medicaid nightmares

The process of qualifying for Medicaid—utilizing Pooled Income Trusts, protecting assets for nursing home placement, accessing home care services—is indeed a very difficult maze to navigate. Unfortunate—but true. Below are several case scenarios I have come across in my practice.

Case 1:
Carol’s family came to me for advice because they had filed a Medicaid application for home care and didn’t know the next steps. Carol is in a nursing home rehab center and wants Medicaid in place upon her discharge—for home care. Upon a quick review of the application they filed, I identified two problems: (1) She has too much money so she’s not actually eligible, and (2) They filed in the wrong county—filing where she plans to live but not the county where she owns a home. Her home is only exempt if she lives in it so this makes her even less eligible based on assets. A month into the process, the family hadn’t made any headway. Shortly after our meeting, they received a denial from the Medicaid office for the two reasons cited above. This lost time means she may run out of Medicare rehab days and incur charges in the rehab facility. On top of that, they have to start over in another county.

Case 2:
John moved to a nursing home. Upon review of his assets, he was told by the home’s finance department that he didn’t qualify for Medicaid, and that he had to pay the nursing home privately—about $15,000 a month. The home did not offer the family any strategies to protect any of John’s assets so they began paying. After several months of writing large checks, they came to me. The first question I asked was, “Are any adult children collecting Social Security disability?” It turned out one of them was, in fact, disabled. A transfer of assets to an adult disabled child is not penalized by Medicaid even if it is done immediately prior to applying for Medicaid in a nursing home. We simply moved all of John’s assets to this child, and established Medicaid for the first of the following month! All remaining assets were protected for the benefit of the family. But they lost upwards of $60,000 in payments to the nursing home.

Case 3:
When I met Mary’s family, they were very frustrated—having applied for Medicaid six months before and denied. I determined the “denial” was actually an approval! They weren’t able to interpret the document Medicaid sent them. This actually happens quite often. The letter did indicate they had a Medicaid spenddown, meaning they must pay some of Mary’s income towards care. The misinterpretation cost the family six months of private pay care. We immediately set them up with a Pooled Income Trust to protect excess income and helped them through the home care assessment process. Within six weeks, long term care at home was in place and all of Mary’s income was protected.

Case 4:
Martin’s family was successful in getting him through the Medicaid home care process. They also successfully navigated the Home Care Services evaluation but were stunned when the managed long term care program offered them only four hours a day when they felt he needed round the clock care. That’s because they presented him as relatively mobile and capable physically but cognitively impaired. They stressed with the evaluator how he needs constant supervision and cannot be left alone due to his dementia. However, managed long term care plans do not have to pay for “safety and supervision.” They only have to pay for the physical tasks he needs help with—which are minimal. So they continued to pay out of pocket for additional help, not understanding other programs and options are available for the type of care their dad needed. Again, here’s a family who paid a lot of money for services when they could have sheltered those assets.


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