Applying for Assistance Clause Samples

Applying for Assistance. (1) The Resident and Designated Representative agree to submit a timely application for all available benefits, including Medicaid benefits, and to timely apply for Medicaid recertification as necessary. The Resident and/or Designated Representative agree to notify the Facility at least three (3) months prior to the depletion of the Resident’s funds and/or insurance coverage and to apply for Medicaid, including the provision of all necessary information and documentation, within the required time frame. All financial requirements for Medicaid eligibility have been explained to the Resident. (2) Should the Resident and/or Designated Representative fail to apply promptly for Medicaid benefits or if the Resident has been admitted as a Private Pay Resident, at least three (3) months before the Resident’s personal resources for payment of the Facility’s charges are depleted, the Facility may, at its sole discretion, and the Resident hereby authorizes the Facility, to take any actions necessary to ensure an application is timely filed on behalf of the Resident, including the submission of the Medicaid application, Fair Hearing request, appeal or any other required documents. The Resident, and/or Designated Representative shall cooperate fully in the preparation and submission of such filings and shall provide all requested documentation necessary to establish the Resident’s eligibility. The Facility shall not have any obligation to process such applications or appeals. The Resident and/or Designated Representative understand that they may be held personally liable for damages sustained by the Facility caused by the submission of intentionally false information to the Facility, including undisclosed transfers of assets. (3) The Resident and/or Designated Representative further agree to provide the Facility and/or the County Department of Social Services with the last sixty (60) months of bank statements for open and closed accounts, open and closed security transaction accounts, open or closed, tax returns and all other necessary information and all authorizations necessary to obtain such information. (4) The Facility will inform each Medicaid-eligible applicant and Resident of the items and services that are included in Facility services under the State Medicaid plan and for which the Resident may not be charged and such other items and services that the Facility offers and for which the Resident may be charged, including the amount of charges for those services...