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How a Medicaid Paralegal Adds Profit & Value to Your Elder Law Firm

If you’re an elder law attorney, you value the insights of your colleagues when it comes to their success stories and tips for finding the best tools of the trade. In fact, those insights have likely directed some of the decisions you’ve made in your own practice. To that end, if you’ve been considering adding a Medicaid paralegal to your elder law practice, we’d like to share with you some insights from Michael Luizzi.

Mike is a Medicaid and long-term care paralegal with the Pierro Law Group in upstate New York. His journey to becoming a dedicated paralegal in this arena highlights the benefits your elder law practice could realize by adding a dedicated Medicaid paralegal to your staff, and how you can find qualified candidates for this position.

Mike’s introduction to Medicaid came when he began working as a Welfare Examiner in a local Department of Social Services office. There he learned the ins and outs determining eligibility for chronic nursing care for the elderly and disabled, and working with lookback periods, penalties and gift issues. He spent 10 years in this capacity, and gained a wealth of knowledge in the intricacies of processing applications for benefits.

He then transitioned to the private sector, working as a paralegal at a New York law firm. Ten years later, Mike accepted his current role with the Pierro Law Group, where he has been the head Medicaid paralegal for nearly 13 years. His background working in the Medicaid office has served him well in designing strategies to assist clients in obtaining benefits and in submitting applications and other complex Medicaid documents.

Hiring Paralegals from the Medicaid Office

It is an interesting fact that in the region where Mike lives there are many attorneys who specifically look to the Medicaid office for welfare examiners to hire as paralegals. While this might not be common practice in your area, it may be a tactic you want to use when seeking a Medicaid specific paralegal for your firm. This person would already be well versed in the intricacies of processing Medicaid documents in your state, and therefore ideally positioned to prepare applications that will be quickly approved.

Personal Relationships with the Local Medicaid Office

Mike believes that it is imperative for an elder law practice to maintain a personal relationship with the local Medicaid office. There are many ways to do this, and while historically it may have been necessary to drop off an application in person, even if this is not required you may still want to request a face-to-face interview. Additionally, even if simply working with the examiner over the phone or via email, it is still possible to develop a friendly and collaborative relationship. The value of this cannot be overstated, as the examiner can make the application process smooth or challenging for you, and may even deter the acceptance of the application. That said, best practices include taking a non-confrontational approach, even in the midst of confrontational issues, and finding common ground all while remaining professional and friendly.

Medicaid Paralegals Generate Revenue for Your Firm

Hiring a paralegal to specifically focus on Medicaid applications not only adds value in the services you can provide to your clients, but it can also be a significant revenue generator for the firm. Having a dedicated paralegal handling Medicaid applications from start to finish is a simple way to consistently generate revenue because very little of the attorney’s time is needed to manage the case. You are still able to charge the client for your time, and yet you actually have very little contact with the case outside of oversight and review.

I asked Mike if he could share a story of how his work has positively affected both Medicaid clients and his firm. He shared his experience with a husband who had retained Pierro Law Group to obtain community Medicaid benefits on behalf of his wife. “The goal was for the wife to obtain coverage for her receipt of home care services in the household,” Mike recalls. “The strategy our office utilized to qualify the wife for Medicaid was that of a spousal refusal, whereby her eligibility would be based only upon her income and resources, and not to include her husband’s.

“The application was submitted to a smaller local government district where we do not have frequent contact and they seemed unfamiliar with this strategy. They proclaimed it could not be used unless the wife was in a nursing facility and denied the application due to excess resources as they included those of the husband. After a Fair Hearing request and multiple agency conferences, the decision was reversed in favor of our client without the requirement of a hearing and further expense to the client.

“It seems unfair that without representation, this applicant would have been denied coverage and this agency may have treated other prior applicants in this position in a similar manner.”

In this case, Mike says the best interests of the client were definitely served through managing the relationships with the Medicaid office and making a clear and effective argument based on deep knowledge of Medicaid process and law.

Serving your clients’ Medicaid estate planning issues can help ease the financial burden families feel when dealing with long-term care expenses. By adding an expert in this area to your elder law practice, you can help your clients eliminate some of that burden while also generating more revenue.

If you’d like to learn how ElderCounsel and Practice Enhancement Program can partner with you to increase your practice efficiencies and help you reach your practice goals, contact us today to schedule a brief consultation at (888) 789-9908, or email us at info@eldercounsel.com.


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