Medicaid is not a D-I-Y Project

Our office receives regular calls from families asking us to intervene in Medicaid cases that have been denied. Often times, family members are handed a copy of the Medicaid application from a social worker in a nursing home or the nursing home admissions director, so they think they should just fill out the application and submit it themselves. Applying for Medicaid, however, is not a do-it-yourself project, and if the application is not done correctly, it will result in a Medicaid denial or unnecessary penalties.

Consider the case of Sarah who applied for Medicaid on behalf of her father, Don. Don owned a home that he placed in an irrevocable trust in 2014. When he first moved to the nursing home, he had about $85,000 in his checking account and a few certificates of deposit. Sarah dutifully paid the $7,800 nursing home bill every month out of his income and the $85,000 in the bank. She did this until his bank balance was down to $2,000 because that’s what she was told she had to do before Don would qualify for Medicaid by a volunteer at the Area Agency on Aging. Sarah then got a copy of the Georgia Medicaid application online, filled it out, disclosing Don’s irrevocable trust and the checking account with less than $2,000 in it. She filed the application in the last week of November. Two months after submitting the application, the caseworker at DFCS requested a copy of the deed to the home and copies of the last three months of Don’s bank statements. Sarah sent the bank statements and deed to the caseworker. Everything was in order with the bank account because it only had $1,600 in it. However, the caseworker assessed a penalty when he approved the application because Don’s home was transferred to the irrevocable trust in 2014 (within the 60-month look-back period). Then Sarah received a bill from the nursing home for $23,400 for Don’s care in December, January, and February. In addition to being extremely anxious about how she was going to pay the nursing home bill throughout the penalty period, Sarah was confused about why Don received the penalty. How did this happen?

In Georgia, a nursing home resident can qualify for Medicaid and still own their home. Many people own a home and still get nursing home Medicaid benefits. The problem is that if you transfer the home out of your name, it is subject to the 60-month look-back period. You cannot give your home away without receiving a penalty, and Georgia considers moving your home into a trust a form of giving it away. Simply, because of the way Don’s home was titled, he was forced to pay privately for his nursing home care for many more months. If Sarah had consulted with an elder law attorney and let them do the application, the lawyer would have been able to avoid this lengthy penalty period.

This is why applying for Medicaid is not a do-it-yourself project. The laws and regulations impacting seniors become more complex each year, and most families only deal with this once in their lives. Tens of thousands of dollars or more can be at stake–it is penny wise and pound foolish not to consult with experts who are committed to guiding clients through the process. If you are acting on behalf of a person who needs nursing home care, please be careful. Don’t just fill out forms and submit them before investigating the rules and legal process. Never apply for Medicaid until you know that the person qualifies, and if you have any questions about how the rules can work for you and your family, please call our office for a complimentary phone consultation at 404-843-0121.

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