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By John M. Bigler In the infancy of elder law all the way back in the 1980's, one of the least concerns that anyone had was the actual filing of the Medicaid application. Typically, we as elder law attorneys would do planning for clients and their families and the consultations would normally end with "at the appropriate time you will file the Medicaid application". The form to file the application has hardly changed at all since way back then, yet very few families actually file the application on their own anymore. More and more, a family will hire either the law firm that has been advising them or a geriatric care manager to file the application on their behalf. The cost of filing an application can range from several hundred dollars to many thousands of dollars depending on the amount of work to be undertaken. What's is the reason for this change in tactics in the last 20 years?
In 1989 Medicaid laws changed, not necessarily for the worse, but they became much more intricate and subtle. Also, as the cost of Medicaid grew dramatically, the local Department of Social Services were under increased pressure to carefully scan the applications to determine eligibility.
Now there are two distinct types of Medicaid: community and institutional. Planning for eligibility for institutional care requires a careful determination regarding transfers and the period of ineligibility. A small miscalculation can result in a loss of hundreds of thousands of dollars to an applicant and his or her family. Applications filed too early can result in catastrophic financial consequences. As well, applications filed too late can result in needless payment to a nursing home. I normally urge families not to have a nursing home file the application simply because the nursing home staff has many responsibilities and can't always give a particular application the attention that it deserves.
Years ago, once the community application was filed, it was not unusual to be awarded all type of benefits, including 24-hour home health care. Now, a big part of the community Medicaid application process is advocating to obtain as many hours of home care as possible. The way the medical evaluation is prepared will have a major impact. An experienced planner can help guide a doctor who means well but may not know what to say on the forms.
Not everyone needs to hire someone to file the application. As noted, the application is not that difficult. It can be tedious and requires a great deal of patience to provide all the documentation regarding identity and finances that is required. It can be frustrating, especially when dealing directly with a Department of Social Services worker. However, particularly on Long Island, most of the employees are cooperative and will work with the family.
It's incumbent upon the attorney to advise the family when he or she thinks the application can be done without assistance. Many people still choose to have a professional file the application simply as a matter of convenience, but the family will still be required to provide the documentation. Recently I've heard of situations where an enormous fee will be paid and the law firm will actually obtain the necessary documentation. Personally, I tend to hesitate. As much as I like fees, I don't like charging for something that is not really legal work, but that is a personal preference.
Every application in every family is different. Ask your elder law attorney whether he or she feels professional assistance is necessary.
Reprinted with permission of the Suffolk Times © 2003 [ Contact Us ] [ Guestbook ] [ Email ]  The Law Offices of John M. Bigler, Attorney At Law 1421 Wantagh Avenue, Wantagh, New York 11793-2206 1-888-ELDER-LAW · 516-409-6565 · Fax: 516-409-6522 E-Mail: info@biglerlaw.com · Web Site: www.biglerlaw.com |
One reason is simply that Medicaid planning has become much more sophisticated. In the '80s Medicaid law was simpler. No matter what type of Medicaid you applied for, if you made a gift you would be ineligible for at least two years with monthly increments that would jump dramatically based on the amount transferred. The law made no distinction when it came to transfers between community and institutional Medicaid. Many nursing homes offered the service of filing the Medicaid application, which was typically done by an employee who was also responsible for numerous other tasks.