Pitfalls and Problems
Ignorance of the Law
Do Not Assume just because someone works in a nursing home, or even works for the State, that he/she knows and understands Medicaid. Medicaid has been described by some of the brightest judges in the country as a program that is "incomprehensible for the uninitiated". We hear misstatements regarding the law from every source, even employees of the Department of Public Welfare, the agency that administers the Medicaid Program.
You've heard it before. "They'll take your home. They'll take everything you have. Medicare stops paying because you're not improving. If you sell the house you have to give them all the money." These are just a few of the statements we hear every day from people. The biggest problem you will have when caught in the long term care system, is someone telling you what you can and cannot do. More often than not, that person will be wrong. For example, Medicaid law states that a person can apply for Medicaid and that he/she will be allowed to keep his or her home. Yet, they are almost always told that they must sell the house. If you do not question or challenge the person giving you this information,you will end up doing as they say; even though, it is contrary to the law. Having an attorney from Zacharia & Brown to be your advocate is a necessity in the field of long term care. Also, in almost every case there will be money that must be spent before you can get benefits such as Medicaid. Your first expenditure should be for an attorney who knows the system; someone who will be your voice and lookout for your best interests.
Failure to Plan for Long Term Care
Far too many people believe that elder law involves doing everything you can to obtain Medicaid benefits for nursing home care. Perhaps that is what some elder law attorneys do. That is NOT the goal of Zacharia & Brown. Our goal, for clients who come to see us early on in the process, is to avoid the nursing home whenever possible. There are so many other options available that nursing home care should be the last resort. They key is to have a plan. Such a plan is termed a Life Care Plan.
A Life Care Plan involves a review of one's health care issues, financial status, income status, and legal documentation. From there, we create a plan specifically for you that will help provide what everyone wants as they get older: comfort, care, peace of mind and dignity.
Having a plan will give you options. Having a plan will help protect your assets. Having a plan will help you obtain benefits from various programs when you are eligible. For example, your plan may involve retitling some of your assets into a trust; making certain that the house you live in has secured safeguards; planning for Veterans eligibility and minimizing or eliminating the need for Medicaid and nursing home care.
The Five Year Look Back
Most people do not fully understand the five (5) year lookback rule. It is really an audit period. Anything you give to another person for less than its fair market value (gift) causes a period of ineligibility for Medicaid. The gifts made over the previous five years are added together and the penalty begins as soon as the applicant is out of money. Some nursing homes will look to the children to pay during this period. It is real cause for concern. Nevertheless, there are ways to resolve this and oftentimes the gifts can be addressed without penalty or problem if managed properly. Zacharia & Brown's years of experience are invaluable in this area. We've helped hundreds of families convert the gifting issue into a non-issue.
Estate Recovery
Estate Recovery is a program that provides that when a person who is on Medicaid passes away, his or her Estate must pay back the Commonwealth of Pennsylvania up to the amount they paid out in Medicaid. Currently in Pennsylvania, this amount is only recoverable from those assets that pass through the decedent's Will. Estate Recovery is a very serious issue and you must always be vigilant in addressing it.
