Checklist For Buffalo Nursing Home & Medicaid Eligibility

The County Social Services Nursing Home Units in New York are specialized Medicaid Units that determine 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.

Upon receipt of the completed Access NY application by Social Services, the application will be assigned to an examiner who will contact you to discuss the application or arrange a face to face appointment.

In addition to verification of gross monthly income and outstanding medical bills, you must supply the last 60 months of financial records. This may include all pages of statements from brokerage houses and banks. Documentation of the source of all deposits and withdrawals of $2,000 or more is usually required.

It is in your best interest to provide as much verification as possible. 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 that 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 spouses must provide the following verifications:

    • Original 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 assisted living (ALP) facility.
    • 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 be passbook or account statements for both open and closed accounts. Transaction histories from the financial institution are accepted 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. Verification of GROSS benefits is required.

  • Letter from hospital verifying Alternative Level of Care [ALC] date and Medicare cut-off dates
  • Tax returns with all appropriate schedules for the past four years
  • Letter/bill from nursing home verifying the ‘paid through’ date
  • Stocks, bonds, and/or securities 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
  • Deed(s) to all real estate owned, including deeds to all vacation property, time shares, life estates etc., even if owned in another state.
  • Proof of prepaid funerals and burial spaces.
  • Documentation for Power of Attorney or guardianship for applicant.

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 citizenship.

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