Elder law attorneys have many areas of expertise, but for the most part, all of us in this field will have to get hands-on with Medicaid application issues on a fairly regular basis. To do so, you will need to know how to provide counsel to your clients regarding the dos and don’ts of this process, from application through approval stages.
There is certainly no one-size-fits-all solution when it comes to Medicaid applications, but once you understand the basics and the details you need to look out for, you can then apply those best practices on a case-by-case basis for each of your clients.
Pre-filing: What to do before filling out the application
It’s important to understand who the client you’re serving is before beginning the process. Are they the applicant, the agent, or the child of the client? Your engagement level needs to reflect the client you’re serving.
Remember that there are many different benefits under Medicaid and you need to have a solid understanding of which benefits your client will be filing for. Different states have different benefits and the best practice here is to make sure you and your staff are informed about all of the different options. For example, different benefits will have different exempt resources, penalty periods, and asset limits, and some will have different application forms to fill out.
Get all of the details
There are questions that will need to be addressed and legwork that will need to be done before you complete a Medicaid filing for a client. One of the major details you can’t afford to overlook is whether or not they’ve made any gifts or uncompensated transfers over the past 60 months. This can be one of the most detrimental factors when it comes to a Medicaid application, and it’s important that your client divulge the information ahead of time because Medicaid has a five-year look back. If this timeline is not adhered to, there can be penalties that can only be reversed if the gift funds are returned.
Of course, you also need to ensure that your client is eligible before applying for Medicaid, otherwise you are wasting time and money, and potentially causing harm to your client. The basic criteria to determine client eligibility are:
- Single clients - Have assets under $2,000* and must be institutionalized (in a long-term care facility).
- Married clients - Must meet spend down requirements where assets have already been repositioned.
Gathering the appropriate documentation is another important detail you can’t afford to overlook. Keep in mind that different states and localities require different types of documentation and that deadlines for responding to information requests can be very tight. For example, if Social Services requests documentation on any detail of an application, the deadline for submitting that additional information is generally 10 days.
To simplify the document gathering process, it’s helpful to have a checklist to provide to your clients to ensure that they don’t overlook anything when submitting their information.
Preparing and submitting the application
Once you’ve gathered all of the information and details, you can then begin preparing the Medicaid application for submission. Make sure the application has been thoroughly completed, including using “N/A” where applicable. Many Medicaid forms will allow applicants to request several different benefits on that single form so make sure each applicable benefit is addressed, or again, that N/A is selected to denote that the client is not seeking that benefit.
Before submitting the application, also make sure to disclose all of the specific things your application locality requires, such as uncompensated transfers, annuities, or promissory note transactions. Remember, the more complete your application, the more quickly it will be processed.
Once you have submitted the application, there are some things both you and your client can do while waiting for a response to increase the chances of approval. First and foremost, make sure your client understands that it is imperative to continue paying his or her patient responsibility to their nursing home or long-term care facility while approval is pending, but that they should not be paying the full monthly fee for residence in the facility.
They also need to make sure that their account balance is less than $2,000* each month. You will want to assign someone on your staff to follow up with clients to make sure they’re doing everything correctly, to give them payment amount reminders, to make sure they’re keeping the proper records and documentation, etc.
What to do after approval
Once you’ve gotten through the entire process and your client has been approved for Medicaid you need to make sure he or she understands the importance of retaining bank statements and other important records and documentation. Discuss with your clients what they will need to do in order to get recertified each year. Where appropriate, you’ll also want to discuss estate recovery and the importance of a living will with the proper complementary protections — such as an irrevocable trust — to ensure that your client’s assets are protected.
Medicaid planning for your elder law clients can be tricky, so make sure to lean on your colleagues and peer network for questions and support. It may sound simple, but when in doubt, always ask questions. If you’d like to know more about establishing a network of resources for your elder law firm, contact ElderCounsel today to learn about all of the resources we provide including more information about ElderDocx, our 5-star drafting software for elder law attorneys.
* Some states have different asset requirements. Every attorney should do their own research and meet their state's requirements.