Michigan Medicaid Nursing Home Application


Ten Rules For A Successful Medicaid Application In Michigan

Do I need an attorney for the Medicaid application?

1. Have authority to apply for the nursing home resident. Unless you have a power of attorney that authorizes application for government benefits you may need to petition the probate court to be appointed the residents guardian and conservator. When it comes to maximizing the savings allowed by Medicaids loopholes probate court can be both unfriendly and very expensive. Contact an experienced elder law attorney about your alternatives. The attorney may first need to determine if the resident has the mental clarity or capacity to sign legal documents. If the resident does not have legal capacity then probate court may be the only option.

2. Be Able to Prove What You Say Get a copy of the Medicaid application and be sure you have written proof for virtually everything you write down. Failure to provide adequate documentation will result in dismissal of the application. Consider these points:

a. Medicaid requires proof of all income, that includes employment, pension, social security, investment, rental etc.

b. Medicaid requires proof of all assets, whether they be countable or otherwise. A rule of thumb is that countable assets are those that must be spend down to $2,000. Exempt assets need not be spent down. These include homestead , one vehicle, prepaid funeral arrangements for the applicant, within limits, and life insurance limited to a face value of $1,500.

c. Medicaid requires proof of all insurance.

All the best,

Apply And Qualify For Benefits Fast Or Appeal If You’ve Been Denied

  • Time is critical so you dont lose money. Also, eligibility for Medicaid is extremely complicated. Even the smallest mistake can lead to a denial that can take months or years to fix. A Medicaid Attorney is a trained professional who can make sure the application process is followed correctly in accordance with the law so you get approved for benefits quickly.
  • Working with a Medicaid Planning Attorney speeds up the application and review process and reduces stress because you know a professional is leading the way.
  • If you applied for benefits before and were denied, all is not lost. A Medicaid Lawyer can help you with a Medicaid appeal so you can get the benefits you need to pay for your loved ones care.

Michigan Medicaid Frequently Asked Questions: The Single Nursing Home Resident

Note: this article is based on the hypothetical situation of a child applying for Medicaid for a parent who is in a nursing home. The comments below may be applied to other situations. In any case you must first have the authority to take any action described below. A complete elder law not estate planning power of attorney should give you the authority you need.

A family member is in a nursing home and is on private pay. Can we save any of the money?

Yes. Medicaid is the result of laws that Congress passed. It surprises some people, but the law does provide for asset protection. Like the income tax, Congress left ways for a person to save money in the Medicaid law. A Single applicant can save 60 to 90% of assets. Medicaid will pay the bill after the resident has spent down his or her money to $2,000.00. We help you save as much as we can out of the rest. You have probably heard you cannot save anything, it must all go to the nursing home. Many people are free to give advice. But, are they attorneys? Are they responsible if they give you wrong advice? Have they gone through law school and sat for a bar exam? Have they taken the extra step to be tested and certified as an elder law attorney? Can you sue them for malpractice if they are wrong?

How can you save money from going to the nursing home?

Even if your loved on is in the nursing it is not too late to act. Heres how:

Michigan Medicaid Annuity

Esoteric Michigan Medicaid Strategies

Does Medicaid Mean Poor Care?

Also Check: How Much Does Medicaid Cover For Childbirth

What Is The Program Of All

The Program of All-Inclusive Care for the Elderly is a program for people over age 55 who need nursing facility level of care. The goals of this program are to enhance your quality of life and autonomy, maximize your dignity, enable you to live in the community for as long as possible, and preserve and support your family unit.

When you are a PACE participant, you have an interdisciplinary team that coordinates all of your services, including Medicare, Medicaid, and other services. Your team will assess your needs, develop a plan of care, and monitor how your services are being provided. Usually, PACE organizations provide social and medical services in an adult day health center and also provide necessary home and other services.

Services must include, but are not limited to:

  • Adult day care that offers nursing, physical, occupational and recreational therapies, meals, nutritional counseling, social work and personal care

  • All primary medical care provided by a PACE physician familiar with the history, needs and preferences of each beneficiary

  • All specialty medical care

Preserve Wealth And Plan For Incapacity

Michigans Medicaid Waiver
  • A Medicaid Planning Attorney can help you create Estate Planning documents to protect your assets and preserve your wealth so that you can pass your legacy on to your children.
  • A Medicaid Planning Attorney helps you plan for incapacity with documents like Financial Power of Attorney, Medical Power of Attorney, and Living Will so that designated family members can manage the finances and care of their loved one receiving long-term care.

