Medicaid Explained: What Families Get Wrong (And What It Actually Covers)

Medicaid is one of the most misunderstood programs in healthcare.

And for families navigating long-term care, that misunderstanding can be costly.

In Part 2 of our Medicaid deep dive, we sit down with Lisa to break down the biggest myths, mistakes, and realities families need to understand before it’s too late.

Because the truth is…

Many people assume they won’t qualify — and never even apply
Others wait until a crisis — and limit their options
And some rely on outdated or incorrect advice that can lead to serious financial consequences 

In this episode, we cover:

•  The real difference between Medicare and Medicaid (and why it matters) 
•  Why Medicaid does cover long-term care — and Medicare doesn’t 
•  The truth about income limits (and why “too much income” is often a myth) 
•  What “too many assets” actually means 
•  The reality behind the fear that Medicaid “takes everything” 
•  How the 5-year lookback works 
•  What a Qualified Income Trust (QIT) is and when you need one 
•  Why every Medicaid case is different (and why that matters) 
•  What happens if you get denied — and your options 
•  Why planning early can save families tens of thousands of dollars

One of the most powerful takeaways:

“An inheritance is not an entitlement.” 

This episode is essential for anyone caring for aging parents, planning for long-term care, or trying to understand how to protect their family financially.

For Mature Audiences Only is a podcast dedicated to real conversations, honest stories, and practical guidance for families navigating caregiving, aging, and senior living.

If this episode resonated with you, follow the show, leave a review, and share it with someone who may need support.

Presented by Archer Law Office https://archerelderlaw.com

Music provided by MIBE https://mibemusic.com/

Transcript

Welcome And Series Setup

Shannon 0:02

Welcome back to For Mature Audiences Only, presented by Archer Law Office, the podcast where we break down complex aging, caregiving, and elder care topics into clear, practical guidance that you can actually use.

Mary 0:14

We're your hosts Mary Shapiro and Shannon Johnson, senior resource specialists at Archer Law Office. And each week we sit down with trusted professionals to help older adults and caregivers navigate real life challenges with less stress and more confidence. If you're caring for an aging parent, supporting a loved one with a serious illness, or planning ahead for yourself, this is an essential conversation. This is for mature audiences only, presented by Archer Law Office. Let's get started.

Shannon 0:49

Lisa, thank you so much for coming back today and joining us for part two as we take a deeper dive into Medicaid. Um, so we're just going to jump

Medicare Vs Medicaid Basics

Shannon 0:57

right into it. So a lot of people confuse Medicare and Medicaid. In our first segment, we talked about what the difference is, but can you briefly talk about the purposes of why they're fundamentally different and why it's important to know the difference between the two?

Lisa 1:09

Sure. Well, first of all, thank you so much for having me back. I appreciate the opportunity. Okay. Medicare is generally offered only to seniors. There are some situations where that's not the case, but they are few and far between. So when you're talking about the difference between the two, again, Medicare is fully federally funded. You have the situation where it comes out of your social security.

Mary 1:40

Right.

Lisa 1:41

It kicks in when you're 65.

Mary 1:43

Right.

Lisa 1:44

You have to work a certain amount of they transfer it into points. So you work points, and when you reach 65, Medicare is a benefit that comes through Social Security. Medicaid is different in the sense that you apply for it. It Carl often refers to it as it's like Baskin Robbins. There's a lot of flavors. It's through the New Jersey Family Care Act. There's a lot of flavors to it. And it services a lot of different sects. And so it caters to a lot of different aspects, socioeconomic diversities. It caters to children. Medicare does not, it's not offered to children. Medicaid is offered to children. Here's the biggest difference between the two. Medicare does not cover any room and board. Right. So for the purposes of this topic that we're talking about, that is really where it hits home for what we do, for what we're talking about.

Mary 3:13

That was my first experience with Medicaid when I worked for hospice, was my only knowledge of it was knowing that it covered room and board if you were on Medicaid and a nursing home. Right.

