As part of the transition of our patients from short term to long term care, the families will typically apply for Medicaid on behalf of the resident (acting as their proxy) in order to secure a long-term payor source for 24 hour skilled nursing care.
Inevitably, Medicare is synonymous with short term rehab only.
Traditional Medicare is finite and only allocates up to 100 days of in-patient skilled rehab and based upon specific conditions and criteria.
However, Medicaid is the go-to long term payor source for all residents living in a nursing home, because they cover (long term) custodial care.
In securing Medicaid there are financial and clinical criteria to determine eligibility which sometimes requires a private pay ‘spend-down’ period. Thereafter, the patient must be considered ‘Medicaid Pending,’ which is the period during which the Medicaid application has been successfully submitted to the State, but not yet fully executed by the State.
In successfully submitting the application and in order for the application to be considered ‘pending,’ it must be correctly done and without any anticipated difficulties and/or penalties which would preclude the applicant from qualifying once the state takes a close look at the documents.
To this end, families will often require help from a specialist who is versed in the minutiae and tedious nuances of various State mandates and ‘look backs’ and information gathering etc.
There are two types of facilitators in the field of Medicaid applications; there are Elder Attorneys and Medicaid Specialists and families have the ability to choose one over the other.
What is the difference between the two?
Let us first understand the definition of Elder Law and what it encompasses.
What is Elder Law?
The practice of Elder Law is a specialty practice that encompasses a broad understanding of aging and the law, and the interaction between the varied issues which may affect the elderly.
Elder Law addresses a multitude of needs and issues, including:
- Guardianships
- Durable Powers of Attorney
- Health Care Surrogate Designations
- Planning for Long Term Care and Medicaid
- Residential Alternatives
- Special Needs Trusts for Disabled Individuals
- Trusts – Revocable and Irrevocable
- Preventing and Correcting Abuse, Exploitation or Neglect of an Elderly Person
What is a “Medicaid Specialist?”
Conversely, a Medicaid Specialist is usually a firm that specializes in the emerging niche market of facilitating Medicaid eligibility for elderly people by coordinating the entire effort to procure the appropriate and requisite documentation which the State requires and actually applying for Medicaid on behalf of the resident.
The Medicaid specialist is typically not an elder attorney and will therefore not specialize in (or otherwise pursue) estates, trusts and other such matters concerning the elderly.
Instead, they focus exclusively on applying for Medicaid on behalf of their clients and on following up with the often time consuming process of seeing the application through to its successful conclusion.
Who to use?
There are benefits inherent in using or preferring each of these two different business models and much of it will be subjective and personal.
I will enumerate and highlight but a few of the differences for your considerations:
- Elder Lawyers offer a robust array of services including Medicaid applications, in the event that you wish to use one vendor for all of your senior planning.
- Medicaid specialists are often more competitively priced than attorneys and will also offer varied payment options and packages, including a flat fee per application and an hourly fee for consultation and implementation. Therefore, depending on the severity of the case, folks will do better financially by choosing one over the other.
In all instances, however, it is vital that you conduct proper research and do your due diligence before making an important decision of this magnitude.
Good luck!
