Medicaid Overview

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Medicaid Planning, Applications & Appeals


When the client learns that Medicare pays only for hospital, rehab and therapy, but not for long term care at home or in a facility, we must counsel them on Medicaid, which does pay for custodial long term care.

To qualify for Medicaid, there is an onerous application which must be filed with the County Social Services Agency, and if there have been any gifts/transfers within the five years prior, there will be a penalty period assessed. It is therefore, unwise to file a Medicaid application prior to seeking legal advice/representation from a qualified CELA attorney who can assist you with effective Medicaid planning strategies.

If the application is denied, there is an appeal process which is time consuming and far more expensive than any legal fee for representation on the initial application. Do it right the first time - with a professional! The irony is that the final decision on an appeal is made by the Director of the state agency (DMAHS) - which agency's policies caused the denial in the first place. Not very comforting! Let's analyze each step:

Medicaid Planning

The federal government offers a program for elders and the disabled called Medicaid, which will pay for custodial nursing home care that Medicare and Medicare Supplement Plans don't cover. However, there is a precondition. To qualify for Medicaid, you have to spend all of your own assets first. When you have less than $2,000 left, the government will pay for nursing home costs. The Medicaid resource and income limits will reduce the quality of your lifestyle unless you have a plan to supplement/avoid this impoverishment legally...
Medicaid Planning continued >

Medicaid Applications

It is critical to evaluate if/when a person will be eligible before filing the Medicaid Application. If not, the information volunteered could result in a denial and longer period of ineligibility than necessary. As noted above, the Medicaid Application is extensive and should never be filed before seeking legal advice or representation...
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Medicaid Appeals

A Medicaid Appeal is filed with the state Medicaid agency (DMAHS) and the denied applicant, alone or with their attorney, is heard by an Administrative Law Judge (ALJ). His/her decision (ALJ), however, is only a recommendation for final decision filed with the Director of DMAHS. Should the Director affirm the denial, the client must then file another appeal in the Appellate Division of the New Jersey Superior Court and wait approximately 1½ years before the case is heard... Due to that delay, a CELA has the knowledge and expertise to file a Federal Court appeal which will typically be decided within 6 months.
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For a free initial consultation regarding Medicaid Planning, Applications & Appeals, call us at973-887-4254 or click here to contact us online.