Each year, I have the pleasure of chairing the Massachusetts Continuing Legal Education (MCLE) seminar on The MassHealth Process from Application to Appeal. While preparing for this year’s seminar which is scheduled for November 10, 2015, I began to think about the complexity of the process, how daunting it is for families and the myriad of mistakes that are made every day which often result in tens of thousands of dollars in uncovered medical expenses for seniors. It often feels like a runaway train, careening out of control as the forms, notices and lists of requested information take control of the gears.
Here’s the scenario—Anxious, emotional and weary family members set forth on a journey to secure Medicaid benefits (known as MassHealth in Massachusetts) which will allow their ill and frail loved ones to receive much needed care. These sons and daughters, husbands and wives have careers of their own. They are focused on caring for a loved one and maintaining their own family, yet the MassHealth application takes over, controlling every free moment of time. The stakes are always high (at $12-$15K per month in private pay) and the terrain is frequently uncharted. When the train falls off the track, which it often does, the nursing home is left holding the bag for the uncovered medical care it has already rendered and they look to these family members for answers (and possibly restitution).
So what can be done to avoid the head-on collision before it’s too late? Hiring an elder law attorney to be your guide through the long and rocky course can prove invaluable. We can assess an application from the outset and determine where the traps lie along the way. Were there gifts to family members within the lookback period? Were assets transferred into or out of a trust? How were the funds spent down to qualify for the program? Often a good elder law attorney can give the family an honest answer on how these factors may affect the success of the application and provide a strategy for how to resolve the issues before facing a denial. We also help to keep the train running smoothly and on schedule—interpreting and responding timely to requests for further information from MassHealth and filing an appeal when necessary.
At end of the journey, the train eventually reaches its destination—the nursing home costs are covered, all is well. Our goal during the journey is to minimize the burden to the family, keep open lines of communication with the nursing home and MassHealth, and ensure a smooth ride to approval for benefits. If you need assistance with the MassHealth application process please feel free to contact one of the attorneys at Samuel, Sayward and Baler.