Income Myths And The Real Cap

Shannon 3:26

A lot of myths out there. One of them that is that people think that they make too much money to get Medicaid or their income is too high to ever get it. Are either of those things true?

Lisa 3:35

Let's start with the easier one. Their income is too high. There is an income cap for Medicaid. There's something called a qualified income trust that comes into play. There used to be something called an income waiver where you had to do a couple of different things, but now there's a qualified income trust. We can talk about that later, but basically, there's really no such thing now as your income being too high. And yes, that actually causes a lot of people not even to seek Medicaid because they automatically think I make too much money in my income between my pensions and between, you know, what my annuities pay out and between my social security, I just make too much money. Not true. Unless your income exceeds your actual level of care. Now, if you're going into a long-term care facility, your level of care can actually be well over $15,000 a month. So, man, if you have an income that's sat high in your retirement or in your advanced age, good for you. Right.

Shannon 4:40

You're sitting pretty much.

Lisa 4:41

I want that secret. I know, I know, I know. And good for you because you've done something right. Right, right. And you listened to all those people that talked about how to plan for your retirement. But there really are things that the qualified income trust really helps take care of that. So don't ever discount yourself just because you think your income is too high. And that's why there are people out there that know a lot more about this that you should talk to.

Mary 5:07

That's why we're doing this. That's why we're doing this.

Lisa 5:11

That's why we're doing this. And and another favorite saying of Carls: do not ever confuse a Google law degree with an actual law degree. So now let's.

Mary 5:24

I'm sorry. No, I was gonna say that's like using WebMD and think you're a DM. Oh man. Yeah.

Shannon 5:29

Oh man. Yeah, when you're gonna do that. So worst thing you can do with FMD. Worst thing you can ever do.

Lisa 5:33

You have a cut on your finger and you automatically think you have like Wendangi fever. Yes, exactly. Yeah. So now let's talk about you have too much money.

Why “Too Much Money” Depends

Lisa 5:43

There there is truth to that. Maybe. So there's also a lot of different factors to that. You have too much money. There are mitigating factors to that. So you have too much money for what? So Medicaid says how much money the applicant can have. So there may be some things there that have to be done, like as far as spend down. But medical costs are really high. So how long is that money going to last you? And also what happens if you have a spouse? Because that spouse is going to need some of that money. So then what does that actually look like? And how does that money get split up? And what does that money get to be spent on? And how much of that money does the spouse get to keep and use for their survival? So again, we ask the question, what does too much money look like? And there are people that can actually answer that question. I may know a few of them. So those are questions that need to be asked.

Shannon 6:55

What would be considered too much money like that? Is there an amount? Is there a dollar amount that would be considered too much?

Lisa 7:03

Well, again, talk to me about what your debt is. Right. And what your don't talk to me, actually. Talk to somebody that's talk to somebody who knows a lot more than me. Um, but you know, you have to decide what's your debt, what do you owe, what can you pay off? Because when all of that is said and done, and too much money, or what kind of assets are we talking? How's that money being held? So are you considering what your house is worth too much money? Because if there's a spouse, Medicaid's not going to really care about that house unless it exceeds a certain number.

Shannon 7:35

Right.

Lisa 7:37

There's again, there's a there's a lot, there's a lot about this that needs to be kind of fished out and talked about.

Shannon 7:45

Absolutely.

Mary 7:46

There's no one fit answer. Yeah, I think that's what a lot of people, I know I get approached by professionals, family members, just looking for a blanket answer about it, Medicaid. What, you know, what does it cover? Am I eligible? But there are so many different, like you said, flavors and what are your debts? Like you really do need to talk to a professional.

Lisa 8:10

So can I just say one thing, Mary? You just said you need to talk to a professional. One of the mistakes that people make, they talk to people in their senior group, they talk to their next door neighbor, they talk to their cousins, nephews, aunt who did Medicaid for their mother. Remember the Baskin Robbins comment that I made? That also goes towards your Medicaid application, your husband's Medicaid application, your grandmother's Medicaid application that you're trying to navigate is not like anybody else's Medicaid application. Their assets aren't the same, their income's not the same, the process isn't the same, the county is not the same.

