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Medicaid Planning

Medicaid Planning is about getting you or your loved one help in paying for long term care. The average monthly costs for long term care in Massachusetts is $10,000. At that rate even a substantial net worth of $600,000 would be depleted to zero in 5 years. Therefore, it is important to preserve an estate for a surviving spouse or to hand down a client’s lifetime works to their heirs.

MassHealth, which is Massachusetts’ version of Medicaid, is an entitlement program that is a subset of Department of Health andHuman Service (DHHS) which is a federal program. However DHHS gives the authority to individual states to run their own programs under similar guidelines. Each state gets to set their own guidelines but if those guidelines fall outside the requirements of the federal program the state can not seek reimbursement for the money they spend to pay for the citizens of their particular state. Therefore, you will see similar requirement across different states.

There are three ways to pay for long term care or nursing homes. Private pay, Long Term Care Insurance or State pay rate. Private pay rate is the highest rate that a nursing home will charge you. Long Term Care insurance rates are the second highest but they are subject the limits of the policy. For example, you could have long term care insurance and still have to pay out of your pocket if a particular item is not covered or the nursing home charges more than what your policy limits allow. The state rate is the least expensive rate that a patient in care will pay. That is because a qualified nursing home has already agreed with MassHealth to only charge a maximum amount if the patient qualifies for MassHealth benefits. In some cases, the state rate can be as little as one- third of the Private pay rate. Our job is to get you qualified for Medicaid so that you are charged the least amount as possible and still get help paying the lower amount.

The Medicaid application process can be very tedious and time consuming. It’s very important to answer every question. Every answer has a certain ramification based on your answer. If you answer a question a certain way that answer could open up a can of worms and cause the case worker to ask ten more questions. One wrong answer can result in a denial of benefits. Some eligibility rules are listed below.

If you are denied benefits or your application is turned down we may be able to overcome a denial by requesting and representing you in a fair hearing. A fair hearing is an administrative review of why you were turned down and it gives you a chance to argue your case before a neutral magistrate.

If we have the benefit of planning before a nursing home is needed we can arrange your affair so that you won’t have to spend down your assets to the $2000 maximum limit of assets to qualify for MassHealth Benefits. If we are able to set up an irrevocable trust we will need five years lead time before any asset in the trust is protected. This is called the five year look back period. If a long term stay in a nursing home is imminent and you don’t have five years to plan, we may still be able to get you qualified for MassHealth benefits under the Medicaid provisions.

If you or a loved one is facing the possibility of needing long term care and you need help deciphering the maze of red tape give us a call. We can help you. If you want to protect assets for the possibility of a long term care need in the distant future and would like to organize your affair in a fashion that will protect those assets maybe some preplanning could help. If you have been denied benefits or have had your application denied, we may be able to overturn your denial.

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