Recently, a lawsuit was filed against the Illinois Department of Human and Family Services over delays in the processing of claims for Medicaid benefits. Although the lawsuit focuses primarily on applications for community Medicaid and health insurance benefits, delays by IDHFS in processing Medicaid claims for long-term care benefits can have a dramatic effect on those seniors requiring assistance to pay for long-term nursing home care.
A quick synopsis of the Medicaid system as it applies to nursing home benefits:
Medicaid (not to be confused with Medicare) is a government program funded by both state and federal resources to help seniors and disabled individuals with limited resources pay for long-term care. Although Medicare will cover short-term stays in a nursing home for rehabilitation and some respite care, Medicare provides no benefit to those seniors that need to move to a nursing home on a permanent basis.
Medicaid will provide benefits only for skilled nursing and supporting living facilities. Medicaid does not cover independent living, assisted living or memory care facilities and benefits are only paid for those individuals with assets of $2,000 or less in their names individually.
Medicaid applications require that an applicant provide up to 5 years of financial records including bank statements, deposit slips, images of checks, tax returns, deeds, affidavits, and verifications of pensions and life insurance policies. To help manage the overwhelming amount of documents submitted every year to Medicaid, the State of Illinois recently spent millions of dollars to implement a new software system that went “live” in October of 2017. This is the very software that IDFHS blames for the further increase in delay in processing Medicaid applications.
The practical effect of all these delays is an even greater unwillingness of quality nursing facilities to accept Medicaid pending residents. The longer a Medicaid application remains pending, the more uncertainty the nursing home faces as to whether it will get paid for the care it provides to a resident. Nursing homes are also concerned about how the delay in Medicaid approval will affect their operating budget and cash flow.
Delays in Medicaid benefits have given rise to facilities requiring large deposits or proof of the ability to privately pay for skilled nursing care for an extended period of time. When searching for a Medicaid bed at a long-term care facility, it is important that seniors and their families understand their rights and obligations. Proper planning and careful management of assets can greatly reduce the stress and uncertainty involved with the transition to a long-term care facility, maximize the government benefits available, and preserve asset for the senior.
If you have questions about asset protection strategies and Medicaid, please call us at 708-482-7090 to schedule a consultation.