When it comes to navigating Medicaid’s rules and regulations, many seniors and their families find the process confusing, frustrating and stressful. The application process is one of the biggest hurdles that families face, and with regulations varying by state, it can be difficult to even know if you’re eligible.
According to Stuart Furman, Esq. an elder law attorney in California for over 35 years and author of the award-winning “ElderCare Ready Book” and “ElderCare Ready Pack,” it’s critical to know whether your assets will put you over your state’s exemption limit. If they do, then you’ll need your attorney to help you set up your estate in a way that strategically plans for a future Medicaid application.
“Your assets drive the Medicaid application and approval process and it depends whether the Medicaid applicant is married or single,” Furman explains, “so the planning is finding the “sweet spot” which minimizes the spending of resources and maximizes the Medicaid payments,” he says. “For example, in some cases it may be better to claim more income for the Medicaid recipient knowing it will be part of the co-payment in exchange for allowing more resources be kept for the spouse. Sometimes you need to adjust income to minimize your overall expenditures.”
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An elder law attorney like Furman knows the complications and pitfalls surrounding Medicaid, many of which are state specific. For instance:
You can’t exceed the asset limit in your state, but if you properly place your assets in a Medicaid Planning type estate plan, then you’ll be able to better navigate the qualifying and application process.
Medicaid is a complicated system and planning for Medicaid needs to be specific to individual situations, so it’s something that you should talk to an elder law attorney about well before it’s time to apply. You should also see your elder law attorney while you are mentally competent to set up proper Medicaid type estate planning vehicles. Since you do not know if or when a catastrophic health care event will occur, the time to see an elder law attorney is now.
The Medicaid application itself is tricky and it’s easy to make simple mistakes that have serious implications.
For example, in California, your house is exempt if you “intend to return home.” Your intention about returning home is completely subjective, so when the application asks if you intend to return home, the answer should always be yes, even if objectively you will not be, otherwise the home will not be exempt and thus a countable resource, Furman warns.
Other common roadblocks that can cause trouble on your Medicaid application include:
Some potential issues that could jeopardize your existing Medicaid coverage include:
Be cautious when looking to Medicaid for advice, Furman warns. “The government doesn’t give legal advice, so don’t rely on them. Also, the government representatives often do not understand their own rules as well as the private sector.”
Nursing homes and hospital staff are also not always equipped to offer the detailed advice that many seniors need, plus they may be guided by their own interests. Hospitals are looking to discharge patients quickly and nursing homes want to maximize the private pay they receive, Furman says.
An elder law attorney can help you navigate Medicaid, but you want to see them while you are mentally competent to establish a Medicaid type estate plan, and well before you plan to apply for Medicaid to facilitate approval to ensure you haven’t done anything that could jeopardize a future application (like making a gift to a relative which could be considered a disqualifying transfer and thus causing a period of disqualification when you need Medicaid).
Have you already completed a Medicaid application and been denied? It could be worth it to talk to an elder law attorney about your application. They may be able to file an appeal on your behalf, or re-apply for you.
In addition to seeing an elder law attorney, visit A Place For Mom’s directory on state Medicare websites. There are also a few online resources that Furman recommends visiting for more information, including:
What have you found most confusing or difficult about the Medicaid process? We’d love to hear your experiences in the comments below.