Should you prepare a Medicaid application yourself, or get help?

A decision on whether to prepare and file a Medicaid application on your own or hire help depends on answers to these questions:

• How old is the applicant?
• How complicated is the applicant’s financial situation?
• Is the individual applying for community or nursing home benefits?
• How much time do you have available?
• How organized are you?

Medicaid is the health care program for individuals without other insurance or those whose insurance does not cover what they need, such as long-term care. Many people rely on Medicaid for assistance in paying for care at home or in nursing homes.

For those under age 65 who don’t need long-term care, Medicaid eligibility is determined largely by income, and the process of applying is not very complicated. Most people can apply on their own without assistance.

Matters get a bit more complicated for applicants age 65 and older, and those of any age who need nursing home or other long-term care coverage. In such cases, it is practically essential to seek the services of an attorney.

To be eligible, Medicaid applicants over age 65 are limited to $2,000 in countable assets (in most states).

It’s possible to transfer assets over this amount to become eligible, but seniors need to be careful. They may need the funds in the future, and if they move to a nursing home the transfer could make them ineligible for benefits for five years.

Professional advice is also crucial because there is a confusing array of Medicaid programs that may be of assistance in providing home care, each with its own rules.

The application process is not as complicated for community benefits, meaning care that takes place outside of an institutional setting, such as in the beneficiary’s home.

In short: in many cases people older than 65 will need to consult with an elder law attorney for planning purposes, but they or their families may be able to prepare and submit the Medicaid application unassisted.

Submitting an application for nursing home benefits without an attorney’s help, however, is not a good idea. Medicaid officials subject such applications to enhanced scrutiny, and the application requires submission of as much as five years of financial records and documentation of every fact. Any unexplained expense may be treated as a disqualifying transfer of assets, and many planning steps, such as trusts, transfers to family members and family care agreements, are viewed as suspect unless properly explained. The process generally takes several months. An applicant should expect Medicaid to continue asking questions and demanding supporting documentation for answers provided.

Many elder law attorneys offer assistance with Medicaid applications as part of their services. By enlisting a knowledgeable attorney you will receive expert advice on how best to qualify for benefits as early as possible, experience in dealing with the more difficult eligibility questions that often arise and a high level of service through a long, grueling process.
The drawback of using an attorney rather than a lay service is that the fee is typically substantially higher. Given the high cost of nursing home care, however, accelerating eligibility by even a month with the help of a lawyer will generally cover the fee.