MEDICAID PLANNING, MEDICAID APPLICATIONS, & MEDICAID APPEALS
Medicaid Planning
When a loved one needs to move to an assisted living or skilled nursing care facility or requires nursing care in their home, you face a lot of difficult decisions as a child or other family member. The move itself can be very stressful for everyone, and your loved one’s sudden loss of independence can be very difficult. Adding financial concerns on top of this only make matters worse.
Thankfully, Medicaid can be a helpful resource for individuals who need long-term care. In fact, more than half of long-term care costs in the United States are paid for by Medicaid programs. Medicaid is a federal program that is administered by each state that offers it. In Texas, the Health and Human Services Commission is tasked with setting the eligibility rules and processing Medicaid applications. Unfortunately, qualifying for long-term Medicaid benefits (known as Medicaid for the Elderly and People with Disabilities) can be very complicated and burdensome. Because the individual who needs care is restricted on what they are allowed to have in terms of assets and income, qualifying for benefits can be challenging and require planning with unique solutions. Many people do not qualify simply because they did not take the time and make an effort to plan properly.
Proper Medicaid planning should be done at least five (5) years in advance of needing to live in a care facility or receive long-term care to avoid any stress about losing benefits due to a transfer of assets to family or friends. However, more often than not, the decision about whether to place a loved one in a care facility often has to happen quickly after a sudden and unexpected change in circumstances. That means that the sooner you start planning, the better. We can help regardless of the timing of planning, whether you are anticipating life in more than five years, or if you moved into the nursing home two months ago and need Medicaid to begin immediately.
Qualified Income Trusts - also known as Miller Trusts. If a Medicaid applicant in Texas receives more income than allowed by law, I can assist in drafting and setting up a Qualified Income Trust and establishing a financial account to manage the excess income and ensure your Medicaid application is approved.
The Law Offices of Nathan Peters, PLLC can help with Medicaid planning, no matter where you are in the process, whether its years in advance or if Medicaid benefits were needed starting a month ago. Learn more by contacting me or reaching out to our Denton, Texas office to schedule an appointment. We serve clients all across the State of Texas by investigating a Client’s circumstances and creating a custom plan to best serve my Client’s needs through virtual meetings and phone calls.
Medicaid Applications
The Medicaid program’s purpose is to serve as the payor of last resort for long-term care for indigent individuals. Through proper planning and in the right circumstances, an Applicant can preserve and protect some of their income and assets to provide for their spouse, disabled children, and minor children. You should know that the Medicaid application process is not easy. In fact, for most Applicants the application is extremely confusing and daunting—to the point where some families avoid applying altogether, even if they qualify. Oftentimes, the nursing homes offer to assist with completing and filing a Medicaid application for new residents. Do not make this mistake as nursing homes are not interested in preserving your assets and income for your loved ones. Nursing homes want you to pay privately using your assets and income to spend down until you are eligible for Medicaid. Instead, contact the Law Offices of Nathan Peters, PLLC, for help with you or your loved one’s Medicaid application. I can make the Medicaid application process as easy as possible for you and your loved one while seeking to protect your income and assets to the extent allowed by law. Generally, the earlier you apply the better.
I have extensive experience helping persons in need of Medicaid benefits with filing applications. I also have handled over 100 appeals of incorrect denials and litigated issues with the Health and Human Services Commission. This experience allows me to help my clients prepare their Medicaid applications with the right information and using the correct language that the Texas Health and Human Services Commission looks for in granting benefits.
I can help you through the application process by:
- Filling out forms
- Gathering medical information
- Gathering accurate income and asset data
- Submitting your application in the best light possible
Sometimes simply having a full understanding of the qualifications and information you need can be the difference between denial and acceptance. Our Denton, Texas office serves individuals and families all across Texas with respect to Medicaid applications. Contact me to set up an appointment or get more information.
Medicaid Appeals and Undue Hardship Waivers
Not every Medicaid application will be approved the first time. The Texas Health and Human Services Commission can make mistakes in the processing of a Medicaid application or you may have included wrong information on the application leading to its denial. If an error was made, you may request to re-open your application or you have to assert your rights through the appeal process. I have worked through numerous Medicaid appeals and represented Clients at over 100 fair hearings, and I can put that experience and knowledge to work for you and your family in your Medicaid appeal.
Do not get discouraged if your Medicaid application is denied the first time or if a penalty period is imposed for a transfer of assets. You still have options to get benefits even if your initial or renewal application is denied. Perhaps you simply needed more time to provide additional information, maybe the agency misapplied policy or failed to follow the required procedures, or perhaps the agency miscalculated an Applicant’s income and assets. Whatever the case, we can review your denied application and help walk you through the appeal process. However, you must act fast. If you were receiving Medicaid benefits and the renewal application is denied, you must appeal within ten (10) days of the date of the Denial Notice in order for benefits to continue during the appeal. If you appeal a renewal application more than ten (10) days after the date of the Denial Notice, you can still appeal the Denial Notice up to ninety (90) days after the date on the Notice. Similarly, if your initial Medicaid application is denied, then you have ninety (90) days from the date on the Denial Notice to request an appeal.
If you receive a Form H1226 - Transfer of Assets/Undue Hardship Notification from the Health and Human Services Commission, it is imperative that you respond within ten (10) days of the date of the Notice. If you receive one of these forms imposing a penalty period and delaying the start date of your Medicaid benefits and you did not plan on receiving the Form H1226, you should immediately contact our office to schedule a consultation. We can evaluate and develop a proper plan to timely respond in hopes of removing the penalty period and immediately begin eligibility for the Medicaid Applicant.
If your Medicaid application for long-term care Medicaid benefits was denied or a penalty period was imposed unexpectedly, not getting the benefits that you were expecting can put a serious financial and emotional strain on you and your family. However, you do not have to work through this process alone. I can help you and provide an honest assessment of the facts of your case.
As noted above, there are very specific deadlines that you must follow in a Medicaid appeal. Do not wait too long to assert your rights after your initial application is denied. Contact our Denton, Texas office to learn more about how I can help. Since Medicaid appeals are handled over the telephone, we are able to represent clients all across the State of Texas, and it would be an honor to work with you as your advocate during this difficult time.
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Disclaimer - Nathan Peters is responsible for the content of this website. The information presented on this website for Law Offices of Nathan Peters, PLLC is displayed as a service. This information is not to be construed as legal advice nor is it intended to be a substitute for legal advice on any of the subject matters discussed. This information does not form an attorney-client relationship between you and the Law Offices of Nathan Peters, PLLC. The information on the website is presented for general information purposes only and may not reflect the current law in your jurisdiction. No visitor to this website should act or fail to act on any information included in this website without consulting an attorney on the particular facts and circumstances involved in your case from an attorney licensed in your jurisdiction. Please contact me to set an appointment, and once an attorney-client relationship is established, I can provide you with comprehensive legal advice. If you communicate with me through this website or any other means regarding a matter for which I do not represent you, such communication may not be privileged and does not create an attorney-client relationship.