Shannon 8:49

Yeah.

Lisa 8:49

It's not the same time. The regulations aren't the same as they were five years ago. The asset limits aren't the same.

Mary 8:56

The There's always changes.

Lisa 8:59

There's always changes. I get people that say to me all the time, well, when my sister did this for so-and-so, she didn't have to do that. You're right. You're probably right. But when did she do it? How did she do it? What was that person's asset limit? What was that person's income? What was you can't do that. So people listen to other people talk about it and then expect it to be the same for them. Right. And I can guarantee you nothing is the same. So that is the worst place to get advice.

Shannon 9:28

Right. And I kind of feel like if you're if you're a client that's consulting our firm, you know, I feel like you're kind of better off not saying, well, my sister did it X, Y, and Z because we have our own order of operations for doing our own things here and while we've been so able to do it so successfully.

Lisa 9:43

Exactly. And sometimes they will even talk to somebody who is a retired attorney that did this 25 years ago.

Shannon 9:51

Right.

Mary 9:52

And things as we know are very different now. Right. Absolutely.

Shannon 9:54

And all acts like that. Yeah, absolutely.

Lisa 9:56

And we try so hard to be respectful to that 25-year retired attorney because they have a wealth of knowledge, but unfortunately, that knowledge is antiquated if this is what they're trying to advise you on in today's

County Differences And Caseworker Judgment

Lisa 10:09

world.

Shannon 10:09

I do want to ask you, touch on one thing that you talked about, it being county specific. We have offices in five different counties across the state. Does that play kind of a big part into someone's approval or disapproval of Medicaid? How different is it across the different counties in the state?

Mary 10:24

Are we? I was gonna say maybe that back up a little and just kind of rudimentary go through the process of an application, like the fact that it isn't just federal and it is state level as well.

Lisa 10:38

Right. So the regulations are the regulations. The regulations are also left up to interpretation.

Shannon 10:45

Okay.

Lisa 10:46

Interpretation by the county caseworker. So the regulations are federal and state regulations. And if I told you how thick the regulations are, I mean, you guys have actually been in my office. You've seen what that binder looks like. When I do these, when I do presentations in person, I bring the binder with me. So you've both seen what that binder looks like. When the application is put together, our office follows those regulations. And when we prepare the application, it's not just pushing paperwork. We actually work to make sure that we are to the best of our abilities following those regulations and making sure that our clients, the information that they've given us. And we also try to solve all the problems that we see with that application prior to that application being put in. Because if we don't do that, then what's the point? Right. That really is just pushing paper. We try to be proactive with that application, find things that we think the county, according to the regulations, are going to pick up on as an issue and see if we can find problems to that issue.

Shannon 11:54

Gotcha.

Lisa 11:55

And solve it, or at least find paperwork to lessen that problem or explain that issue, why it occurred before we put that in. So then it goes through to the county, and the caseworker does the same thing that we did, or we hope that they do. We hope that they do. And but again, it comes up to interpretation. So I'm gonna give you one example of something that happened with one of our clients. The client had checks, and they didn't cash the checks at all as the checks were given to them. They were rent checks that were being paid. And then all of a sudden, they cashed the checks. They were minimal checks. The county said that they actually were just cash the checks so that they could get on Medicaid. They were checks that were being written out, I think, from a family member. And we tried to explain: listen, the cash the checks are not in sequential order. They weren't being written out, you know, in sequential order. And I actually had to fight with them because they were like, oh, they were just trying to dump money. And I said, the client did not write the checks just to dump money for the purpose of Medicaid. They cannot help that the checks were held by the landlord and cashed all at once. That's not that's that was out of their control. And the caseworker was actually arguing. And I said, Okay, so you're arguing and the caseworker said, I'm a landlord, I hold a rental, and I cash the checks that I'm given immediately. And I turned around and said to the supervisor who I was arguing the case with, we actually have a tenant in one of the buildings that we own and I hold the checks because I'm not going to run to the bank immediately. And I hold the checks sometimes for four months because they're nominal and there's not, they're not worth a lot of money for me to just run constantly. We won the case because I just countered to what they said.

