what is medicaid lawyer

Full Answer

What does a Medicaid lawyer do?

A Medicaid lawyer is a legal professional who specializes in the complex laws of the Medicaid program. A Medicaid lawyer assists eligible people who have been denied coverage in obtaining their legal rights to Medicaid benefits. Medicaid lawyers intervene on a client’s behalf by filing an appeal to review a denial of benefits.

Should I hire an attorney for Medicaid Planning?

However, based on one’s marital status, financial holdings, and complexity of other relevant factors, it may be best to hire an attorney who specializes in Medicaid in the state in which one resides. Also, as covered above, it is illegal for non-attorneys to do some aspects of Medicaid planning in several states.

Do elder law attorneys provide Medicaid planning services?

Not all elder law attorneys provide Medicaid planning services and not all Medicaid planners are elder law attorneys. It is important to find a lawyer or non-attorney, professional Medicaid planner that specializes in this area and is familiar with state law.

Do you need a lawyer to get Medicaid in Texas?

In these states for these specific services, non-attorney, Medicaid specialists often partner with attorneys to provide services. These states are Florida and Texas and to a lesser extent, New Jersey, Ohio, and Tennessee. Is a Lawyer Needed to get Medicaid? The short and simple answer is no, a lawyer is not needed to get Medicaid.

What is a medicaid lawyer?

A Medicaid lawyer is a legal professional who specializes in the complex laws of the Medicaid program. A Medicaid lawyer assists eligible people who have been denied coverage in obtaining their legal rights to Medicaid benefits.

Who is eligible for medicaid?

Medicaid is the federal program that provides healthcare benefits to a wide variety of people including uninsured individuals with low income, pregnant women, certain children and disabled individuals, and senior citizens who need nursing home care. However, in order to receive Medicaid benefits individuals must meet financial eligibility ...

Do you have to meet financial eligibility requirements for medicaid?

However, in order to receive Medicaid benefits individuals must meet financial eligibility requirements. Medicaid benefits and eligibility requirements are even more complex because each state manages its own Medicaid program while the federal government sets Medicaid policies and contributes money to the state Medicaid fund.

Do you need a lawyer for medicaid?

Medicaid recipients are not the only people who need the services of a Medicaid lawyer. Oftentimes the legal guardian of a child or the caregiver for an elder must act on their behalf to obtain Medicaid benefits or handle other Medicaid problems.

Can a lawyer file an appeal for medicaid?

A Medicaid lawyer may also file an appeal if a Medicaid application is stalled in the system and has not been reviewed in a timely fashion. A Medicaid recipient may have trouble with the care and services received from a health organization authorized to provide Medicaid services.

Is Medicaid a bureaucracy?

Medicaid is a bureaucracy that is a partnership between the federal and state governments with services provided by huge healthcare corporations. It’s easy to understand how mistakes, delays and denials can occur.

What is the role of a Medicaid attorney?

On the other hand, Medicaid attorneys often focus more on the legal aspects of Medicaid planning, such as creating Medicaid asset protection trusts or Qualified income trusts, which makes them the better option for this type of assistance.

How much does it cost to hire an elder care attorney for Medicaid?

After the consultation / planning conference and gathering of the facts and needs, a price for services can be quoted. Medicaid planning fees can range from $3,000 to $12,000.The following factors can all impact the cost the cost of a Medicaid planning engagement. The more complicated the case, the higher the fees.

How does Medicaid annuity work?

This strategy reduces one’s countable assets, while at the same time , protecting some of them for family. Essentially, Medicaid applicants gift approximately half of their “excess” assets (assets over Medicaid’s limit) to their loved ones and then purchase an annuity with the remaining “excess” assets. (An annuity turns countable assets ...

How long does it take for Medicaid to pay for long term care?

Medicaid attorneys and specialists also assist with crisis planning, which occurs when a senior needs Medicaid benefits within 30-60 days.

How to avoid looking back on medicaid?

One such strategy that elder law attorneys can implement is a Medicaid asset protection trust (MAPT). This type of trust not only prevents one from becoming ineligible for Medicaid due to gifting assets (if done prior to the look back period), but it also allows one to protect assets for spouses to ensure they can live independently. Furthermore, MAPTs protect assets, including one’s home, for relatives upon the death of the Medicaid recipient, as assets in this type of trust are protected from Medicaid’s estate recovery program. This means that the state cannot attempt to be reimbursed for long term care costs for which it paid for the Medicaid beneficiary via these assets.

What is a medicaid planner?

For persons who have Medicaid cases that are fairly simple and straightforward, a Medicaid planner, also called a Medicaid specialist or a Medicaid Advisor, might be a good option. Working with a professional Medicaid planner can be a lot more cost efficient than working with a Medicaid attorney.

How long does Medicaid look back?

The look back period is 5 years in all states except California (Medi-Cal has a 2.5 year look back).

