Medicaid Specialist vs Elder Law Attorney
Do you need help with your Medicaid application? Learn more about whether you should hire an elder law attorney or Medicaid specialist to ensure you get coverage.
As part of the transition of our patients from short term to long term care, 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.
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 considered to be 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 order for the application to be considered ‘pending,’ it must be correctly done and submitted, 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: Elder Law Attorneys and Medicaid Specialists – and families have the ability to choose one over the other.
What is the difference between the two? Keep reading to find out.
What is an Elder Law Attorney?
The practice of Elder Law is a specialty practice that encompasses a broad understanding of aging and the law, and the interplay between the varied issues which may affect the elderly.
Elder attorneys address a multitude of needs and issues, including:
- Guardianships, Proxies, POA (including Financial and Clinical)
- Healthcare Surrogates and Proxies
- Planning for Long Term Care, Medicare Enrollments, Medicaid Applications, Miller Trusts (QIT)
- Durable Power Of Attorney and Other Legal Designations
- Healthcare Surrogates and Decision Makers
- Special Accounts and Trusts For Individuals With Disability
- Revocable and Irrevocable Trusts
- Issues of Elderly Abuse, Neglect and Exploitation
What is a “Medicaid Specialist?”
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 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.
A Word Regarding ‘Medicaid Pending’
I previously referenced the term Medicaid Pending to refer to the transitional period between Medicare and Medicaid. As mentioned earlier, this is when the Medicaid application has already been submitted to the state but the state has not yet reviewed, processed and executed the paperwork.
I call this period “the twilight zone.”
Families will find that many (if not most) nursing facilities, will not entertain a Medicaid Pending admission. This is because of two factors:
First, during this period, the facility does not receive any reimbursement from the state because the state does not yet agree that this individual is a Medicaid recipient. Therefore, aside from the facility’s legal obligation to collect the resident’s social security income, they do not otherwise receive payment for this resident and are essentially footing the bill for free.
Once the state does process the Medicaid application and provides the newly minted resident with approval (and a Medicaid number), they will reimburse the nursing home retroactively back to the date of the Medicaid Pending transition. However, the fact that the facility must wait for payment isn’t something most facilities are keen on.
Second, during the Medicaid Pending period, there is never any guarantee that the application will be approved retroactively, once the state takes a closer look. In fact, the state may find a discrepancy or an issue which will defer eligibility and they will not pay the nursing home for the time in between. Therefore, there is a risk to the nursing home in every Medicaid Pending admission that something may go awry in the actual processing of the application. Most nursing facilities are unwilling to entertain this risk.
Medicaid Specialist or Elder Attorney? Who to Use?
Because of the aforementioned points regarding Medicaid Pending admissions and/or transitions, it becomes even more vital to ensure that you work diligently to submit the Medicaid application properly.
For many people, this is difficult to accomplish alone and they prefer to work with a professional to see the application through to its conclusion.
An additional benefit to engaging with a specialist or attorney is that this is deemed to be one of the proper methods for ‘spending down’ of ones assets as a pre-condition for achieving eligibility (For instance, in the State of New Jersey where we operate our Regency Nursing and Post-acute Rehabilitation Centers, in order for the resident to qualify financially, he or she is allowed up to $2000 in remaining cumulative assets.)
Because there are only several ‘allowable’ divestments of assets (of which hiring an attorney or specialist is considered one of them), it is often a no-brainer to hire a specialist to do the application, when there is money left to spend (the proverbial “killing two birds with one stone”).
So now you ask, well, which of the two should I use?
Excellent question!
There are benefits inherent in using 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!
Judah Gutwein
Judah Gutwein, LNHA, is the Director of Admissions, Administration, Marketing, Social Media for Regency Nursing and Post-acute Rehabilitation Centers, NJ. The Regency organization has become synonymous with the best in senior healthcare and has garnered a well deserved reputation for its unsurpassed commitment to its patients and residents. The Regency Nursing and Rehabilitation Centers and Facilities throughout New Jersey have achieved numerous industry ‘gold standard’ benchmarks an have received accolades from all corners of the HealthCare community.
19 Comments
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I’m glad you pointed out the medicaid pricing and how it’s more competitive. Comparing the cost of the two is my priority right now. I’m trying to help my grandparents choose the best option.
