Do You Really Need a Medicaid Lawyer?

Do you really need a Medicaid lawyer?

You might be surprised that I’m the one saying this, but the answer is: No, you are not required to have a lawyer but you are required to know the federal and state statutes and regulations whether you have an attorney or not. In some cases people are able to get through the process on their own. The most common traits present in those cases are:

  1. An un-married applicant with less than $2,000 in counted resources;
  2. A married applicant with less than $25,448 in counted resources (that is for both spouses in a case where deeming applies);
  3. No gifts, transfers, transactions, or other co-mingling of funds that might result in a Medicaid penalty in the last 5 years;
  4. An applicant with gross monthly income below $2,163 per month;
  5. Someone acting through a power of attorney that is not concerned about being on the wrong end of responsible party litigation.

If all of those elements are present in your case then you might be able to get through the process without an attorney. However, if you are missing even one of those elements then you might want to carefully consider the advantages an experienced attorney can provide.

When do you need a Medicaid lawyer?

When the benefits outweigh the cost. It is as simple as that. There is a lot at stake when your parent or spouse needs to qualify for nursing home Medicaid, potentially hundreds of thousands of dollars in many cases. So let’s take a look at some of the most important benefits of hiring the right Woodlands Medicaid Elder Law Attorney and then you can decide what cost those benefits are worth in your case.


1. Maximize assets for the applicant’s spouse at home. When there is a spouse at home there is a critical goal of any plan to provide financial security for the at home spouse. If a married couple has more than $25,448 in combined counted resources then they are confronted with the choice of what to do with the excess resources. If you follow the default one-half rule you could be sacrificing a lot of assets to the nursing home that could have been protected for the at home spouse. If a married couple has $100,000 in cash and investments as of the Medicaid snapshot date they are going to have to decide what to do with approximately $48,000. Doing nothing will likely result in the money being spent on medical costs whereas the right Medicaid asset protection plan in many cases will protect the assets for the spouse at home. Which option would you prefer?

2. Protect available assets for family members. If an un-married Medicaid applicant has more than $2,000 in counted resources they will have to do something with their resources that exceed $2,000. Without the right Medicaid asset protection plan that usually results in the money being spent on medical costs. With the right plan all or a portion of it may be protected for family members or other individuals. Which option would you prefer?

3. Avoid costly mistakes. There is a lot of misinformation out there and many families end up believing that Medicaid is going to begin coverage for their parent or spouse on a specific date which later turns out to be wrong. This happens a lot with nursing homes that accept a resident as “medicaid pending” when anyone who knows Medicaid eligibility requirements knows the resident will be denied Medicaid without further action. These mistakes can be expensive and can also be avoided by working with an experienced Medicaid attorney who can give you accurate information.

4. Making sure you don’t spend more than you have to or lose exempt assets. When it comes to nursing home Medicaid eligibility there are very specific rules for certain assets and transactions. Your Medicaid Attorney’s ability to put your loved one in a position to take advantage of all these rules can be the difference between protecting an asset and losing an asset. When it can involve a house worth over $150,000 or other valuable assets it is critical to follow the required steps to be protected under the laws. One wrong move can result in a loss of protection and yes, I have had people come to me after they tried their own asset protection and it ended up costing them a house and a car that could have been protected if they came to me earlier. I am good at what I do but I do not have the ability to go back in time and undo mistakes that have already occurred.

5. Avoid MERP claims in the future. An experienced nursing home Medicaid attorney will not only protect your loved one’s assets and help them to qualify for Medicaid, he will also put them in a position to avoid a Medicaid Estate Recovery Claim in the future. If your loved one does not complete this step then a valuable asset protection opportunity is lost. In some cases this can be the difference between preserving the value of a house and losing the house to a Medicaid Estate Recovery claim.

6. Expedite HHSC eligibility determination. The government acts on its own timetable and it is not particularly quick. If you try to file your own nursing home Medicaid application and do not include all of the required information or supplement the required information while the application is pending that leads to increased requests for information from the HHSC. The back and forth involved in those requests leads to avoidable delays in getting a ruling from the HHSC as soon as possible. Even a simple mistake like checking off the wrong box can set you back about 45 days.

7. Peace of mind. With nursing home bills averaging almost $5,000 a month and in some cases going as high as $9,000 a month there is a lot at stake in ensuring a smooth transition to Medicaid coverage. One mistake can easily cost you anywhere from $5,000 – $20,000 (including innocent mistakes and mistakes caused by you listening to nursing home staff). An experienced Medicaid Attorney is there to make sure everything is addressed in order to avoid those mistakes and create a smooth transition from Medicare or private pay to Medicaid without a gap in coverage. If you choose to do it yourself, then that is your responsibility which might keep you up some nights if you don’t want to risk losing large sums of money on avoidable mistakes.


There is a cost that goes along with obtaining those benefits. Experienced attorneys do charge for their services. Although there is a fee for hiring a Medicaid Lawyer to protect assets and establish nursing home Medicaid eligibility, it is paid from the Medicaid applicant’s assets. In many cases, the assets that are used to pay the legal fee are unprotected assets that would have been spent on nursing home bills anyway without receiving any of the benefits of having an experienced Medicaid lawyer listed above.

While not always cheap, the cost of taking advantage of the proven and legal asset protection a Woodlands Medicaid Elder Law Attorney can provide to your family in many cases pales in comparison to the cost of the endless nursing home bills that will continue to come each month until the Medicaid applicant blindly spends down to eligibility while sacrificing financial security for their spouse or leaving a legacy to their family.

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