The Devil Can Be in the Details

Medicaid is a health payment plan for needy individuals.  If you qualify for Medicaid benefits, the program will pay for most of the costs associated with long-term care, such as care in a nursing home, an assisted living residence, or at home (a home health aide).  Long-term care costs can be exceedingly high—anywhere from $6,500 to $15,000 a month.  Most people could not afford to pay these costs for an extended period, so they attempt to qualify for Medicaid benefits to defray the costs.

I have been representing people in qualifying for Medicaid for over twenty years.  In that time, I have helped thousands of clients plan for or qualify for Medicaid benefits.  But I think there are a lot of people who could use my help who fail to consult with me for fear of the costs associated with consulting with or retaining my services.

When it comes to Medicaid planning—a form a planning that helps people qualify for Medicaid benefits while preserving a portion of their assets for their family—I charge a flat fee.  The fee I quote the client at the start of my representation is the fee the client will pay; the fee does not go up no matter how much time I invest in the client’s case.  Most of my fellow elder law attorneys bill on a flat fee basis.

My flat fee is about one-half the cost of one month of long-term care.  I think that’s quite reasonable given the advice I can give to a client throughout the Medicaid application process and given the amount of money I am often able to preserve for the client’s family.

In the last ten years, several non-attorney Medicaid advisory companies have come into being. These companies hold themselves out to be “specialists” or “experts” in the field of Medicaid planning.  These companies hold no license or degree that would denote any level of expertise in the field of Medicaid planning.

The companies are frequently owned by or closely affiliated with the nursing home or assisted living residence that is making the referral to the advisory company.  The more fervent the referral—and many nursing homes nearly insist that a family uses the advisory company—the more a person should realize that the advisory company has the interests of the nursing home at heart, not the interests of the client.

Unlike a company without a license of any sort that holds itself out to be an “expert” without basis to make that claim, I can only take into consideration my client’s interests.  I am literally duty-bound to advocate for only my client’s interests.

Recently, I had a person contact my office.  They used the services of one of these companies to apply for Medicaid benefits and were denied benefits.  The company charged the client an exorbitant amount of money to apply for Medicaid, substantially more than I have ever charged a client in my twenty years of practice.  When the client sought to reapply for benefits after initially being denied, the company asked for more money to file the second application.

Here’s the thing:  To qualify for Medicaid benefits, an applicant must have no more than $2,000 in assets (this figure does not include the applicant’s monthly income).  If the applicant owns assets worth one penny more than $2,000 (or $2,000.01), he will be ineligible for Medicaid benefits.  I tell my clients that they should bring their assets down to $1,000.  I tell the client this, so he has a cushion between the amount I tell him to retain ($1,000) and the Medicaid assets limit ($2,000).  If the client discovers a small asset of which he was unaware or forgot about, there is that $1,000 cushion.

Clients often say to me, “I thought I could keep $2,000.  Why are you telling me to keep $1,000?  I want to keep $2,000.”  I then explain my thinking and the client agrees with me.

In the recent case, the advisory company did not tell the client to bring his assets down to $1,000.  The client owned a small bank account worth a few hundred dollars of which he forgot.  He was over the $2,000 limit because of this small account, and he was denied benefits.  He lost months of benefits because he did not receive this seemingly minor piece of advice.  The failure to get that advice cost him tens of thousands of dollars in long-term care benefits, so in reality, this small piece of competent advice was worth tens of thousands of dollars.