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Cost should never be a factor. A Medicaid application is a time sensitive and involves legal strategies that Medicaid specialist aren’t able to legally guide you or advise you correctly because they are one not educated enough and two are not privy to some strategies due to their lack of legal experience. I used Goldberg Law Group in NJ and even though they cost $2k more it was worth it because they made sure my loved one got on Medicaid in a timely manner not costing me any money and they had a reputable reputation with the county and financial instituations. They even saved me some money by making some suggestions with the remaining funds during spend down.
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I need help from an attorney to help me with my mother’s case she’s in a rehab and 93 years old
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How much is the z specialist and where are they located? And how much does it cost with an attorney? Have you heard of taking case on contingency?
Thank you,
Lisa falero -
Need help in filing either Medicaid or Disability ? Currently receive Medicare.
Thanks -
My mother was declined Medicaid coverage to cover the cost of staying in a nursing home. She already filed her application, she is 88 years old and cannot manage by herself. She requires 24/7 care and is on dialysis. She is in a nursing home in Cuero, Tx.
Does she need an attorneys help? -
I would like to know how to apply for Medicaid..so I can live in my home now..and when I need it help for nursing home ,etc.
I may need financial help to help me paid for home help.
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I am on Medicare now. I would like,to know how to apply for Medicaid in Texas..Also , would like to know if you can stay in your home if you received Medicaid.
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What is the going rate for a Medicaid Specialist in NJ?
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Hello my name isMarjorie Franceschini. My father-in-law is 92 years old and lives in Long Beach, New York. He has been on Medicaid for over 4 years now. He lives in a rental house with his daughter and is entitled to an aide every day for 12 hours plus he gets free prescriptions.
We want our family to move down to FL where we now live and want to know what kind of benefits he would receive in this state.
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Thank you! Very helpful!
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Hi, Thanks For Sharing this Article. This article is very attractive and informational regarding Medicaid planning. I’m glad you pointed out the Medicaid pricing and how it’s more competitive. Comparing the cost of the two is my priority right now. I’m trying to help my grandparents choose the best option. Medicaid Planning can be different things to different people. However, usually, it involves planning for Medicaid qualification without first going broke. There are multiple legal options, many of which are not intuitive nor widely known. Another goal of many is to legally protect assets from attachment by the government within the confines of federal and state laws.
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We need medicaid for my mom she had her leg amputated I like to speak to someone about this issue
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Hi there, My mom is currently medicaid pending. How ever….my dad and I have filled out the Medicaid application and did everything they have asked us to do and she is still not approved!! We have the Nursing Home helping us but the lady here who says she does a bunch of the applications is really no help. She is the one who had us start on the application late and now my mom is the one paying for it!! Any help is greatly appreciated.
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My sister is a Medicaid/long Term Care recipient presently in a Nursing Home with Alzheimer’s. She is retired now and give all her income to Nursing Home. She retired while living in NHome and give her present Pention to the Facilitya. I am her Attorney in Fact and had to fill her application for retirement in 2018. The application had two options to Retire: Basic Pension and/or Retirement with survival options, I opted survival options, that means that when she passes, her beneficiary will receive a Pension for Life. Can Medicaid go after her beneficiary to recover her Long Term Care expenses while in the Nursing a Home?
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I’m trying to get longterm Medicaid for my brother. His disability is more than the amount to qualify. He has alzheimers and needs a special care unit. Do I need an elder care attorney or a Medicaid specialist?
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You need an elder law attorney in instances when legal planning is needed before applying for Medicaid. An elder law attorney is prepared to answer questions such as look back period, allowable transfers, penalties for gifting within the look back period, setting the proper trusts to ensure qualification, and other complicated issues. At least in Florida, only attorneys can engage in Medicaid Planning. Anyone is allowed to help you prepare and file a form. However, if something goes wrong, you may have not recourse against the Medicaid Specialist. Lawyers typically carry malpractice insurance. In short, check your state about unlicensed practice of law and do your due diligence before hiring either.
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How much does it cost for help me get Medicaid. I am a senior with no money and need help. Could I pay after I get Medicaid
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I’m in a nursing home, disabled and already receiving Medicaid. My father passed away while I’m in here. He left me an Ira, regular Ira not Roth. In order to make a change in ownership, I first have to put it in my name, then in someone else’s name (sister). It’s not a lot of money, under $7k. But I’m afraid the short number of days it is in my name it will kick me off Medicaid. Any suggestions?
