WHAT ABOUT CITIZENSHIP?
As of July 1, 2006, anyone applying for or receiving Colorado Medicaid will need to prove that they are either a U.S. citizen or national, or a qualified alien. Such proof must be made at the time of applying for Medicaid for the first time, or upon the first re-determination of eligibility (which is done once a year following initial approval) for those already receiving Colorado Medicaid benefits. It is only done once per person. Proof may only be made by one of several documents. Give us a call at (303) 409-3578 for a complete listing.
WHO PAYS THE NURSING HOME BILLS DURING THE APPLICATION PERIOD?
Once you apply for Colorado Medicaid, the nursing home where you are staying may not make you pay the nursing home bill until the application process is complete and you are determined to be eligible to receive Colorado Medicaid. They call this “Medicaid pending.”
If you are approved, the nursing home would then be able to apply to Medicaid for the back charges. If you are denied and then appeal the denial, the nursing home may be able to charge you for the period of the appeal process. If, however, you are ultimately approved for Colorado Medicaid, the nursing home will have to refund your family all of the charges they’ve received from your family during the appeals process.
Since it can be difficult and time-consuming to get the nursing home to refund money you already paid them, you should always hold off on paying them during the initial application process. Remember, you are not responsible for paying the nursing home during your application process. By law, the nursing home just has to wait.
RETROACTIVE COLORADO MEDICAID BENEFITS
It’s possible to apply for Colorado Medicaid coverage for a period beginning up to 3 months before the date of an application. If the applicant would have qualified for Medicaid as of such date that he or she applied at such time, then the applicant would be covered starting on such date. You can even get coverage as of the first day of that month.
For example, if you thought you would not qualify for Medicaid for several months and then found out you actually could have qualified, you could apply for Colorado Medicaid immediately and ask for coverage going back up to 3 months. Unfortunately, the period of time before the 3-month date will not be covered by Medicaid even if you could have qualified had you applied back then.
Even though this is tricky, it is very important to apply as soon as you think you are qualified. Once the 3-month retroactive window closes, your family may wind up having to pay privately for care when you could have gotten Colorado Medicaid to pay all of your nursing home bill.
Therefore, if you are thinking seriously about applying for Colorado Medicaid, give us a call asap and we will help you work through the crazy maze of rules.
WHERE TO APPLY FOR COLORADO MEDICAID?
Go to the blue government pages in your phone book and look under the listing for either Human Services or Social Services for your particular county. Yes, you need to go to your county listings, not the state Colorado listings.
The application form you will get requires that you list your current income and assets. You will also need to gather your bank account records, going back 6 months (and sometimes longer, depending upon your county’s requirements). The Colorado Medicaid technicians are looking closely for gifts you may have made. Some states even make you produce a copy of every check you have written over the last 5 years! Checks written for Christmas gifts, Easter gifts, birthday gifts, church donations or other charitable gifts could be cause for you to be disqualified. Gifts that were made exclusively for a purpose other than to qualify for Medicaid may be ignored. This is tricky business, however, and will cause issues anytime you apply for Colorado Medicaid. We advise our Colorado Medicaid applicants to start gathering the necessary information far in advance of an application. We have a complete checklist of documents we give our clients so they know exactly what to gather up before we file.
If you or one of your family members are ready to make application for Colorado Medicaid benefits, give us a call and we will give you a game plan to follow so that there will be minimal delays in the application process and the minimum loss, if any, of valuable benefits.
WHEN AND HOW TO APPLY FOR MEDICAID
Although when filing for Colorado Medicaid, it is permissible to apply for benefits for the period starting up to three months before the date of application, you cannot go back any further than that. Therefore, it makes sense to apply as soon as you are sure your family member can qualify.
Applying for Colorado Medicaid too early, however, can be an expensive mistake if gifts have been made that affect eligibility. Most gifts made by the Medicaid applicant and/or spouse can cause a period of disqualification if either or both of them apply for Medicaid within five years of the gift. Applying before this five-year “look-back period” has expired can cause a huge increase in the penalty period.
Here’s an example. Let’s assume John made a gift to his children of his house worth $250,000 on March 1, 2006. If John waits until March 1, 2011, to apply for Colorado Medicaid, there will be no period of disqualification because his gift was made outside of the five-year look-back period; however, if he applies for Colorado Medicaid on February 1, 2011 he could be disqualified from receiving Medicaid coverage for approximately 40 months!
Subject to some exceptions, the general rule is never to apply for Colorado Medicaid benefits until you’re sure your family qualifies. If gifts have been made within the last 5 years, the opinion of an experienced Colorado elder law attorney should be sought before actually applying for Medicaid to make absolutely certain that the time is right to do so.
My next blog will discuss where you go to apply for benefits.
DOES MEDICAID PAY AN ASSISTED LIVING BILL?
In most states, including Colorado, it is possible to have Medicaid pay for certain services even if you are living in an assisted living facility. The facility, however, must be “Medicaid certified, “so you will want to make sure about that when you are searching for a facility to move in to. Keep in mind, however, that the facilities cost of basic room and board will not be paid for by Medicaid as it would be if you resided in a nursing home.
