It might be easy to think that filing for Medicaid assistance for nursing home care is as simple as completing the Medicaid application forms, but that is just the start of a time-consuming process that often takes several months.
Working with an attorney can be critical to the success of your application. Here are a few reasons how working with our office can be beneficial:
- We make sure that the client is actually eligible and is filing the application at the correct time. Due to budget cuts, most county Medicaid offices are understaffed and it can take several months for them to review and approve or deny your application. Thus, it is critical to make sure that you are eligible. Otherwise, if the applicable is denied several months after filing it, that’s several months of lost coverage—potentially resulting in tens of thousands of dollars being owed to the nursing home.
- We know what documentation is required to support an application so that we can help assemble and file as thorough an application as possible to reduce delays with application approval.
- Unlike the nursing home, our duty is to act in your best interests. The private pay rate at most nursing homes is significantly higher than the Medicaid reimbursement rate (the amount that the government pays them for a patient that is approved for Medicaid). Thus, it’s not really in the nursing homes best interest to help you get your application approved as quickly as possible.
- We conduct a full application “audit” prior to submitting the application to Medicaid. We review all of the bank statements and supporting information as if we were as caseworker from the Medicaid office to look for any “red flags” that might slow down or jeopardize the application. If we find any, we’ll work with you to get them properly documented to ensure that your application gets approved as quickly as possible.
- While your application is pending and after the application is approved, you are still responsible for paying a “Patient Monthly Liability,” i.e., your share of the nursing home bill. We’ll calculate this amount for you to make sure that you don’t fall into arrears while the application is pending.
Spend-Down and Eligibility Planning
If it is determined that you are not yet eligible for Medicaid, then we can assist you with a Medicaid spend-down plan to achieve Medicaid eligibility. There may be separate legal fees to create a Medicaid spend-down plan. As part of the plan, we’ll discuss various Medicaid exemptions and allowable expenditures until assets are reduced sufficiently to qualify for Medicaid. Legal fees for Medicaid spend-down planning and/or assistance with preparing and filing the Medicaid application are allowable Medicaid spend-down expenses.
Pre-Filing of the Application
Our process begins with working with you to gather the supporting documents for the Medicaid application. When appropriate, we are happy to contact banks and financial institutions on your behalf to gather supporting financial information (though some banks will charge a fee for this service). While we will do what we can to reduce the burden on you of tracking down information, we will need your involvement in tracking down records such as important biographical information (e.g., birth certificates and similar), but we work with you to try and make this as easy as possible. We’ll provide you with a thorough checklist of information needed.
Our office will then conduct a pre-submission “audit” of the application materials and supporting documents to ensure that the client is eligible, that we’re filing at the correct time, and if there are any potential “red flags” in the financial statements, that we have the supporting documents for them. We’ll also calculate the Patient Monthly Liability for you and instruct you regarding how to pay the nursing home while the application is pending.
Filing of the Application & Advocating for Eligibility
Once we file the application, we will handle all follow-up and interaction with the Medicaid office until the application is processed. Due to budget cuts, many Medicaid offices are understaffed, so the Medicaid application review process can take several months. During this time, we will follow up on your application status to ensure that it was properly received and filed, that is has been assigned to a caseworker, and what the status of the application processing is.
While the application is pending, we’ll answer any questions that might arise from the Medicaid office regarding the application. We’ll also continue to work with you if any questions arise on your end.
We are well versed on the Medicaid manual and the various eligibility rules and exemptions. When we file your application, we include supporting documentation specifically citing the various sections of the Medicaid manual that allow for certain exemptions to ensure that the application is processed in a timely manner and that you receive the exemptions that you are entitled to.
During the Medicaid application process, it is common for the Medicaid office to send “Requests for Information.” These letters come with strict deadlines and it is critical to comply with them. We docket all deadlines, ask for extensions when needed (however the number of exemptions is limited), and work diligently to gather the information requested and submit it in a timely manner.
Review of Medicaid Approval
When the Medicaid application is approved, we’ll review the approval letter to ensure that the Patient Monthly Liability was properly calculated. We’ll also advise you regarding how to ensure that you maintain ongoing Medicaid eligibility and don’t do something to jeopardize your Medicaid status.
Additional Information on North Carolina Medicaid Assistance for Nursing Home Care:
Download a free copy of Jackie Bedard’s book, The Ultimate Guide to Paying for Nursing Home Care in North Carolina, to learn the nursing home and Medicaid secrets you need to know to avoid going broke in a nursing home and leaving your family penniless.