When your loved one first enters the unfamiliar waters of long-term nursing home care, the journey may seem smoothly charted under Medicare’s coverage. But choppy seas loom on the horizon. After just 100 days adrift, the Medicare vessel runs aground, leaving families stranded without ongoing support. As savings rapidly drain away, many turn in desperation to the only vessel that can rescue them – Medicaid’s less luxurious but steady ship.
Yet safely boarding the Medicaid boat is no easy feat. Applicants must navigate a gauntlet of tricky eligibility requirements and documentation demands that threaten to capsize even the most seaworthy crew’s efforts. Without an experienced first mate well-versed in this taxing transit, you may find your application taking on water.
This guide will illuminate five of the most treacherous straits applicants face when navigating the stormy passage from Medicare to Medicaid. We will also chart a course through case studies to demonstrate proven strategies for smoothing the hazardous sailing ahead. Keep reading to learn how to successfully transition between these two crucial coverage programs and reach safe harbors.
The Ghost Ship of Medicare – Vanishing After 100 Days
Maryland mariners reliant on Medicare’s reliability are often shocked when coverage evaporates after only 100 days in a skilled nursing facility. Designed for short rehabilitation stays, not long-term care, Medicare pays the full cost for just 20 days. Out-of-pocket coinsurance payments then steadily rise until coming to a crest at day 100, when benefits completely disappear.
Families are left blindsided, with ongoing care still required but no assistance on the horizon. As Captain John of Anne Arundel County discovered, his mother Susan quickly ran through her 100 Medicare-covered days after entering a nursing home following a stroke. On day 101, Medicare terminated, and the facility informed him he must fully shoulder the $115,000 yearly cost himself.
The key is being prepared well in advance for Medicare’s rapid retirement. Consult navigational charts like medicare.gov to understand exactly when you will hit the 100-day limit. Then begin the journey over to Medicaid with ample time to reach approval before Medicare washes out.
The Bermuda Triangle of Assets
Successfully crossing over to Medicaid demands sailing under strict asset limits that many ships flounder against. In Maryland, individual applicants can only have $2,500 in countable assets, excluding certain exemptions like homes and cars. For married couples seeking coverage, one spouse can only have $137,400 while the other preserves joint resources.
But accurately documenting and allocating resources between spouses is a true maritime mystery. Like the eerie Bermuda Triangle where vessels mysteriously disappear, assets can sink out-of-sight during the application process if rules aren’t followed properly.
When 77-year-old Sailor Gary of Silver Spring prepared his application, he made the common mistake of not correctly distinguishing assets between himself and his still-healthy wife Landlubber Linda. When asked to account for $165,000 in retirement savings, he claimed it fully as his own. This immediately torpedoed his eligibility, leaving the couple devastated.
The key is to clearly chart each spouse’s respective ownership of all resources from the start, seeking legal guidance to avoid traps. Transparency and accuracy are essential to traverse these dangerous waters.
The Doldrums of Documentation Deadlines
Succeeding with Medicaid requires assembling an armada of financial statements, medical assessments, and identity verifications within fixed timeframes. For 73-year-old widow Claire of Easton, this demand overwhelmed her. Her application foundered in the doldrums for months as she struggled compiling tax returns, bank records, and physician approvals solo.
Missing deadlines results in costly delays that can completely scupper eligibility. Beating the clock takes diligent preparation, organization, and decisive action. Start gathering materials the minute you set sail toward application. Create detailed checklists and files, seek help preemptively filling any gaps, and submit your sealed application packet well before expiration. Tick tock – don’t let the clock run out!
The Maze of Medicaid Rules
Maryland’s Medicaid guidelines form a tangled maze of clauses and provisions that applicants must carefully navigate to avoid running aground. Complex regulations around asset division, income sharing, and transfer penalties perplex many voyagers.
Sailor’s Alan and Margaret of Towson saw their journey quickly capsize when they misunderstood the rules about gifting assets prior to Medicaid. On their attorney’s poor advice, they transferred $175,000 to their grandson Lewis a year before applying, triggering a multi-year penalty period.
The keys are consulting accurate maps of the Medicaid maze and securing an expert first mate to guide you. Work with an experienced elder law attorney from the start to chart a course that aligns with all applicable rules. Having the right navigator can make all the difference.
The Wrong Route to Application
Maryland’s Medicaid application itself spans 12 lengthy sections and over 40 pages. Subtle mistakes anywhere along the way can steer applicants irretrievably off-course. 68-year-old unmarried sailor Bartholomews’ journey foundered when he applied as a married man, failing to first change his status after his wife Patricia’s recent passing.
The solution? Carefully plot each turn one-by-one using pre-voyage planning tools. Review the application layout in advance and collect every piece of required data. Take your time filling out each section accurately. Ask an expert to double-check your headings before setting sail. With good charts and patience, you can stay on course.
Set a True Course to Medicaid Approval
The passage from Medicare to Medicaid is beset by obstacles, but you can reach safe shores with smart preparation. Begin your travel early, assemble a complete crew, and steer steadily toward completion. Keep your keel even, your sails trimmed, and success will soon be on the horizon. Let Medicaid’s sturdy vessel provide safe passage to the care your loved one needs. Bon voyage!
Ready to begin your voyage on your way from Medicare to Medicaid? Schedule an appointment with one of our attorneys, now.
By: Jeffrey D. Katz, Esq., Managing Partner, JDKatz, P.C.