Woman visiting elderly mother in nursing home who's Medicare is running out

“Your mother’s Medicare coverage is ending,” intones the desk clerk at the outpatient rehabilitation center. “Next week, she will be responsible for all fees.” You resist the urge to scream. Mom needs months of physical therapy. The center’s daily fee is several hundred dollars. You mentally calculate the cost: there’s no way Mom can afford the bill. What can you do?

Don’t panic. As Mom’s advocate, you must be calm, organized, and resolute. Keep copies of all correspondence and health records. Document and date every conversation you have with the staff, medical professionals, and government officials.

Our elder law attorneys at Carolina Family Estate Planning, who have helped clients face this scenario in rehabilitation centers, skilled nursing facilities, and home health agencies, created the following checklist just for you.

Step #1: Appeal the Decision

You have the right to a fast appeal. The rehabilitation facility should have given your mom a paper entitled “Notice of Medicare Non-Coverage” at least two days before covered services ended. The notice will list a number to call in North Carolina for an outside agency (referred to as a Beneficiary and Family Centered Care Quality Improvement Organization) to review her case. The agency makes a decision within a day or two. Even if the decision is not in your mother’s favor, filing an appeal will buy you time.

Step #2: Gather Legal Papers

Locate Mom’s healthcare power of attorney, advance directive (living will), power of attorney, and will. Is she missing any documents? Now’s the time to fill out the paperwork and get her signature. If Mom becomes incapacitated for any reason, you will need legal authority to act on her behalf and have access to her medical records and financial accounts. Depending on Mom’s situation, she may also need a trust. Carolina Family Estate Planning can assist you with preparing legal documents.

Step #3: Apply for Medicaid

States jointly fund Medicaid, and the federal government and states administer it. Most Medicaid beneficiaries in North Carolina are part of NC Medicaid Managed Care or NC Medicaid Direct. Mom may already be enrolled in one of these programs through her health plan. If she isn’t, collect her tax papers, bank statements, birth certificate, and other required documents. Apply online or mail the application to the Department of Social Services in Wake County or Chatham County. 

However, before applying, we’d encourage you to first consult with an elder care attorney. Similar to the tax code, the Medicaid-eligibility rules are quite complex and just like the IRS isn’t there to advise you how to save money on your taxes, the Medicaid department isn’t there to tell you how to protect your assets. An elder law attorney can advise you on how to accelerate eligibility while legally protecting as much of your parent’s assets as possible. 

Further, the application process itself can be somewhat overwhelming and one small mistake can lead to a denial of benefits. The burden is on applicants to prove they are eligible for assistance, and the elder care attorneys at Carolina Family Estate Planning can help you get the best results for Mom’s specific circumstances. The American Council on Aging, which recommends obtaining professional assistance for Medicaid estate planning strategies, notes that applying for Medicaid can be a complex and drawn-out process. If not done correctly, it can cause a delay or denial of benefits.

Watch below as Jackie Bedard, Estate Planning and Elder Law Attorney and Founder of Carolina Family Estate Planning, explains why it’s never too late for Medicaid or long-term care planning.

Step #4: Implement a Long-Term Care Plan

Hopefully, your mom’s health improves after rehab – but since Medicare does not pay for long-term care, it’s wise to plan now should the unexpected occur. According to LongTermCare.gov, An American who turns 65 today has an almost 70% chance of needing some type of long-term care services in her remaining years. Long-term care ranges from assistance with daily living activities, such as dressing and bathing, to skilled nursing care. 

Depending on Mom’s wishes and physical needs, she might remain at home (with or without paid caregivers), move in with you, or move into a nursing home. Each of these arrangements has a financial and emotional cost to both Mom and the family. One way to respect her dignity and protect her assets is to develop a long-term care plan. Usually, a well-rounded long-term care plan involves a combination of legal, healthcare, and financial tools. Check out our articles and videos on this topic. Also, we regularly offer online seminars featuring our elder care attorneys discussing long-term care planning specific to North Carolina residents.

Step #5: Talk to us at Carolina Family Estate Planning. We’re Here to Help

Managing a parent’s medical crisis is exhausting and stressful. If your mom (or dad) has neglected to plan for NC Medicaid and requires immediate assistance with healthcare coverage, an experienced and knowledgeable elder law, estate planning, and asset protection attorney can explain many workable legal strategies, including:

  • Asset protection trusts
  • Caregiver agreements
  • Medicaid strategies aimed at maximizing available legal “safe harbor” provisions to protect assets

With the help of a Medicaid planning lawyer, you can comply with NC Medicaid requirements. 

We Help Families Build Better Lives by Planning for A Secure Future

Are you struggling to find a solution for your mom or dad because their Medicare has run out? Give us a call at Carolina Family Estate Planning at 919-500-7757 or schedule a needs assessment call. We have years of experience helping clients in the same situation, and we’re here to help you, too.

We also encourage you to use the experience to focus on your own long-term care plan. This is an excellent opportunity to meet with an estate planning attorney to prepare for a secure future—while you have the luxury of time, unburdened by medical issues. From advising hundreds of clients over the years, we know how to custom design a long-term care plan that will suit your current requirements and adapt as necessary in the future. Let us help you get your ducks in a row.


Copyright© 2021. Carolina Family Estate Planning. All rights reserved.

The information in this blog post (“post”) is provided for general informational purposes only and may not reflect the current law in your jurisdiction. No information in this post should be construed as legal advice from the individual author or the law firm, nor is it intended to be a substitute for legal counsel on any subject matter. No reader of this post should act or refrain from acting based on any information included in or accessible through this post without seeking the appropriate legal or other professional advice on the particular facts and circumstances at issue from a lawyer licensed in the recipient’s state, country or other appropriate licensing jurisdiction.

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