BDear Attorney Tully: My husband is in a nursing home and will be applying for Medicaid (Title 19) in a few months. The nursing home is saying they will do the Medicaid application for free. I like the cost of that but I am concerned that our interests will not be represented. I have heard some things regarding this very issue but unfortunately I didn’t pay too much attention. Can you tell me if it’s a good idea or not? Thank you.
ANSWER: How much is your peace of mind worth? How much knowing that the person you hired works for you and you alone? “Don’t worry, we’re here to help.” When the IRS agent says that, start to worry. But when a nursing home says that it’ll help with your Medicaid application, it’s time to panic.
Lots of nursing homes offer to help with the Medicaid applications at a stressful time, that’s a tempting offer. And in most cases they are truly trying to be helpful to the family. But even in those cases, you may end up paying the nursing home with private funds much more than necessary.
What’s the problem with letting a nursing home help you with the Medicaid application?
First is that the Medicaid rules are complicated. Most of the people who handle Medicaid applications at nursing homes are not lawyers and do not have a good
understanding of the law. They go to a one day seminar and think they understand how Medicaid works. A good lawyer has spent years learning the Medicaid rules, and there are still areas that are hard to understand. Does the nursing home really work for you? That’s the biggest problem. Nursing homes are businesses. They are owned to maximize revenues. And they get paid more from private pay than Medicaid. So it’s not in the nursing home’s interest to get you Medicaid. Let me give you one recent example. We recently had a case where a married couple, who had assets totaling $400,000, was told they needed to spend down $300,000. The husband was already in the nursing home and the wife was still at home. The wife relied upon this information and spent $200,000 before she was told to speak with our office for a second opinion. Before she spent the additional $100,000 we were able to qualify her husband for Medicaid (Title 19) benefits so she kept their home and the rest of what was left. Unfortunately, the $200,000 that she had already spent was not recoverable. The lesson is be careful who you listen to. Listening to the nursing home cost this couple $200,000. We are often asked, “Can’t a family just do their own Medicaid application?” I don’t recommend it. The Medicaid law is complicated, and if you don’t fully understand the law, you could spend many thousands of dollars (sometimes hundreds of thousands), unnecessarily.
Medicaid (Title 19) law requires you to submit lots of paperwork. This includes bank and brokerage statements for 5 years, cancelled checks, even statements for closed accounts. And keep in mind one mistake could cost you a lot by increasing the ineligibility period unnecessarily.
So where can we get help? I recommend you get an experienced Elder Law attorney to help, a lawyer that will stand up for you, not the nursing home. One that does Medicaid applications on a regular basis. We’ve done hundreds, maybe thousands, and they’re not easy to do.
If the nursing home offers to do your Medicaid application, just say no; otherwise, you might spend thousands of dollars unnecessarily.
