Medicaid Long-Term Care Application Organizer

An organizer for a long-term care Medicaid application, for nursing home care or care at home. Keep the income, accounts, property, gifts and transfers, the caseworker's requests, your calls, and the decision in one place. Built for the family member doing the paperwork.

WHAT YOU GET (12 pages)

1. The Application: dates, numbers, the program applied for, and every contact
2. Notices and Requests for Information: what they asked for, the due date from the notice, and proof you sent it
3. Income
4. Bank and Investment Accounts, with the months of statements gathered
5. Property, Vehicles, and Policies
6. Gifts and Transfers Record
7. Large Deposits and Withdrawals
8. Monthly Costs
9. Contact Log
10. Decision and Fair Hearing Record
11. Renewal and Changes Log
12. Document Checklist

Plus a Read Me First page.

Bonus: Where the Official Rules Live: federal limits on decision times, the look-back for gifts and transfers, and fair hearing requests, with sources, checked November 10, 2026.

FILE FORMATS

• Fillable PDF you can type into, or print and fill in by hand
• Word (.docx) for Microsoft Word and Google Docs
• US Letter and A4 sizes
• Two looks: Classic and Modern

GOOD TO KNOW

• This is a digital download. Nothing will be mailed to you.
• These are blank forms for your own records. This is not an application form. Use your state's official application.
• Each state runs its own Medicaid program, so the forms leave room for your state's lists and dates. Always follow the dates in your own notices.
• I'm not a lawyer or a Medicaid planner, and this is not legal or financial advice.
• Not affiliated with or endorsed by any state Medicaid agency, CMS, or care facility.

PLEASE DON'T SHARE

These files are for your own personal use. Please don't resell, share, or post them.

Free updates: when a rule or date changes, your download link gets the updated file.

Can't pay right now? Email thedenialdesk@gmail.com with the subject "Free kit" and the name of the kit you need. No reason needed. Please don't include medical details, bills or insurance numbers. Limit one free code per email address, good for one kit.

AI disclosure: This kit was drafted with help from AI tools, then reviewed and fact-checked by our founder, a certified medical coding professional.