Medicaid Application Guide

Nevada Medicaid may cover children who live in families making under 133% of the Federal Poverty Level for children under the age of six (6) or under 100% of the Federal Poverty Level for children over the age of six (6).

Medicaid Eligibility Guidelines

Who Qualifies?

Low-income Families with:

Child(ren)
Pregnant women
Infants
Children aging out of Foster Care until age 21
Emergency services for undocumented immigrants or refugees

Must be a US Citizen or Legal Resident
Must be a Nevada Resident
Pass asset test

Less than $2,000 in bank accounts
Own no more than 1 home
Own no more than 1 car
There is no asset test for the Family Medical Coverage Medicaid Program if it is for pregnant moms or children ages 0-19. Eligibility is solely based on income, citizenship, and Nevada residency.

Meet income requirements

Children ages 6-18: Income at or below 100% of the Federal Poverty Level
Children ages 1 through 5: Income at or below 133% of the Federal Poverty Level
Children less than 1 (if mother is receiving Medicaid) and pregnant mothers: Income at or below 133% of the Federal Poverty Level

These are very general guidelines and do not guarantee eligibility. The Welfare Office uses a very complex formula to determine eligibility based on household make-up and deductions for certain expenses (like childcare), so the actual income limits for the Family Medical Coverage Program may vary slightly from those listed above.

FAQs about Medicaid

List of Frequently Asked Questions (FAQs) about Medicaid

Can applicants apply for Medicaid for their child(ren) if they are not legal US Citizens?

Yes, however, in order to receive benefits a person must be a legal US resident. A non-citizen can apply for their child(ren) if they are legal US citizens. Applying for Medicaid will not affect a person immigration status.

Illegal immigrants or non-citizens can apply for month-to-month emergency Medicaid. They must meet all Medicaid or TANF requirements except for citizenship.

Can the applicant complete the household members section for the applying family only?

No, applicants are required to list everyone living in the house. Also, all of the information needs to be completed if the person is applying to receive benefits.

Do applicants need to fill out all sections on the application?

Yes, unless at the start of the section it says it should only be filled out if they are applying for a certain program.

How do applicants verify that they are legal US citizens?

Applicants must provide the original copy of one of the documents off the CMS approved list in person to the Welfare Office. Applicants can simply show the document to the receptionist along with the application and the front office can check off that they have seen it. If a person is undocumented they must provide their birth certificate from their country of origin.

How do families apply for Medicaid?

Applicants fill out the Division of Welfare and Supportive Services Application for Assistance. Return the completed application with appropriate documentation to the local Welfare Office.

How long does Medicaid last?

Medicaid coverage is for one year. Medicaid enrollees will receive a re-determination notice before the anniversary of the date they were enrolled. For continued coverage, reply to the request with all the information requested.

There is a family member who is disabled; how do I know if they could possibly qualify for MAABD?

The MAABD applicant should fit into one of the following categories:

Supplemental Security Income (SSI) recipients;
Employed individuals, ages 16 through 64 with disabilities with a combined net earned and unearned income up to 250% of the Federal Poverty Line;
Nursing facility residents with gross monthly income up to 300% of the SSI payment level (state institutional cases);
Certain individuals who have lost SSI eligibility but would still be eligible if some of their income were disregarded (Public Law Cases)
Disabled child(ren) who require medical facility care, but can be appropriately cared for at home;
Aged or physically disabled people who require medical facility care, but can be appropriately cared for at home and aged individuals who have been residing in nursing facilities who can appropriately be cared for in adult group care facilities (Home and Community-Based Waivers); or
Ineligible aliens or non-citizens who do not meet citizenship eligibility criteria and have emergency medical services may qualify for some limited Medicaid coverage.

What are the applicant’s responsibilities if they move?

The applicant needs to contact the Welfare Office and ask for the address change form. If the applicant does not notify the Welfare Office they may miss critical notices about benefits.

What do the abbreviations on the first page mean and which one should be marked if an applicant is applying for Medicaid?

The abbreviations stand for the different types of programs an applicant can apply for using this application. The names and abbreviations are as follows:

FS= Food Stamps;
TANF= Temporary Assistance for Needy Families (cash assistance);
FMC= Family Medical Coverage (Medicaid);
MAABD= Medical Assistance for the Aged, Blind and Disabled (special Medicaid program).

What should an applicant do if the original birth certificate is unavailable?

Applicants should try and produce one of the other acceptable CMS required documents. If an applicant cannot find any of them then the applicant has to apply for a replacement birth certificate. If the child(ren) were born in Nevada, Welfare can access the Bureau of Vital Statistics and look up the child(ren)’s birth records for no cost. If the applicant cannot afford a replacement birth certificate Welfare can purchase one but then Welfare will retain the original.

