Beware of the "We Do That" Syndrome

We had a client come in the other day that has a parent in an assisted living facility that does not accept Medicaid. Her husband passed away a little over a year ago and at that point they had enough funds to last them maybe a year and a half. The attorney that they were with at the time helped them through the probate of their father’s estate. She told them that they did not need to do anything for Medicaid and that all they needed to do was spend down their assets, apply for Medicaid, and then mom will have to move at that time.
We always say beware of “we do that” syndrome because today it has become so important to use an attorney who is knowledgeable about estate planning, probate, trusts but more importantly to also be knowledgeable about Medicaid and the Medicaid process. In this case, mom should have moved to a place that accepts Medicaid.
The Medicaid waiver program pays for assisted living however does not work like nursing home Medicaid. In fact, it is a much different program. To qualify for Medicaid waiver, the same basic income and asset rules apply however, Medicaid allows the assisted living facility to set their own policy as to how long you can be there private pay before you can go on Medicaid. For example, there are some assisted living facilities in our area that require you to be there for a year, others two maybe three years. So, you can see the importance of planning ahead to make sure that the facility you are in accepts Medicaid waiver. The fact in this case is that mom could probably use memory care. And that brings in a whole other set of issues. Had this woman been brought into a facility that accepted Medicaid waiver it would have been a smooth transition from private pay to Medicaid. At this point she is in a facility that does not accept Medicaid and now does not have a choice to go to assisted living but rather must go to a skilled nursing facility to qualify for Medicaid without any private pay waiting period.
After discussing the options. I always hate to say “boy I wish you would have” but rather I always say “don’t look behind there is always scary things back there. We are where we are, and we must look forward.” The lesson is we need to consider all our options at the time when someone needs even independent living because going from your home to any other environment shows there is a need for additional care and their assets will run out at some point.
Therefore, we need to be talking when your loved one goes into independent or assisted living. Most people will tell you not to worry and to just continue paying. That cannot happen. When you consult someone, you must ask what their knowledge is of the Medicaid process. How many cases have they processed through Medicaid? Are they familiar with the different programs through Medicaid such as waiver and skilled nursing care?
The “we do that” syndrome to me is anyone who does or practices in the area of estate planning will tell you “oh yes we do that.” The fact is Medicaid is a very complex set of rules and exceptions and there are exceptions to the exceptions. If they do not practice Medicaid planning and have not filed Medicaid applications with clients and know these complex rules and exceptions, you are probably not getting the best representation. Don’t be afraid to ask. It is like anything else in the world such as the doctor who you might ask for a second opinion or may ask for qualifications. Insurance companies today are giving you statistics on how many procedures the doctors have performed and how many incidents of rehospitalization have occurred since these procedures. These are things you must know. We believe knowledge is power and that is why we invite you to one of our workshops to learn more about this process and how you can stay in control.
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