• Assess Financial & Health Needs
• Rules of Medicaid & Apply to Client Situation
• Assist with Medicaid Applications
• Assist with Long Term Care Options
• Assist with Life Care Planning
Medicaid Planning is a comprehensive and complicated process of evaluations of a client’s short and long term financial and health care needs to determine what each individual wants, needs and can or cannot afford. The rules for Medicaid Federally and in Illinois are complicated and sometimes open to interpretation by local caseworkers or which need higher level review. As with healthcare that is highly specific to each patient, each client situation is different and often leads to ambiguities in Medicaid laws and rules. Those persons who may not need to consider Medicaid because their finances appear adequate to support their needs for years to come, still need careful planning. Situations can change in a heartbeat, as some of us know firsthand and most people now in their late 80’s and 90’s never expected to live that long and yet they live on, often beyond their retirement savings. Medicaid Planning may come about naturally because someone outlives their savings or perhaps because their money was taken from them as early inheritance deemed to have been earned or surreptitiously without their knowledge.
Some clients need help defining options available to them or resources to assist them to find proper placements or services. Some people need to devise a plan to allocate their limited resources to maximize expenditures and at the same time have contingency plans in mind in the event that some unforeseen event throws a wrench into plan A. Some need help to plan to take care of a disabled child but still care for themselves as well. A reputable Elder Law Attorney will assess all senior clients for Medicaid Planning needs in conjunction with estate planning requests. Seniors frequently have no concept of how much money would be needed if their health needs suddenly changed and $100,000 looks like a lot of money until the tables turn and a stroke takes them to a nursing home at $7,000 a month unexpectedly.
The types of clients our firm generally works with are those with more complicated legal and care issues that present a need for involvement to interpret the rules. As this area of law grows, those of us who have been here for some time, appreciate the complexity of the tasks before us and are humbled by the intricacies and issues that we often can anticipate but cannot predict the outcomes. There is much more to Medicaid Planning than filling out an application. Generally that is the easier part. It is what one does to support the application so that it gets approved, that takes the time and effort and skill. Even with the utmost care and careful documentation, any submitted application can be triggered for audit by random selection. Things that seem simple on the surface can be intensively complicated to explain within the confines of the rules. It is also important to remember that the completeness of the application and the timing of filing is primarily dependent on the client who must produce the documents needed. Failure to produce or incomplete documentation will almost always result in audit and/or denial. That we can predict with some certainty.
Our first goal for our clients is to always preserve as much as can be preserved for the sole use and comfort of the elderly or disabled client and/or spouse, first and foremost. While financial exploitation is currently on the rise, due partly to the economic environment we now live in, I am always refreshed to meet families who are committed and dedicated to make sure their elderly parents or aunts and uncles are able to take care of themselves financially. We always want to remain positive and trusting. The cases of exploitation that come to our door sometimes make that difficult to maintain.
Part of Medicaid Planning may involve trying to help stop exploitation if it is still occurring. It may mean changing an estate plan or changing acting agents or trustees. It may mean guardianship needs to be implemented. These situations do not endear the attorney to the exploiter and opens up some considerable risk for those who chose to be involved. If the exploitation has already occurred and there is nothing left to take, the missing or misdirected funds wreak havoc when Medicaid applications are filed. Audits, regardless of whether just a random file picked or due to deficiencies in the file, are time consuming and expensive.
Our second goal then, is to do everything possible to properly compile and prepare the application to be favorable for approval, with or without audit. This does not mean to falsify or cover up anything. We insist on full and complete disclosure of all accounts and transactions by our clients. Everything must be honestly and accurately explained and then we hope for the best. To fail to disclose, to cover up or out and out lie, is predictably fatal if or when discovered, not just for the client but for the attorney as well. Your attorney has to work with the same caseworkers over and over, sometimes the same auditors. One bad case can ruin a reputation and can result in every file sent in by that attorney being audited or otherwise scrutinized. In most circumstances, we will not submit an application if it is incomplete unless it is fully documented that the client has attempted to obtain the documentation and a provider has refused or failed to produce. This is a cooperative effort and in order for the attorney to do the meticulous preparation, the documents have to first be received from the client with time allowed for the fine tuning to take place.
As mentioned before, it is difficult to predict which files that are adequately prepped will go to audit. I have prepped a squeaky clean application with absolutely no gifts or transfers and every “i” dotted and “t” crossed and not one missing piece of documentation that ended up in a random selection for audit and eventually approved but it took over 60 days for the auditor to figure out there was nothing amiss. Another with multiple transfers that were all documented and explained and the client warned that the file may be flagged for audit or result in spenddown, because of one of the transfers that may be deemed to be a gift, flew through without the blink of an eye by the caseworker and triggered no penalty. An attorney that has a good working relationship with the DHS caseworkers because their files are well prepared and fully and honestly documented is usually an asset for the client. We are proud to say that so far, in our 7 years of practice, that we still have a 100% approval rate and our client’s applications have all survived the few audits that have been done with resulting approvals. I never kid myself though. The next case in the door could change that….in a heartbeat. Thus, I remain humble and never cut corners. Every application gets the same meticulous care, no matter how clean or complicated. This is a time consuming, meticulous, detail oriented process that should not be rushed or short-changed. I limit how many applications my office will take on to try to make sure that I have adequate time to properly process and prepare each for submission in the time frame anticipated.
As new attorneys enter the picture, they will have less of a track record to rely on, however, one must remember we all started with our first application sometime. I have just recently heard that there are some accountants and financial planners who are offering to file applications for their clients. While an attorney is not necessary in some cases, if there are allowable transfers that can be legally done, or Medicaid Trusts that could preserve assets for use by the client, or estate documents that could protect clients, these professionals will not be able to provide these services and may not even be aware that they exist, nor do many of them understand the relationship between allowable assets or income levels and how to petition the court to overcome shortcomings in the estate.
With all that said, it is still important that the firm or person you work with will devote the time, energy and skill necessary to give each application the best chance it can have to survive the process and will maximize the legally allowable means to protect or preserve assets. It is equally important that each client has a thorough assessment of what planning is necessary, what planning could be done but may be optional or not time sensitive, and what the time tables are for what is recommended to be done. It is also important to remember that no matter what is recommended, the client has the last word to decide, even sometimes to their own detriment.