Personal care is expensive, whether at home, in an assisted living facility, in an adult family home, or in a nursing home. In Washington, nursing homes can cost as much as $12,000 a month. Providing the same level of care at home or in assisted living can be even more expensive. These costs, for the most part, are not covered by Medicare. They may be, on the other hand, covered by long-term care insurance. Unfortunately, few of today’s seniors have such insurance. That means that they must rely on their savings to cover the cost of care. Few people can afford to pay for long-term care for very long and doing so can leave a healthy spouse destitute and deplete the inheritance a couple has worked long and hard to leave to their family.

The Medicaid program pays for nursing home care, assisted living, and home care for those who qualify. The rules are complicated and ever-changing, and the application process can also be daunting.

Weppler Law Office PLLC has successfully guided seniors and their families through this process, helping them to protect their savings and to receive the benefits and care to which they are entitled. We do this both through advance planning with clients in good health or who have just been diagnosed with an illness and through crisis planning with families of seniors who are hospitalized or in a skilled nursing facility, in need of immediate long term care solutions.

Many hardworking Americans facing the prospect of long-term care may eventually rely on Medicaid to pay for some or all of the cost of care. Many mistakenly believe that Medicaid planning is unnecessary or unfair to taxpayers, although hardly anyone questions the value and legitimacy of tax planning. The truth is, Medicaid planning is no different from tax planning. Medicaid planning seeks to utilize the available laws that exist to allow persons facing long-term care basic dignity and to protect their spouses from impoverishment. Proper Medicaid planning can not only save the your money in the long run but also ensure the best possible care. There are always more opportunities for those who plan ahead, but there may still be options available even at the last minute.

The Medicaid application process is not as simple as filling out the application form. The applicant must establish eligibility by providing verification information to the satisfaction of the caseworker. The applicant has the burden of proof with convincing evidence that the applicant is entitled to the Medicaid services. It can be daunting and time consuming to see the process through to a successful resolution. Without the knowledge of the Medicaid rules and how the Medicaid bureaucracy work, the applicant is defenseless against mistakes and miscommunications, resulting in delays and denials. Weppler Law Office PLLC prepares and submits the Medicaid application and all required verification documentations to the Department of Home and Community Services (DSHS). We handle all communications with the DSHS, thereby removing the individual as much as possible from the tedious and often frustrating application process. We ensure each application is handled efficiently, promptly and correctly, resulting in a timely approval. In addition, we identify and address all related legal issues that are crucial to obtain and maintain Medicaid eligibility.

Our job does not simply end with the approval of the Medicaid application. Proper follow-up is crucial to maintain continued eligibility and to avoid or minimize estate recovery. Unfortunately, many individuals are unaware of these traps. At Weppler Law Office, PLLC, we inform and remove these traps for our clients.    

If you handle your applications on your own or with the assistance of an unqualified helper, your application may be denied. If your application for Medicaid is turned down, you have the right to appeal the denial and ask for a fair hearing. You must file a Notice of Hearing within the deadline, and you should consult with an Elder Law attorney with experience in handling Medicaid appeals, such as June Weppler, as soon as possible.

Unlike staff and social workers at hospitals and care facilities, we have a duty of loyalty only to our clients. Our goal is to advance our client's interests and needs, which may, at times, conflict with the financial interest of a particular facility. We have the specialized knowledge and experience to not merely guide the client to achieve the best outcome but also effectively advocate the client's rights to preserve the client's assets as allowed under the law.

1. Not consulting with an attorney due primarily to the cost. The truth is, legal help is a lot less expensive than paying for care privately. In Washington, nursing homes generally charge more than $10,000 a month. At stake can be a lifetime of hard work, savings, and financial burden on your loved ones. Undoubtedly, the savings far outweigh legal costs. 
2. Assuming that your application process will be simple and easy: Certainly, public benefits should be available to those who qualify without having to resort to hiring an attorney. Unfortunately, this aspiration and the reality of the Medicaid rules are far apart. The eligibility requirements are defined in a conflicting set of state and federal laws, regulations, bulletins, and practices that make it impossible even for attorneys to fathom unless they specialize in the field. Your case may be simple and may not require the depth of knowledge needed to plan for a more complicated estate. However, you can’t be sure of that without first meeting with a specialist. Again, a lot is at stake and given the cost of long term care, it is not difficult for a qualified attorney to save the client more than the attorney’s fee.
3. Relying on advice and assistance of unqualified individuals: Yes, some nursing home provides application assistance at no charge. Some financial advisors selling annuities and burial policies also provide assistance for slightly a reduced fee. In the majority of cases there is no risk in using these services if you have checked it out with an attorney ahead of time. But there is a great risk to using these services without first consulting an elder law attorney. We have seen countless examples of incomplete or improper advice leading to significant lost planning opportunities for our clients, no matter how well-intentioned the advice giver may be. Rectifying the situation may cost more in legal fees than would have been the case with a proper plan. In any event, the nursing home and the resident’s family often have conflicting interests since their private-pay rates are substantially more than they receive in Medicaid reimbursement. In other words, every month that a resident pays privately rather than receives Medicaid coverage is additional money going to the nursing home and less preserved for the resident’s spouse and family.  Likewise, those who sell financial products are not completely free from their financial interests in the eligibility planning process. In addition, to the extent the application raises legal issues (and it often does), it makes sense to have an elder law attorney prepare the application and advocate for you in the process. This would be the case, for instance, if a trust were involved or if you were seeking an exception to the usual penalties for transferring assets.
4. Assuming that you are too well off to qualify for Medicaid: Medicaid serves a number of different populations, including poor recipients of Supplemental Security Income (SSI) and Aid to Families with Dependent Children (AFDC). No one would argue that when Medicaid was created that it was meant to be the main system of paying for long-term care for older Americans. But in the absence of any other program to fill that need, Medicaid has become the nation’s long-term care financing system by default. Medicaid rules protect many seniors who would have been otherwise financially secure but for the high costs of long term care. Congress can change the rules, and often does. Consulting with an attorney permits seniors and their families to understand the rules as they are and the options available to them. It does not require them to take any particular steps. It can be vital to preserving the financial security of a healthy spouse continuing to live at home.