The Medicaid eligibility process is like a stairway, there are a bunch of steps you have to complete before you get to the top and obtain Medicaid nursing home eligibility. A mistake at any one of the steps can lead to a very bad outcome at the end, kind of like how dominoes fall one after another. Very rarely is it a matter of filling out a form and waiting for an automatic approval. You need to be able to prove that the Medicaid applicant meets all the legal criteria for eligibility. If you can’t prove that your parent or spouse meets every single eligibility criteria, then the HHSC can deny their application and you should be prepared for that outcome.
Remember, the HHSC is part of the government and if they can save the government a lot of money by finding a valid reason to deny your application they almost always do. So what is involved when you need to qualify a parent or spouse for Texas nursing home Medicaid?
Is it simply filling out a form?
If you are lucky it may be this simple, but if you guess wrong the consequences can be very expensive. For a person that already meets the financial and non-financial eligibility requirements for nursing home Medicaid then the application form may be the last step as long as it is prepared and filed correctly with the required documentation. If the application is not prepared or filed correctly or the required documentation is not provided to the HHSC then you could still trip up even at this last step and de-rail a timely Medicaid application resulting in the nursing home looking at you for payment of uncovered bills.
It may seem like a simple application, but I have met people that have made a mistake as small as checking the wrong box on the application which resulted in months of lost benefits because of the delays that single error created. If you are doing it yourself, make sure you do everything correctly so that does not happen to you.
Is it more than filling out a form?
In many cases it is a lot more than filling out a form.
For example, if the Medicaid applicant is over the income limit then we have to create income eligibility with a Miller Trust.
Or, if the Medicaid applicant is over the asset limit then we have to find ways to get them under the asset limit without creating a Medicaid penalty and protecting as much as possible for family members.
Or, if the Medicaid applicant has unique or divided ownership assets then we have to determine how the HHSC is going to treat those unique or divided ownership assets. (Hint – even an asset that is 50% owned by a Medicaid applicant can be treated by the HHSC as if they own 100% in certain situations).
And last but not least, if the Medicaid applicant has already made gifts or transfers to individuals in the last five years we need to create a plan to minimize the effects of the Medicaid penalty. If you know how a Medicaid penalty works, you know that finding out about a penalty after the money is already gone is a recipe for disaster.
As you can see, in many cases Medicaid eligibility is more than a form. The form is one of the last steps in the process, not one of the first. This is just a small glimpse of the many eligibility issues your Woodlands Medicaid Attorney needs to address and resolve to make your case for Medicaid eligibility. If you insist upon going through this process yourself, then stay tuned for my next post on some common do-it-yourself mistakes that people make which leads to very bad outcomes for them and their loved one.