Does it pay to get a lawyer to help with Medicaid application?

How picky should I be about the home my wife is in. She has Dementia. There is sometimes a strong urine odor in the place, sometimes my wife has a wet depends on and I change her, Because other clients are uncontrollable they can't leave water out for everyone hence my wife doesn't get a steady supply of water and forgets to ask for it. They hire young girls who are still developing a "work ethic" and when I ask for certain things to be done they give me a look that indicates they have drummed me out. On the off shifts they use two girls for 16 clients and sometimes that doesn't seem to be enough. What can I expect and am I asking too much. I don't want to alienate the staff and at the same time I want my wife taken care of. Is there a standard or a level of care that I can measure things with?

First, let me say that Medicaid is an excellent program, once you get it. My brother and I had to get Dad (and later Mom) eligible in New York State. We used an elder lawyer and it was definitely worth it. After Dad was no longer able to handle their banking and finances, Mom took over. She was less than organized and we found that some bank statements were missing and checking account records were haphazard at best. This was before online banking and the like, so we had to do everything by phone and snail mail. My best advice is to keep copies of everything you submit; be prepared for files to be lost/never received and to have to resubmit. We also found that your local Medicaid office was not always the best source of correct information. Hang in there, however, because in the end it will be worth it.

Applying for a person with a spouse living in the community is (in my experience) extremely complicated. Applying for a single person is a walk in the park. I've been through both. I had (and needed) a lawyer when my husband applied, but not when my widowed mother applied.

I am going through this right now. Mom is in rehab at a NH and they advised us to go ahead and apply since we knew mom would need help once she returned home alone. We did the elder atty which cost us 2750. in the Houston area. With all I have going on with mom it is well worth the money. I tried reaching out the Health and Human Services, 5 calls and it would disconnect without giving you an opportunity to leave a message. My brother asked "why spend that kind of money when it sounds like something we could do?". I told him my plate was full so go ahead and handle it. His check arrived soon after to pay the atty. :) They are able to convert the deed to a ladybird deed. I did have to cash out her life insurance policy and prepay for her funeral. She doesn't have a lot in assets, 50k house and 16 yo car. Had to get all checking and savings below the 2k mark needed in Texas. A lot of paper trails but was able to deal with it. Yes, you could do it yourself as many others have but when time is of the essence and you're busy being a caregiver it can be a bit much. Good luck, it's a challenge but you have to be prepared for what's coming next.

There is a difference between Medicaid PLANNING and Medicaid APPLICATION. Frequently the actual filling out of the application form is no more complicated than your Form 1040 tax return and usually much simpler.
However, it can be a costly mistake to apply for Medicaid TOO EARLY. For example, if a large gift (such as a house) has been made within the past 5 years, applying before the end of the 5-year period from the date of the gift could result in a penalty/disqualification period that is MORE than 5 years long.
If no large gifts have been made in the prior 5 years, and the assets are modest and you think you will qualify for Medicaid now, there is no harm in getting a copy of the application form and reviewing it yourself to see if it is too much for you to do.
I have a section in my Medicaid Secrets book on how to locate and "vet" an elder law attorney to help you with Medicaid planning. Good luck!