Medicaid

Funded by federal and state governments, Medicaid helps low-income patients pay for a variety of inpatient and outpatient medical, dental, behavioral health care services, and medical equipment and supplies. Medicaid is a complex system or rules and regulations and sometimes Medicaid representatives can improperly deny services, equipment, or supplies to its member patients resulting in harm to the patient..

Should I Hire a Medicaid Attorney?

If you have been denied services, equipment, or supplies you believe were necessary and allowed by Medicaid, your best recourse is to hire an attorney who is well-versed in Medicaid rules and regulations, insurance law, and has experience suing Medicaid with good results. State Medicaid laws can differ, so you will need at attorney who knows the Medicaid program or Medicaid fraud laws in your state..

What Does a Medicaid Attorney Do?

The first step is to determine if you have a viable case.

What is Medicaid coverage?

Medicaid is the single largest source of health coverage in the United States. To participate in Medicaid, federal law requires states to cover certain groups of individuals. Low-income families, qualified pregnant women and children, and individuals receiving Supplemental Security Income (SSI) are examples of mandatory eligibility groups (PDF, ...

How many people are covered by medicaid?

Medicaid is a joint federal and state program that, together with the Children’s Health Insurance Program (CHIP), provides health coverage to over 72.5 million Americans, including children, pregnant women, parents, seniors, and individuals with disabilities. Medicaid is the single largest source of health coverage in the United States.

What is MAGI for Medicaid?

MAGI is the basis for determining Medicaid income eligibility for most children, pregnant women, parents, and adults. The MAGI-based methodology considers taxable income and tax filing relationships to determine financial eligibility for Medicaid. MAGI replaced the former process for calculating Medicaid eligibility, ...

What is the Medicaid age limit?

The Affordable Care Act of 2010 created the opportunity for states to expand Medicaid to cover nearly all low-income Americans under age 65 . Eligibility for children was extended to at least 133% of the federal poverty level (FPL) in every state (most states cover children to higher income levels), and states were given the option to extend eligibility to adults with income at or below 133% of the FPL. Most states have chosen to expand coverage to adults, and those that have not yet expanded may choose to do so at any time. See if your state has expanded Medicaid coverage to low-income adults.

How long does medicaid last?

Benefits also may be covered retroactively for up to three months prior to the month of application, if the individual would have been eligible during that period had he or she applied. Coverage generally stops at the end of the month in which a person no longer meets the requirements for eligibility.

Does Medicaid require income?

Certain Medicaid eligibility groups do not require a determination of income by the Medicaid agency. This coverage may be based on enrollment in another program, such as SSI or the breast and cervical cancer treatment and prevention program.

Do you have to be a resident to get medicaid?

Medicaid beneficiaries generally must be residents of the state in which they are receiving Medicaid. They must be either citizens of the United States or certain qualified non-citizens, such as lawful permanent residents. In addition, some eligibility groups are limited by age, or by pregnancy or parenting status.

What does an attorney do for Medicaid?

Seventh: The attorney will represent the client (s) before the Medicaid agency. Many Medicaid workers give clients and families wrong information. We see many mistakes that are not to the client’s benefit. For example, the agency will lose an application and tell the client to re-file with the result of loss of months of coverage. Your attorney will not allow that to happen.

How can the attorney help?

How can the attorney help? He can often avoid the cost and delay of probate court entirely by having the resident knowingly sign a power of attorney.

What does "spend down" mean in Medicaid?

Spend down means that the applicant has only $2,000 at the time of application. If an average suburban married couple follows the advice of most nursing homes they may spend over $100,000 at the nursing home before applying for Medicaid. The attorney should be able to help an average couple to save that $100,000.

How do attorneys charge for applications?

We might note that there are two ways attorneys charge for applications: 1) attorney asks for a retainer and bills hourly against the retainer; 2) a flat fee. Most clients prefer the latter since they know the fixed cost and the fee will be part of “spend down.”.

How long does it take to get a medicaid application?

A Medicaid application will be rejected without “documentation” of the current cash value of the asset. It can take four weeks to get the needed paperwork. When children help elderly parents, finding or recovering the documentation can be challenging and time consuming.

Should an attorney prevent a resident from being transferred out of a nursing home?

And a bonus, Eighth: The attorney should prevent the applicant/resident from being transferred out of a good nursing home, where he got post-hospital rehab, to a poor one that always has beds open because nobody wants to be there. We have prevented many such transfers and our clients stay at the good nursing home.

Who does and who should hire an attorney?

So who does and who should hire an attorney? It is the client who has significant savings in various institutions, a home and other “assets.” This person has much to lose. And, the need is doubly true if the client has a spouse. Clients do not hire an attorney to fill out a four to six page application. There is much more to do and much more to the value of the attorney’s work. Here are some considerations: