What To Do If You Are Denied Medicaid Eligibility
It is possible that DCF may reject your application for Medicaid benefits. You will receive a letter in the mail following their review of your case, indicating whether or not your application is “Medicaid eligible” for benefits, or “ineligible” for benefits. If it is determined that you are “ineligible” for benefits, they will state to you WHY they rejected your case.
In some instances, it involves missing documentation, or invalid transfer of assets. (See the Asset Section under “gifting and transfer of assets”.
If you are denied eligibility, you may apply for a Fair Hearing within 90 days. You will be representing your case before a Hearing Officer who will make the final determination (on the State’s behalf) whether you should be eligible or ineligible. However, you could retain an attorney to represent you in a civil suit to pursue eligibility. Proper preparation and planning prior to a Fair Hearing is most important, as many cases will be heard by the Officer, and the efficient use of the court’s time is essential. Prepare properly, and have all your documentation in place. The Fair Hearing panel will advise you of your case date and time. As in all court proceedings, professional dress and demeanor is essential. The caseworker for your particular application will most likely be present, and will give the Hearing Officer his/her reasons for the denial. You will have the opportunity to rebut the caseworker’s denial of your application before the Hearing Officer. It could be upwards of 30 days before you are notified of the final decision of the Hearing Officer for your particular case.
Note: Should you wish to engage the services of The Angel Solution to prepare your Medicaid application, we guarantee your approval, based on the initial information you will provide to us at the “consultation” appointment. If we have accepted your case and your eligibility is denied, we will attend the Fair Hearing on your behalf. You will not have to face a caseworker or a Hearing Officer. Our Medicaid professionals have a 100% approval of the cases we have accepted through The Angel Solution
Alternatives To Medicaid Benefits
We are aware that it may not be to everyone’s advantage to attempt to qualify for Medicaid, especially if their asset base is so high that it would cost just as much in penalties and lost benefits as it would to private pay for the applicant’s care. In situations like this, we would highly recommend Long Term Care Insurance. The “problem” would be waiting until too long to obtain this coverage, and being unable to meet the eligibility requirements. It would be our recommendation that persons in their 50’s and 60’s who have a family history of catastrophic illnesses might seek out a competent Long Term Care provider. The newest policies are available for 5 years of benefits.
What that could mean to you is that if you found yourself in need of 24/7 custodial care (and you were a single person), you could give away all your assets over $2,000 and apply for Medicaid (you would be disqualified for 5 years because of the invalid transfer). Depending on the extent of the coverage of your Long Term Care policy, you would have partial coverage for a Nursing Home (supplementing the cost of the nursing facility with your income). At the end of the 5 years, you would have exhausted your Long Term Care coverage, however, the 5-year penalty for the invalid transfer has been satisfied, and therefore your assets are still protected. This approach can be helpful, but the downside is that the Long Term Care Insurance coverage must be purchased prior to any pre-existing conditions.
It might be feasible for you to have in-home care, rather than be admitted to a nursing home for custodial care. In-home care personnel will help you with all the activities of daily living, such as dressing, bathing, fixing your food. They often will accomplish some household chores, such as laundry, cleaning, and shopping. They are NOT medical personnel; however, they function as a “helper” in the home. Costs for this type of assistance can range from $16/hour upwards, for a minimum of 4 hours a day. Some in-home agencies will work with you if you only require 2-3 days a week of help. Historically, they do not spend overnight hours with a patient. If the patient is able to be left alone for long periods of time, this type of care might be suitable.
What Is Meant By ‘Crisis Planning
Crisis planning occurs when a loved one is already IN a Nursing Home or will be entering within a short time, and needs to apply for Medicaid benefits immediately.
If there is too much income, or too many assets, the time frame for an inexperienced person to complete all the required paperwork may prove to be too long, and the first month’s stay in a nursing home would have to be paid for privately.
If you find yourself in this situation, it would be advisable for you to enlist the services of our competent and qualified Medicaid planners ASAP.
