Avoid These Nursing Home Medicaid Mistakes

mistakeWhat are some common mistakes to avoid during the nursing home Medicaid eligibility process?

If you insist on attempting to complete the process without a Woodlands Medicaid attorney, then be careful. The people I see that try to apply for nursing home Medicaid without an experienced attorney working for them make a lot of mistakes. If you make those mistakes it can end up costing your family not only a big hassle (including a possible eviction nightmare) but also more money than you expected to or needed to pay in nursing home bills. Here are some of the mistakes which you should avoid if you decide to not invest in a Medicaid attorney.

Applying Too Soon. Your nursing home Medicaid application cannot be approved until after the applicant has been in a nursing home for 30 days. If you apply too soon the HHSC can deny the application for applying too early.

Applying With Too Many Assets. If the Medicaid applicant is not married and has more than $2,000 in counted assets on 12:01am on the first of the month then it is almost certain they will be denied unless some very narrow exceptions apply. If the Medicaid applicant is married, then unless their combined counted assets are below $23,844 the HHSC will deny the application until you complete the spend down. If you want to avoid the spend-down and protect some assets for the financial security of an at home spouse, then give me a call.

Applying With Too Much Income. Texas has an income cap for nursing home Medicaid. It changes every year, but right now the gross monthly income limit is $2,199. That is GROSS monthly income, not net. If the Medicaid applicant is over the income limit (even by as little as $0.01) their application will be denied. This is not something the government has any flexibility on, it is a hard cap and you are either over or under the limit. You can use a Miller Trust to get around the Texas income cap.

Applying With Gifts/Transfers and Penalties. Medicaid penalties are a 100% bar to nursing home medicaid benefits, a Medicaid penalty is not some kind of fine that you can ignore. Therefore, if your Medicaid applicant has gifts or transfers during the lookback period which might result in the HHSC imposing a Medicaid penalty then in my opinion you need to know that as soon as possible and before the money is all gone. If there is an issue with a Medicaid penalty sometimes I can fix or minimize the damage from the existing penalty, but if the money is already gone then that becomes less likely.

Not Being in a Medicaid Bed in a Medicaid Facility. Your loved one must be in a Medicaid certified bed in a Medicaid certified nursing home. Just because they are in a Medicaid certified facility do not assume that they are in a Medicaid certified bed. Many facilities only have less than 50% of their beds that are Medicaid certified. And just like with doctors in insurance networks, if your loved one is not in a Medicaid certified bed in a Medicaid certified facility then Medicaid is not going to pay the bill.

I have seen people make many mistakes over the years but these are some of the more common ones. At this time you might be thinking: “what is so horrible about making a mistake during the Medicaid application and eligibility process? We can just correct it after they tell us the mistake and everything will be rainbows and unicorns.” Well, the damage from some mistakes cannot be undone unless you have a time machine so in my next post we are going to discuss some of the bad things that can happen when you make one or more mistakes while trying to get Medicaid nursing home benefits.

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