A Six Figure Medicaid Mistake (Part 1)

We received a recent call from a child about her parents.  Dad has been in a nursing home for more than a year.  A Medicaid application was first filed by the facility on behalf of Dad 16 months ago.  The reason for the call is that the application was denied.  As far as I could tell, it appeared that they tried more than once.

Now the outstanding bill was more than $150,000 and the facility had been sold to a new owner.  The meter was continuing to run.  Each month that went by without Medicaid resulted in the bill going up by approximately $12,000, the private pay rate for care.  The new owner wanted to refile the Medicaid application and the family was understandably skeptical.  That’s why they called our office.

I told them I first needed to determine the reasons why the previous applications had failed.  I asked for copies of all the communications from Medicaid and I asked some questions.  Because they didn’t deal directly with the Medicaid caseworkers (because the facility did), the family only had a few documents and could only tell me what the facility employee told them that Medicaid had said.

Very quickly, however, it became clear what had happened.  Mom and Dad had numerous accounts  but almost all were in Mom’s name.  I asked whether Medicaid had been provided with 5 years of records for all these accounts.  Mom told me that she provided only the accounts in Dad’s name.  When I asked why she said that the nursing home employee told her it was not necessary and in fact would only complicate the application process.

I told her that was flat out an incorrect statement and was the reason her application had been denied.  Next week I’ll share with you why.