Applying for Medicaid

I have been helping clients apply for Medicaid benefits for nearly twenty-five years. Medicaid is a health payment plan for needy individuals. Unlike health insurance or Medicare, if a person qualifies for Medicaid benefits, Medicaid will pay for most of the costs associated with long-term care.

For instance, if Mrs. Smith requires care in a nursing home, Medicaid will pay for most of the costs associated with the nursing home. Nursing homes in this area cost between $12,000 to $15,000 a month. If you add in ancillary costs (diapers, medicines, etc.), the cost of long-term care can be near $20,000 a month or $240,000 a year. Medicaid will also pay for many of the costs associated with an assisted living residence. For those living at home, Medicaid will pay for a home health aide.

I have helped thousands of clients qualify for Medicaid. From time-to-time, I have sued the State in federal court to compel the State to grant my client eligibility for Medicaid. The Rules of Professional Conduct govern a lawyer’s conduct. The New Jersey Rules of Professional Conduct require that a lawyer represent his client with competence and diligence. In my opinion, this means I must do all I can to get my client qualified for Medicaid benefits, including suing the State in federal court to compel the State to grant my client the Medicaid eligibility she deserves.

In the past ten years, a number of non-Attorney Medicaid application companies have popped up. Many of these companies appear to have a strong connection to the nursing home in which your family member may reside. I say this because the nursing home staff often very aggressively “refers” the family to these companies. One thing is certain, these companies are not “professionals”—they are not governed by rules of professional conduct; in fact, their conduct is wholly ungoverned.  Other than opening a business and saying that they are specialists in the field (a self-proclamation of skill), these companies do not have to have any knowledge of the Medicaid program or Medicaid planning whatsoever.

I have seen nursing homes have new residents sign documents saying that the resident cannot hire an attorney to assist them with applying for Medicaid benefits and that the family must use the non-Attorney company to assist them with applying. Why would a nursing home do this if there was not something in it for the nursing home? I do know that the point of being in business is to make money.

Families often want to hire these companies because they want the nursing home to continue to care for their family member. The family is concerned that if they do not keep the nursing home happy, the nursing home will discharge their family member and the family will have to care for their sick loved one.  Since the family members lack the time and skill set to care for their sick family member, they believe their family member will suffer.

Most people end up in nursing homes after a short stay in a hospital. For instance, Mrs. Smith falls at home and breaks her hip. She goes to the hospital for surgery. From the hospital, she is sent to a “rehab center.”  The rehab center is really just a nursing home; Mrs. Smith is now a resident of a nursing home.

Once Mrs. Smith is in a nursing home for rehab, the nursing home cannot discharge Mrs. Smith to her home or to a family member’s home unless the discharge is safe for Mrs. Smith and, in the case of a discharge to a family members house, unless the family member agrees to accept and care for Mrs. Smith.  A nursing home cannot compel a family member to care for Mrs. Smith, and the family member has no obligation to care for or house Mrs. Smith.

Unlike family members, the law compels the nursing home to care for Mrs. Smith. So, what is in it for the nursing home to refer (often with gusto) a family member to a non-Attorney application company? Control of the process, the nursing home knows everything about the resident’s finances and controls the application process. Control of the information, the nursing home is interested in being paid by Mrs. Smith up until such time all of Mrs. Smith’s assets are spent on her care in the nursing home, not in saving some of Mrs. Smith’s assets for her or her family.

In the next article, I will discuss the amounts these companies charge and some of the promises they appear to make about their services that lack a foundation in the law or reality.