When you or a loved one applies for Medicaid in North Carolina, one crucial aspect is your financial eligibility. Medicaid requires that your assets and income stay within certain limits. To ensure compliance, Medicaid may check your bank accounts. But how often does this happen?

Medicaid’s Initial Financial Assessment

Upon applying for Medicaid, the program conducts an initial financial assessment. This assessment thoroughly reviews your financial status and bank accounts to determine if you meet the asset and income criteria. They will ask for statements and detailed records for a specified look-back period, typically up to five years.

What the Initial Financial Assessment Involves

• Income Verification:
  • Employment Income: Proof of wages, salary, or other income through pay stubs or employer statements.
  • Social Security: Statements showing Social Security benefits received.
  • Pensions and Annuities: Document any pensions or annuities you receive.
  • Other Income Sources: Verify rental income, dividends, interest, or other regular income, such as child support or alimony.

Ongoing Monitoring and Reviews in North Carolina

After the initial approval, Medicaid doesn’t stop monitoring your financial status. Here are some critical times they might review your bank accounts:

1. Annual Renewals: Medicaid beneficiaries must renew their eligibility every year. This process often includes submitting updated financial information. Medicaid will review your bank statements to ensure you meet the financial requirements.
2. Periodic Reviews: Medicaid can conduct periodic reviews at any time. These reviews could be more predictable and aim to ensure ongoing compliance. Beneficiaries might be randomly selected for these checks, or they might occur if Medicaid suspects a change in financial status.
3. Change in Circumstances: If there is any significant change in your financial situation—like receiving an inheritance, selling property, or a substantial increase in income—Medicaid needs to be informed. They may then re-evaluate your eligibility by reviewing your bank accounts.

What Medicaid Looks for in Bank Accounts

During these checks, Medicaid examines various aspects of your bank accounts:

• Deposits and Withdrawals: They look for patterns and significant transactions that might indicate undisclosed income or assets.
• Account Balances: Your account balances should align with the asset limits set by Medicaid. Any substantial increase or overage could raise red flags or disqualify you from receiving continued Medicaid benefits
• Consistency with Reported Information: Medicaid checks to ensure that your reported income and assets match the financial activity in your accounts.

Consequences of Non-Compliance

Failing to comply with Medicaid’s financial requirements can have serious consequences. If Medicaid finds that you have not disclosed all your assets or income, or if they discover discrepancies, you may face penalties, including:

• Repayment: You might be required to repay the benefits received during non-compliance. This substantial repayment can cover all the costs Medicaid paid on your behalf when deemed ineligible.
• Loss of Benefits: Your Medicaid benefits could be terminated, leaving you without essential healthcare coverage. This can be particularly devastating if you rely on Medicaid for long-term care or other critical medical services.
• Legal Action: In severe cases, non-compliance can lead to legal action, including fraud charges. Medicaid fraud is a severe offense and can result in criminal charges, fines, and imprisonment.

Staying Compliant with Medicaid Regulations in North Carolina

To avoid issues, it’s crucial to maintain transparency and keep thorough records of your financial transactions. Here are some tips:

• Report Changes Promptly: Notify Medicaid immediately if there are any significant changes in your financial status.
• Keep Detailed Records: Maintain records of all bank statements and financial transactions. This documentation will be crucial during reviews.
• Consult with an Attorney: Navigating Medicaid rules can be complex. Consulting with an experienced elder law attorney can help you remain compliant and protect your benefits.

Contact Salines-Mondello Law Firm for Guidance

Understanding how often Medicaid checks your bank account and staying compliant with their regulations is essential. If you need help navigating Medicaid rules or protecting your assets, or if you have experienced an increase in assets and are worried about it affecting your benefits, contact Salines-Mondello Law Firm. Our experienced attorneys can provide the guidance you need to maintain your benefits. Call us at (910) 777-5734 or online to schedule a consultation today.