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The Path to a Smooth North Carolina Medicaid Application…How to Avoid Denials and Appeals

Have you ever filed a Medicaid application? Or have you worried about the need to file one? An inadequate Medicaid application can lead to delay and lack of payment to the nursing home. These problems lead to denials of applications and appeals.

Filing a Medicaid application can be daunting. Think of an income tax return, where you have to not only provide income, but also asset information, family information, health forms, detailed banking records for past years and do this while a loved one is facing a care crisis. Daunting may be an understatement.

Knowing the ins and outs of Medicaid applications can mean the difference between spending hundreds of thousands of dollars unnecessarily, or preventing a nursing home resident from being discharged for nonpayment. Our office regularly files Medicaid applications in many counties across North Carolina, and we know that families are simply unprepared for what awaits them at the Medicaid office.

Sometimes our clients have already tried to file a Medicaid application and failed. They know firsthand the difficulty in gathering and organizing the needed information, and the frustration of waiting in line to meet with the Medicaid office. After we tell them that we can handle the Medicaid application for them, there is a tremendous sigh of relief and the tension lifts from their shoulders. They smile. They are thrilled to hear that they don’t have to deal directly with a government office. They were worried about filing the wrong information, or saying the wrong thing, or not knowing whether what the caseworker says is correct or not…but not anymore.

On top of that, the Medicaid laws are complex and ever-changing. We’ve seen more errors made by the Medicaid office than we can count. While we were able to catch these mistakes, we wonder about the thousands of people who file applications without expert help… they never know the mistake was made so of course they can’t correct it!

Should families get professional assistance to file Medicaid Applications?

  • Families who get advice from well meaning friends, neighbors and even social workers who generally do not understand the potential complexities and ticking bombs involved with these applications.
  • You need to know the actions you should take the month before filing a Special Assistance application for a married couple (Medicaid for Assisted Living).
  • Medicaid attorneys can advise on issues such as the right time to file (yes, even the right day in the month depending on whether we are dealing with Medicaid or Special Assistance), what information you need to gather in advance to avoid a denial and valuing land and investments.
  • Some people seek information from the Medicaid office, and only hear part of the story. You shouldn’t have to be an expert in Medicaid, but you need to know how to find one.

Some REAL Examples!

  • A wife has gone to the Medicaid office to apply for her husband in the nursing home, and she was told that they needed to spend half of their money and come back to apply later. Don’t let this happen to you! The Medicaid office will tell you to spend half of your money, while we will show married couples how to preserve nearly all of their assets.
  • A family that had tried to apply for Medicaid but was denied was worried that their parent would be forced to leave the nursing home for nonpayment. Not only were we able to get Medicaid approved, we were able to get the facility’s back bills paid in full by working out a contract with the Medicaid office.
  • When families have real estate in addition to the home place, they are often told that they have to sell that real estate in order to qualify for Medicaid. That is not the case, but the families believed what they were told by the social worker. By taking the right steps, at the right time and in the right order, we were able to get Medicaid almost immediately…without selling any real estate.
  • The Medicaid office has made mistakes in calculating the required monthly payment to the nursing home, which would have cost the family money month-after-month until we had it corrected.
  • A family that made transfers before the rule changes in November 2007, assumed that they could not apply for Medicaid because they were under a penalty period. They were afraid to go to the Medicaid office for fear they might be turned away, or be accused of doing something wrong. We reviewed the situation, determined that the transfers were not a problem, and started the Medicaid application right away. Getting the right advice saved that family tens of thousand of dollars.
  • We frequently hear from families that they “couldn’t have gotten through this without us,” that they had “no idea that anyone could help them this way.” We truly enjoy helping!
  • We have been contacted by nursing homes, who asked whether we could help, and then put their resident in touch with us, so that we could ensure that the resident could qualify for Medicaid and continue to get needed care without fear of being forced to leave for nonpayment.

When it comes to filing a Medicaid application, there is no substitute for knowing the law and how the system works. Our office regularly assists families with their Medicaid applications. We can ensure that the application is handled professionally and promptly. Professional assistance will give families peace of mind, and ensure that the nursing home facility is paid in a prompt and orderly manner.

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