April 2003
The answer to this question is NO….it certainly is possible to get through the Medicaid filing process without professional help....The same way it is possible to paint your own house, lay your own carpet, change the oil on your car, etc. The real question is …Do you have the time, energy, and stamina to learn the process and navigate the maze???? For most of us, this is the real kicker. For an 86 year old woman filing for her husband going into the nursing home, this may not even be an option.
What most people don’t realize is just how complex the filing process is. Many are led to believe by well intending nursing home staff that the process simply involves filing an application with the Department of Children and Families and going to an interview. They are shocked to discover that the process involves hours of searching for long lost documents, and sorting through reams of papers to find the exact one that the caseworker wants. Often, documents have to be replaced – which can take weeks or months. Many are hoping that the caseworker will dispense advice on how to arrange the finances to achieve eligibility or tell them at the interview just what papers they need to provide. The truth is that many people are more confused after the interview than they were coming in.
The Department of Children and Families is not set up to counsel clients on how to achieve eligibility. The caseworkers are inundated with more cases than they can handle in a day as it is. Their role is to simply review what is presented and determine whether or not it meets the eligibility guidelines. When clients come in without the requested documentation, the case is put to the side until the client brings in what is requested. There are timelines to go with this. Generally, requested information needs to be brought in within 10 days of an interview. If more time is needed, a time extension can be requested. If the extension is not made timely, the case is permanently closed and a new application has to be filed …. In other words, you have to start over.
Prior to an interview, the Department of Children and Families will send the client or their representative a list of paperwork that should be brought to the interview. Unfortunately, this list is not specific to the individual – it is a form letter. The list also does not specify how the documents should look. For example, the list says “verification of Social Security benefits”. What it doesn’t say is that this has to be something on Social Security letterhead – they can’t accept direct deposit listings on bank statements or even copies of checks as verification of benefits. If the client doesn’t have this – they will have to request it from the Social Security Administration – which takes at least 3-4 weeks. If the representative happens to be a child of the applicant and not listed as representative payee with the Social Security Administration, then they will have to go through this process before the Social Security Administration will release the information to them. Meanwhile, the case is pending and you have to remember to keep requesting extensions to keep it open while you are gathering the information.
Which brings us to another point…. Communication. Most of the Department of Children and Families offices have one central phone line. Many times that phone line is unmanned when there is an acute staff shortage. Getting through to your caseworker can be a full time job when you consider that each office has about 50 or so caseworkers – and all of these have more cases than they can handle. In rare cases, the caseworkers may have independent lines. Very few of these will dispense the phone numbers to clients as they want to avoid continual interruptions throughout the day. Requesting an extension sounds easy until you try to start calling…..
Faxing can be a better option. At least this way you have a written record of the fax and timeliness of the request. The problem is that there are one or two fax machines for the whole office. The fax line is difficult to get through to, and there are no guarantees that the paperwork will get to the right party. It is crucial when sending a fax to be certain that the client’s case number is on every page, and that there is a cover letter clearly marked to the caseworker with every fax sent. If you are going to turn in paperwork to the caseworker after the interview, the best way is to send it certified mail with a return receipt. Keep a clear list of exactly what you are sending and keep the receipt as proof of delivery within the timelines.
When an interview date is given… keep it! Many times the appointment date and paperwork packet comes one or two days before the interview. Changing the interview date can be difficult (see above) and delay the case processing. Allow at least 3 hours for the interview. You will probably wait at least an hour in the waiting room, and the interview itself takes about 2 hours or so to complete. Failure to keep or properly cancel a scheduled interview will result in the case being closed. The record is marked with the reason the case was closed. This can play against you if you have to go to an appeal process later.
So how does professional assistance help with this process? Well, experience counts! People who do this routinely know the ropes. They can help you go into the process fully prepared and save you hours of frustration and time. The preparation is done well in advance of filing the application and attending the interview. Professionals have communication systems worked out to be more efficient. Most people in this business have relationships developed with the caseworkers because they work so many cases together. Caseworkers used to be skeptical of professional assistance. Since this has become more prevalent in recent years, they are becoming more grateful than skeptical. Prepared clients mean smooth processing.
Probably the most important factor is the moral support. This is a really intimidating process for even professional people (probably even more so!). Having someone with you that has the confidence and the proper verbiage at the appropriate moment can be very comforting. There is a lot to be said for being prepared!
The irony of the whole thing is that it takes a hired professional to access funds meant for the impoverished. The service doesn’t come cheap. Some Elder Law Attorneys offer the assistance through paralegals in their office. The price tag can range from $3000- $5000 when you go this route. The advantage is that you will have the legal counsel to go with it – which will usually include the drafting of any needed documents.
A more cost effective means would be to use a Geriatric Care Manager (GCM) to do the actual leg work, and an Elder Law Attorney for only those parts that need legal counsel to do. The GCM will charge between $1200-1500 for the leg work part of it – which is often all that is needed.
The price tag sounds outrageous until you consider the time elements involved. Nursing home costs range from $4500- $5000 per month. Most fees are completely paid with the savings from the first month of eligibility. When you start to factor in the hourly cost of lost time at work, etc. in pursuing the process, it doesn’t take a mathematician to see the benefit. It takes an average of 10 to 15 hours of preparation / application / interview time to go through this process. The reduction of stress level for the applicant and their representative is priceless!!!
One very important thing to remember is that hiring a professional to assist with filing DOES NOT guarantee an outcome. The applicant has to meet the eligibility requirements of the benefit in order to receive that benefit. Medicaid fraud is a felony – so don’t expect the pro assisting you to help you “fudge” the system. Even the most experienced professional is only as good as the information that you provide. Most will not want to risk losing their reputation or sharing a cell with you! You must be truthful with disclosure. A good Medicaid filing assistant will let you know ahead of the game what the pros and cons are so that you can decide if the effort is worth the hassle.
This is not a process that you can hand over to the pro - then come back later to collect the details. When you hire the professional, remember that you are hiring an assistant that will guide you through the process. This is sort of like hiring a guide for a whitewater rafting trip. The guide is with you in the boat to help you avoid capsizing on the big rocks, but everyone in the boat has to paddle to keep the boat going in the right direction. Much as you would like to let the guide go down the river by herself and meet her at the end….it just doesn’t work that way! You certainly never want to give some stranger the financial freedom and liberties that would be needed to do this process without you. With a team effort, however, it is possible to reach the goal without losing your sanity or drowning in the process.
For more information on Medicaid filing assistance, contact:
Elder Advocates Incorporated | 407.898.9080 | www.elderadv.com
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