Whether or not it’s advisable to prepare and submit your own application for Texas Medicaid nursing home benefits turns on several questions:
- How complicated is the applicant’s financial picture?
- How well-organized are you?
- How much time do you have available?
- How comfortable are you dealing with a government bureaucracy?
- Can you afford to lose a month or more of eligibility if you are denied eligibility because of an error?
Medicaid offers a variety of financial support programs. The application process for non-nursing home programs are relatively simple. Most people can apply without help. Nursing home benefits are a different matter.
Nursing home Medicaid is a form of insurance for long term care costs. Because the cost of nursing home care is so high (up to $6,000 monthly in Texas) most middle-class families need this program to help cover the monthly fees. The application process for long-term nursing home coverage is complex and confusing to the inexperienced. Relying on the skills of an experienced Elder Law attorney is a near necessity.
Successfully applying for Medicaid requires meeting strict guidelines on income and assets. It also requires you to understand the terminology and definitions unique to the program. Like all government agencies, the Texas Department of Health and Human Services (which runs Medicaid in Texas) has its own definitions for the terms used in their regulations. How they define “income,” for example, is different than the definition used by the Internal Revenue Service or the Veteran’s Administration. The agency counts some forms of income when determining income eligibility. It ignores other. For example, the “aid and attendance” income portion of a Veteran’s enhanced pension is not “countable income.” Social security, pensions, interest, dividends and IRA distributions count.
If the applicant’s countable monthly income exceeds the limit, an Elder Care attorney can draft a special document called a Qualified Income Trust. But, drafting the document is only half the battle. You’ll also need to attach a bank account to the trust. The bank account receives the income, but not necessarily all of it. The State also has rules regarding how and when money must be deposited into the trust and how it’s paid out. Handled improperly Medicaid can disqualify the trust costing a family thousands of important Medicaid dollars.
Texas also limits the amount of assets a person can keep and still qualify for benefits. As with income, certain assets are not counted. Examples include the personal residence, prearranged funeral plans and one automobile. Yet, to exclude these items Medicaid requires other rules to be met. The Medicaid caseworker is required by law to count these otherwise excludable resources when they fail to meet all the requirements for exclusion.
How Medicaid treats a personal residence is another complicating factor. Just because the house is not counted when determining eligibility, doesn’t mean it’s protected. Medicaid considers the money provided by the agency like an advance. It’s not a gift from the government. That means the State has a legal right to recover the amounts they’ve spent once the person passes on. Since the home is typically the largest asset a person owns when they die, you face the very real possibility of the state forcing the sale of your home get repaid for the funds used to pay for your care.
A good Elder Care attorney plays a valuable role. Hiring a Houston Elder Care attorney has several advantages:
* Expert guidance on the best way to qualify for Texas nursing home Medicaid
* How to get benefits sooner
* How to keep your share of costs as low as possible
* Experience dealing with complications as they arise
* Serving as your advocate through a challenging application process
* Protecting the family home
A drawback to hiring an attorney is the fee you’ll incur. Given the high monthly cost of Texas Nursing home care, if an attorney can speed up eligibility by as little as a month or two, you’ll generally cover the fee and then some.
For some families the peace of mind that comes from knowing the application is in capable hands is enough to justify hiring an attorney. Also keep in mind the funds used to pay the attorney would have likely been paid to the nursing home anyway.