FAQs About Medicaid
Can I apply for Medicaid benefits regardless of my income and assets?Yes. Everyone can apply for benefits, even illegal immigrants. The correct question to ask is are you eligible to receive benefits? There are specific financial and non-financial eligibility requirements that must be met before your application is approved. If you don't meet them, your application is denied, but you always have the right to apply.
The requirements are more complex for spouses, and Nevada applies a method to increase the amount of assets and income that a spouse may keep that is different from most States. Understanding this method will ensure that you keep as much of your estate as possible, and still be eligible to receive benefits.
How much can I keep and still be eligible to receive Medicaid benefits?Unlike Medicare, which is a totally federal program, Medicaid is a joint federal and state government program which pays medical costs and long-term care costs. Medicaid is designed as a payor of last resort, however, and to qualify you must meet strict financial requirements. An individual applying for Medicaid can have only $2,000.00 in assets, and certain exempt assets (home, car, clothing, jewelry, etc.). In addition to assets, income must also be contributed toward the cost of care, and an individual in a nursing home is entitled to keep only a $35.00 per month allowance out of his or her monthly income. There is also a "Medicaid Institutional Cap" of $1,911.00, which means any individual with income above that amount may need to employ the use of an "income reduction trust" (IRT) or "Miller" trust as it is sometimes called, in order to become Medicaid eligible. If the Medicaid applicant is married, different rules apply.
What if I'm married? How much can my spouse keep?If the Medicaid applicant is married and enters a nursing home while the other spouse remains in the community, the community spouse may keep the minimum resource allowance (CSRA) of $21,910.00 or, pursuant to Court Order, keep up to a maximum of $109,560.00 in assets. This amount may actually be higher in the event of a "division of assets" between spouses. With regard to Income, a community spouse is allowed a minimum income of $1,821.00 per month. However, a request for an increase in the monthly income allowance, up to $2,739.00, can also be included in the Court Order granting an increased resource allowance. Without proper planning and legal advice, all assets and income above the minimum levels listed above, must be spent on care or on exempt items before Medicaid will pick up the tab for skilled nursing home care. It is important to consult an Elder Law Attorney, before filing for Medicaid long term care benefits.
What can I do if my application is denied?Frequently, complications also arise after the application is filed. These can include requests from Medicaid for additional documentation regarding assets and income, clarification of purchases, gifts, and expenses, and applications for other government benefits that must be made contemporaneously with the Medicaid application. Failure to submit requested information timely, request additional time or assistance, can lead to a denial of benefits.
It is important to know what your rights are, and what to do if the information requested cannot be obtained. Although every application is unique, there are certain exceptions in the law that can pave the way to approval. If the issue cannot be resolved with your caseworker, you may need to appeal the denial of benefits, and request a "Fair Hearing," as discussed below.
What can I do if I already receive benefits, but they are being terminated?One of the most important documents is the letter you receive that explains why your benefits are being terminated. This is called a "Notice of Decision," and must give you the legal grounds for termination. It also contains the steps to follow if you disagree with the reason for termination. It is very important that you act quickly to preserve your benefits. In most cases, you can appeal the termination of benefits, but still receive them until a final decision is made. The appeal process for termination is generally the same as for a denial of benefits.
What matters most if I appeal my denial or termination?It is important to consult an Elder Law Attorney, before filing for Medicaid long term care benefits, especially when applicants are married. By recognizing and removing impediments to eligibility before applying, spouses can avoid the debt that results when an application is denied.
Details that can determine the outcome of a Fair Hearing usually involve:
az, The reason stated in your Notice of Decision for denial/termination
az, Knowledge of Nevada's Medicaid manuals
az, Governing Federal and State law
az, Presenting your case to the Hearing Officer
az, Creating an accurate Fair Hearing record in case further appeal is necessary.
How do I appeal the denial, or termination, of Medicaid benefits?We often represent both individuals and facilities when access to long term care Medicaid benefits are at risk. It is critical to the success of your appeal that you timely request all available "administrative remedies." Generally, administrative remedies consist of a "Hearing Preparation Meeting," or "conference" as it is usually called, and a "Fair Hearing." The Notice of Decision will contain information on each remedy, but it is usually best to ask for both. The purpose of a conference is to resolve the issue informally. The conference is held with a Hearing Representative, someone other than your caseworker, who reviews your file and can advise you of any options you may have. If a resolution is reached, you will not need to have a formal Fair Hearing, and your file is returned to your caseworker. If the problem cannot be resolved at the conference, a Fair Hearing will be scheduled by the Hearing Officer. It is very important to attend this hearing, with an attorney if possible.
How do I appeal the Hearing Officer's Decision?Just like with other types of cases, if you disagree with the Fair Hearing Decision, you have 90 days to request a Nevada State District Court to review it for errors. The Court will review the record from the Fair Hearing, and the written Decision. However, there is a limit to what the District Court Judge can do. In order to fully understand what is involved in this process, you should consult with an experienced Elder Law attorney who is familiar with these types of appeals. If appropriate, a District Court Decision can also be appealed to the Nevada Supreme Court.
What is an "Undue Hardship Waiver?"In certain cases, even ineligible applicants can receive Medicaid benefits if an "undue hardship waiver" is granted. Put simply, a valid denial or termination of benefits can be avoided if it would produce an "undue hardship" on the applicant, his or her spouse, a disabled or "caretaker" child, or the facility in which the applicant is receiving care. If this application is successful, Medicaid "waives" the requirement that is not met, and the applicant is deemed eligible.
As you can guess, the requirements for a successful waiver are not easily met, and the assistance of an experienced Elder Law attorney is recommended before requesting one. In addition, if the waiver is denied, a conference and Fair Hearing on this denial can also be requested, since it is a new issue. All appeal rights discussed above also apply to the denial of an Undue Hardship Waiver.
When should I consult an Elder Law Attorney?As stated above, it's important to speak with an attorney if you have any doubts as to your eligibility, or if you are in one of the above situations. Remember, Medicaid personnel does not represent you. Only an attorney represents your interests alone. Often, misinformation, or lack of information, leads to a denial that could have been avoided. At Palmer Law Group, PLLC, we can arm you with accurate information about your options, help you navigate the Medicaid maze, and effectively represent you in administrative proceedings and/or court. Call us for a free 30 minute consultation. (702) 215-9441