MEDICAID/TITLE XIX

Why Have an Elder Law Attorney Prepare the Application? 

Medicaid, also known as Title XIX (T19), is a welfare program, by definition, for anyone who needs long term services and support (LTSS). We all hope to never have to go this route, but with the cost of long term care today (upwards of $14,000/month for a skilled nursing facility (SNF)), it is a reality for more and more people. Many times the SNF will offer to do the application for you free of charge, or, alternatively, they may refer you to a fee-for-service company that will charge a fee, which may be close to the fees charged by a law firm. Unlike an attorney, neither the SNF nor a fee-for-service company can provide the legal advice that an attorney can and does include in his/her representation, again for a fee similar to what the fee-for-service companies charge. In addition, there may be conflicts of interest with either the SNF or one of these companies preparing the T19 application in terms of whose interest is being protected. For example, a SNF receives upwards of $14,000/month from a private pay patient. It receives approximately $6,500/month from a T19 patient, depending on the specific facility. If there is a legal way for you to preserve or protect some assets for the patient, his/her spouse and/or family, there is always the question of whose interest the SNF or Medicaid company is protecting.  It might in the SNF’s best interest not to advise you of the possibility of protecting assets as the facility will end up receiving approximately $7,500/month less than if you continue to pay privately?

 Furthermore, the fee-for-service companies that prepare these applications (the Elder Law Profession believes that merely preparing these applications may constitute the practice of law without a license even without “advising” the client) sometimes are providing services to the SNF either directly or through other service contracts. For example, some of these companies provide the billing services to the SNF for a fee. They have an interest in the SNF prospering because of their business relationship. Again, how likely do you think they are going to “advise” you of legal ways to protect assets that will reduce the amount the SNF will collect?

 There is never a substitute for the advice of an attorney regardless of the issues you may have. It is better to ask and be informed than to find out after the fact that there was a better alternative or there was much more you could have done to benefit your loved ones. Consult an Elder Law Attorney when considering Medicaid/T19.