Don’t Try To Do it by Yourself !
The Medicaid Application process is complex and filled with hidden dangers. In this time of financial difficulty for the State, they are actively seeking to deny or impose penalties on as many applications for Medicaid as possible. It makes sense for you to have an experienced Elder Law attorney assist you in the process. This is particularly true if you previously have done any Medicaid Planning or Asset Preservation planning. However, the vast majority of Medicaid denials or approvals subject to penalties are not the result of planning, but are the result of normal innocent patterns of family life. If you have gifted money to a child or grandchild, assisted a child in financial need, paid for a grandchild’s education, made lump sum donations to charity, or any of many actions which you did to help your family, these actions could result in the imposition of a penalty where Medicaid will not pay even though you have no money left. Generally, people are unaware of a problem until it is too late. One misstep and your application for benefits may be denied, requiring a Medicaid Appeal.
If you decide to have the facility assist you with the application, don’t expect them to recognize a potential problem, and they will not advise you how to legally address the problem. If you retain the services of an experienced Elder Law Attorney early enough, frequently they can avoid the denials and deal with any potential penalty period. The Law Office of James C. Siebert & Associates, P.C. /Elder Law & Estate Planning Attorneys of Illinois, P.C. has successfully assisted many Clients in the Medicaid application process including dealing with potential issues to avoid or minimize any negative impact on the Client. The Law Office of James C. Siebert & Associates, P.C. /Elder Law & Estate Planning Attorneys of Illinois, P.C. helps clients qualify for Medicaid, complete the Medicaid application accurately and submit all of the supporting documents necessary to get their applications approved, avoid Medicaid denials, obtain their benefits as soon as they are eligible and handles all communications with the State. Call the Law Office of James C. Siebert & Associates, P.C. /Elder Law & Estate Planning Attorneys of Illinois, P.C. at (847)253-7500 today to schedule an appointment with an experienced Elder Law Attorney.
What happens when the Money Runs Out?
The cost of care in a Nursing Home or other long term care facility can be prohibitive and the average family can easily expend its entire savings in a very short time. The annual survey of costs by a major long term insurance provider found that for 2015 the average rate for a nursing home semi-private room in the Chicagoland area was $225.00 per day or approximately $82,125.00 per year and for a private room it was $253.00 per day or approximately $92,163.00 per year. As anyone who is a resident in or has family in a nursing home knows this is just the start of the expenses.
Medicaid is a joint federal and state government program that helps people with low income and assets pay for long-term care services in nursing homes. Unlike Medicare, Medicaid does pay for custodial care in nursing homes. However, there is no right to have Medicaid pay for Nursing Home costs, the burden of proof is on the applicant to show that they not only meet the present qualifications for Medicaid, but that they have done nothing in the last 5 years which would violate Medicaid rules and therefore result in an outright denial of Medicaid benefits or a period of ineligibility.
Is the Nursing Home really being Honest when they offer to help with the application?
What does that really mean? It frequently means that the nursing home will have you spend all your money paying the facility, then it will give you a blank application and a list of documents that you need to provide. Even if the facility actually assists you in compiling the application, the individual who helps you is generally only vaguely aware of all the application process and the Medicaid rules. In either case you will spend untold hours collecting documents and trying to figure out how to complete the application. What the nursing homes don’t tell you is they cannot advice you on options you may have, how to handle potential issues, or that there may be certain specific procedures or documents that the State will require to approve your application, because they are not Attorneys and cannot provide legal advice. Ask the nursing home facility whether they will assist you once the application has been filed and the State seeks additional documentation or an explanation or whether they will advise you or assist you in an appeal if the State mistakenly denies your application or imposes a penalty period during which Medicaid will not pay.
