How to Approach the Medicaid Process

For many people, Medicaid is an important benefit that enriches their lives and allows them to receive much-needed care. Known as Medical Assistance in some states, Medicaid is a comprehensive health care program that helps give financial assistance to people who need skilled nursing care and meet certain financial guidelines. Medicaid is especially important for senior citizens who may need assistance paying for in-home care or nursing home care. In fact, about 65% of nursing home residents are receiving Medicaid. For this reason, it is important that you know what common mistakes to avoid when navigating the Medicaid application process.

Common mistake #1: Not admitting you need help. Nobody wants to think that they may need to go to a nursing home in the future. However, whether we want to think about it or not, the fact remains that nursing home care is often the default care setting for people who have chronic long-term illnesses that cannot be treated at home. Nursing home care can cost $7,000 per month or more in Virginia, which would be a devastating financial blow for most people. For this reason, it is important that you see an elder law attorney as early as possible when you discover that you have a condition that may require you or your spouse to enter into a nursing home. Asset protection planning attorneys specialize in helping people preserve their hard-earned assets for future generations while still being able to pay for long-term care. Without the help of an experienced attorney, many people will make crippling mistakes that will affect not only their assets, but their ability to get Medicaid assistance as soon as possible. Admitting that you need help with nursing home planning is a vital step in planning for your future.

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Common mistake #2: Failing to recognize potential problems. The process of applying and qualifying for Medicaid can be confusing and complicated for someone who is not used to navigating the system. Because it is a government benefit, the review process for Medicaid applicants is exhaustive. It involves a detailed review of your financial history for the past five years, including investments, bank accounts, real estate transactions, and transfers (also known as gifts). Many people do not realize how complicated the process can be, and still more people may not understand the impact that their financial transactions may have on their Medicaid eligibility in the future. Lack of planning can result in a significant delay in receiving Medicaid benefits.

Common mistaken#3: Lack of communication. Because it is such a complicated process, the Medicaid application can take several months to complete. During this time period, a nursing home may be waiting to be reimbursed, while the resident is paying a small portion of the actual monthly cost in the meantime. The nursing home, the resident or his family, and Medicaid caseworkers should keep a constant open line of communication so that no confusion arises over Medicaid eligibility, nursing home bills, or other related issues during the months it may take to get the Medicaid application approved. Each of the parties should keep the other updated about the status of the application and any changes or concerns that arise during that time.

Common mistaken #4: Delaying or failing to follow through with appeals. Many Medicaid applications are initially denied, especially if they are not completed by an expert in the Medicaid planning field. This can happen for a variety of reasons, including incomplete verifications or gifts that are not exempt from a Medicaid penalty period. Regardless of the reason for the denial, it is important to seek guidance as to why the application was denied and, if necessary, appeal the decision as soon as possible in order to maintain the ability to receive retroactive coverage once a decision has been made in your favor. The window to appeal once a denial has been issued is only thirty days. At this point, you may only need to give additional information; however, in more complicated situations, there may be a legal issue that needs to be solved by a judge or experienced elder law attorney. It is important to appeal as soon as possible so that you do not lose your chance to receive Medicaid benefits.

Common mistake #5: Trying to do it yourself. As you know by now, becoming eligible for and applying for Medicaid benefits is a complicated process that often requires specialized knowledge. Medicaid coverage for long-term care is a complex blend of federal, state and local law. It is important make sure that the application is filed correctly the first time in order to protect the health, safety, and financial security of your loved one. Although it is never too late to plan, it is also never too early. The sooner you make arrangements to pay for long-term care, the more financial protection you are going to have for yourself as well as future generations.

Ask Jolene: Pit Bull Ban

Hook Law Center: Jolene, is it true that Denver voters recently approved a measure to lift the city’s pit bull ban?

Jolene: Yes, this is true. On November 3, 2020, Denver voters overwhelmingly passed a measure to repeal the city’s 30-year ban on pit bull ownership. The bill also limits pit bull ownership to two per home and orders pit bull owners to pay a higher pet licensing fee than is set for other breeds. In pushing to get the legislation passed, Councilman Chris Herndon argued that because many Denver residents already owned pit bulls despite the law, this legislation would allow the city to track and regulate the dogs.

The law banning pit bulls was put into place in 1989 after 20 people had been attacked by pit bulls in the previous five years, including a three-year-old who died from an attack in 1986. Although Denver has now repealed the law, other cities in Colorado still have a pit bull ban in place, including Aurora, Lone Tree, Louisville and Commerce City. The ban was lifted in Castle Rock in 2018.

Posted in Senior Law News