Protect Your Home And Life Savings From Nursing Home Costs While Getting The Benefits You Need To Pay For Care

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Why You Should Do Medicaid Planning For Long

Most people engage in Medicaid Planning to protect their assets while ensuring they are eligible for Medicaid. This helps relieve the financial burden and can preserve the familys wealth by making sure that there are assets left to pass on to the future generations instead of losing it all to pay for nursing home costs.

However, one must be eligible to apply. With state and federal governments frequently changing eligibility rules and regulations, the application process is usually complicated for non-professionals. Even the smallest error on an application can result in a denial, or can delay the applicant from receiving benefits for weeks, months, or even years. This means you will have to pay for long-term care out of pocket. A Medicaid Planning Attorney can make sure your assets are properly structured to qualify for benefits and that the application process is done right the first time.

Home Health Care And Assisted Living

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    Updates In Michigan Present A Prime Opportunity For Local Agents

    As Marketing Director, Amy is responsible for all company communications and ensuring our clients have the most accurate and up-to-date information. In addition to her communication expertise, she has prior experience as a paralegal and a Krause Benefits Planner.

    Disclaimer: With Medicaid, VA, and insurance regulations frequently changing, past blog posts may not be presently accurate or relevant. Please contact our office for information on current planning strategies, tips, and how-to’s.

    This month, the Michigan Department of Health and Human Services made a change to its Medicaid eligibility rules that affects how senior clients can find financial relief from a nursing home stay. However, Michigan attorneys should not fear, especially if they have agents like you on their side.

    Residents May Be Charged For:

    What are the Michigan Medicaid Eligibility Guidelines/Requirements?
    • Private room, unless medically needed
    • Specially prepared food, beyond that generally prepared by the facility
    • Telephone, television, radio
    • Personal comfort items including tobacco products and confections
    • Cosmetic and grooming items and services in excess of those included in the basic service
    • Personal clothing
    • Gifts purchased on behalf of a resident
    • Flowers and plants
    • Social events and activities beyond the activity program
    • Special care services not included in the facility’s Medicaid payment

    Also Check: Medicaid Cost Sharing With Medicare

    Michigan Home Help Program

    Seniors who prefer to age-in-place and receive care services in their own home may consider the Michigan Home Help Program, which operates similarly to the MI Choice Waiver. Seniors who require assistance with their activities of daily living may participate in the Home Help Program to receive Medicaid coverage for in-home personal care and housekeeping services.

    Individuals who currently reside in nursing homes may not qualify for the Home Help Program. The program is designed to help seniors remain in their private residences for as long as possible without being institutionalized, therefore a nursing home resident may not use the program to relocate from their facility into a residential setting.

    The Home Help Program operates using Michigans Cash and Counseling model, allowing participants to select their caregivers. They may select anyone to provide their care, including family members or close friends. The person who is selected to provide care may be paid for their services through the Home Help Program, although they may not be paid as much as a caretaker working for a facility. However much a caretaker is paid depends on the county in which they provide service.

    Additionally, an applicant must meet the asset and income requirements for Medicaid to qualify for the Home Help Program.

    What Is The Medicaid Waiver Program

    What the Medicaid Waiver Program does is let you use the same money you would have used for nursing home care to live at home. However, Medicaid will only pay for in-home care if you are able to get it for a lower cost than what would be offered in a nursing home. An elder law attorney Grand Rapids Mi can help you determine if the Medicaid Waiver Program is feasible for your region.

    Also Check: Having A Baby On Medicaid

    Contesting Adverse Decisions By Medicare

    • Medicare Appeals. U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services.

    • This handbook, written in easy-to-understand language, includes detailed information about the process to contest or appeal Medicare decisions with which you disagree.

  • Self Help Packets. Center for Medicare Advocacy.

  • The Center for Medicare Advocacys self help packets are fantastic resources to help you to handle your own Medicare appeals.

  • Can You Tell Me About The Home Help Program In A Nutshell

    Iowa Medicaid Critical Incident Report printable pdf download

    The Home Help program provides unskilled personal care services to help people who have certain limitations to function as independently as possible.

    The Home Help program is run by the Michigan Department of Health and Human Services . If you are interested in and/or enrolled in Home Help, you will be working with a DHHS employee called an adult services specialist.

    To be eligible for Home Help, you must:

    • Be eligible for Medicaid

    • Have a certification of medical need for personal care services from a Medicaid-enrolled doctor, nurse practitioner, or therapist

    • Need at least some direct assistance with one or more of the following things:

    • Eating

    • Mobility

  • Have an appropriate level of care status

  • You are not eligible for Home Help services if you have a spouse who is able and available to provide the services. Your spouse is considered unable if he or she has his or her own disabilities that prevent him or her from caring for you. Your spouse is considered unavailable if he or she is away from your home for an extended period because of something like work or school.

    YourDHHS adult services specialist will come meet with you in your home to assess whether and how much help you need with the things listed above.

