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Expensive Nursing Home Pitfalls
That Can Cost You A Fortune

Any Of These Mistakes Can Cost You $5,000 or More.

Losing A Spouse's Money

Nursing Home Mistakes

Losing $172 a day Waiting

Recovery Lien Problems

Mishandling Money

You have to be careful once you're in the 5 year lookback period. The HHSC looks at what went on in your parent's bank accounts. If they see something they don't like they can hit your parent with an eligibility penalty.

As a result, any use of funds that is not for fair value (as defined by the HHSC) can cost you a lot of money.

Remember, the HHSC has the final say on this. The burden is on you to prove there is no transfer. Arguments like "my parent wanted me to" or "I've always used their money for this" aren't very persuasive. You need evidence.​

In addition, the HHSC expressly prohibits a few specific transactions that many people are caught off guard by.​ Make sure you aren't violating that list.

​What can you safely spend their money on without creating a penalty? Can you pick out what is allowed and what is not? What can you do with joint accounts? Are tax free gifts safe?

The answers may surprise you.

Not Protecting a Spouse at Home

If your spouse is in a nursing home, and you have more than $26,180 in assets, then you need to know about asset protection. If you don't find out now, you are going to lose a lot of money that you can't get back.

Why $​26,180?

The minimum guaranteed to the spouse is $24,180. On top of that the Medicaid applicant can have $2,000.

The further north of that number you get the more you are looking at losing. This doesn't just mean cash. It includes CDs, annuities, some real estate, retirement accounts, cash value life insurance etc.

But you can change that with the right plan.​ Learn more from a recent client that we got Medicaid approved while keeping $71,000 and cutting the nursing home bill from $4,200 down to $600.

Trusting The Nursing Home

When you get Medicaid, the nursing home makes less money (they still get paid well, don't worry). So right at the outset they have a conflict of interest with helping you since helping you hurts their profit.

On top of the conflict of interest, nursing homes make a lot of mistakes.

  • They might never file your application.
  • They might file it late.
  • They might not spot obvious eligibility issues you can fix before they cost you money.
  • They might not spot an HHSC mistake that costs you money.
  • And lastly, they definitely aren't going to represent you in an appeal to fix their mistake. That's just embarrassing.

Their mistakes cost you money when they create gaps in Medicaid coverage.

The Wrong Bed or Facility

Nursing home Medicaid works like health insurance in many ways. They only pay vendors that are part of the Medicaid program. They only pay benefits that they have contracted to pay.

Your parent or spouse must be in a Medicaid bed in a Medicaid participating facility ​before they will get Medicaid nursing home benefits.

Thinking Its Automatic

The transition from private pay or Medicare rehabilitation to Medicaid is not automatic. But many people think it is.

First, you have to apply for Medicaid. The application may not seem too intimidating but what you should be concerned about is what they don't tell you on the forms. Some things you might think are just income are actually assets for example.

Then you have to prove your eligibility. This is key. They don't have to prove you are not eligible, you have to prove you are eligible. That means some key legal presumptions go in their favor if you don't have the evidence.

​And lastly, you have to time everything correctly to avoid a gap in coverage. Some key Medicaid snapshots only occur on the 1st of each month. If you are not eligible on the 1st but then think you can become eligible on the 20th and still get benefits for the month, well you may be in for an expensive surprise.

Counting on the HHSC

I don't know a good way to describe how the HHSC processes Medicaid applications because it is so odd. They used to have a stronger human element to the process, but now they are fully invested in a computerized process called TIERS. The end result is when the caseworker makes a mistake in the computer program, there is no human to catch it. Unless you know the regulations well enough to spot it or you have an experienced attorney.

And just like with the nursing home, when you get Medicaid the HHSC loses money. So do they really want to approve you?

Every day in a nursing home costs money. Each day they chip away at your life savings a little bit until there is nothing left. The average daily rate in Texas is $172. That's more than $5,200 every month!

Every month you wait is another $5,200 (or more) you lose. Once it's gone, it's gone. If you want to protect assets, then the more you start with the better the results.

Forgetting About the MERP Lien

Getting nursing home Medicaid is a big deal, but it doesn't mean as much if you still lose assets later on. That is exactly what happens when you don't plan to avoid the liens and other recovery techniques used by the Texas Medicaid Estate Recovery Program.

​We protect our clients from Medicaid Estate Recovery as part of our initial Medicaid services so you don't get ambushed years down the road and lose everything you thought you protected.

How To Avoid These Mistakes

Self Help

You can learn all the statutes, regulations, and customs that apply to your case. Start with the federal regulations.

Then look at the Texas Administrative Code. And then look at the Administrative Handbook.

For case law you are going to need to subscribe to a case reporting service.

Get Help

Hire an experienced attorney that already knows how to win your case.

Do Nothing

There is a third option, which is do nothing and cross your fingers, but if that is your plan you might want to start learning nursing home eviction laws.​

The choice is yours!

Our Successful Clients

I highly recommend his law firm and him. He was able to get my dad approved and believe you me, it was not an easy task but he stayed at it and was able to get him approved.

Lori Montoya

I could not have been happier with The Shea Law firm. Rich Shea helped me obtain nursing home Medicaid for my dad, which I thought was going to be impossible.

Colleen Duewel

More About The Shea Law Firm

The Shea Law Firm is a local law firm based in The Woodlands, Texas. Attorney Richard Shea helps families eliminate out of control nursing home costs by showing them how to qualify for nursing home Medicaid without losing everything they worked their entire lives for. And yes, that even includes situations where you are already in the 5 year lookback period.

Don't accept the Medicaid spend-down, we can fight it and win.

Take It From People Who've Been In Your Shoes