Who Is Protecting You?

Information, knowledge, experience, and knowing when to take action are some of the most important traits you need to have when you undertake to obtain Medicaid nursing home benefits for someone. If you have wrong information it could cost you a month or more of Medicaid benefits. If you don’t know what to do with the information you have, it could cost you a month or more of Medicaid benefits. If you don’t have the experience to overcome obstacles it could cost you a month or more of Medicaid benefits. And last but not least, if you do not know which deadlines you have to meet for certain items it could cost you a month or more of Medicaid benefits.

Some people put their trust in nursing home staff when it comes to obtaining Medicaid benefits for their parent or spouse. After all, you might think they have significant experience with these situations. If you don’t look at the details, it may sound like a good idea to have someone from the nursing home prepare and file your Texas nursing home Medicaid application to save some money but keep these important facts in mind before you decide who to rely on with your parent or spouse’s money:

1. nursing home staff does not represent you, they work for the nursing home and will do what is best for their employer (which may not be best for you and could even be the exact opposite of what is best for you because they make more money off of you than Medicaid, this is a conflict of interest);
2. nursing home staff has no obligation to you concerning the Medicaid application. I get calls too often from families who relied on the nursing home staff to prepare and file the Medicaid application only to find out they never did or they filed it later than they should have. If the delay is too long, you could lose a month or more of Medicaid covered expenses that the nursing home is going to expect someone to pay;
3. many of the staff have an incomplete knowledge of Medicaid eligibility rules and regulations. They often tell a family their parent or spouse has too much income to qualify for Medicaid which appears correct, but what they forget to tell you is that can be fixed with the right strategy. Similarly they will tell a family they have too many assets without considering the asset protection options the family may have to fix the obstacle without losing everything to nursing home bills;
4. the nursing home can and will still hold you responsible for any mistakes in the eligibility process even if those mistakes arose because you relied on their staff;
5. if they try to impress you with claims that their staff member used to be a caseworker with the HHSC, keep in mind the caseworker position is mostly a data entry position. If you want to rely on advice from someone with that level of experience then good luck. The supervisors and regional attorneys are the decision makers at the HHSC, not the case workers.

Establishing Texas nursing home Medicaid eligibility is a process where mistakes and delays are expensive and the potential liability is significant depending on the specific terms of your nursing home admission contract. Who is protecting you?

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