    Home Help can help you with the following things:

    • Eating
    • Light housework
    • Shopping and errands

    There are some things Home Help cannot help you with, including:

    • Transportation

    • Home-delivered meals

    • Adult day care

    Don’t Miss: Medicaid Point System For Braces

    Take Advantage Of This Opportunity

    If youve been looking to grow your referral network, its a great time to connect with Michigan attorneys to let them know you can offer a solution for their crisis planning clients. Now that a common strategy is no longer viable and with the favorable beneficiary rules in Michigan, there is no better time to provide Medicaid Compliant Annuities as a solution to attorneys and their clients.

    Overview Of Medicaid For Long

    The cost of senior care is a concern many individuals as they age. Many wonder how they will afford long-term care services once they can no longer care for themselves independently. For thousands of low-income and medically needy seniors in Michigan, Medicaid is a viable option to make long-term care more easily accessible.

    Long-term care is an expensive investment, with nursing homes, in-home care services, and assisted living facilities having a median cost of $21,500 – $103,295 per year in Michigan. To offset some of these costs, Medicaid offers coverage for certain types of long-term care for those who financially and medically qualify.

    Those who prefer to receive long-term care services in their home may qualify for coverage through one of Michigans Medicaid Waivers. Participants of Medicaid Waiver programs may qualify to receive alternative types of long-term care to help them age in place and avoid being institutionalized.

    Medicaid is funded jointly by Michigan state and the Federal government. Michigans Medicaid program must operate within the federal governments guidelines, however the state may make their own decisions within the federal rules.

    The Federal government pays the largest portion of Michigans Medicaid budget by far, and is responsible for 73.1% of the states Medicaid funding. The state government funds the remaining 26.9% of Michigans Medicaid budget.

    A person may be eligible to receive Medicaid for long-term care in Michigan if they are:

    Read Also: Assisted Living In New Jersey That Accepts Medicaid

    What Does This Mean For Agents In Michigan

    Michigan attorneys may be fearful that their go-to crisis planning strategy is no longer an option. Fortunately, a Medicaid Compliant Annuity is the perfect alternative. This annuity converts a couples excess countable assets into an income stream for the community spouse, allowing the institutionalized spouse to qualify for benefits.

    Agents in other states may be aware that MCAs typically must name the state Medicaid agency as a primary beneficiary on the annuity. However, Michigan does not have this requirement when it comes to MCAs purchased in the name of the community spouse. Thats rightthe state Medicaid agency does not have to be named a beneficiary in these cases. Its the definition of a win-win situation.

    Problems In An Adult Foster Care Home Or Home For The Aged

    What is Michigan Medicaid spend down?

    If you have a problem with the staff, other residents, or visitors in your adult foster care home or home for the aged or any other problem you have a number of options available to you. Depending on the problem you have, some of the options discussed here may be more appropriate than others. You can also consider doing more than one of the things listed here at the same time.

    1. Document the problem and any specific incidents. This will make a record of what happened and could be helpful if youre taking some of the other actions listed below.

    2. Talk to the state or local long-term care ombudsman. Long-term care ombudsmen are advocates for residents of long-term care facilities and other licensed settings and help them deal with any problems that arise in those settings. They can help you with many if not all of the other actions listed below.

    3. Talk with a staff member at the adult foster care home or home for the aged, or someone in the homes administration to try to fix the problem. The home may be willing to work with you to fix the problem.

    4. File a complaint or grievance with the adult foster care home or home for the aged. You have a right under state law to present your grievances to the staff at your adult foster care home or home for the aged.

    Recommended Reading: Does Medicaid Cover Hearing Aids In Ohio

    The Estate Recovery Law

    Under the law, the states estate recovery claim will only be presented in probate estate administration. There will be no liens prior to death on homes. There are two points that should be made up front:

    First, estate recovery may be avoided if the recipient has taken steps to avoid probate.

    Second, if a Medicaid recipient has died and there is no property to go through probate then any contact from the Michigan Department of Community Health about an estate recover claim can be ignored.

    What if the Medicaid recipient did not take steps to avoid probate? There are limitations and exemptions built in Michigans estate recovery law.

    The homestead is exempt if it is occupied by the spouse, disabled or minor child or a relative who for two years or more provided care sufficient to postpone entry into the nursing home. It will be exempt if a sibling co-owner lives in it.

    Farms, businesses and other income producing property are exempt if they are the primary source of income to the survivors.

    Dependents may make a hardship claim with the state where value of the home is below 50% of the average price of a home in the county. Note the state takes the position that this claim must be made in response to its letters and the claim may not be made in probate, nor does it apply if the home is sold. If sold the state will go after the money no matter how little.


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