The truth is that State Medicaid programs are complex and many of us have preconceived notions about Medicaid coverage of nursing home care. Here are 10 common myths about Medicaid in the nursing home setting:

1. Medicaid coverage means substandard care.
False. Providing substandard care to Medicaid recipients and discriminating based on the resident’s pay status is illegal under both state and Federal law. Besides, typically the caregivers and staff do not know which resident is a Medicaid recipient as there is no public identification of pay status.
2. You must be poor or broke to qualify for Medicaid.
False. You may own property and qualify for Medicaid as certain assets are non-countable or exempt under the Medicaid regulations.
3. You must transfer or hide your assets to protect them.
False. This is a crime. While it is not illegal to plan or structure your assets in order to qualify for Medicaid nursing home benefits, you must fully disclose the details to the State Medicaid agency.
4. The state will take your house to qualify you for Medicaid.
False. In most states, the resident can maintain a principal residence and will not be a countable asset if a spouse or specific individuals live in the house. Keep in mind that there are estate recovery laws which allow the state to seek reimbursement from your estate to recover Medicaid costs after your death.
5. You cannot qualify for Medicaid after you have become a nursing home resident.
False. You may qualify for Medicaid benefits prospectively even if you entered the nursing home in private pay status. There is a disclosure requirement – you must disclose up to 5 years of financial records and transactions when applying for Medicaid coverage.
6. Once you become eligible for Medicaid, you remain eligible permanently.
False. Medicaid is not for life but once your eligibility is established, it will be maintained unless your circumstances change (i.e. inheritance, settlements, sell an exempt asset, Medicaid rules change).
7. Medicaid will not cover all the nursing home care and services you want.
False. There is no difference in the type of care or services available to Medicaid recipients as they are entitled to the same nursing home services as other residents.
8. All nursing homes accept Medicaid patients.
False. Although a large percentage of nursing homes accept Medicaid recipients, not all of them do. There are some that will transfer you to a Medicaid nursing home if you spend down your resources in a non-Medicaid nursing home, then qualify for Medicaid.
9. Your agent under a Power of Attorney can retitle your property to qualify you for Medicaid.
False. It depends on the type of Power of Attorney. Many power of attorney documents do not contain the gifting provision or power to make gifts. The power to do so must be explicitly granted to the agent.
10. Your income may to be used to pay for your spouse’s nursing home bill.
False. In the majority of state, only the income of the nursing home spouse is used to pay the nursing home expenses.

Here at Schutjer Bogar, we assist you with the often grueling Medicaid eligibility process so that you can focus on what matters most – your health.

Monica works out of our Manhattan office with Trisha Cowart

As you may be enjoying sweet treats this week in honor of Valentine’s Day, the day we take time out of our busy schedules to celebrate the love we have for our significant others, it is also a good time to remember the spouses of our residents.

I know many of you have witnessed the emotional struggles of many spouses coming to the realization that they are no longer able to provide the level of care their beloved requires. We seek to do everything in our power to make this transition easy for them, however, navigating the labyrinth of Medicaid regulations affecting community spouses can cause additional stress.

In our continued effort to make a spouse’s transition easier, offer the following reminders:

1. Be sure to provide all resource information to the caseworker during the application process. A common denial of a Medicaid application is not due to the resident having excess resources, but instead a failure to provide necessary resource information.

2. You usually have a right to appeal the spousal resource assessment. In determining Medicaid eligibility, the caseworker will issue a form dictating the amount of resources the spouse is allowed to retain. When this assessment is filed with an application for benefits both the resident and spouse will usually have appeal rights.

3. There are community outreach programs to help with this transition. Many communities have support groups for caregivers and family members.

I still believe that love conquers all, and hope you do too! Happy Valentine’s Day!

Julie works out of our Canfield, OH office.

It’s that time of year again. It’s time to figure out what our resolutions are for 2012! Here at Schutjer Bogar, the number one resolution on our list every year is to provide the best Medicaid legal services to our clients.

In order to ensure the Medicaid process goes as smoothly as possible, the one resolution we ask our clients to make is to try and gather as much information as possible from the resident and/or the resident’s family at the time of admission. The time of admission is the best time to gather this information because it is when the resident is most likely to provide the details necessary to process the Medicaid application. Later, after the resident has resided at the facility for a while, oftentimes the family stops visiting, or the resident becomes incompetent; making it very difficult to even obtain the most basic information.

