Retroactive Medicaid/ Medicaid pending--When is the start date?

We just received a notice from our state DHHS that if they don't complete the process in 45 days from the date we applied, and it's their fault, then they will start paying at that point. If the person is eventually found to not be eligible for the LTC coverage, the person doesn't have to pay it back. Of course if the delay past 45 days is due to a problem on the applicant's end, that's another story. The social worker at the nursing home said that in his experience our state's Medicaid program wants people to keep their Medicare supplement insurance; the costs for that would continue to be paid by the recipient and would be considered when Medicaid figures the person's share of cost amount. That actually would work for our relative, as their gross income is a sight amount over the eligibiity level but if you subtract out what they pay for the supplement and Medicare Part D (presecription drugs) their income is well under the guideline.

In New York, it took six months to process because of an uncooperative elder. "They don't need to know that." 'I gave that to them already" (No, he didn't. )

It was retroactive to the date of application.

For my mom in TX and my mil in LA and then again in TX, the start date for LTC NH Medicaid was the date the application was signed off on by them. Medicaid retro’s for coverage to the date of the application whether it took 5.5 months for my mom or 5 weeks for mil for her LA one. For both of them, it was the process where their NHs submitted the moms Medicaid application and the moms’ stack of documents (hubs & I gathered up, filled out and gave to the NH which did a initial review to see if all looked ok) along with their (the Nh’s) initial bill. It was “Medicaid Pending” status for them at their respective NH, as they each entered their NH as Medicaid pending.
Your situation is different as your mom has been a resident for quite a long time & basically on a spend down. I would guess that your moms approval will be pretty fast as it’s likely very very clear where the $ went with a preset pattern of spending over past 2 years. I’d suggest you ask & reask admissions at the NH as to their submitting the whatevers needed from their end to the state to get her approved as efficiently as possible.

As an aside on this, please review your mom’s secondary insurance policy. If she is still using one to pay for health care copays, once she goes onto LTC Medicaid and she gets approved and retro’s to date of application that old secondary policy will either be suspended or more likely cancelled outright. Everything now bill to Medicaid. Secondary usually have it where WHEN they become eligible for another insurance (Medicaid) THEN secondary stops the date Medicaid takes over. For my mom, she was on sPouse benefit FEHIB as dead dad was a fed, this was with BlueCrossBlueShield. For the 5.5 mos to get her LTC application thru, any vendor billing to BCBS was paid as she was still on it. BUT once she went onto Medicaid & it retro’s back 5.5 mos, BCBS clawed back all payments to vendors done over that 5.5 mo period of time. BCBS sent a notice on suspension of FEHIB abt 90 days in (FEHIB is pretty organized & does match ups); & I sent NH a letter as to this with xerox of FEHIB notice, so NH was clearly on notice & aware on this. Long story short, many many months later mom gets billed from 2 PTs seeking $ as they got a BC clawback & could not rebill to MedicAID as they did not participate in medicAID. It was a bit of a clusterF; why a PT seeing residents of a Medicaid participating NH would not accept Medicaid is beyond me to phantom.... Anyways, I mention this as this was something that never ever would have occurred to me to be on the alert for in the Medicaid/ Medicare LTC maze. So ck your mom’s secondary insurance and ask billing & SW at your moms place as to if all service providers at her NH fully participate in Medicaid.
Good luck in getting her eligible quickly.

Your husband will need to call and ask. It may vary from state to state. My MIL's app took 3 months to process. Once she qualified Medicaid allowed her to submit medical bills for payment that predated the application date back 3 months. That was in 2016 in MN. Again, don't go this info since it's now 2020 and I probably don't live in your state.