Will Medicaid cover any of the medical bills the applicant already has?

For eligible applicants, Medicaid may cover some medical bills that have accrued in the 3 months prior to the month of application. The applicant must note on their application that they have prior medical bills on their application and provide copies of the bills.

CMS Approved List of Citizenship Documents

As of July 1, 2006, Medicaid applicants and recipients are now required to show U.S. citizenship documentation. The original documents must be shown in-person by the applicant or an authorized representative to an employee at the Welfare Office for verification (front office staff counts). Copies are not considered acceptable anymore.

Applicants who are already enrolled in Medicare or SSI are not required to prove citizenship.

The guidance from the Department of Health and Human Services uses a hierarchical approach. This means if an applicant presents one of the documents from the primary documentation list no other documentation is required.

Primary Documentation

A U.S. Passport
A Certificate of Naturalization
A Certificate of U.S. Citizenship

Secondary Documentation

If no primary documentation is available, applicants must provide two documents, one to verify citizenship, and a second to verify identity.

Acceptable forms of citizenship verification

U.S. Birth Certificate
Certification of Birth Abroad
Baptismal Certificate (showing date and place of birth)
U.S. Citizen I.D. Card
Adoption decree showing name and U.S. birthplace
Official Military Record of Service
American Indian Card with Classification Code “KIC”
Northern Mariana I.D. Card

Acceptable forms of identity verification

Current Driver's license with photo
Government issued I.D. card with photo
School I.D. card with photo
U.S. military card or draft record
U.S. military dependent's I.D. card
Tribal Enrollment Card

If under 16, the following can be used for identity verification

School record showing date and place of birth and parent's name
Clinic, doctor or hospital record showing date of birth
Licensed daycare or nursery school record showing date and place of birth.

Special Programs

There are a number of special programs within Medicaid for those in certain situations.

Emergency Medicaid

Emergency Medicaid is month-to-month Medicaid Coverage for people who are undocumented or non-citizens and have an emergency medical situation.

Only emergency medical conditions are covered. For example, pre-natal care is not covered, but the actual delivery of the child is covered.

Who is eligible?

Parents of a dependent child or children age(s) 6-19 in a household earning 100% or below the Federal poverty Level. For parents to be eligible, households must meet the Asset Test (less than $2000 in checking and savings, own one car and own one home).
Children 1-5 in a household earning 133% or below the Federal Poverty Level.
Pregnant women and child(ren) 0-1 in a household earning 185% or below the Federal Poverty Level.
Individual with disabilities, blind or over 65 years of age, who would qualify for SSI if not undocumented immigrants.

Basically, Emergency Medicaid is for people who would be eligible for Medicaid based on income resources and household size, but due to citizenship requirements they are not eligible. For example, a single person with no disabilities who is age 26 would still not qualify for Emergency Medicaid because there is no Medicaid category for this person.

To Apply:

Fill out MAABD application or check “MAADB” box on regular application for person applying for benefits. Also, write “Emergency Medicaid” on the top of the first page of the application.

This program does do retroactive payment of medical bills for eligible applicants. However, the applicant must mark “yes” to question #13 on Page 2 of the Medicaid application. In addition, the applicant must have evidence of all prior medical bills they are asking for payment.

Katie Beckett Option

This program provides medical assistance coverage for certain children under age 18 who have disabling conditions and live at home. This program enables children with special health care needs or disabilities to be cared for at home instead of in an institution. Only the child's income and resources are used in determining financial eligibility. The cost of care at home compared to the cost in an institutional setting is also used in determining eligibility. In order to find out if you and your child qualify for the Katie Beckett Waiver it is important to make an appointment at the nearest Welfare District office. They can assist you by providing more information and providing help in the application process.

Eligibility Guidelines:

Be age 18 or under
Be living at home
Require a level of care provided in a nursing facility as determined by Nevada Medicaid Office
Meet all eligibility criteria of an institutional case except residing in an institution.
The child(ren) must have a disability, but does not qualify for SSI
The child(ren) must have a level of care that would be provided in a hospital, nursing facility or intermediate care facility for the mentally retarded
A physician must validate it is appropriate for the child to receive necessary services in the home
Costs for medical coverage cannot exceed the amount Medicaid would pay if the child were institutionalized (the established amount is dependent on the specific level of care).

