Eligibity/FAQs About Medicaid

/Eligibity/FAQs About Medicaid
Eligibity/FAQs About Medicaid 2017-05-18T15:02:23+00:00

About Our Services

Are you a law firm?
NO. We process Medicaid applications and work with families to answer questions presented by Medicaid examiners. It is your right to obtain independent counsel to answer a question about a legal matter. We will work with your attorney or can provide you a list of referrals to qualified counsel.

When should I apply for Medicaid?
If you are eligible for Medicaid (click here for requirements) and if your remaining assets fall within the right range, you should begin the process right away. Click here to check your assets against the Medicaid “spend down” amounts for your state.

Often, a community spouse (the one not requesting services) can maintain half a couple’s liquid assets, subject to certain limits. As a couple, you do not necessarily need to spend all your assets to qualify for Medicaid. Many spouses wait too long and apply for Medicaid benefits much later than they could have. Your “spend down” period starts when the initial Medicaid application is submitted (or if you can document a prior 30-day nursing home stay). For a detailed example of this process in action, view our Case Study: Community Spouse.

Won’t I save money by filling out the Medicaid application myself?
Probably not. If you are like most of our clients, you need to spend down your liquid assets in order to qualify for Medicaid. Medicaid has deemed hiring a company such as ours a legitimate use of your remaining funds. You may apply for Medicaid yourself, but by doing so you aren’t saving money. In most cases, the money you “save” will go to your nursing home facility or caregivers. What you will save, by allowing us to help you, is 50 to 100 hours of time and a lot of frustration!

Can’t I use a lawyer instead of Medicaid4You?
Yes. Medicaid has declared the use of an attorney to be an allowable “spend down” expense, and many attorneys do offer the same service we do. However, we routinely see the legal community quote $8,000 to $15,000. Our fee is $4,000. We’ll also travel to your home and collect documentation for you; attorneys place that burden on the customer. (You can see a full, side-by-side comparison chart here.)

The best time to hire an attorney is five years before you need Medicaid — to help you plan the allocation of your assets before the “look back” period.

What if the patient dies before the application is approved?
In many cases, even if the patient has died, we need to complete the process because the facility is waiting to receive its Medicaid payments.

Once the process begins, the flat fee is non-refundable. However, Medicaid4You, LLC will allow you three days from signing the contract to change your mind and receive a refund.

What if the application is rejected?
The overwhelming percentage of applications submitted by Medicaid4You, LLC are approved on a timely basis. If the application is denied due to missing or incomplete information, Medicaid4You, LLC will assist in obtaining the necessary documents and submit to the appropriate office. If the application is denied for substantive reasons we will notify you of your rights. If possible, we will continue to work with you and/or your attorney to obtain eligibility.

Do I need to attend a hearing?
With the proper authorization, our personnel will attend an appeal hearing with you. Depending on the reason for the denial, there may be an additional charge. However, we do not give legal advice and it is strongly recommended that you secure counsel. An appeal is the result of a rejection generally based on improper transfers, incomplete information, and/or the inappropriate use of trusts.

About the Medicaid at Home Waiver Program

My spouse needs at home care but I don’t. When should I seek your help in applying for Medicaid at Home?
If your spouse is eligible for Medicaid (click here for requirements) and if your combined remaining assets fall within the right range, you should begin the process right away. Click here to check your assets against the Medicaid “spend down” amounts for your state.

Often, a community spouse (the one not requesting services) can maintain half a couple’s liquid assets, subject to certain limits. As a couple, you do not necessarily need to spend all your assets to qualify for Medicaid. Many spouses wait too long and apply for Medicaid benefits much later than they could have. Your “spend down” period starts when the initial Medicaid application is submitted (or if you can document a prior 30-day nursing home stay). For a detailed example of this process in action, view our Case Study: Community Spouse.

Is a medical evaluation required to qualify for Medicaid at Home?
Yes. Once you apply for the program, a representative from the Alternate Care Unit will come to your home and conduct an evaluation to determine what services are needed to allow you (or your loved one) to stay safely in the home. During this evaluation, the representative will also determine if staying at home is cost effective in comparison to nursing home care.

If the evaluation determines that 24-hour care is not warranted, state programs are available that may be able to help you afford part-time care. However, these programs will only provide limited care at home.

How much will the state pay towards at home care?
Every state has limits; no state will pay more than the cost of staying in a nursing home. As an example, as of January 1, 2014, the State of Connecticut set a monthly cap of $5800 for at home care. If your representative decides that your necessary at home medical expenses exceed this amount, your family may be expected to pay the difference out of pocket, or your health care provider, if they accept Medicaid, may accept the set price provided by Medicaid.

Will Medicaid at Home pay family members to take care of relatives?
No. With very rare exceptions, family members are not eligible to be paid for health care.

Does Medicaid at Home cover mortgage, rent, or assisted living room and board?
No. Medicaid pays only for services and medical costs; federal law (42 CFR 441.360(b)) prohibits the state from using Medicaid funds to pay costs that are not for direct services. If you need help paying for room and board, mortgage, or rent, state rental subsidies do exist that can help residents of government-funded facilities meet these costs.

Do I contribute to the cost of at home care?
Once your home care is granted, you may need to pay applied income if your gross income is $1916 or higher. In some cases, medical premiums can be used to offset this income. For details, please speak to your Medicaid4You case manager.

If I apply for at home care but later need to switch to a long-term care facility, am I still covered by Medicaid at Home?
You will still be covered by Medicaid, but you will need to change programs from Medicaid at Home to Long Term Care Medicaid. If the change happens before the Medicaid is granted, it’s easy to change programs at no additional charge. If you have been receiving Medicaid at Home and later need to switch to a nursing home, you will need to initiate a program change. This process is relatively straightforward because your Medicaid criteria will have already been met.

I have another question not covered on this FAQs page – can I speak with someone?
We would be happy to answer your Medicaid application questions. Feel free to give us a call at 877-514-1102 or 860-657-3058 or fill out our contact form and a caseworker will contact you shortly with some help.

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