Should I Let the Nursing Home Employee or Social Worker Complete My Medicaid Application for Me?

Quick Answer

You can, but understand what you are getting. A nursing home employee or social worker is filling out a form so the facility gets paid. They are not doing Medicaid planning, and they are not looking at what your family could have protected. Mistakes on the application cause delays, denials, and asset loss that is often permanent by the time anyone notices.

Their job is not your job

Let me be fair to the facility staff first, because most of them are kind and overworked people who genuinely do want to help you get through this.

But realize whose interests they are actually serving. The facility needs that resident approved so the bill gets covered, and that is a completely legitimate goal for them to have. It is just not the same goal as protecting a spouse’s savings or keeping a family’s home in the family.

Nobody in that business office is going to pull your deed and look at how the property is titled, and nobody is going to ask whether the transfer you made two years ago created a penalty period. That is not their role and it is not what they were trained to do.

The advice families get along the way

Full disclosure, some of what people are told before they reach us is genuinely alarming.

I had a consultation once where a client had been advised to take his money out of the bank and bury it in the backyard. I started laughing because I thought he was kidding. He was not. Our next words to him were get a shovel and go get that money and put it back in our account.

That is an extreme example. But it tells you something about the quality of guidance floating around when families are frightened and moving fast.

What actually goes wrong on these applications

The application asks for financial history, and that history is where the real decisions live.

Five years of statements get reviewed, you guys, and everything in them surfaces. A gift to a grandchild for a wedding shows up, and so does a car sold to a nephew for well below what it was worth. Money moved into a child’s name to “get under the limit” shows up too, and instead of helping, it creates a penalty period, which is a stretch of time where Medicaid will not pay even though the money is already long gone.

Guess what happens then? The money is spent, the applicant is not covered, and the family is paying privately during exactly the window they thought they had solved.

Denials cost you time on top of everything else, because an application that gets denied and has to be refiled can leave months of facility bills sitting squarely on the family in the meantime.

Who should be paying attention

If any of these apply to your situation, do not hand the application to the facility and walk away.

Anyone with a spouse still living at home. Anyone who owns real property, especially property that is not the primary home. Anyone who has given money to family in the last five years, even small amounts, even for good reasons. Anyone with income over the Georgia cap, because that requires a Qualified Income Trust to be set up correctly, and what that means is a Miller trust that income passes through like a conduit.

Anyone with a business interest, rental property, or an inherited account.

The Georgia piece

Georgia applies a five year look back to transfers. Georgia is also an income cap state, so the Qualified Income Trust question is not optional when income runs over the limit, and it has to be handled properly and in the right order.

Georgia policy has genuine complexity in it. I had a client who was a civil servant, paid on the first of the month. One month the first fell on a weekend, so the deposit landed on the 30th of the prior month instead. That created a double income month on paper. We had to argue that in front of a caseworker and a judge.

Nobody in a facility business office is having that argument for you.

When to talk to somebody

Before the application is submitted, and not after a denial letter shows up, although we can certainly still help you at that point.

What I will say is this. Once an application is filed with wrong or incomplete information, you are no longer planning. You are cleaning up. Cleaning up is slower, more expensive, and has fewer good outcomes available.

My comment is this. Have somebody who is on your side of the table look at the whole picture before anything gets signed.

A note on how to use this

Everything here is for educational purposes only. None of it should be treated as legal advice, because Medicaid outcomes are very fact specific to you, your assets, and your family. I am licensed in Georgia and Michigan only, and I can speak to those two states. Medicaid policy and the dollar figures behind it change regularly.

If you are in another state, get the foundational knowledge here and then seek an attorney in your jurisdiction so you at least know the right questions to ask.

Your next step

Before you sign a Medicaid application, schedule a complimentary 15 minute Strategy Session with our office. Call 404-549-5001.

If long-term care costs are the thing keeping you up at night, ask us about “Don’t Go Broke In A Nursing Home.” I also run a weekly webinar every Thursday at 1pm, and the topic changes each week.

Related questions

• Why should I hire an attorney to prepare and file my Medicaid application?
• Should I let the nursing home help with my Medicaid planning?
• How does the Medicaid application work for nursing home care?
• How do I protect my resources and qualify for Medicaid?

   

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