An Overview Of Medicaid & VA Benefits
When clients learn that Medicare pays only for hospitalization, 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, an onerous application must be filed with the county social services agency, and if there have been any gifts/transfers within the past five years, a penalty period of ineligibility will be assessed. It is therefore unwise to file a Medicaid application prior to seeking legal advice/representation from a certified elder law attorney (CELA) who can assist you with effective Medicaid planning strategies.
If the application is denied, there is an appeal process that 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 Certified Elder Law Attorney! The irony is that the final decision on an appeal is made by the director of the state Division of Medical Assistance and Health Services (DMAHS), whose policies caused the denial in the first place. Not very comforting! Let’s analyze each step:
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 financial and clinical 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 and you must sign over your income. The Medicaid restrictions will reduce the quality of your life unless you have a plan to supplement/avoid this impoverishment legally …
It is critical to evaluate if/when a person will be eligible before filing a Medicaid application. If this is not done, the information volunteered could result in a denial and longer period of ineligibility than necessary. The Medicaid application is extensive and should never be filed before seeking legal advice or representation.
A Medicaid appeal is filed with the state Division of Medical Assistance and Health Services (DMAHS) and the denied applicant, alone or with an attorney, appears before an administrative law judge (ALJ). The judge’s decision, however, is only a recommendation for a final decision filed with the DMAHS director. Should the director affirm the denial, the client must then file another expensive appeal in the appellate division of the New Jersey Superior Court and wait approximately 1½ years before the case is heard. … A certified elder law attorney (CELA) has the knowledge and expertise to instead file a federal court appeal, which will typically be decided within six months.