Should You Prepare a Texas Medicaid Application Yourself?
Planning for the future is to determine how you can both meet your financial needs and be eligible for Medicaid and other government benefits as well. Medicaid is a U.S. federal program that provides medical care coverage for elderly individuals – 65+ – who are otherwise unable to pay for medical treatment. Medicaid covers doctors’ services, hospital care, medications, medical supplies and other necessary services once you has been made eligible for the program.
Medicaid is a critical financial resource for older individuals who need nursinghome care. Good care in the State of Texas can cost an average of $5,000++ per month. To qualify for Medicaid benefits – applicants are limited as to the amount of assets they control, and the monthly income they receive. Effective legal advice regarding the rules that apply to these and other issues can make a significant difference in an elderly person’s quality of life.
To decide if you should prepare and file a Texas Medicaid application by yourself or should hire professional help depends on your answers to the following questions:
- How old is the applicant to Medicaid?
- How complex is his or hers financial situation?
- Is the person applying for nursing home benefits?
- How much time do you have before benefits are needed?
- Are you organized enough?
Medicaid in Texas is the health care program for individuals who do not have another form of insurance or whose insurance does not cover what they need, such as long-term care. Many people rely on TX Medicaid for assistance in paying for care at a nursing home.
If you are under the age of 65 and not in need of long-term care, eligibility is based largely on income and the application process is fairly uncomplicated. Most can apply on their own without assistance.
Matters get a bit more complicated for applicants age 65 and above and especially for those of any age who need long-term care coverage. In these cases, availing yourself of the services of a Medicaid Lawyer is practically essential.
Medicaid applicants in Texas over age 65 are limited to $2,000 in countable assets. It’s possible to transfer assets over this amount in order to become eligible, but seniors need to be careful in doing so because they may need the funds in the future and if they move to a nursing home, the transfer could make them ineligible for benefits for five years.
Professional legal advice is also crucial because there is a confusing array of different Medicaid programs in TX that may be of assistance in providing home care, each with its own rules.
The application process itself is not so complicated for community benefits. Those over 65 in many cases will need to consult with an elder law attorney for planning purposes, but they or their families may be able to prepare and submit the Medicaid application on their own.
However, submitting an application for Medicaid nursing home benefits without a lawyer’s help is not a very good idea.
That is because Texas Medicaid officials subject such applications to enhanced scrutiny, requiring up to five years of financial records and documentation of every fact. Any unexplained expense may be treated as a disqualifying transfer of assets, and many planning steps – such as trusts, transfers to family members, and family care agreements – are viewed as suspect unless properly explained and documented.
Finally, the process generally takes several months as Medicaid keeps asking questions and demanding further documentation for the answers provided.
Many elder law attorneys offer assistance with Medicaid applications as part of their services.
Elder law attorneys in Texas offer you peace of mind throughout the entire complex Medicaid eligibility process. Including:
- Preparing a Medicaid Eligibility Plan,such as a Miller Trust or Qualified Income Trust;
- Assisting you or your family in choosing a nursing home;
- Co-ordinating Medicare and Medicare Supplement benefits;
- Filing a Medicaid application for medical care assistance;
- Representing you before the Texas Health and Human Services Commission (HHSC);
- Preparing a Medicaid Contingency Plan to ensure continued Medicaid eligibility;
- Creating a Medicaid Asset Protection Plan to protect the home and other assets against the Texas Medicaid Estate Recovery Program.
Working with an elder law attorney has several advantages, including expert advice on how best to qualify for benefits as early as possible, experience in dealing with the more difficult eligibility questions that often arise, and a high level of service through a long, grueling process.
Given the high cost of nursing homes, if the law firm’s assistance can accelerate eligibility by even one month will generally cover the lawyer’s fee. In addition, the payments to the lawyer are generally with funds that would otherwise be paid to the nursing home. In other words, the funds will have to be spent in any event, whether for nursing home or for legal fees.