"Crisis" Medicaid Eligibility

Why hire us to help with your Medicaid long-term care application?

 

 

 

 

 

 

Let's look at the ordinary progression of events

once you identify the need for care...

Apply through DHS or a facility...

Contact with facility or DHS directly will result in a DHS caseworker being assigned. 

DHS caseworker will provide limited information to you while requiring submission of detailed financial records and application forms. 

The DHS caseworker is only going to review the rules with you that you already know to ask about. 

DHS will make an eligibility determination that may result in denying Medicaid or causing you to spend much of your money before Medicaid starts to help. In some cases, the determination becomes final and there is nothing you can do to change it. 

From the very start, we put you in control of the Medicaid process!

Work with us...

Detailed Medicaid eligibility analysis will give you a clear picture of what to expect financially.

We will review financial records with you to ensure accuracy of our analysis and prepare for the Medicaid application we will complete on your behalf.

We will review all the Medicaid rules on your behalf to ensure the best financial outcome possible.

We will prepare and file a Medicaid application that takes full advantage of all the rules that benefit you! Throughout the application process, we will be your advocate and advisor.

 

Result? A better financial outcome - guaranteed! 

Maybe you've heard of the "secret" menu at Starbucks, drinks you can only get if you specifically know to ask for them? Or the places that give you special treatment on your birthday... if you know to ask?

Medicaid is like that. There are rules built into the statutes and regulations that you have to know to ask for or they won't help you. 

That's what we're here for! We show you the rules you need to know about, and then help you put them into action.

Success with Medicaid eligibility is measured in dollars: we can often protect 10x our fee or more!

Medicaid is the most complex government benefit program most people will ever interact with. Every year people are improperly denied benefits, or given incorrect information about eligibility by case workers and nursing home administrators.

 

Our Medicaid eligibility work is designed to tilt the odds back in your favor. There are Medicaid rules you need to know about that can help you protect assets and save tens of thousands of dollars. 

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70% of all nursing home care is paid through the Medicaid program. 

Medicaid is a joint federal-state program. The bulk of funding comes from the federal government through payroll taxes. Administration is done by state agencies, which in Oklahoma is the Department of Humans Services or DHS. 

Medicaid's Complexity is in the Financial Calculations

Medicaid long-term care eligibility requirements consist of both financial and non-financial criteria. Without a doubt the most complex part - and where DHS caseworkers spend the most time - is financial eligibility. 

 

There are three parts to financial eligibility:

  1. Assets

  2. Income

  3. Uncompensated Transfers of Assets

Assets

A Medicaid applicant who is unmarried must have less than $2,000 of countable assets. Examples of countable assets include cash, bank accounts, investment accounts such as stocks and bonds, CD’s, annuities, land, rental properties, mineral interest and some vehicles. Your residence is generally not countable as a resource, but it is subject to "estate recovery" which is a way the state will demand reimbursement from you.

Adding other people to bank accounts or other investments or assets will generally not protect the assets under the Medicaid rules, but it will make it more complicated to qualify for Medicaid.

Income

Income and asset are treated differently under the Medicaid rules. Monthly gross income must be less than $2,382. Income follows the “name on the check” rule, meaning it counts as income of the person named on the check. A Medicaid applicant whose income exceeds the limit may qualify for Medicaid by using a Medicaid Income Trust. 

There are a number of ways that you can protect your assets and income, and a plan should take into account your unique situation and desires. Planning for married couples is especially tricky due to the complex rules regarding income and assets of a married couple. A non-institutionalized spouse is entitled to a "Community Spouse Resource Allowance" as well as a "Monthly Maintenance Needs Allowance.Planning for a married couple involves using the Medicaid rules to maximize income and retain assets for the non-institutionalized spouse. 

Uncompensated Transfers of Assets
One of the most confusing aspects to Medicaid is the "look-back." This is the most recent five-year history that a caseworker go through to see if the Medicaid applicant of spouse has given away or sold anything for less than fair market value. If the caseworker determines they have, a penalty period - a number of days that the applicant is ineligible for Medicaid and must private pay for care - will be applied.

Did you know nursing homes charge more to families private paying than they charge Medicaid?

It's perfectly legal, but keep in mind when the nursing home administrator offers to help you with your Medicaid application... when you private pay, the nursing home makes more money! 

The penalty period is calculated dividing the total uncompensated transfer by the Medicaid penalty divisor, currently $179.57. For example, a $10,000 transfer divided by $179.57 results in 56 days the applicant is not eligible for Medicaid. This penalty period does not begin until the applicant meets the asset limit ($2,000), which means the applicant in this example must pay for care for almost two months, but has less than $2,000 with which to do so. 
 
Medicaid penalties can produce very difficult situations for families. In some cases, the penalty can be corrected to comply with the rules.  
Estate Recovery
Federal Medicaid statutes require states to seek recovery of Medicaid expenditures through the use of liens on real estate, collections in probate, and similar measures to go after the assets of a Medicaid recipient or spouse. Estate recovery can be a particularly nasty surprise for heirs and any good Medicaid eligibility plan needs to take steps to avoid it.  
We Use Legal Medicaid Techniques Aimed at Eligibility NOW!
We have the experience and in-depth understanding of the relationship between the rules governing assets, income and the look-back to help you avoid Medicaid denials and achieve the optimal financial outcome. In many cases we can obtain immediate eligibility!!
There is certainly no magical solution and we always follow the law, but the Medicaid rules allow significant opportunities that a DHS caseworker or nursing home administrator may not know and is unlikely to want to share with you. 
If you want to know more or you're ready to get started:

Call   (405) 435-9700