Quad Cities, IL/IA

Working with the community... for a healthier community.

Independent Senior Advocacy—Misconceptions of Medicaid


Submitted by Kathy Nitz, GolderCare Solutions

In the 19 years I have been advocating for seniors, I find there is always a lot of worry around Medicaid. There are preconceived notions that have been perpetuated through society based loosely on facts. While I am glad to have the knowledge to put clients at ease, I worry about those that do not seek professional help when navigating the complexities of Medicaid. I would like to clear up some of those rumors that create unnecessary worry in our aging community.

The house is always the first concern for our clients. Sometimes the concern is that because Dad is now in nursing care, the “State” will take the house and Mom will have nowhere to live. If one spouse is in care and the other spouse is still at home, the State won’t take the house. However, what the State may do is attach a lien on the house. If a lien is attached to the house which is titled in the name of an institutionalized person, when the house is sold, the Medicaid debt must be paid off from the sale. If planning is done correctly, that can be avoided altogether.

Another issue that frequently comes up is the question of the “look back period.” During the approval process, the Department of Human Services (DHS) does LOOK back 60 months. DHS will examine all financial records for the last five years. They will require volumes of paperwork verifying transactions with a very short deadline. People are denied benefits because they are unable to satisfy DHS’s requests in a timely manner or they misunderstand what is required.

The “Disqualification Period”
Under DHS policy, any transfers made for less than fair market value during the look back period causes a disqualification period calculated using a formula specific to the situation. Confused? DHS prefers it that way. We have had many clients come to us with a decision from DHS that is calculated incorrectly and we have had to intervene on the client’s behalf to get it corrected. Even that is no easy task. There are rules and procedures to follow and DHS rarely explains that to the client. One misstep and you will have forfeited your options.

The public has come to believe that if you have made any transfers during the look back period, you are automatically disqualified from receiving benefits for five years. That is not the case. The amount of the transfer determines the disqualification period. You need to talk to someone who knows the policies in detail so that you get the right answers.

You don’t know what you don’t know. You need to talk to a professional with experience and is well versed in this subject matter before making any moves. The policy and the law change frequently. What was once a policy and worked for others may now cause you undue problems. When faced with a loved one in long term care, the last thing you need is to make a misstep.

If you have a loved one facing the rising costs of care and are looking for guidance on qualifying for benefits such as Medicaid or Veterans Benefits, we invite you to attend our upcoming educational seminar – Who is Going to Pay for the Nursing Home?  This event will be held at CASI — Center for Active Seniors Inc. at 1035 W Kimberly Road, Davenport on two different dates and times: Tuesday, October 24 at 6 pm and Monday, October 28 at 2 pm. These events are free and open to the public.

Kathy Nitz is a Benefits Advocate for GolderCare Solutions. She uses her wealth of knowledge and experience in benefits planning to help seniors and those who are disabled. For more information visit goldercare.com.