The real issues start if you do have difficulty in your application, or the State mistakenly denies your application or imposes a penalty period during which Medicaid will not pay. If you Read the Nursing Home Agreement it will generally have a provision within it that makes it clear that you are solely responsible for applying for and getting approved for Medicaid. It is also possible that the contract calls for you and your Personal Representative or agent under a Durable Power of Attorney to be personally liable for the private pay rate for any uncovered period, and the facility may begin a collection against you and your Personal Representative. In addition, the facility then will likely bring Involuntary Discharge actions against the resident for non-payment. The Law Office of James C. Siebert & Associates, P.C. /Elder Law & Estate Planning Attorneys of Illinois, P.C. will assist Clients in a Nursing Home contract review, modifying and negotiating the terms of the agreement with the facility. Call the Law Office of James C. Siebert & Associates, P.C. /Elder Law & Estate Planning Attorneys of Illinois, P.C. at (847)253-7500 today to schedule an appointment with an experienced Elder Law Attorney.
An example from a contact which was recently brought into the Law Office of James C. Siebert & Associates, P.C. /Elder Law & Estate Planning Attorneys of Illinois, P.C. is quoted below.
“ Resident and Resident’s Representative agree to assume full responsibility in making timely and proper application for Public Assistance, and for its contents thereof, at such time when Resident’s assets are depleted and to pursue any necessary appeals or denials of Public Assistance as may be required. A failure by the Resident or Resident’s Representative to so apply for Public Assistance or appeal a denial of an application constitutes a breach of this Agreement and subjects the Resident and Resident’s Representative to liability to the Facility in the amount that the Resident is charged utilizing the Facility’s then-applicable private pay rate.
This facility may provide the undersigned with information regarding eligibility and other assistance in completing forms, but makes no promises or guaranty as to the timeliness or success of such application which is the full responsibility of the undersigned. The resident and/or Resident Representative agree not to use any action taken by Facility or any error or omission by Facility in helping you obtain Public Aid as the basis for any claim or defense in any civil or administrative proceeding of any kind. Appeal of any Medicaid decision is solely the responsibility of the undersigned.”
Given these risks and all the extra work associated with having the resident complete their own applications you might wonder why all Nursing Homes don’t refer their residents and their families to Elder Law Attorneys. The reason of course is MONEY. The facility knows that the money you pay to an Elder Law Attorney to represent you and your family throughout the entire Medicaid Application and approval process is money that the facility would otherwise receive.
Unfortunately, the reality is that if you rely upon the Nursing Home’s offer of assistance that you really are on your own.
Have the Law Office of James C. Siebert & Associates, P.C. /Elder Law & Estate Planning Attorneys of Illinois, P.C. represent you in the Medicaid Application Process
The Law Office of James C. Siebert & Associates, P.C. /Elder Law & Estate Planning Attorneys of Illinois, P.C. can navigate this process for you so you can focus your time to care for your loved one. One mistake in eligibility can cost you months of nursing home care. Let the Law Office of James C. Siebert & Associates, P.C. /Elder Law & Estate Planning Attorneys of Illinois, P.C. work for you in filing your Medicaid Application. The Law Office of James C. Siebert & Associates, P.C. /Elder Law & Estate Planning Attorneys of Illinois, P.C. saves you time and stress and insures that you’re in complete compliance with Medicaid law. If you seek legal assistance early enough, then the applicant’s money pays the legal fees which are an allowable part of the Medicaid spend down process. Since at the time of the application, the Applicant can only have $2,000 of exempt money, and so you can use all the applicant’s funds on the facility and complete the application process yourself or you can use some of the funds which would have been paid to the nursing home to pay the Law Office of James C. Siebert & Associates, P.C. /Elder Law & Estate Planning Attorneys of Illinois, P.C. to represent you through the application process and relieve you of much of the burden and stress of qualifying for Medicaid. Call the Law Office of James C. Siebert & Associates, P.C. /Elder Law & Estate Planning Attorneys of Illinois, P.C. at (847)253-7500 today to schedule an appointment with an experienced Elder Law Attorney.
How would you rate Mr. Siebert and his Associates legal expertise? SUPERIOR. Did Mr. Siebert and his Associates give you thoughtful, well-reasoned advice and did he explain clearly your options and strategies? YES, VERY MUCH SO. SERVICES WERE EXCELLENT. NO IMPROVEMENT NEEDED.
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