Getting on Medicaid is not the end of the story

3 years ago the rules changed so that it is okay for nursing home personnel to assist families in making out a Medicaid benefits application.  The change seemed to be a good one for both nursing homes and families.  Both want to get payments coming in to cover the cost of care as soon as possible. Coupled with the general social aversion to having to pay attorney fees, the change seemed a welcome relaxing of a strangely strict rule.

But this change had a very intentional but not well-advertised side effect.  It encouraged people to “go it alone.” There is nothing illegal about that.  HHSC has made the application form attractive and easy to fill out.  But in so doing, they have set traps for the unwary and unsophisticated.

When a self submitted application is granted it seems that the change was a good one.  But, all approvals are subject to redetermination.  This means that steps may need to be taken between the initial approval date and the redetermination date in order to continue to qualify.   These requirements are not spelled out in the forms and may not be known by the helpful person completing the form.   Nursing Homes can’t advise families about how to qualify or stay qualified and they can’t advise people on the legal steps necessary to protect against Medicaid estate recovery.  Without legal advice, an application for benefits is really just be a loan application.

When a self submitted app is denied, since the State is not required to specify every defect at once, a family can accumulate several months of liabilities for private pay care before they finally get all the kinks worked out.  Two frequent sources of denial are based on penalized transfers and over resource determinations.  Phrases like, “Momma has next to nothing” and “she just reimbursed us for picking up little things for her” are very often the harbingers of doom in a Medicaid application.    But, in general, friendly helpers do not know how deep they have to probe in order to actually uncover issues.
While the moral to this snippet may seem self serving for an Elder Law attorney, it is the moral none-the-less:  Medicaid applications are serious business with long term repercussions and should not be completed or submitted without qualified legal advice.

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