Dear Attorney Tully: My husband is in a nursing home for long-term care. I tried to file for Medicaid benefits on my own in order to save money, but the application was denied because we gave gifts to our children. Now what do I do?
Answer: You are not alone. Many people think that they can fill out the paperwork and file for Medicaid benefits on their own, but it is not as easy as one might think.
For years I have taught that there are certain situations that require legal assistance to get the best result when a Medicaid application is filed. Among the most common are those cases where someone has made a gift of money or property during the five-year look back period or when they have paid private caregivers or have large retirement plans. In those instances, it’s likely that without expert guidance, in most cases, you won’t get the hoped for result.
As Connecticut’s budget deficit grows, the state is looking for better ways to deliver services on limited funds.
It’s becoming more common for Medicaid (Title 19) applications to be denied.
More and more individuals are experiencing delays and denials due to a lack of complete information provided along with the application or by mistakes made in the processing of the application. If you receive a denial notice, here is what should you do.
If you are able to reach a caseworker (which is not always easy to do) you may be able to advocate for the application which was originally filed and explain why it should have been approved. In certain cases that can work.
In other cases, however, it may be necessary to file for a fair hearing. A fair hearing is done through the Office of Administrative Hearings and is an opportunity to go before a hearing officer to explain why the application should have been approved. In order to handle the appeal in the appropriate manner, a hearing brief should be prepared outlining the facts and legal precedents that bolster your position.
Preparing a fair hearing brief can be complicated. The brief establishes the record for what is to be considered in the event that the case ultimately winds its way through the administrative hearing system and into the courts.
If you have a situation where the application has been denied and it is necessary to go into the administrative appeal process through a fair hearing, you should not undertake this lightly. In many instances, pursuing a fair hearing is the practice of law and should be undertaken by an elder law attorney very familiar with the entire Medicaid process and the art of prevailing at a fair hearing.
