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Kevin O'Flaherty

In this article, we discuss the necessity of legal experience when applying for Medicaid and the common mistakes that applicants make when completing the process independently. We will answer the following questions:

  • Should I plan for nursing home assistance?
  • Are my finances reviewed to determine Medicaid eligibility?
  • What if I need Medicaid eligibility now for nursing home costs?
  • What happens if I need to appeal a Medicaid denial?
  • Can I complete my Medicaid application by myself?

For many people, Medicaid provides an avenue to a richer, more fulfilling life. By providing financial and medical assistance that would otherwise be obtainable, Medicaid helps millions receive the care they need to keep living. Many families depend on Medicaid to cover the cost of end-of-life care. So why do many still try to complete the application process without assistance? The main reason may be that most don’t realize the help is there. Whether it’s ignorance or fear that the price is too high, they don’t understand that they could get much more out of Medicaid if they had an experienced professional that understands the Medicaid system to help them complete their application. 

Should I Plan For Nursing Home Assistance Through Medicaid?

You may think, “I’m healthy now; why would I even consider a nursing home?” But, we can’t ignore that nursing home care is the primary means by which a chronic long-term illness Medicaid patient is cared for when home treatment is not an option. Even if you’re in good health as you plan for Medicaid, if you have a condition that may require you to spend time in a nursing home, it should be factored into your Medicaid planning. The average cost of nursing home care in Illinois is $11,250 per month. You can’t simply assume you’ll never need nursing home care. Even if you tell your family that you don’t want to be placed in a nursing home, some conditions make at-home care nearly impossible. Estate planning and Medicaid attorneys can help you create contingency plans that protect your assets and qualify for long-term care through Medicaid.

Are My Finances Reviewed To Determine Medicaid Eligibility?

Medicaid is a government program, but the eligibility requirements are set at the state level. The review process is exhaustive and includes a review of your financial history going back five years. The auditor reviewing your application will comb through your bank accounts, retirement assets, real estate assets, business holdings, and gifting history to determine your eligibility. Many people don’t realize how their day-to-day transactions can affect medicare eligibility, even years before they ever apply. However, just because you made a large purchase at one point or gave a child a lump sum of cash, don’t immediately assume this disqualifies you from obtaining Medicaid. There are many pathways to becoming Medicaid eligible; many even require spending your assets down or wrapping them up into trusts to qualify.

What If I Need Medicaid Eligibility Now For Nursing Home Costs?

Unfortunately, it’s not that simple. If you’re not already covered under Medicaid, the review process can take time. However, for those over 65 and older, there are dual Medicare and Medicaid plans under which you can qualify. The important thing here is to plan ahead. Most elderly have an idea of when they may need nursing home care, and if they are already on Medicaid or have a dual Medicare-Medicaid plan, nursing home care should be covered according to their plan. For those applying for Medicaid, to help cover the cost of nursing home care, open communication between the Medicaid caseworker, family members of the patient, and the nursing home facility is critical. If the nursing home facility knows that the patient will eventually be picked up by Medicaid and that the bill will be retroactively paid through Medicare, the nursing home will be less likely to ask for the patient to cover the costs in the interim.

What Happens If I Need To Appeal A Medicaid Denial?

Unless you or the person completing your Medicaid application is an experienced in the process, expect the initial application to be denied. Assuming a denial is coming may seem like a pessimistic stance, but unfortunately, it happens to most first-time applicants. Usually, denials are due to incomplete verifications, the caseworker finding gifts that are not exempt under Medicaid, or trivial fact mistakes on the application. However, it’s not always clear why an application is denied. Upon receiving the notice of denial, the applicant should ascertain the reason for denial and file an appeal as quickly as possible. The window for an appeal is thirty days, and failure to meet the deadline can result in loss of retroactive coverage. If you’re trying to complete the application process alone, receiving a denial is a good indication that it’s time to seek an attorney.

Can I Complete My Medicaid Application By Myself?

You can, but hopefully, you better understand the risks of trying to apply for Medicaid without experienced help. It may be difficult to justify the cost of hiring a Medicaid attorney. Still, the price pales in comparison to how much you can lose in Medicaid benefits from even a single mistake on your Medicaid application. Don’t wait until you need Medicaid; plan now for the eventual transition.

Disclaimer: The information provided on this blog is intended for general informational purposes only and should not be construed as legal advice on any subject matter. This information is not intended to create, and receipt or viewing does not constitute an attorney-client relationship. Each individual's legal needs are unique, and these materials may not be applicable to your legal situation. Always seek the advice of a competent attorney with any questions you may have regarding a legal issue. Do not disregard professional legal advice or delay in seeking it because of something you have read on this blog.


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