Medicaid is a health insurance program for needy individuals. Unlike most policies of health insurance, Medicaid will pay for the cost of long-term care, such as care in a nursing home. Nursing homes cost a great deal of money, anywhere from $9,000 to $12,000 a month.
Few people could afford to pay $12,000 a month for very long without bankrupting themselves. For the family of an individual who requires care in a nursing home, there is the concern that the loved one will receive the care he needs and there is the concern that he will be able to afford the care he needs.
Because of the cost of a nursing home, many individuals who require long-term nursing home care wish to qualify for Medicaid benefits. The Medicaid program is governed by a very complex series of laws, so people who want to qualify for Medicaid are often confused, intimidated, and scared.
When this happens, people typically seek the advice of other individuals whom they believe have a certain level of expertise and knowledge in the area. I am a Certified Elder Law Attorney. Most Certified Elder Law Attorneys have the necessary level of expertise needed to help their clients qualify for Medicaid benefits.
In the past several years, there have been a number of “Medicaid experts” that have opened businesses to assist people in qualifying for Medicaid benefits. As stated, the Medicaid program is governed by a complex series of laws, yet these so-called Medicaid experts have no legal training whatsoever.
Furthermore, some of these application companies have a very close relationship with the nursing home in which the nursing home resident lives. Some of the owners of these application companies may even be relatives of the people who own the nursing home, and the nursing home refers the family to the application company.
The fees these companies charge to assist their customers with filing an application for Medicaid benefits are equal to or greater than the fee the family would have paid to retain a Certified Elder Law Attorney. Sometimes the fee is quoted as a flat fee, sometimes the fee is quoted as an hourly fee, but in the end, the total fees often range between $2,500 and $4,500.
The problems I see with these companies are multi-fold. For one thing, these companies fail to disclose their relationship with the nursing home to their customers. When a company is dependent upon the nursing home for its business because the nursing home pushes the families of residents toward the services the company provides, the application company is going to feel a greater loyalty to the nursing home than to its customer. This is particularly the case if the application company is owned by the same people who own the nursing home or owned by people who are relatives of the people who own the nursing home.
Secondly, Medicaid is a complex law. If you are not a lawyer and you are providing advice to someone who is seeking to qualify for Medicaid benefit, you are doing that person a disservice. A non-lawyer cannot effectively provide advice regarding a law as complex as Medicaid to its customers and certainly cannot effectively litigate the improper denial of Medicaid benefits.
Yet, the customer of the application company is paying for Cadillac service and getting Yugo support. If a nursing home is pushing you to use the services of a company to qualify for Medicaid, you may want to pause for a moment and think about why the nursing home is so keen on your using that company.