Ben calls us with some basic questions about his mom’s long term care needs as she is very close to needing nursing home care. The subject turns inevitably to Medicaid as I explain the complexities of the program and how people get tripped up by it with often disastrous consequences. Ben then makes a statement I hear often. “The nursing home social worker will help me with the application. She says Mom’s situation is very simple.” But how do either of them know if that’s really true? Is there really such a thing as an easy Medicaid application?
A trend we have noticed in recent months in many county offices (Medicaid applications are processed on the county level) is the high turnover of staff and the severe understaffing of offices. Many offices are filled with inexperienced and overworked employees – a bad combination. That’s when mistakes happen. If you’ve been a reader of this blog for even a short time you know how many things can go wrong with a Medicaid application and it’s almost never in your favor.
The family doesn’t know the ins and outs of the Medicaid rules. Completing a Medicaid application is more complicated than preparing the average tax return. That’s why you hire a good CPA. The nursing home is not any more equipped to handle it either. It’s just not the business they’re in and it can cost the applicant and the nursing home tens of thousands of dollars if they make a mistake.
The reply I hear so often is “I looked at the application form. It’s only 8 pages and looks pretty straight forward”. For the most part that’s true. Except that it’s not the application that’s really the problem. It’s all the documentation you must provide and the follow up scrutiny. Going through the Medicaid process is sort of like undergoing an IRS income tax audit, only worse. Why? First of all, most people have some basic knowledge of income tax just from the fact they have been filing returns for many years. Most people who file a Medicaid application, however, do it only once. They know next to nothing about the laws and regulations (or even worse they think they know and are flat out wrong).
Secondly, the tax auditors are so much more experienced than Medicaid caseworkers. They generally know the tax laws, or at least how to interpret the laws in the government’s favor (which is why you don’t walk into an audit on your own). You can’t really blame the Medicaid workers. They are thrown into the job, usually with next to no experience, and try to do their best. But, in so many cases it’s the blind leading the blind. When the caseworker says an asset is countable how do you know it really is? If he/she is wrong you wouldn’t know it.
So, let’s go back to my original question. Is there really any easy Medicaid application? If for the past 5 years you literally never had any assets and only a checking account and lived on Social Security and a pension then, yes, that would be a painless application. But, that’s a pretty rare occurrence.
If you’ve got more assets than that, it is impossible to say it will be an “easy” application until an elder law attorney who knows the rules and regulations really scrutinizes all the transactions in every document provided to Medicaid before you file the application, not after. That’s the best way to insure you’ll have a painless Medicaid experience.