She came to see us, as many do, during a time of family crisis. “Margaret” had spent the last few years caring for her husband who was slowly declining in health and mental capacity due to Alzheimer’s disease. The crisis occurred when he fell at home and had to be hospitalized. The hard to hear truth was that he was going to require 24 hour skilled nursing care for the remainder of his life. This lovely woman, who brought a neighbor to her first meeting for moral support, was facing the difficult tasks of finding a good facility, managing his health care and getting legal help in hopes of finding a way to pay for it. She had to do this on her own. They’re only child lives far away and has a very demanding job that, despite her desire to help her mother, prevented her from being here.
We talked about all of it. We welcomed her tears and let her share her fears. Then we set about doing what we do. We created a plan to protect their hard-earned savings and get benefits in place to alleviate the expense of her husband’s care. The good news was that we could get the benefits.
Margaret was completely cooperative and helped us help her. She gathered all the necessary documents, and we re-arranged her assets so that he would qualify for benefits. In applying all of our experience and knowledge of Medicaid law, we were confident that the plan would result in an award of benefits for him beginning the very next month.
We compiled and filed the application only to be surprised a few weeks later to receive a denial from the Medicaid office. The reason cited on the denial seemed like a misunderstanding, which happens from time to time, so we made the necessary phone calls to clear things up. Unfortunately, we had run head first into the machine, which continued to deny benefits. We filed an appeal.
We attended the appeal hearing on Margaret’s behalf, and explained the misunderstanding in the application to the Administrative Law Judge. He seemed to understand and we were feeling confident again. Only to be shocked to receive the official ruling a few weeks later also denying benefits to this qualified family.
Our experience and expertise told us that this family was eligible for benefits. We KNEW it! At this point in the process, the family was questioning the wisdom of continuing to pursue the matter. They were tired and frustrate and were losing confidence in our skills because the Medicaid office continued to (incorrectly) deny the benefits. They were ready to give up.
Margaret even talked about moving him back home. A situation that could only have resulted in disastrous effects on her health in addition to his. I spent time on the telephone with Margaret and her daughter and asked them to allow me to continue to pursue the matter, as I was certain that their loved one was eligible for benefits and the denials were nothing more than red-tape. They were reluctant, feeling as if they had been punched in the face three times and continuing the fight would only make matters worse. They were inclined to quit, but we weren’t ready to give up. After considering the matter and several conversations, the family agreed to allow us to pursue the benefits.
With their permission, we continued our efforts. In the end, the Medicaid office got it right, and (6 months after starting the process) benefits were awarded retroactively to the original application date. We were successful in our pursuit of benefits for this deserving family.
It’s regrettable that the bureaucracy slowed us down. I’m saddened that this family was caused unnecessary levels of stress as a result. It’s shameful that it took over 6 months to get through the process. But at the end of the day, I know that we did what was right for this family. We fought for them even when they wanted to give up. We kept fighting even when the bureaucracy seemed bent on shutting it down. That is what we do … because it is the right thing to do. I don’t like to think about what would have happened had they not sought our counsel. The likely result would have been that the family would have paid tens of thousands of dollars (or more) on care, when they were actually qualified to receive assistance from the State.
Hunter Estate & Elder Law will not stop fighting for your benefits. We will continue to advocate for our client families until the right result is reached. That’s what makes us the right choice for counsel when your family needs long term care.
If you want to join us for a FREE Lunch & Learn and discover what you need to know about medicaid planning and asset protection for your family, just click here today to reserve your seat. But hurry - seating is limited!