Is it advisable to see an elder care attorney to help with Medicaid or Medicare benefits for assisted living/ nursing home?

The sooner you talk with an Elder Law Attorney, the sooner you will have a clear understanding of the care resources and payment sources open to you, as your father graduates to higher levels of care.

His life savings can be directed to pay for care that he needs to stay in the least restrictive setting, and can also be allocated to pay for the valuable services you provide to him. If you establish a Caregiver Agreement now, payments to you could be accepted by Medicaid as valid transfers, if he applies for eligibility in the future.

An Elder Law Attorney in your state can explain the Medicaid regulations that are relevant to you, and make you aware of programs that can supplement his private payment for services.

If you wait until a nursing home admission is required, the facility business office might offer Medicaid application preparation service at no charge. But the application preparers work for the facility (not you) and they have no duty to make sure your father's interests are first priority.

Since private payment rates are higher than the Medicaid rate, a facility paid application prep service does not have an incentive to protect what remains of your father's life savings.

It depends. When my mother went into a nursing home, their financial department handled everything and got her approved with 3 months. Getting an attorney would have been a waste of money. But, if things start happening that cause you dismay and confusion, by all means don’t hesitate to enlist the help of an attorney.

If he just has money in the bank and does not have insurance policies or own property, it should be an easy transition to Medicaid. The nursing home will help with the application as you spend down his assets to them. no need for an attorney. If he's a veteran, especially if he served during wartime, he may have access to veteran benefits though. You may want to have someone help you with that. Otherwise, no need for an attorney unless he has significant property, insurance policies or assets. I just went through this with my father.

Medicaid, usually, does not pay for AL. In my state, they may if u have paid at least 2 yrs of ur care. I would not go thru a NH for help. In my opinion, a Social Worker cannot possibly know all the ins and outs of Medicaid.

I had a lawyer because a house was involved and had two people living in it. Plus what the Township had it appraised at, there was no way I was going to get that if I sold. But I did all the work. Mom paid 2 months private pay to the NH, the 3rd month she was on Medicaid. You have to start the process 60 or 90 days before u need Medicaid. In that time you have to cash in any insurance policies that have cash value. Prepay a funeral helps with the spenddown. All paperwork needed has to be to them and facility found. If not done in 90 days, u have to reapply.

If this seems too overwhelming, then u may want a lawyer and Medicaid allows that out of Dads money.

Biggest factors in seeking attorney:
community spouse needing assets to support themselves not in care
gifting that may cause penalty
any jointly held property with family
any insurance policies that may need to be liquidated or NOT
family members that may have claim against Medicaid lien for providing care at home or qualifying disability
assets held in family trust that may not be Medicaid compliant
veterans that may not know of other programs they qualify for
family members that want to set up caregiver agreement to get paid by person without later Medicaid gifting questions and reporting properly
many people do it themselves. I would not perform my own surgery and sometimes the complexity is similar.

What does his doctor say about the level of care that he needs? Often nursing homes will help with the application for medicaid.

You really only need an attorney if there is a spouse and assets IMO. When there’s a spouse and assets, and issues that may affect the look back period, then applying for Medicaid is NOT DIY. You need an attorney. You can apply for Medicaid at your local social services offices, you’ll be assigned an eligibility worker who can explain everything to you and determine what you and or your spouse are eligible for. My FIL had no spouse and no assets and there was absolutely NO NEED for attorney. He had a Medi-cal eligibility worker and a VA social worker who took care of everything. But again, he was single and had zero assets other than a truck that wasn’t paid off yet. No house, no pension, nothing but a small social security check. If an AL/nursing home has already been picked then they may have staff that can help with this as well.