Should You Prepare a Medicaid Application Yourself?

Navigating the Medicaid application process can be complicated, especially if you are applying for long-term care benefits. Hiring an attorney to help you through the process can be extremely helpful.

Whether you should prepare and file a Medicaid application by yourself or should hire help depends on answers to the following questions:

  • How old is the applicant?
  • How complicated is the applicant’s financial situation?
  • Is the individual applying for community or nursing home benefits?
  • How much time do you have available?
  • How organized are you?

Medicaid is the health care program for individuals who do not have another form of insurance or whose insurance does not cover what they need, such as long-term care. Many people rely on Medicaid for assistance in paying for care at home or in nursing homes.

For people under age 65 and not in need of long-term care, eligibility is based largely on income and the application process is not very complicated. Most people can apply on their own without assistance.

Matters get a bit more complicated for applicants age 65 and above and especially for those of any age who need nursing home or other long-term care coverage. In these cases, availing yourself of the services of an attorney is practically essential.

Medicaid applicants over age 65 are limited to $2,000 in countable assets (in most states). It’s possible to transfer assets over this amount in order to become eligible, but seniors need to be careful in doing so because they may need the funds in the future and if they move to a nursing home, the transfer could make them ineligible for benefits for five years. Professional advice is also crucial because there is a confusing array of different Medicaid programs that may be of assistance in providing home care, each with its own rules.

All of that said, the application process itself is not as complicated for community benefits (care that takes place outside of an institutional setting, such as in the beneficiary’s home). In short, those over 65 may need to consult with an elder law attorney for planning purposes, but they or their families may be able to prepare and submit the Medicaid application themselves.

But submitting an application for nursing home benefits without an attorney’s help is not a good idea. This is because Medicaid officials subject such applications to enhanced scrutiny, requiring up to five years of financial records and documentation of every fact. Any unexplained expense may be treated as a disqualifying transfer of assets, and many planning steps — such as trusts, transfers to family members, and family care agreements — are viewed as suspect unless properly explained. Finally, the process generally takes several months as Medicaid keeps asking questions and demanding further documentation for the answers provided.

At Wenzel Bennett & Harris, PC we offer full-service representation in preparing the Medicaid application on your behalf and all necessary documentation and follow-up, as well as guidance for the client and his or her family throughout the process. This has several advantages, including expert advice on how best to qualify for benefits as early as possible, experience in dealing with the more difficult eligibility questions that often arise, and a high level of service through a long process, which can be fraught with difficulty for those who are attempting to apply without assistance of a law firm . Although there are significant fees for this service, the value of the service is also very significant; as we can generally help the client become eligible as soon as possible. Given the high cost of nursing homes, if the law firm’s assistance can accelerate eligibility by even one month, that will generally cover the fee. In addition, the legal fees are usually paid with funds that would otherwise be paid to the nursing home — in other words, the funds will have to be spent in any event, whether for nursing home or for legal fees. If you would like to learn more about planning for Medicaid eligibility for Long-Term Health care needs, please call 989-356-6128 to schedule a consultation for Long-Term Care Planning.

According to a recent national study, nearly a quarter of Americans aged 50 and older say they – or a loved one – needed long-term care in 2022. The findings further suggest that seniors and their caregivers could benefit from more consumer-friendly information and guidance about long-term care services, a need researchers say will grow exponentially in the future.

Finding Long-Term Care Causes Wide-Ranging Emotions

Results showed that people looking for long-term care experienced a range of emotional responses in searching for a provider:

  • 53 percent of respondents reported feeling anxious about the process 

  • 52 percent described feeling frustration

  • 23 percent said they were confident during the process of long-term care for themselves or their loved one

  • 23 percent of respondents felt “at peace” about the choice they made for long-term care

  • Only 14 percent of respondents reported feeling happy

Respondents Want to Feel Prepared When Deciding on Long-Term Care

Researchers found that respondents want advice for seeking long-term care when it comes to the following:

  • 92 percent wanted to know what types of long-term care services are available
  • 90 percent wanted more information about paying for long-term care
  • 90 percent said advice and support on long-term care would have been helpful to them
  • 88 percent needed help understanding whether their personal or health care needs require long-term care
  • 88 percent of those surveyed also said they needed help choosing a long-term care provider
  • 86 percent said having someone to listen to them when seeking long-term care services would have been important to them
  • 84 percent of respondents wanted help deciding whether to pursue in-home care or community-based services (i.e., nursing home care)

Paying for Long-Term Care

A large number of respondents reported needing more information about how to pay for long-term care.

Of the people who were surveyed, 63 percent said it was extremely important to have additional details about the various types of care options available. Meanwhile, 69 percent said it was extremely important to have further details about the cost of care and their payment options.

To learn more about long-term care services and options, it is often helpful to work with an elder law attorney in the community who can help you assess the benefits and services available to you and create a plan for how to pay for long-term care. At Wenzel Bennett & Harris, P.C., we offer a consultation called a “Long-Term Care Consultation” in which we meet with clients to help create a plan for long-term care. If the client has a need for care in a nursing home or skilled care at home, we will work with the client and their family to explain how the Medicaid program works , review the clients’ assets and income, and assist the client in obtaining Medicaid benefits, where applicable. Many families are surprised to learn that they may qualify for benefits they weren’t aware were available to them. In addition, we help clients to make sure they have a good plan in place should it become necessary for them to have long-term care in the future. This often includes having Powers of Attorney for both financial and health care needs, so that appropriate agents are granted the authority and have the information needed to obtain benefits in the future, should that become necessary. If you or a family member would like to schedule a Long-Term Care Planning Consult, please contact our office at 989-356-6128.

If you have specific questions about your situation or would like to learn more, reach out to the team at WBH here.

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