Private Health Insurance card and a premium bill or other proof of cost and proof of last premium paid.
  • Proof of residence prior to admission to a Long Term Care Facility (nursing home) -OR- admission documents from the skilled nursing facility if already placed -OR- letter from hospital verifying Alternative Level of Care (ALC) date and Medicare cut-off dates.
  • Armed Services discharge papers or other proof of service for applicant and spouse.
  • Proof of separation or divorce.
  • If spouse is deceased - copy of the Death Certificate.
  • Title/Registration for all vehicles including trailers, RVs, and boats.
  • All bank and credit union account transactions for the past 60 months prior to the date medicaid coverage is sought:  savings, checking, Certificates of Deposit [CDs], Individual Retirement Accounts [IRAs] and annuities - verification must include account statements. This applies to both open and closed accounts. We also accept transaction histories from the financial institution in lieu of actual statements.
  • Explanation and proof [including receipts and cancelled checks] of all large withdrawals and deposits slips and offsets from bank/credit union accounts.
  • The last eight [8] pay stubs/statements from your employer.
  • Letter from appropriate agency or photocopy of most recent check stub for:
    • Social Security
    • Pension or Retirement
    • Veteran's Benefits
    • Railroad Retirement
    • Union Benefits
    • Workman's Compensation
    • NYS Disability Insurance
    • Court Ordered Support Payments

      NOTE: If any of the above benefits are deposited directly into a bank/credit union account, indicate most recent deposit on bank statement/book. We need verification of GROSS benefits.

  • Tax returns with all appropriate schedules for the past four years, including 1099s.
  • Letter/bill from nursing home verifying the 'paid through' date.
  • Stocks, bonds, and/or securities owned by the applicant during the previous 60 months to date and any transactions made within this period.
  • Face and cash values of all life insurance policies.
  • Trust and annuity contract(s) showing the amount of principal and income. All transactions for the past 60 months to date.
  • If applicant sold or transferred property within the previous 60 months, present closing statement of sale/proof of transfer.
  • If applicant has tenant(s): tenant(s)' statements/rent received; book showing amount of rental income, maintenance and repair costs.
  • Current proof of: mortgage/escrow, tax bills, homeowner's insurance premium, water bill for any rental properties.
  • Deed(s) to all property [real estate] owned including deeds to all vacation property, time shares, life estates etc., even if owned in another state.
  • Proof of irrevocable pre-paid funerals and burial spaces.

IMPORTANT: If you are unable to obtain Birth Certificate, Social Security Number, and/or Social Security Award amounts, request a TPQY [Third Party Query System] form for the applicant by calling the Social Security Administration at 1-800-772-1213. The TPQY does not verify citizenship, however a medicare card does verify legal status.

Links to Internet sites with interesting and beneficial information:

Selecting a Nursing Home: New York State Department of Health - "Guide to Finding a Nursing Home in New York State"

New York State Department of Health - Nursing Home Facility Characteristics and Survey Summary Reports

'The Official U.S. Government Site for Medicare Information provides detailed information about the performance of every Medicare and Medicaid certified nursing home in the country'

A Personal Account

Long Term Care Insurance: NYS Partnership for Long Term Care [Long Term Care Insurance]

Click for information on New York State's Medicaid program.