What You Need to Know Before You File

Lately it seems like we have had a lot of consultations with people who initially filed a Medicaid application for nursing home coverage on their own, were denied, and then come to us hoping we can fix it. The truth is, it is much more difficult to fix an application after it has been submitted. Worse still, if you are denied the facility is often looking to the responsible party for the tens of thousands of dollars they are now owed since Medicaid isn't paying.

We are seeing some disturbing trends in South Carolina. First, the state has been taking longer and longer to make a decision on applications. If they are approved, this isn't a big deal since they will pay retroactively for the care back to the month in which the application was filed. However, if they take 4 months to make a decision and then deny the application, you could be required to pay for that 4 months of care while you put together a new application. With the average cost of the nursing homes our clients want their loved ones to be in ranging from $8,000-$10,000 per month, that could be a substantial bill.

The issues almost always start when the person is filing an application for someone else. The most common situation is a child filing the application for one of their parents. Medicaid has the right to look back and require documentation for any transfers made up to five years before the application is filed.We have had several people call us because Medicaid wants to know what checks were written for 3-5 years ago. Did you review all of those transactions before you filed the application? Do you know exactly where those funds went? If so, can you prove it with written documentation?

These are all questions Medicaid can ask. Typically, when they make this request you have 10 days to respond or they can deny your application. Have you ever tried to order bank statements? Good luck getting statements from four years ago within 10 days. Worse still, at this point mom or dad have no money left and someone needs to pay the bill.

You can see how this can quickly become a major issue. This is why we strongly encourage everyone to hire an attorney to help with filing the application. You would be crazy to walk into an IRS audit without a professional. Medicaid is the same. If you have questions or need advice, contact us before you file the application. We can still help even in the middle of the process, but if we are involved in the beginning we can deal with problems before they become crises, instead of trying to react and deal with what we can on the back end of the process.

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