Today, times have most definitely changed. For a while in the '90s when requirements for the documentation became more stringent, the field of geriatric-care management flourished. We would review the client's situations, advise them as to what we thought was the best course to follow and then send them on to a geriatric care manager, who was often a social worker, and would have someone on staff who was familiar with gathering the documentation with which to file a Medicaid application. This person typically had other responsibilities as well, but could do an adequate job of filing a straightforward Medicaid application.

Little by little, the application for Medicaid became increasingly more complex. Then in February 2006 the law changed drastically, becoming much more complicated, calling for two Medicaid applications in nursing home situations and involving two periods of ineligibility, promissory notes and asset saving strategies. An attorney will charge a significantly higher fee than a geriatric care manager, but the applicants and their families will have the peace of mind of knowing that the job is being done correctly. This does not mean that an attorney must be hired in all Medicaid scenarios. When applying for community Medicaid, an expedited application is filed for which less financial documentation is necessary. The main advantage of having an attorney file a community Medicaid application is so that the attorney may work with the treating physician to make sure that the individual at home receives as many hours of home health care as possible. However, a good geriatric manager or even a persistent family member can often achieve the same results. Further, when a married person is applying for institutional Medicaid, and if the assets are not that significant, then it will be possible for either the nursing home, a geriatric care manager or even the family members to file the application.

If there are significant assets, and an attorney has been involved in planning to protect assets, then the sensible thing to do is to seriously consider having the attorney file the application. The old proverb "penny wise and pound foolish" is applicable. However, the attorney is not always necessary and a good elder law attorney will advise the family as to the best course to follow. At times, I have advised the family that under no circumstance should they consider anything but having my office file the application. However, there have been other times when I have advised that there is no reason to incur the expense of using my office. As always, each case is different, and having confidence is your elder law attorney is critical.