Each state manages Medicaid for its citizens within the regulatory guidelines established by the federal government. Medicaid is an insurance program like Medicare, though not guaranteed to everyone over 65. Participants must qualify for Medicaid based on income. The Department of Medical Assistance Services (DMAS) manages Virginia’s Medicaid program with the local Department of Social Services (DSS), determining participant eligibility. Commonwealth Coordinated Care Plus handles the Waiver program for Virginia’s Medicaid Managed Care services.
The complexity of Medicaid makes it difficult to understand. Each program or process has a unique name descriptive of the program but is not common to everyday life. It isn’t very clear to most of us. People who try to file on their own get denied frequently on their first attempt. They endure multiple appeals feeling overwhelmed by the enormity of the bureaucracy of the Medicaid system.
Medicaid Eligibility Requirement
Medicaid’s eligibility requirements are extremely strict, with many people failing to qualify initially due to owning too many assets. However, eligibility limits are rather low; therefore, if you have savings or retirement plans, chances are you may have to spend down your assets before you become eligible.
Medicaid rules regarding income, assets, and how you can eliminate assets are tricky. However, if you violate the rules, you can lose your ability to participate in Medicaid permanently or at least for many years. Therefore, I strongly recommend that you consult with an eldercare attorney or Medicaid Planner who can help you plan how to reduce your assets in a Medicaid acceptable way.
As a result, most applicants contract with a Medicaid planner to help them with the process. There are a few different types available. Here are your choices:
Elder Law Attorneys
Probably the most expensive but the most knowledgeable about Medicare law are the Elder Law Attorneys. Their fees range from $300-$600/hr. or more, so your bill could be as much as $3,000 – $15,000 depending on how many hours it takes them to look up information about your issues. However, they can help you establish trusts and restructure your assets within the legal limits of Medicaid without the risk of violating the law and becoming ineligible for Medicare as a result. That makes the cost easier to accept if you have the money available.
Geriatric Case Managers
Also known as elder care managers, senior care managers, or life care managers, many of them are former nurses or social workers who have entered the field to help patients find the resources they need in their community. They help with care planning, assessments, financial planning, and care coordination. In comparison to an Elder Law attorneys, they are not as effective in dealing with legal matters but are probably more client-centered in their overall approach. A big plus, however, is they are less expensive.
Eldercare Financial Planners
Financial Planners have a broad understanding of all things financial and are available to seniors. They can help someone with a disability or the elderly plan for long-term care needs, fund a trust, explore life insurance settlements, and reverse mortgages. However, apart from financial matters, their in-depth knowledge is usually limited unless you happen to find one who is purposely self-educated for that weakness. Some financial planners specialize in Medicaid so ask as you look for possible resources. FYI, these services are expensive, just like the Eldercare Attorney options.
Public Benefits Counselors/Case Managers
Several state agencies have counselors or case managers to help Medicaid applicants; however, state agencies are understaffed and overworked. You wait in long lines and have limited time with the agent. They can only tell you how to apply, not what to do to get the best outcome. For example, if you’re over the Medicaid limit, they can’t tell you how to reduce your assets to remedy the issue to become eligible. Therefore, unless you know you’re eligible and need someone to help you fill in the blanks, it’s best to find a private sector company to help you.
State Health Insurance Programs Counselors
The folks who work in these programs are often volunteers trained by state agencies to answer basic questions. Unfortunately, their knowledge and experience are not deep enough to handle more than just routine questions. However, the service is free, and if you only need guidance and routine assistance, this may be a good option, especially if you are below the eligibility criteria and know you are likely to be approved.
Commission-Based Medicaid Planners
Medicaid planners who work on commission provide a free service but beware; they make their money by selling their clients Medicaid-compliant annuities. As a result, they take on clients who are not eligible for Medicaid due to having too many assets. Since they make a commission by selling annuities, their primary recommendation for reducing assets is the purchase of a Medicaid-compliant annuity. Often, they advertise their services under “Asset Protection” since the asset is not “lost” but converted to another resource; however, carefully evaluate how free the service remains once you deduct commissions and fees.
While some insurance companies advertise that they provide counseling toward Medicaid asset protection, their main goal is to get you to buy insurance. Therefore, their pitch focuses on burial insurance, annuities, and other final expenses when you meet with them. Other than information related to insurance, they have little to offer.
Long Term Care Ombudsmen
A long-term care ombudsman is a governor-appointed public official who investigates and resolves complaints about long-term care facilities. They are public employees usually who work with families of nursing home patients to resolve issues they have with nursing home care. They can help with explaining the process of applying for Medicaid funding and provide some counseling related to financial matters. Still, they don’t tell you how to reduce your assets to qualify for Medicaid. They work best for families currently self-paying for nursing home care and trying to qualify for Medicaid.
You can apply for Medicaid yourself without the aid of any of the above. There are many websites, books, apps, software programs, and seminars you can attend to learn what to do. If you choose to go this route, here are some pointers I learned from applying for Medicare myself.
- Decide upfront to take your time and research each question thoroughly from the start.
- Understand what information you need to share and in what format.
- Organize your materials, labeling each entry to match the associated question to help the investigator follow your train of reasoning.
- Remember, you tell your story to a stranger who knows nothing about you or your life. You are trying to convince him that you deserve Medicaid with facts
- Don’t embellish your story. Instead, tell just the facts and provide supporting evidence from doctor’s appointments, work papers, physical therapy, witness statements, etc.
- Please keep it simple; no longer than is necessary to tell the full story. The extra length does not gain you points.
- Type it, spell check, and use good grammar.
- Send it certified mail with a return receipt, so you know they got it.
If you would like to see a comparison of all the options above, Medicaid has a very nice comparison table on their website – Medicaid Planners Comparison Table https://www.medicaidplanningassistance.org/types-of-medicaid-planners/.