When I took over my parents finances due to Dad's worsening dementia, they had their home, car and around $200,000 in investments. They also had a living trust, done through an elder care attorney. Dad needed placement, and Mom still home with early Alzheimer's herself. The eldercare/trust attorney had staff that did all the financial applications, first with VA for Dad, and when that was not going to work out well, we moved to Medicaid. I have been very glad that I used some of their assets to pay the firm a flat fee for all legal and case management for the rest of both of their lives. I just didn't want to have all these fees for every app't, letter written or assistance. Their plan was called a "Life Care Plan". So their office did all the application stuff. I just had to locate all the documents that were needed. BUT...even with that, it took over a year to get the approval done....with three denials and MANY pages of documents having to be gathered. The worse part of it, at least here in AZ, is that if you don't meet the deadline, or get denied....then the next month, you start over...must resubmit EVERYTHING again in a new packet...and if the Medicare person changes in the middle of it, you can have to submit all kinds of new stuff as there doesn't seem to be a cut and dried list that they work from or anything! Federal Gov't crap, in my opinion. One person doesn't need to look into some account from 20 years ago but the next person assigned decides that they do. It almost seemed at times, like they lost papers and caused delays on purpose, hoping to wear us out so we would give up. I would have given up if it had all been on my shoulders due to all the OTHER negative issues relative to my parents that I was also dealing with. And, YES, when it was finally approved, it was back dated....but we had to still spend over HALF of the assets, between the private pay time at Dad's facility and the spend down requirements. Then, the entire trust had to be redone, and my Dad's name had to come off ALL remaining assets in order to keep him qualified. In fact, there was one extra month of private pay to the facility and I could NOT get that back in one lump sum because it would have caused a Medicaid denial, as it would have been considered my Dad's money.....so that was set up to cover our share of his rent monthly as a credit until it was used up! I must say, that even with all the firm's help....and even though the firm also has a caseworker assigned who helps me with all things medical for both parents....this has STILL been, easily, the most negative experience of my life....and I do not even have the total 24/7 care most of you on here have, because I live out of town from them. My own business has been ruined, my health IS being ruined, my stress levels are constantly on edge and I am so DONE with this after only three years, that I am ready to turn it all over to a public fiduciary. AND Mom is STILL at home and causing me difficulties on a daily basis via long distance. We do have caregivers in with her now and have a long term plan to move both of them together either with family in Washington State or into AL in Phoenix where our other daughter lives, and where it's about an hour closer for me to travel to deal with stuff. I will continue to have the financial issues forever I guess.....although our daughter in Phoenix is a BIG help and is willing to take it all off my shoulders, should my husband's Parkinson's get worse too quickly. So, to summarize....I would seriously recommend the attorney if there are similar amounts or more of assets to deal with.

OldBob - you bring up a good point on the SPIA (single premium immediate annuity) is that it has to have state as beneficiary to be Medicaid compliant. Finding annuities Meducaid compliant are few & far between. You found a great firm. Personally I hate annuities as an investment and they so often are sold not to the elderly owners benefit.....with huge commissions to the insurance agent.
But for couples, doing a SPIA can be a simple solution to getting your spouse qualified ASAP in chaos situation.

In our case, we applied in May of 2008...the first application did not have quite the exact documents or whatever in every specific way, so we reapplied after 45 days and that one got approved by about September, but it was awarded retroactively to the date of the first application..
I have no connection with this firm, but I used Dale Krause for my Medicaid compliant annuity....I bought one for $61K and the firm took $1K for premium and the rest plus a little interest I got back within six months.
This was over and above the allowance of $109000 that I, at that time, was entitled to keep...A feature of such annuities is that must name the Medicaid people as beneficiary and must be paid off in full within the applicant's life expectancy, so they made it all payable in six monthly payments..It was purchased with after tax money, so the only tax was on the few dollars of interest earned in six months.) You can google on Dale Krause insurance to find out more....he is the largest such annuity firm in the USA as I understand it.

only saying
Bob

I went through a lawyer experienced in this subject and it took about six months but once done we were accepted by Medicaid and COPES. Had in home care first and then placement without a problem. I could see it coming and wanted all my ducks in a row when it was time to place her. Worst event in my life but it had to happen as I had reached my limit. Looking back I think the lawyer was worth it.

How do you know you are getting a "run around"? It takes a long time from what I hear to get benefits, and all your documents must be in place. Instead of spending money to hire anyone, contact the Medicaid office which handles your area and find out exactly what the delays are (each state has their own benefits). You do not state how long this process has been, so I cannot comment further.

