THE BEST MADE PLANS SOMETIME GO AWRY

I often talk to the public about Medicaid and Medicaid planning. Frequently, a member of the audience will have experience with applying for Medicaid benefits for a family member. Most often, the experience was negative. They found the process to be protracted and arduous; the Medicaid office requested document after document and provided little assistance or reassurance.

In my experience, apply for Medicaid benefits is a job onto itself. I have a staff member whose primary job is applying for Medicaid benefits for my clients and following up with those applications. Most applications take months to process – although, technically, the Medicaid office only has thirty day in which to process an application.

Oftentimes, the “rules” under which the Medicaid office works vary from county to county and team to team within a county’s office. These “rules” are not written in any book of law, but in my opinion, spawn from office meetings. Unquestionably, an applicant will have some difficulty navigating through these unwritten rules, not only because they lack a basis in the actual law governing the Medicaid program but also because the rules are subject to change at the whim of the Medicaid office worker.

By far, however, the worst situations with the Medicaid office arise from a worker’s refusal to honor the actual, written laws governing the Medicaid program. If you understand the Medicaid law – you’ve read it, you’ve discussed it with legal practitioners who work with the law every day of the week, and you take action based upon that law – you have an expectation that the Medicaid office will adhere to those written laws and will process your Medicaid application according to the terms of that law.

Not so. At least, not always so.

Sometimes, the Medicaid office will not honor the law. You’ll first hear it from the caseworker who is processing your application. You’ll think to yourself, Well, I’ll just talk to the supervisor and it’ll all get straighten-out. But, guess what, sometimes that’s not true either. Sometimes, the supervisor simply agrees with the caseworker, and now, you’re well on your way to a nightmare.

Your mom’s in a nursing home. The nursing home costs $7,000 a month. You’re mother has no money. The nursing home is telling you that they’re going to discharge your mother for non-payment. And, now, she’s not being approved for Medicaid.

You think it doesn’t happen to people who play be the rules; believe me, it does. For instance, I have a client, let’s call her “mom,” who has a daughter who is totally and permanently disabled. If you know anything about the Medicaid law, you’d know that totally and permanently disabled children are granted certain privledges.

For instance, there is a specific provision in the Medicaid law that allows a Medicaid applicant – mom in this case – to transfer her house to her totally and permanently disabled daughter without being disqualified for Medicaid benefits for one day. Daughter gets the house, mom gets Medicaid.

In my case, mom transferred a one-half interest in her house to her daughter in April 2002; in other words, mom added daughter’s name to the deed. In June 2002, the daughter was found to be totally and permanently disabled by the Social Security Administration. In July 2002, mom applied for Medicaid benefits.

The Medicaid office denied mom benefits until such time as the daughter re-transferred her one-half interest in the home to mom, and mom transferred the home back to the daughter. Both the re-transfer and transfer to the daughter occurred on the same day.

According to the Medicaid office, the “taint” of the April transfer stayed with mom’s action in transferring the house to the daughter until the daughter made the re-transfer to mom and mom transferred the whole house to the daughter. In the meantime, mom was found to be ineligible for Medicaid benefits for ten months while the Medicaid office fabricated a solution with which they felt comfortable.

Ten months of ineligibility resulted in a bill for $70,000 and cost the family a world of concern. The daughter who was not only disabled but indigent, as well, now has to fight off collection proceedings by the nursing home.