The information that should always be compiled at Admission includes the following:
1. A signed Admission Agreement
2. Any valid Power of Attorney documents
3. Contact information for all next of kin; including work, home and cell phone numbers
4. Resident ‘s date of birth and copy of birth certificate
5. Copies of any and all medical insurance cards
6. Marital status of resident, and information regarding divorce records
7. Information regarding social security benefits
8. Asset information; address of any real properties; and bank names and account numbers where accounts held; pensions, 401K information; life insurance information; burial trusts;

With this information in hand, the Medicaid application can basically be completed at the time it is initially made, making the entire process much easier for all.

Happy 2012!

Eva works out of our Mount Laurel, NJ office with Ivana Grujic, Penelope Jones and Laura Fabiano.

If there is a specific topic that you would like to learn more about, please post your ideas here. We are looking for ideas for blog posts and webinars for the upcoming year.

This is also a reminder that Brad is always available to visit your facility at no charge and conduct a Medicare Training/Refresher.

To submit your ideas or if you would like to schedule a free Medicaid training, contact Janet Wright at jwright@schutjerbogar.com

We look forward to hearing your ideas!

The entire staff of Schutjer Bogar would like to say Happy Holidays and have a wonderful New Year! We look forward to working with you in 2012!

The Harrisburg office recently held a cookie exchange to get us in the holiday spirit! Everyone that brought in cookies got to bring home a nice assortment of cookies and treats. Did your office do anything special for the holidays? Feel free to let us know!

The dawning of the New Year is good time to reflect on the year past, take stock of all that we have learned, all that we have to be grateful for, and set goals for the year to come.  In my time at Schutjer Bogar, I have learned a great deal from my colleagues, the facilities that we serve, the residents, and their families.  In the spirit of the season, I would like to share with you three important lessons that I will take with me as we embark on 2012:

1. Don’t underestimate the power of good faith.  Time and time again I have seen previously denied Medicaid applications be re-opened and benefits approved because the facility, the resident, and/or their family has made a good-faith effort to provide the information requested by the county.  Diligent efforts to obtain the documentation and keeping the caseworker informed of the status of those efforts will to a long way toward the goal of securing Medicaid benefits.  If you have been trying to obtain those last few bank statements, or a copy of that deed, but just can’t get it, don’t despair!  Tell the caseworker.  Ask for more time.  Or ask for the caseworker to assist with getting the needed information.  The caseworker should accommodate a reasonable request and failure to do so can be grounds for an appeal and, ultimately, lead to the approval of Medicaid benefits.
2. Be kind to your fellow man.  The process of securing Medicaid benefits for a resident can be, as we all know, a lengthy and frustrating process.  Maintaining a cordial and professional relationship with the caseworker, the resident, and their family can go a long way toward securing their assistance and cooperation.  In some cases, the resident and their family may appear hostile or uncooperative simply because they do not understand the process and the need for their cooperation.  Reach out to them.  I have had many cases where a previously uncooperative spouse or child would, once the eligibility process and the importance of securing Medicaid benefits for their family member was explained to them, prove not only cooperative but eager to assist.  There are, of course, unfortunate instances where the unwillingness of the resident and/or their family is evident and appropriate legal action must be taken, but holding firm in your position without sacrificing civility has, in my experience, yielded a far better result under any circumstance.   
3. Communication is key.  Communicating with your residents, their family, and the caseworker is the best way to ensure that an application for Medicaid benefits is timely processed.  Although many counties are backlogged and routinely process applications well beyond the required period, regular and continuous efforts to contact the caseworker to determine the status of an application or inquire whether additional information needed are important.  Even if the caseworker does not respond, the effort that has been made can prove useful in the event that an appeal is necessary.  Keeping a log of attempts to contact the caseworker or, as the case may be, the resident’s family, is also extremely helpful should an appeal or other legal action be necessary to secure Medicaid benefits.

I have no doubt that the New Year will bring challenges, new lessons, and, hopefully, triumphs.  As I go forward, I will take with me the experiences I have had in the hope that they will guide me toward achieving a better outcome for our clients so that they can focus on doing what they do best – caring for their residents.

 Best wishes to all for 2012!

 Erin works in our Washington, DC office with Elizabeth Meadows, Monica O’Connell, Elizabeth Spawn-Stotler and Lucretia Bailey.