Medicaid Planning, Applications, and Appeals

It’s Never Too Late To Protect Your Assets

Medicaid is a joint program involving both the federal government and state governments that can assist with the costs of nursing home care and, increasingly, alternatives to nursing home care such as home care, assisted living, and adult day care.

While it is true that you must meet financial requirements to qualify, it is not true (in most cases) that you must spend down your belongings before you can apply.  An elder law attorney can help preserve your assets while still qualifying for valuable Medicaid benefits (as well as VA Pension and other benefits).

Our Medicaid planning lawyers will analyze your situation, develop a personalized plan, and walk you through the legal process of structuring your assets or transferring them to protect as much as possible.  We can show you how to maximize your eligibility benefits without giving away all the things you’ve worked a lifetime to achieve.

Medicaid Applications

A mistimed application for benefits can be disastrous.  Events, such as gifts prior to the application, can significantly impact eligibility for benefits.  Knowing what transactions may be a barrier to Medicaid eligibility (and dealing with them effectively) is key. You should also know what transactions do not affect your eligibility. Finally, applicants may be unaware of errors that can occur during the application processing.

Accounting for all of these factors is crucial to ensure that your application is processed by the State Medicaid Agency correctly.

We can help you with applications for Medicaid to ensure you receive a timely, correct result.

Medicaid Appeals

You have the right to appeal any adverse action by the State Medicaid Agency.  You are entitled to representation with any appeal and we can represent you in a fair hearing.  Often, adverse actions are made because there was an error in the processing of an application or subsequent transaction report. By allowing us to handle your Medicaid application process, we’ll be sure to help you eliminate any errors that could lead to adverse actions.

We can begin your Medicaid plan today. Start by scheduling an appointment for an initial consultation.  We will outline your options and assist you in making an informed, well-reasoned decision on what approach is best for you.

My business is a part of me. I celebrate my clients’ achievements, and I suffer through their losses with them. They are getting a full investment out of me when they hire me. I enjoy working with folks, learning more about them, and not just focusing on the situation.

Jeffery D. Stinson

Certified Elder Law Attorney

What to Expect from Stinson Law Firm

 

First and foremost, we take the bureaucratic burden off of your hands. Stinson Law Firm ensures that the information requested by the Medicaid agency during the application process is appropriate, that the decision is timely, and that the result is correct.

While some parts of the Medicaid application process seem simple, the process is full of hidden stumbling blocks and pitfalls.  We constantly monitor the application process to find and adapt to small changes that may ruin or delay an applicant’s eligibility.

In the rare instances when the attorney advises a client that there are limited options to protect assets or expedite Medicaid eligibility, the consultation offers reassurance that no crucial opportunities have been overlooked.

Begin Your Legal Journey

1. Call, Email, or Submit a Contact Form.

Our intake specialist will follow up with you to gather some additional general information and schedule a meeting with an attorney.

2. Legal Planning Questionnaire.

To assist in preparing for your appointment, we ask that you complete a Planning Questionnaire at least five (5) days in advance of our appointment.  Returning the questionnaire ahead of your appointment allows us to deliberate on the issues and potential solutions available to you before your meeting. It also allows us to get directly to the heart of the issue that brought you to us, rather than expending a good deal of time during your meeting reviewing data.

3. Initial Consultation.

The initial meeting will focus on your circumstances, your concerns, your goals and the legal options you have to address your concerns. At the initial meeting we will quote you a fixed or estimated fee for the projected legal work. If you decide to proceed, a partial fee payment will be due at the conclusion of the meeting. There is an initial consultation fee of $395 payable at the time of the initial meeting. 

4. We Get Working for You!

Your legal team will get right to work collecting precise asset and income verifications, health insurance premium information, and other documentation as required from the FSSA.  Your team will provide you with a comprehensive list of everything needed as well as a deadline to keep your application on track for the target date.

5. Eligibility Plan

We will instruct each client on liquidating assets, purchasing exempt assets, transferring assets, and/or funding a Miller Trust.  Not all Medicaid eligibility palns are the same, so your plan may not include all of these tasks to become financially eligible for Medicaid.

