Medicaid Specialist vs Elder Law AttorneyMedicaid 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, 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. Visit us at www.RegencyNursing.com and www.NJNursing.com.

2 Comments

  1. Skylar Williams July 28, 2016 Reply

    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.

  2. Ms. Alfano May 22, 2017 Reply

    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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