A do-it-yourselfer is a practitioner of self-reliance. This descriptor usually refers to amateurs without special training, but who are enthusiasts of doing things themselves. Is applying for Medicaid for do-it-yourselfers?
Medicaid or Medical Assistance is the program that is used by the majority of people receiving long-term care in a skilled nursing facility, at home under the Pennsylvania Department of Aging Waiver Program, or through the LIFE program. Medicaid has many rules and requirements, and nearly as many exceptions to those rules and requirements. Applying for Medicaid is a process that is time sensitive yet can be drawn out over a long period. The rules are different for single and married applicants. Unless you have specialized knowledge, it is easy to miss an opportunity to protect the spouse of the applicant.
The Medicaid application requires listing and verifying a mountain of information such as assets, income, expenses, and any transfers made within five (5) years of the date of the application. This five-year window is commonly known as the “look-back” period. The applicant or the applicant’s family is often assisted by the nursing facility in completing this application; however, that assistance does not include protecting assets for the spouse and family and often occurs when the applicant is already out of money. The nursing facility staff are not attorneys, and they are prohibited from giving legal advice.
If an application is submitted without complete information or outside the required time frame, it will likely be rejected. At best, the process will be delayed. In the interim, the nursing facility bill continues to accumulate at a rate of several hundred dollars each day.
If the County Assistance Office worker reviewing the application determines that there are unexplained expenses incurred by the applicant, a period of ineligibility for Medicaid will be imposed. Sometimes these expenses can be justified through affidavits or other means. There may have been gifts made by the applicant or the applicant’s spouse within the look-back period that fall under certain exceptions to the transfer rules. A certified elder law attorney knows the intricacies of the rules, regulations, and exceptions. If a period of ineligibility is imposed, it often begins running in certain circumstances, which usually include having the applicant’s assets significantly spent down. But if the applicant is down to only a few thousand dollars, it is going to be difficult paying the nursing facility privately. If things are not handled correctly, the nursing facility may sue the adult children for the care costs of the applicant.
The mistakes that we see most often by the do-it-yourselfers are as follows: missing out on huge financial opportunities to protect the spouse at home, not filing in a timely manner, and being unaware of certain exceptions to the rules regarding transfers for fair consideration.
Yes, there is a cost to hiring a certified elder law attorney, but that cost is typically offset by accelerated eligibility for Medicaid and peace of mind that the applicant’s children will not be held liable for the care costs of their parent. No, applying for Medicaid is not for do-it-yourselfers. You need an experienced Certified Elder Law Attorney to get the best result.