6. Processing the Medicaid Application

Your legal team will review all the documentation and verifications received and submit the application to the Medicaid office. The Medicaid office will schedule an interview with your legal team who will present evidence and legal support to the Medicaid office to confirm your eligibility for benefits.

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7. Post Eligibility Tasks

Some clients may have additional tasks to complete, such as 90 day transfers or post eligibility transactions. Once you have been approved for Medicaid, it will be your responsibility to maintain eligibility. Your legal team will educate you on maintaining eligibility procedures.

Frequently Asked Questions

What's the difference between Medicaid and Medicare?

Although their names are confusingly alike, Medicaid and Medicare are quite different programs. Both programs provide health coverage, but Medicare is an “entitlement” program, meaning that everyone who reaches age 65 and is entitled to receive Social Security benefits also receives Medicare. (Medicare also covers people of any age who are permanently disabled or who have end-stage renal disease.) Medicaid, on the other hand, is a public assistance program that helps pay medical costs for individuals with limited income and assets. To be eligible for Medicaid coverage, you must meet the program’s strict income and asset guidelines. Also, unlike Medicare, which is totally federal, Medicaid is a joint state-federal program.

What qualifies you for Medicaid in Indiana?

To be eligible for Medicaid coverage, you must meet the program’s strict income and asset limitations. For a single individual, his or her countable resources (assets) cannot exceed $2,000.00 at the first of the month. If married, the community spouse can have up to half of the marital assets, subject to certain monetary limitations, unless increased by a judge’s order. The income standard for Indiana’s Medicaid qualification for a person in a nursing home or in equivalent Home- and Community-based Service under a Medicaid Waiver is $2,382 (as of 2021).

What is covered by Medicaid?

While most of our clients apply for Medicaid seeking long-term care, Medicaid covers a broad range of services. This includes physician care, specialized treatments, medical supplies and the reduction or elimination of drug costs.

Medicaid originally covered people needing assistance with long-term care in nursing homes. However, Medicaid covered alternatives to nursing home care are increasing and include home care, assisted living care, adult day care, and more.

How do I protect my assets from nursing home or other long term care?

Medicaid planning typically involves either exempt planning or transfer planning. With exempt planning, an individual converts or “reinvests” assets that count toward Medicaid eligibility limits into assets that do not count toward those limits. Transfer planning involves using Medicaid transfer of assets rules to protect a portion of the individual’s assets.

Does Medicare pay for a nursing home or long term care?

Medicare, for the most part, does not cover long-term care. Medicare Part A covers only up to 100 days of care in a “skilled nursing” facility per spell of illness. The care in the skilled nursing facility must follow a stay of at least three days in a hospital. For days 21 through 100, you must pay a copayment. In addition, the definition of “skilled nursing” and the other conditions for obtaining this coverage are quite stringent, meaning that few nursing home residents receive the full 100 days coverage.

As a result, Medicare pays for less than a quarter of long-term care costs in the U.S.

Should I hire an attorney to help with the Medicaid process?

Most individuals will get a lot of value from an attorney. First and foremost, we take the bureaucratic burden off of your hands. Stinson Law Firm ensures that the information requested by the Medicaid agency during the application process is appropriate, that the decision is timely, and that the result is correct. Error rates in the Medicaid agency are high. We identify errors in Medicaid notices of action that many individuals are unaware of and advocate on your behalf to have them corrected expeditiously.

The Medicaid applications process can be exacting. For example, if an applicant is as little as one cent over a resource or income limit, he or she will be found ineligible for Medicaid benefits. Medicaid requires that you submit written proof of the precise owner of financial assets with full identifying information (full account numbers, etc.) on a precise date to prove the applicant is eligible.

Do I need to be completely broke to get Medicaid help?

No. You do not need to be completely destitute to qualify for Medicaid benefits. While the program has asset and income limits, not all assets must be spent before Medicaid qualification. Some assets do not count toward qualification limits. Careful legal planning can also protect some or all countable assets.

Still have questions?

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