Medicaid Planning Attorneys Serving Western Pennsylvania
Are you or a family member facing a nursing home admission and you are confused with the many rules of Medicaid? Is there fear that many of the assets you worked hard for throughout your life will be lost? At the time, it may seem like there is no hope. However, Heritage’s medicaid planning services can help with saving assets and still getting our clients the skilled nursing care they need.
In most cases, our experienced Medicaid lawyers can save a married couple 90% of the assets when one spouse enters a nursing home. If the client is single, we can typically save 50% of the assets. There is no need to be frightened when navigating this process. Contact our firm to schedule a free, no-obligation consultation to learn what your options are and how we can help ease your burden.
First, the Benefits Associate does a Triage to collect initial information on income and assets. An initial meeting is typically scheduled during this phone call and the prospective client is sent a detailed planning worksheet to complete before the meeting by email or regular mail.
During the initial meeting, the potential client meets with one of our experienced Medicaid attorneys and ideally brings the completed worksheet. The attorney will collect any additional information needed, identify the problem, and then step out of the meeting to do calculations to determine which option is best for the family. Then the attorney returns to the meeting, explains the Medicaid process, and presents the client with the possible strategies available to fix the problem. If the client signs the Medicaid Fee Agreement, a document collection meeting is scheduled at that time.
The Document Collection meeting is usually the next meeting scheduled, and an attorney or benefits associate will collect any additional information or documents still needed at that time. Follow-up meetings usually consist of status updates, document signings, or the spend-down, depending on how complex the case is. Following the spend-down meeting, Heritage will submit the Medicaid application to the County Assistance Office (CAO) and get one of three responses: approval, denial, or pending.
If the application is approved, we check the start date to make sure we agree with it, and if we do not, we appeal. In the case of a denial, we identify the issue then appeal. For a case with a pending status, our staff will reach out to the client and obtain any documentation we do not have. We then re-submit the application and a new decision is issued by the CAO.
If documentation is not received by the deadline, we are given a denial and appeal it, scheduling a Fair Hearing. Heritage will represent the client at the Fair Hearing and usually enter into a stipulated agreement with the CAO. We will talk to the client, discuss the deadline of the stipulated agreement, and ask that the client provide documents to us so we can provide them to the CAO so it can issue a new decision.
Once Heritage receives the final decision, we send the client a closing letter.
What is the difference between Medicare and Medicaid?
Without overcomplicating things, Medicare pays for acute injuries (things you can recover from). The Medicare system is designed to heal your injuries or health issues so you can return to your normal daily life. Medicaid, on the other hand, is a program that provides medical coverage for those in need and financial requirements must be met. Medicaid is also the primary payer for things you are not going to recover from, commonly referred to as long-term care or skilled nursing.
There is a lot of overlap and confusion when it comes to these two programs, so let’s look at a situation. Let’s say mom falls, breaks her leg, goes to the hospital, and gets admitted to the hospital for three overnights. You have to be admitted for three overnights for Medicare to kick in so that they can not only fix you up in the hospital but also pay for your rehabilitation. Medicare will pay for an acute injury as long as you’re recovering and it will even pay for a skilled nursing stay – including the rehabilitation – while you are in a skilled nursing facility. Medicare will pay for the first 20 days completely and after day 20, there is a copay that varies up to day 100.
However, here’s the catch: You have to continue to be getting better. The moment you stop improving or stop participating in rehab, Medicare often stops because the program will only pay to fix you up, not take care of you indefinitely. At the time you stop rehabbing or getting better, you become what we commonly refer to as private pay. Prior to the Medicare benefit being terminated, you will get a 48-hour notice that benefits will end.
It’s this time where most families start to experience a significant amount of stress because when Medicare stops paying for the nursing home, whether you’re able to go home or not, the bill becomes the family’s responsibility. The average cost of a nursing home is over $300 a day and is a daunting situation that can devastate many people’s finances. To protect your family’s finances and still get your loved one the care they deserve, contact the experienced Medicaid attorneys at Heritage Elder Law & Estate Planning, LLC today.
Contact Our Medicaid Planning Attorneys
If you are beginning to think about the future and are unsure of whether you will qualify for Medicare benefits, it is important that you consult with a skilled legal team as soon as possible. With such a time-sensitive matter on your hands, you can count on Heritage Elder Law & Estate Planning, LLC to effectively guide you through the process. Contact our office today to schedule a consultation.