Nearly one in every four Americans is enrolled in a national health insurance program which provides health care for the aged, disabled and indigent populations. The Medicaid program (MassHealth in Massachusetts) provides several programs, each program has different eligibility requirements and provides different coverage. Almost 70 percent of people over the age of 65 will need some type of long-term care, with 20 percent requiring care longer than 5 years. Women need care longer than men and more people are using long-term care services at home, for longer of periods of time, as they attempt to avoid nursing home stays.
Because there are many programs that fall under the Medicaid umbrella, we screen clients to understand their medical issues, family circumstances, and financial standing so that we can apply to the proper Medicaid program for which the client most likely qualifies. Unfortunately, the eligibility requirements for the various programs are too numerous to list here, but suffice it to say that without proper planning, Medicaid participants often find themselves impoverished, suffering the loss of financial autonomy as a precondition to gaining Medicaid coverage. Often times, long term care is needed without regard to whether planning has been done or not. We advocate on behalf of these clients for Medicaid eligibility.
Most people want to stay in their homes as they grow older; accordingly, the most prevalent concern among our clients is the loss the family home. Without advanced planning, there is less flexibility in protecting assets and gaining eligibility. However, there are occasions whereby we can assist a client in protecting assets even without prior planning. By not seeking assistance, these individuals will needlessly spend down the assets they might not have otherwise been required to expend.
Long-term care is designed to help people with health care, personal needs, and activities of daily living. Long-term care does not have to mean a complete loss of independence, or control over your life, or even nursing home care. But once the assets are spent, it is unlikely they will can be recovered. To become a beneficiary of Medicaid benefits, you must apply for entry into the program. Applying for Medicaid is cumbersome and tedious. Every fact asserted in the application must be verified by documentation, which usually grows several inches thick. The application process can drag on for several months as more and more verification is demanded for such issues as the amount of assets and dates of transfers. If the applicant does not comply with these requests and deadlines on a timely basis, the Agency will deny the application. In addition, after eligibility is achieved, the Agency usually requires an eligibility redetermination every other year.
Completing a Medicaid application can be a lengthy and cumbersome process. Although simple applications do not require an attorney’s involvement, the complexity of a given person’s situation or the opportunities present are rarely obvious. It makes sense to work with a qualified elder law attorney in most situations. Furthermore, common situations may delay or impede eligibility without proper legal advice. We do not merely assemble and file the Medicaid application, we have extensive knowledge of Medicaid laws and regulations and advocate on your behalf throughout the entire application process.
In the event your application is denied, you can appeal the denial to the Board of Hearings for a “de novo” proceeding to determine whether eligibility was properly decided. This first appeal, known as a Fair Hearing, is an administrative remedy. If you are still aggrieved of Medicaid’s administrative decision, you are entitled to proceed to a judicial review of that administrative decision. You can further appeal the judicial review to the state’s Appellate Court and ultimately the state’s Supreme Court. Elder & Disability Law advocates has experience in all phases of the planning, application, and appeal process described herein.