by Bill Miller | Aug 31, 2018 | Elder Law, Medicaid, Medicaid Planning, Medicaid Qualification, Nursing Home
It’s a cold, hard fact. Many people in the United States need long-term care at some point in their lives. It’s also true that this care is expensive.
How many people really need long-term care?
As our population ages, the number of people in need of skilled nursing care will skyrocket. Today, roughly 70% of people who are age 65 will need some form of long-term care in their lifetimes.
Also, age is not the only reason people need long-term care. About 8% of people age 40-50 year age group need long-term care due to a disability. And 69% of people age 90 and up are likely to suffer from one or more disabilities.
Long-term care is expensive. How do people pay for it?
There are basically three ways to pay for this type of care:
- Self-pay, which may use up all your savings and resources.
- Long-term care insurance, which can be difficult to get as you get older.
- Public benefit programs like Medicaid.
So, it’s important that you be able to qualify for Medicaid.
That requires planning.
And Medicaid planning should take place years before you need care.
If I won’t need long-term care until I’m 65 or older, why plan now?
Medicaid programs pay more long-term care expenses than any other group. This means it’s critical that you be able to qualify for Medicaid. The whole application process is complicated and frustrating. Not everyone qualifies for Medicaid, leaving their families struggling to find other ways to pay.
The reason to start planning now is because Medicaid doesn’t just look at your current financial picture when considering your application. They actually look at financial records starting from 60 months prior to the application date. During that time, you may have transferred money or property to family as an early inheritance or just a gift. That kind gesture could reduce or eliminate your eligibility for Medicaid.
The Good News.
There are ways to prepare for Medicaid, well in advance of the time you need it. It’s complicated, but we can help.
The attorneys at Miller Estate and Elder Law assist clients just like you apply for Medicaid benefits. We also help with Medicaid planning and estate planning. For a free consultation with an experienced Alabama attorney, contact us at 256-251-2137 or use our convenient Contact Form.
We also offer free guides, videos, and workshops.
We have offices in Anniston and Birmingham and serve clients in Gadsden, Hoover, Talladega, Vestavia Hills, and surrounding areas.
by Bill Miller | Aug 22, 2018 | Medicaid, Medicaid Planning, Medicaid Qualification, Nursing Home
Medicaid, though funded by the federal government, is managed by state agencies. Each agency has the power to customize their program, and this can include imposing co-payments, deductibles, and so on. If you or a loved one receives Medicaid benefits, you need to know how Medicaid handles out-of-pocket costs.
Do I have to pay out-of-pocket expenses?
Many patients are expected to pay co-payments on expenses like:
- Office visits to doctors, optometrists, nurse practitioners, and other healthcare providers).
- Hospital care, including those provided at federally qualified health centers, rural health clinics, inpatient, outpatient, and ambulatory surgical centers.
- Durable medical equipment,
- Medical supplies and appliances, and
- Prescription drugs.
The co-payments are small. However, health care providers cannot deny services if a Medicaid recipient cannot pay the co-payment.
Are any services exempt from out-of-pocket charges?
Yes. Out-of-pocket fees by law cannot be charged for:
- Emergency services,
- Family planning services,
- Pregnancy-related services, or
- Preventive services for children.
Are any groups exempted from paying out-of-pocket fees and co-payments?
Yes, some Medicaid recipients are not expected to pay such fees:
- Children,
- Terminally ill people,
- Nursing home residents,
- Native American Indians with an active user letter from Indian Health Services,
- People receiving emergency treatments, and
- People receiving family planning services.
Check with your Medicaid caseworker to make sure you are not charged for co-payments and out-of-pocket expenses if you are included in one of these groups.
Will Medicaid repay my out-of-pocket expenses?
Not exactly.
Sometimes Medicaid will be awarded retroactively. This means that earlier costs that are eligible for Medicaid coverage may be paid. However, the patient is responsible for contacting the health care provider responsible for anything they paid for themselves. The provider will submit the services to Medicaid and typically reimburse the patient after receiving the payment from Medicaid.
First, You Have to Get Through the Medicaid Application Process.
It’s complicated and difficult, but we can help. We have helped many clients navigate federal and state guidelines to get the benefits they deserve.
The attorneys at Miller Estate and Elder Law assist their clients with all phases of estate planning and incapacity planning. For a free consultation, contact us at 256-251-2137 or use our convenient Contact Form. Although we’re located in Anniston, we also help clients in the Birmingham, Gadsden, Hoover, Talladega, Vestavia Hills, and surrounding areas.
by Bill Miller | Jul 31, 2018 | Medicaid, Medicaid Planning
Moving grandfather to the nursing home was hard enough. But applying for Medicaid at the same time? Very stressful, but it is even worse if you submit incomplete or incorrect paperwork. This could delay much-needed Medicaid benefits. Read on to learn more about the supporting documents to submit with a Medicaid application.
