Understanding the in's & out's of a Medicaid application, or just Medicaid in general, can be extremely exhaustive. Applying for Medicaid can be equally exhaustive. Below, Attorney Leonard Berg answers a few questions regarding Medicaid.
Q: My husband is applying for Medicaid to pay for his nursing home, why is there a penalty for the money I paid to my son to help us these past few years?
A: When one spouse applies for Medicaid to pay for long term care, both spouses must give all of their financial information. You can pay children to care for you, but if you do not treat them as employees and report their income to the government along the way, the State views those payments as gifts to the children, including step children. When gifts are made a "penalty period" is imposed, which basically requires you to privately pay during that time. We can help you properly structure caretaker contracts to permit proper credits to you and your children.
Q: My mom is in the nursing home. Why did Medicaid demand that my mom switch to a Medicare Advantage plan?
A: Illinois Medicaid (more commonly known as Public Aid) is in the process of moving all clients to managed care plans, even those with conventional Medicare. This roll out is not a smooth process. By controlling access to providers and the type of care that you can receive the state believes that it can save money. This conversion process might cause some patients to change their primary and specialists. The patient and their caretakers must carefully review the paperwork to see who is in the network. It is very important to speak to the nursing home administrators to confirm whether it is participating in the plan.
Q: Medicaid has paid for my wife’s nursing home care for 18 months; why is Medicaid halting coverage when we only have $50,000 plus our house and car?
A: Yes, Medicaid will pay for her care if you have the house, car and $109,560 or less, plus $2,000 or less in her name. Medicaid gives you up to one year to remove money from the joint account above $2,000.00. After one year Medicaid says that the whole account belongs to her. Medicaid will halt coverage until this joint money is "spent down". You can transfer the money now and appeal. The appeal instructions are supposed to be in the denial notice. The appeal hearing will initially be set in Decatur, Illinois which is the "local office" for long term care Medicaid cases. You must make a separate written request to have the appeal heard in your county. Even if the Medicaid application is filed by you or your nursing home it is important to consult with a knowledgeable Elder Law attorney to learn about your rights and responsibilities.
Q: Should I let the nursing home file the Medicaid application for my husband?
A: In "simple" cases nursing homes can be very helpful with these applications. When the nursing home files the application the State usually only asks for one year of bank statements, but if a lawyer helps you the State asks for five years of statements. But an elder law attorney can explain your rights including the keeping income for the community spouse; transfer and retention of assets within the rules; the tax efficient use of savings bonds and retirement accounts; preserving value of life insurance policies; transfers to children with disabilities or certain other people that will not cause you to have a transfer penalty; how income can be used to pay uninsured medical bills; and the proper way to purchase a prepaid funeral plan. Even in "simple" cases, a short consultation with an elder law attorney can help preserve your rights and work with the nursing home.
The attorneys at Sivia Law can help you with this difficult process. Give us a call: 618.659.4499 or 618.258.4800.