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Applying for Medicaid: Do I Need an Elder Law Attorney?

Applying for Medicaid

Per the Genworth 2018 Cost of Care Survey, the median cost of nursing home care in the Greater Philadelphia Area is as much as $12,167 per month[1].  With the staggering monthly cost of skilled nursing home care, many seniors that require nursing home care rely on Medicaid. Medicaid is a joint federal-state program that provides health coverage to individuals that are low-income or medically needy.


Filing an application for Medicaid for nursing home benefits is complex, and in most cases filing an application on your own is not a good idea. Medicaid has strict income and asset eligibility rules, and not knowing these rules can be financially catastrophic.

Below is a list of 10 reasons why you need an Elder Law Attorney to file a Medicaid Application:

  1. With all new Medicaid clients, we conduct an initial review of current assets and income and develop a plan to best protect assets and to accelerate Medicaid eligibility. We evaluate each client on a case-by-case basis and develop an individualized plan based on that client’s needs.
  2. We assist with the ancillary documents that must be filed, such as the Resource Assessment for Community Spouses. We also work with the Nursing Home to make sure the proper medical evaluations are completed.
  3. We assist you with the spend-down, advising you on allowable expenses and exempt assets.
  4. The Department of Human Services (DHS) requires five years of financial records and documents. We assist you in gathering the necessary documents and organizing the documents. We know what documentation is needed, and we make sure the application is complete.
  5. We complete the Medical Assistance Application on your behalf and file the application with all required documentation.
  6. We conduct a full application review and audit before filing. We review all bank statements and supporting information. We know what caseworkers for DHS are likely to question, and we answer their questions before they are asked. This helps to make sure your application gets approved as quickly as possible.
  7. While your application is pending, and before you actually receive Medicaid approval, you will be required to pay a monthly income payment to the nursing home called a “patient pay liability.” We will help you accurately calculate this. We will also assist you in calculating the spousal allowance, which is the monthly amount of income the Community Spouse is entitled to.
  8. In the event of a Medicaid denial, we can advocate for you and file an Appeal and Request for a Fair Hearing. This includes representing you at the hearing. This is important as the deadlines are strict, if the appeal is not properly and timely filed you could lose retroactive coverage and need to start the application all over again.
  9. When the application is approved, we review the approval and make sure that the approval contains the properly calculated patient pay liability, the correct spousal allowance, and the right start date.
  10. We can continue to advise you with ongoing questions that may arise, as well as assist you with the annual redetermination application.

OWM Elder Law Attorneys provide assistance with Medicaid applications as part of our services. We represent clients for Medicaid Applications in Chester County, Bucks County, Montgomery County, Berks County, and Delaware County. Having an experienced Elder Law Attorney represent you for a Medicaid Application has several advantages, including expert advice on how best to qualify for benefits as early as possible and experience in dealing with difficult eligibility issues.  One concern many have with hiring an Elder Law Attorney is the cost of the service, where a lay service may not have a fee or have a lower fee. However, given the high cost of nursing homes, if we can assist you to accelerate eligibility by even one month that will generally cover the fee. In addition, legal fees are typically paid with funds that would otherwise be paid to the nursing home, therefore the funds will have to be spent in any event, whether for nursing home or for legal fees. Contact OWM Elder Law Attorneys today to schedule your consultation at 610-323-2800.

–Written by: Rebecca A. Hobbs, Esquire, CELA

DISCLAIMER: The contents of this blog are not legal advice, and are not to be used for that purpose.  If you are faced with a legal matter, you should contact a lawyer immediately in order to ensure that you are protected.


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