Mary 14:12

Right.

Lisa 14:13

And but that caseworker had influence. That caseworker kind of was arguing with interpretation. And that's one of the differences with having it. Now that goes county by county. And we could have a completely different outcome in another county. Right. Because it's the caseworkers have interpretation. They can they can make a stink about something that in another county they'll just let slide right through.

ABD Medicaid And Who It Helps

Shannon 14:41

Medicaid has a lot of different programs covering a lot of different situations. There are different types that cover folks like disabled, folks that are low-income, children. What kind of Medicaid are we talking about today? Or like what's the most often type to use that our target audience could benefit from today?

Lisa 14:58

Okay, so we're specifically talking about ABD Medicaid, aged, blind, and disabled. The client that we normally see are clients that are 65 or over, and that have met with some sort of a situation that comes with the what I like to refer to as aging like fine wine time of their life. I love that. And now they're in need of financial support because they have had to transition into some sort of long-term care or needing Medicaid assistance in the home, which is another type of assistance offered through the ABD program. So we're specifically talking for the purposes of this conversation about the aged, blind, and disabled program. The 65 and over. The 65 and over. We have done other types of Medicaid because unfortunately there are Alzheimer's and dementia, the different types of dementias, Parkinson's, the dementias that come with Parkinson's and things like that do hit, unfortunately. Even early onset now is hitting people in their 40s and 50s. So we do handle those types as well. But that we're talking specifically about the Age of Blind and Disabled program, which is usually 65 and over the

Financial Need Vs Medical Need

Lisa 16:26

Medicaid.

Mary 16:26

And I don't think people realize that Medicaid is two parts. That is correct. You have to qualify. Do you want to just talk about that a little bit?

Lisa 16:35

Sure. So the Medicaid program is, like you said, two parts. It is the financial part, which is what we're talking about today, because that's what we do. That is what most people that we're talking about when they think about Medicaid, think about. Correct. But there's also the medical need. And that is determined from the Office of Community Choice Options. And those two parts actually have to meet. They have to marry together in order for someone to be determined as needing the Medicaid program. So what I mean by that is you can need the money to be in a facility or to have the supports and services offered financially from Medicaid, but if you don't meet the medical criteria, you're not going to be able to receive those services. So if you need to be in a community simply because you're at that point where you can't really live on your own, you have no family in the area, and you need want to be in an assisted living because you just want to be around other people and you don't want to have your meals alone. And you want to be where you're safe and you can be watched because you really have no family in the area, but you don't have the medical need. You don't need the assistance medically. You're not gonna you're not going to be accepted on the Medicaid program just because you need the financial help.

Mary 18:11

And I don't know if a lot of people, your everyday average person listening to this even would realize.

Shannon 18:19

Are there any programs out there for those people? Like what do they typically do in a situation where you can meet one need but not the other?

Lisa 18:29

So I can't speak too much to that because that's outside of what I do, but I do know that when Carl has spoken to people like that, he will try to refer them to the Section 8 housing or things like that.

Shannon 18:44

Okay. Makes sense.

Mary 18:46

So can we

“Medicaid Takes Everything” Fear Explained

Mary 18:47

talk about? We hear a lot of Medicaid takes everything that they're gonna take mom's house. They wanna take everything that they have. She can only have $2,000. Can you make make that make sense for people or maybe clarify what they're address some of those fears, so to speak?

Lisa 19:07

So I will try. And I I have personal, I have a personal way to relate to this. Because anybody who's listened to part one when I came on the first time, this is kind of where I lived. So I sat on the other side of the desk with this one with my mom. And that is how I heard Medicaid explain to me. They take everything, they're gonna take your mom's house. Medicaid is not in the real estate business.