If you are in an actual nursing home, Medicaid will pay the full cost including room and board. Be aware that not all facilities accept Medicaid payments. This is extremely important to know before you sign up for a nursing home. While it is against the law for a nursing home to evict you because you ran out of money and must go from private pay status to Medicaid, this protection does not apply if the nursing home does not accept Medicaid from anyone. So, be certain to ask. It is very upsetting to the nursing home resident to have to relocate from one nursing home to another after finally accepting the fact that they are in a nursing home for good, but have gotten used to the routine, made friends and become acquainted with the nurses, etc. Having a skilled Colorado elder law attorney and/or and experienced geriatric care manager will help the search for a facility make sense for everyone’s needs and budget.
YOU CAN GET CARE IN YOUR HOME
If you are living in your home, Medicaid calls you living “in the community.” Medicaid will pay for certain services in your home if you qualify. Many states, as in Colorado, have a program called “HCBS,” which stands for “home and community based services.”
HCBS will pay for the following in-services:
• Case management
• Personal care services
• Respite care services (which means care for the patient in a nursing home for a few days so that the home caregiver can get a break)
• Adult day health services
• Homemaker and home health aide services
• Habilitation (which means assistance to people to help with mobility, social interaction, self care, basic safety skills, housekeeping, personal hygiene, healthcare and financial management)
The Colorado Medicaid program now allows folks who are in a nursing home the option
of living in a regular home and away from the institutional setting. They will get the
same level of care as they would have gotten in the nursing home and still be covered by Medicaid to help pay the cost of the in-home care. This is a wonderful option that is relatively new for Colorado Medicaid beneficiaries.
WHAT DOES MEDICAID COVER?
Once approved for Colorado Medicaid, virtually all of your medical bills are paid by the program. This includes prescription drugs, hospital stays, nursing home care, etc. Medicare may overlap this coverage, but one way or another, your medical bills will be paid. There are folks who are receiving both Colorado Medicaid and Medicare. They are known as “dual eligibles.” Prescription drugs, formerly paid for by Medicaid, will now be paid for by Medicare part D.
Here’s a list of services that the federal law says all states must offer:
• In-patient hospital services
• Out-patient hospital services
• Physician services
• Medical and surgical dental services
• Nursing home services for folks 21 or over
• Home health care for folks eligible for nursing home services
• Lab and x-ray services
• Family nurse practitioner services
The following services are optional, but most states offer them:
• Ambulatory services to individuals like to folks entitled to institutional care
• Home health services to folks entitled to nursing home services
• Prescription drugs
• Optometrist services and eyeglasses
• Prosthetic devices
• Dental services
• In-home assistance
Medicaid is an amazing present that helps a surprising number of our citizens get the care they need and deserve. Unfortunately, Medicaid can make it extremely difficult to qualify for these services. We will discuss these challenges over the next several blogs and show you why the help of an experienced elder law attorney is critical.
WHAT THE HECK IS MEDICAID AND WHY THE HECK SHOULD YOU CARE?
Medicaid is a joint federal/state program for the medical care of certain needy people within Colorado and the other 49 states. The main emphasis of our elder attorneys is on the payment of nursing home bills. Although established by federal law, the Medicaid program is, for the most part, administered by the separate states. The cost of running the program is shared by the feds and the states, with the feds paying about half the cost.
What makes this area of the law so complicated is that under the federal laws there are many options given to the separate states as to what they will pay for and who is entitled to coverage. As a result, you have 50 different versions of the Medicaid rules with each state selecting a different combination of options. Each state interprets the same Medicaid laws differently. What a disaster. This mixed up mess leaves the residence of each state, including the elder law lawyers in each state, scratching their heads trying to figure out what they can and cannot do to qualify for Medicaid coverage.
Unfortunately, you cannot simply ask the government for an advance ruling or interpretation on certain procedures like you can with the IRS. That problem forces you to try something first and hope for the best. If you’re challenged by the state Medicaid office, you can appeal their interpretation if you disagree with it and even take them to court. Of course, very few people are willing to do that because of the significant expense and hassle involved in lawsuits. So, that leaves you relying on your best guess of what you and your Colorado elder law attorney thinks the state rules actually are.
BEWARE OF THE NEW POWER OF ATTORNEY LAW
As of January 1, 2010, we have a new power of attorney law in Colorado. This new law has two main purposes. One is to make it more difficult for folks to give their agents certain “hot powers” covering several sensitive areas. The other is to make it easier for the law to come down on and punish agents with powers of attorney when they abuse their powers and take advantage of their principles. All of this is good, but will cause some short-term problems.
As with any new law, there is always confusion. We had a case the other day in our office where a bank refused to accept our client’s old power of attorney, saying that the old power of attorney was no longer valid since there was a new power of attorney law that went into affect at the first of the year. That is simply not the case, and we had to spend an inordinate amount of time working with the bank and its legal counsel to persuade them that the old power of attorney was just fine. In other words, just because we have a new power of attorney law does not mean that your old power of attorney is invalid. It just means that any new power of attorney should be drafted in accordance with the new law so that it will be more readily accepted by financial institutions, including credit unions, banks, title insurance companies, hospital administrators and securities firms.
If you haven’t updated your power of attorney in the last three or four years, now is the perfect time to do so. Call Diana in our office at (303) 409-3563 if you would like to schedule a time to discuss this issue and review your other estate planning documents, as well.