Benefits covered:

If a child(ren) qualifies under Katie Beckett they will receive Medicaid coverage, which includes:

Medically necessary hospital care (inpatient and outpatient)
Physician care/services
Most physician prescribed medications
Vision and dental care
Other services provided in the home which would normally be provided in a hospital, nursing facility, or intermediate care facility for the mentally retarded. (exclusions apply)

There is a monetary limit to the medical coverage cost reimbursed which must be no more than the amount Medicaid would pay if the child(ren) were institutionalized.

Applications for Katie Beckett

Apply at the local Welfare Office. Call 1-800-992-0900 or look on the Nevada Division of Welfare and Supportive Services webpage.

Non-Needy Caretaker Program - Grandparents raising grandchildren

This is a Medicaid program for Grandparents or other caretakers to obtain medical coverage for themselves and the children they are caring for.

The income for all individuals in the household related to the child(ren) is counted. There is a higher income limit of 275% of the Federal Poverty Level than with traditional Medicaid.

The regular Medicaid application is used to apply for the Non-Needy Caretaker program options. Applicant should check off “FMC” in the boxes on page 2 for themselves and the child(ren) in the household.

The eligibility worker should realize that the household is applying for a Non-Needy Caretaker Program. However, it is a good idea to write on the top of the first page of the application “Non-Needy Caretaker Program” to help the eligibility worker know what program to screen for.

Tips for Filling out the Medicaid Application

General Info

If you are not sure if a family is eligible for Medicaid they should still fill out the application and leave the decision up to the eligibility workers.
Non-disabled children, pregnant mothers, and parents should apply for the FMC (Family Medical Coverage) program. Check off “FMC” in boxes on page two for every member applying.
Everyone living in the household should be listed on the application.
A pregnant mother should list her child as “unborn” in the household members section on the application and put the due date as the age.
A valid social security number must be provided for every person who is applying for benefits. Anyone who is not applying for benefits does not need to provide their social security number.
The Welfare office provides 10 days to send in additional requested documentation. Applicants can request an extension if needed.
Applicants can reapply at any time if they are found ineligible.

Children with Disabilities

A family with a child(ren) with disabilities should apply for SSI (must still meet citizenship and residency requirements). This is a separate application and families should call the SSI Office at 1-800-772-1213. The SSI application begins with a phone interview and then SSI will also send the applicant a paper application.
Also, screen applicants for the Katie Beckett Medicaid Program

Submitting Applications

Medicaid applications can be mailed in to the local district Welfare Office. If a family is only applying for Medicaid, they do not need to have a face-to-face interview, but are required to provide the original copies of their citizenship documentation.
Applicants for TANF or Food Stamps must have a face-to-face interview with an eligibility worker at the time the application is submitted and then annually to verify eligibility

Referrals to Nevada Check Up

Once a month, Medicaid refers its applicants who were determined “over-income” to Nevada Check Up. The family does not have to send in a Nevada Check Up application. However, Check Up may ask the family for additional information.
However, this only happens if the entire family is found ineligible for Medicaid. If one child is found eligible for Medicaid and the rest are not, the family will not be notified by Medicaid about Nevada Check Up and must fill out a separate application.
Nevada Check Up will refer “under-income” applicants to Medicaid immediately. Families may need to complete a separate Medicaid application.

Other Health Insurance

If a family has private insurance, they may still qualify for Medicaid if they meet the income guidelines. Medicaid becomes their secondary insurance and their private insurance will be their primary insurance. Medicaid will cover the difference for co-pays and premiums after the private insurance is billed.

Previous Medical Bills

Medicaid covers some bills retroactively for eligible applicants. It will pay for medical bills incurred up to 3 months prior to the month an eligible person applied for Medicaid, but the applicant needs to mark yes to question #13 on their initial application.

Delinquent Parents

The Welfare Office does not contact delinquent parents if the custodial parent is only applying for medical benefits for their child or children.
If a parent is applying for benefits for themselves, the Welfare Office will contact the delinquent parent unless:

the pregnancy resulted from rape/incest,
legal proceedings for adoption of the child are pending in court,
parent is being assisted by a social service agency about whether or not to keep the child,
or the parent’s cooperation in establishing paternity support will result in physical or emotional harm to the parent applying for aide or the children involved

Immigration Issues

Welfare requires that all Medicaid recipients are US citizens or legal residents for 5 consecutive years. Children of undocumented parents can still qualify for Medicaid if they are U.S. citizens even though their parents are undocumented. Applying only for medical coverage will not affect a family’s immigration status.
Applying for TANF or Food Stamps can affect a family’s immigration status. Applicants should be told to mark “none” on page one of the application for any family member who is not a U.S. citizen. A food stamp application for eligible children will never affect a family’s immigration status.
See Emergency Medicaid for more information on programs for undocumented immigrants.