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Medicaid Basics

Commonly at GolderCare, we get a call with a scenario something like this: Mom was in the hospital, now “they” are telling the caller that she needs to go to long term care. The nursing home is telling the called that she only gets a short stay under Medicare but Mom probably won’t be able to go back to her home. Panic sets in.

“HOW are we going to pay for this?!”

Long Term Care Medicaid may be an option. Everybody has heard of Medicaid but exactly what is it? Long Term Care Medicaid or Institutional Medicaid is one program through the Department of Human Services (DHS). There are so many rules and regulations that it is impossibly confusing. You know you have to “apply” but what does that mean? How do you know if Mom will “qualify”? You have heard horror stories about Medicaid from your hairdresser’s sister’s husband’s parent’s brother-in-law. In other words, everybody has a Medicaid story. I often get calls comparing one situation to another. I always tell them that I have been doing Medicaid for our clients for well over 18 years. NO two cases are the same.

So, now you have decided you need to apply for Medicaid for Mom. You are told by the nursing home that you are required to apply online. You are sitting in front of the computer and trying to fill in the blanks but every time you think you have it done, it kicks you back because you have made an error. You can’t find a blank to tell them about something specific, you don’t know what they want on one of the questions, you enter the information but it tells you no. There are no local long term care Medicaid offices to visit for questions. If you call, you get put into a general mailbox and if there is no application filed, they won’t call you back! Really?! How do you figure out how to file if they won’t call you until you do file?!

Now you have to learn how to speak a new language. Medicaid uses specific terminology and it is not always clear to the average person, such as:

  • What is “property”?

  • What is a “transfer” of property?

  • What is a “gift”?

  • What is a “look back period”?

  • What about the house which is where Mom lives and Dad is in the nursing home?

  • What if there are multiple people on the account? Who owns it for Medicaid purposes?

How long does it take? Wow! That is one of the first questions our clients always ask. Currently in Illinois it is a minimum of one year from application date to approval. What do you do in the meantime? In Iowa, it is currently about 6 to 8 months for an application to be approved. There are rules concerning this aspect and you have rights. You need to know your rights! Medicaid won’t tell you.

Once the Medicaid application is finally made, what happens next? After a few months you get a letter in the mail with several questions and several pages long. The first statement is, “provide records of all property transfers for the last 60 months”. What do they want? (Probably NOT what you think they want) How do you get it to them? What if they say they didn’t get it? What if I didn’t send the right thing? Can you meet the deadline? What if you can’t?

What happens when DHS finally makes a decision? Is it right? Probably not. Since 2012, our office has been keeping a tally of the number of decisions we have gotten from both Iowa and Illinois that come back correct the first time. In six years we have received six correct decisions. As you can imagine, we file hundreds per year. Six is not a very good percentage. The decision is not “yes” you are approved, or “no” you are not approved. Most times it is yes, but the wrong beginning month, or they have the calculations wrong, or they have the wrong amount to be paid to the nursing home every month, or they forgot to give you credit for medical insurance, etc. etc. So then what? Again, you have rights and you need to know what those rights entail before making another move.

With all of the confusing rules and misinformation, before venturing alone out into the work of long term care, it would be good advice to consult with someone who knows Medicaid and looks at all of the layers of your situation. But, be careful where you get your advice. Does this person have years of experience with DHS and full understanding of current rules and practices? Who are they working for? You? Or the nursing home or the government?

One wrong move can cost you thousands of dollars. We will be discussing the basics of Medicaid in both Iowa and Illinois for long term care in our upcoming presentations next month.

Who Will Pay for the Nursing Home?

Moline Public Library – 3210 41st Street, Moline, Illinois

  • Tuesday, December 4 ● 2 pm

  • Thursday, December 6 ● 10 am

We hope you will join us! These events are free and open to the public.

Kathy Nitz is the Lead Benefits Advocate for GolderCare Solutions. She uses her wealth of knowledge and experience in benefits planning to advocate for seniors and those who are disabled. You can reach Kathy at GolderCare Solutions Unlimited, LLC (309) 764-2273.