The Application
Medicaid consists of more than one program. For example, there’s a program for children and a different one for nursing home residents.
Alabama Medicaid maintains online applications, as well as forms that might need to be attached. Paper applications are available at local Medicaid offices.
Sometimes documents must be attached to the application. For example, if the applicant needs an authorized representative to help with the application, Appendix C should be attached to paper applications.
Make sure you use the right application, filled out completely with all attachments.
The Supporting Documents
The first thing to understand is that Medicaid wants documents going back five years from the date of application (the Look Back Period). The applicant should submit bank statements or balances (monthly for the first 12 months of the Look Back Period, quarterly for months 13-24, and June and December for months 25 through 60). Medicaid will also want to see proof of gross income, including VA benefits, Social Security benefits, rental income, pensions and retirement funds, wages, and interest. In addition, some or all of the following documents from the Look Back Period will be required:
| Annuities |
Life insurance policies |
Power of attorney |
| Long-term care policies |
Receipts and titles |
Bonds |
| Wills |
Trusts |
Social security card |
| Promissory notes |
Stocks |
Burial contracts or policies |
| Conservatorship papers |
Property deeds |
Medicare care |
| Loan documents |
Retirement account statements |
Any other documents that are requested |
| Guardianship documents |
Medicare Part D policies |
|
The applicant should keep copies of all supporting documents, as well as the application and any correspondence sent or received.
Sound Complicated? It is, but We Can Help.
The attorneys at Miller Estate and Elder Law assist clients with applying for Medicaid benefits. We also help with Medicaid planning and estate planning. For a free consultation with an experienced Alabama attorney, contact us at 256-251-2137 or use our convenient Contact Form.
We also offer free guides, videos, and workshops.
We have offices in Anniston and Birmingham and serve clients in Gadsden, Hoover, Talladega, Vestavia Hills, and surrounding areas.
by Bill Miller | Jul 13, 2018 | Medicaid, Medicaid Planning
Both Medicare and Medicaid are government programs that help eligible individuals with medical costs. Because of the similar names, though, people have trouble knowing which program they need. Let’s take a look at how each program handles two important things: eligibility and services.
Medicare and Medicaid Eligibility
Medicare is offered only to those 65 or older or people with End Stage Renal Disease (ESRD). Medicaid offers benefits from children to pregnant women to nursing home residents.
People can check online or with their local Social Security office to see if they are qualified for Medicare. Typically, most people are enrolled in Medicare Parts A and B when they turn 65.
The application process for Medicaid is more complicated. Benefits are based on income and resources. Medicaid looks back at applicant’s finances for five years from the date of application. Some applicants may find they are not eligible for benefits, or their benefits are delayed, because of transactions like transferring assets to their children.
So, a person over the age of 65 with limited income and resources might be eligible for both Medicare and Medicaid.
Medicare and Medicaid Services
Medicare is divided into four parts:
- Part A – Inpatient care at a hospital or skilled nursing facility.
- Part B – Some preventive care, outpatient care like doctor’s appointments.
- Part C – Advantage plans that combine Part A and Part B benefits, as well as the option to include drug coverage.
- Part D – Prescription drug coverage.
Medicare recipients choose which plan they want, usually based on their needs and how much they can pay for the premiums.
Medicaid, on the other hand, pays for care like that received at a hospital or skilled nursing facility, federally-qualified health center, rural health clinic, freestanding birth center, and so on. This is by no means a comprehensive list of the services offered by Medicaid. In fact, states typically offer the following programs to help the following groups:
- Children,
- Parents and caretaker relatives,
- Pregnant women,
- Elderly and disabled persons,
- Nursing home residents, and
- Patients with breast or cervical cancer.
So, Medicare and Medicaid both offer benefits that cover medical care. However, Medicaid benefits target segments of our population that may not be covered by Medicare.
Learn More About Medicaid Eligibility.
The attorneys at Miller Estate and Elder Law know how to help you with Medicaid eligibility. For a free consultation, contact us at 256-251-2137 or use our convenient Contact Form. We also offer free workshops and guides with more information about topics that matter to you. Although we’re located in Anniston, we also help clients in the Birmingham, Gadsden, Hoover, Talladega, Vestavia Hills, and surrounding areas.
by Bill Miller | Jul 6, 2018 | Estate Planning, Medicaid, Medicaid Planning
At age 98, Jamison truly is his family’s patriarch. His children want him to attend the annual family reunion. The problem? Jamison lives in Alabama. The reunion is in Texas. Although he does not live in a nursing home, Jamison requires some skilled nursing care and is legally blind. They are concerned that Jamison’s Medicaid benefits will not pay for medical services while he is away from Alabama.
