What Is Medicaid?
Medicaid is the name of the federal program that helps people with medical costs. In Maryland, the program is called Medical Assistance.
In the context of elder law, Medical Assistance is the program that covers skilled nursing care. There are three levels of care for most seniors: 1) independent living; 2) assisted living; and 3) skilled nursing care. Medical Assistance helps pay for skilled nursing care in the nursing home.
Where to Apply for Maryland Medicaid?
A Medical Assistance application must be filed with the local department of social services. Many of our clients are in Baltimore City and Baltimore County, and their applications are filed at the Bureau of Long Term Care in Catonsville. Depending on which county the applicant lives in, the application may be filed at the Catonsville office or another local department of social services office.
When to Apply for Maryland Medicaid?
The critical date to consider is the last day of the month prior to filing the application. That is a key date in terms of getting the assets in place.
Who Is Eligible for Maryland Medicaid?
Medical Assistance is a very asset-driven process. The Medical Assistance applicant can have no more than $2,500 in countable assets, while the community spouse (if any) can have no more than $130,380 in countable assets. (The community spouse is the healthy spouse who is not applying for Medicaid. It is important to note that the Community Spouse Resource Allowance changes regularly, and this maximum allowance may be lower in some circumstances.)
What Is a Countable Asset?
In short, a countable asset is anything that the applicant or applicant’s spouse can liquidate to pay for nursing home expenses. But there are a number of exceptions to this rule. For instance, the house may be a countable asset, but it depends on factors such as the title to the house, if it was the primary residence, and the amount of the equity in the house. There are a whole host of other quirky rules when it comes to what is a countable asset or not.
How to Access Your Parent’s Assets?
But a preliminary question that you must ask is, “Can you access this asset?” If you’re like most of our clients, then you are probably looking into this issue on behalf of one of your parents who needs nursing home relief. We often work with the daughter or son who is responsible for filing the Medical Assistance application on behalf of their parent.
If you want to access your parent’s assets, then the key document for you to have in this process is the financial power of attorney. It is this document that will allow you to access your parent’s assets—in order to either make them available to pay for nursing home expenses or to put them in a position to be protected from nursing home expenses.
Financial Power of Attorney
The first document we review when a son or daughter comes for a consultation regarding their parent is the financial power of attorney. We typically know in the first few minutes of the consultation if the document they have is going to help facilitate what we want to do or be a problem.
Some people think it will be “easier” to just grab a power of attorney online. However, this can cause several issues. For example, it could be improperly executed; it might not provide the power you need; it might not conform with the changes to the power of attorney rules enacted in 2010; or the current agent might be the community spouse, but they don’t want to relinquish their role as power of attorney holder. Of course, even if there is a wish to get a new power of attorney, it may not be possible if the parent is no longer competent enough to grant one. In that event, the court needs to get involved in order to appoint a guardian.
So, don’t try to do this on your own. Have an experienced elder law attorney draft a proper financial power of attorney that is robust to handle just about every situation. It is our practice to go through this document with you section by section and explain how each section is used, from a practical point of view.
How Long Does It Take to Apply for Medicaid?
If you can get the assets in place within the month prior to seeking the application, then the Medical Assistance application can be filed with the local department of social services, and then…you wait.
Medical Assistance case workers have 30 days to make a “yes” or “no” determination regarding your application. But almost always they ask for more information in a document that both you (if you are the Medical Assistance representative for the applicant) and the nursing home receive. Often, the information asked for by the case worker is due in a week, or a few days, or the deadline has already passed. Unfortunately, because of the normal processing time within the Department of Social Services and the United States Postal Service, it is not unusual that this type of deadline occurs.
How to Prepare
Medical Assistance is such a paper-intensive process (i.e., five years of tax returns, birth certificate, marriage certificate, access to five years of financial accounts and transactions, etc.) that the process itself may seem unwieldy.
It also means that you should be prepared, as a Medical Assistance applicant, to explain every transaction on the five years of banking activities. The normal rule is that the transactions greater than $1,000 are examined (although that is not always the case). All kinds of unique issues may be raised here, from co-mingling assets with a relative, to the gifting of assets, to unexplained deposits and withdrawals. However, you as the applicant have the burden to prove the transactions at issue are not disqualifying events.
The normal Medical Assistance application process takes about three to five months, but it can certainly vary, depending on the complexity of the application. Our firm gets involved with all kinds of Medical Assistance applications, whether it’s a normal application for benefits with no complications, or whether it’s a complete disaster with assets and transactions that are voluminous or unknown.
The Medical Assistance Minefield
Applying for Medical Assistance is like walking into a minefield. This is an analogy that we have created and continue to use with our clients.
If you’re preparing to apply for Medical Assistance, then let us help you navigate the minefield—before it’s too late and mistakes are made. As your family prepares to apply, you will be better served by getting a clear roadmap of your unique application, the problems that you may encounter, the methods to overcome them, and if applicable, methods by which you can protect your family’s assets when you have to pay for things that Medical Assistance will not cover.
Our firm can help, whether you are just starting the process, or whether there is a looming Medical Assistance hearing and the nursing home is threatening to discharge your parent (or worse). Call us today for a consultation at (410) 296-8166 x292.