Elder Law is a legal specialty focused on helping people of all ages handle issues that are of particular importance to the elderly and their families.
Nursing Home Medicaid Planning
An unfortunate fact is that most health insurance plans do not cover long-term nursing home care. Average out-of-pocket costs for skilled nursing care in a facility can average nearly $200.00 per day. Over 70% of Americans will need some form of long-term nursing care during their lifetimes, whether it is because of disability, illness, accidents, or age. With proper planning, the elderly and their families may not necessarily have to surrender everything that they have worked so hard for to qualify for the care that they need.
The questions to ask yourself if you had to go into a nursing home are:
Can you pay the private pay rate of $200.00+ per day (unless you have long term care insurance); or
Apply and qualify for Medicaid/TennCare services
If you are one of the fortunate few who can choose option 1, you may be in good shape. If you are like most Americans however, you will require option 2. Medicaid and TennCare have a very strict process for qualification. Your income and assets both must be under certain limits to qualify. These limits are essentially the poverty line. If you are between the poverty line and the ability to pay $200.00 per day private pay rate. They can't afford private pay, but can't qualify for TennCare. This is where Elder Law and Medicaid Planning can help.
At our office we have a clear process for handling these types of cases:
We meet with prospective clients and their families and review their assets. income, and medical situation.
From this point we determine how we can qualify the client based on the above assessment.
If we need to qualify the client based on income, we prepare a QIT or "Miller Trust" that allows the client to qualify based on their income.
If we need to qualify the client based on their medical situation, we can help the client prepare for the PAE and Activities of Daily Living ("ADL") assessment performed by the medical staff to determine medical qualification. If necessary, we can file a medical appeal, and institute court proceedings to have the client deemed medically eligible.
If we need to qualify the client based on their assets, we can gift, transfer, or spend-down these assets as the law allows, in order to qualify the client.
Once these 3 criteria are met, we fill out the TennCare application, submit it to TennCare, and handle the intake interview for the client.
After the interview, we provide the Bureau of TennCare with any additional information that they have requested.
If the application is approved, TennCare will begin paying for the client's medical care.
If the application is denied, we can handle the TennCare appeal process in order to get the client qualified.
The most valuable asset we have when dealing with TennCare and Medicaid applications is time. The sooner we start planning, the more freedom we have and the more assets we can protect and preserve. While emergency and rapid planning is possible, it is much better to make these plans in advance.
If you are in the Athens, Tennessee area (McMinn, Loudon, Polk, Meigs, Rhea, Monroe, and Bradley counties), and you, your family, or your friends are facing the prospect of needing nursing home care in the future, please give us a call to discuss what your options are going forward.