Jamison’s family is right to be worried. Although the funds for Medicaid benefits come from the federal government, individual states manage Medicaid for their citizens. Jamison’s Medicaid benefits, then, are administered by Alabama Medicaid. Individual states are allowed to develop their own rules and regulations, as long as they comply with federal regulations.
It’s the Law
Federal law at 42 CFR 431.52 provides that state plans will pay for services provided to Medicaid recipients who are temporarily out-of-state. However, the following conditions must be met:
(1) Medical services are needed because of a medical emergency;
(2) Medical services are needed, and the beneficiary’s health would be endangered if he were required to travel to his State of residence;
(3) The State determines, on the basis of medical advice, that the needed medical services, or necessary supplementary resources, are more readily available in the other State;
(4) It is the general practice for beneficiaries in a particular locality to use medical resources in another State.
The law goes on. States are required to establish procedures so individuals who are eligible for Medicaid under another state’s program can receive medical services.
But It May Not Be Easy
Note that medical costs incurred during an emergency are covered. This means that individuals may be billed for services related to non-emergencies, unless that care fits the other criteria listed above. Also, the out-of-state provider has to enroll as a provider with the Alabama Medicaid Agency. And, finally, some services have to be pre-approved.
Medicaid Is a Complex Program.
Schedule a consultation with one of the attorneys at Miller Estate and Elder Law, and find out where you stand. Our phone number is 256-251-2137, or you may want to use the Contact Form on our website. We have offices in in Anniston and Birmingham and assist clients in communities like Hoover, Vestavia Hills, Irondale, and Calera.
by Bill Miller | Jul 2, 2018 | Medicaid, Medicaid Planning
Molly B. has struggled with chronic obstructive pulmonary disease (COPD) for years. Elijah J. has suffered from liver disease for years and now needs a transplant. And after her recent diagnosis, Hannah W. has questions about sickle cell disease. These people have something in common – they might benefit from Medicaid’s Health Home Program.
As a joint federal-state government program, Medicaid offers health benefits to qualifying individuals. Many people think of Medicaid when they face the need for nursing home care. Medicaid is much more than that, though. For example, the Health Home program.
The Details
Medicaid’s Health Home Program connects patients with the right services and resources. It also teaches patients about self-management and provides necessary transitional care. For some patients, Medicaid Health Home provides services to bridge medical and behavioral health services. This is by no means a comprehensive list.
The extra services provided by Health Home are offered, but not mandatory. Patients have the option of not accepting those services.
Eligibility
To receive benefits, the patient’s Primary Medical Provider (PMP) has to be contracted with the regional Health Home group. The patient also has to be enrolled in the Patient 1st Program.
Health Home services provides services in addition to support already received by the patient’s Primary Medical Providers. Patients who suffer from, or are at risk of contracting, the following chronic conditions often need an extra level of coordination between medical providers:
- asthma
- diabetes
- cancer
- COPD,
- HIV,
- mental health conditions,
- substance abuse,
- transplants,
- sickle cell disease,
- BMI over 25
- heart disease,
- Hepatitis C.
Hannah W. worried about how the combination of her sickle cell disease with diabetes would affect her care. Her doctor joined the Health Home program and directed her toward self-management resources and other programs that might help her.
How it Works
The Health Home group in the patient’s region will contact you to discuss their medical needs. They will let the patient know what services are available. The patient then has the right to refuse those services or accept. For example, Molly B. did not feel she needed any additional services and refused those offered by Health Home.
The patient will have to choose a doctor who is signed up with the Patient 1st program. After having been with the same doctor for years, Elijah J. was dismayed to learned that his doctor did not participate in the Patient 1st program. He had to decide whether to stay with him or move to another doctor.
This additional care is not permanent. The patient can cancel at any time.
The Catch? You Have to Be Receiving Medicaid.
The application process for Medicaid is a difficult path for most people to navigate. The attorneys at Miller Estate and Elder Law help many of their clients every step of the way.
For a free consultation with an experienced Alabama attorney, contact us at 256-251-2137 or use our convenient Contact Form. We have offices in Anniston and Birmingham and serve clients in Gadsden, Hoover, Talladega, Vestavia Hills, and surrounding areas.