Genni - I'd like to add something to OldBob's answer, for community spouse situations like his, (where 1 is of immediate need of a facility & the other is healthy and has possibky decades ahead to stay in the community), it is very very different financial approach than for a DPOA doing medicaid for their widow /er solo parent going into a NH.

For CS you have to do some type of moving about of funds to maximize the CS long term view & best use of assets. Like he did a SPIA - those for CS make total sense as its a clear simple way to move that last chunk of money easily - to get his money down to the acceptable CS asset maximum ( usually 114k).

For one doing the Medicaid financial application for an elderly widow/ER parent, I think yiu can do it yourself. The facility should have a list of items needed to accompany the application. In my experience of the Medicaid maze with my mom & MIL, providing all theses documents in a single hugebutt set is best. For 2 reasons - the facility can do their review to determine if they will take them Medicaid pending & the state caseworker can check off all items on the mandated document list in a single session - state worker has maybe 15 minutes to do an review. If either is say missing your moms retirement awards letter for this year, that going to mean a delay and you just have to get the documents. There is no "I can't find it" allowed with the application. If you aren't able to get your best Nancy Drew on and find or send letters to get the documents needed, then getting an experienced elder law attorney is the way to get all this done.

If there are transfer penalty issues lurking in moms past 5 years - I'd get one too.

The financial application for my mom (TX) was a 3 yr 6 mo review and she was coming from IL to the NH and had her home. Over 100 pages (mainly due to her old school life insurance 30+ pages). Took almost 6 months to clear with state & there were secondary ? from caseworker on life insurance & car.

Also at least for my experience, there are two Medicaid approval tracks: financial & medical. Financial is all on family or attorney to get done. The medical review to show the "need for skilled nursing" is done within the NH in tandem with old medical records. Most going into NH are coming from hospitalization, so need is evident. But if coming from home or IL, that could cause a problem in showing "need"- this could cause a delay in approval too. I had this medically necessity glitch for my mom's Medicaid application as well.

What do you think is causing the delay? Documents missing? Transfer issues? Medical necessity issues? Incompetent facility business office?

Yes, IF you get a qualified lawyer.....We interviewd four in 2006-2008 and none knew enough about elder law to fight their way out of a paper bag, although all presented themselves as elder law attys....Then we hit the gold standard and hired the chair of the elder law committee of our state bar association...He saved us a bundle, nearly ten times his hefty fee, and his super-capable paralegal waded through almost two dozen separate financial account records that were three years old (coincided with spouse's original threshhold of eligibility) and the whole process went on for several months due to my not having kept paper copies of our many accounts. (We were well off at the time my wife was sticken, but well over half of that was gone by the time we finally applied). I won't go into details of how he legally and ethically saved us a bundle except to say that it included my buying myself a Medicaid compliant annuity as part of our spenddown...

A tip: qualifications vary, but I would urge anyone to go to their county health and services department (Medicaid at the local level) and ask them for guidance...do not tell them the specific amounts of money you or spouse have...But ask about what is "snapshot" of assets, spenddown procedures, countable assets, and the like. Just take their comments with a grain of salt..
Most applicants have meager assets and so if you have upwards of $125K or so, not counting house or one car, then they may not know what to tell you...

In the end it is simple, but it is definitely not easy.

ps..if a lawyer advises you to divide the money, half to the account of one spouse and half to the account of the other - RUN...fast..don't even say goodbye.

The amount varies according to the attorney and the complexity of the individual's finances. It could be less than $1000 or over $3000. If the person is going into a skilled nursing facility as "Medicaid pending" then the facility likely has a person who will walk you through the application and help you with it. It can be completed online in under an hour if you have all of the required information in hand. An attorney is especially useful for a person who has assets well above the Medicaid cut-off ($2000 in my state with some exceptions such as a vehicle). Their work then can involve estate planning, creating trusts, restructuring assets, etc. in order to legally qualify for Medicaid and not run afoul of the rules related to the look-back period.