Mary 19:36

Right.

Lisa 19:37

They don't want anyone's house. Here is the truth about this, and this is now how I explain it to my clients. What Medicaid does at its core, when someone is accepted onto the Medicaid program, the government, which is Medicaid, is committing to paying for your loved ones' medical cost, their care, and their housing, if they are in a community, for the rest of their natural-born life. They're going to pay for their medication, they're going to pay for their medicals, they're going to pay for the roof over their head, they're going to pay for all of their needs. They're asking you to use your money first. Right.

Shannon 20:29

Imagine that.

Lisa 20:30

Imagine that. So they're not taking their house, they're not taking all of their money out of their bank, they're not asking you to take all of that and hand it to the government. They're just asking them to spend their money first. I don't think that's an absurd request.

Shannon 20:47

Yeah.

Lisa 20:47

No. And by the way, what else are they going to do with those things? Now, I have had people stand in front of me and say, but that's my inheritance. Okay. Harsh reality, an inheritance is not an entitlement.

Shannon 21:05

Oh, you can say that again.

Lisa 21:07

An inheritance is not an entitlement. I will say that again, Shannon, because that is one of the hardest truths.

Shannon 21:13

Absolutely.

Lisa 21:14

Okay. A lot of times, most of the time, our parents, our grandparents, they've worked to amass those assets. And they've saved them and they've amassed them to use for their future. Guess what? This is their future. And unfortunately, their future has resulted in them having illness and needing care. Right.

Shannon 21:38

I think we could do a whole show about how we all feel about that topic. Because we all feel very, very strongly about that. Yeah. Yeah. Absolutely.

Lisa 21:45

And so they need to use their money first. And we can all have our opinions about who uses the government money for what, where, when, and how. But the bottom line is they need to use their money first. And then after. After their money is spent on their care, the government will step in and their money, there they will put their money up and they will use their money. Here's the other thing I want to add to that. When your loved one transitions onto Medicaid, there is no change in their care.

Shannon 22:15

Right.

Lisa 22:16

There is no scarlet A on their on their chart that says they're on Medicaid. Right. Really, the there's only a couple of people in the facility, if they're in a facility, that would know that. And it's actually the business office and the director of nursing, just because she needs to make sure that the doctor that's taking care of them takes Medicaid as the insurance. Right. Along with all of the other insurances that the doctor takes, because Medicaid is just another insurance. Right. Sure. That's all it is.

Shannon 22:42

Absolutely.

Lisa 22:44

And so, no,

Asset Limits And Spousal Protections

Lisa 22:45

Medicaid does not take everything. You're just asked to spend everything on their care until there's nothing left. And then Medicaid steps in.

Shannon 22:54

So is there an asset limit that people are allowed to have once they're on Medicaid?

Lisa 22:57

The recipient, the Medicaid recipient is allowed to have $2,000 in assets.

Shannon 23:02

Okay. Is there any flexibility within that rule or the situations where different limits apply, such as married couples or certain other programs?

Lisa 23:09

Yes. I'm going to be left destitute. No, you're not.

Shannon 23:19

Right.

Lisa 23:19

You're not. No, you're not. You're just not. Right.

Shannon 23:22

That's right.

Lisa 23:23

Um, so Medicaid actually, there's calculations. Now, people come in and they're like, we have two million dollars. So that means that I can spend money down, but I get to keep at least half, right? I get to keep a million. Well, no, it's not quite like that either, because that's just not how it is. And so there's a calculation that is done and it's made, it's a formula, and there's a portion of it that the spouse gets to keep. Now, I will tease a little bit and say that if you seek help in the right place early enough, and you seek counsel by someone who knows what they're doing, you may be able to keep a lot more than you think you can.

Shannon 24:09

Okay.

Lisa 24:19

But there is a formula that no spouse is left destitute, no spouse is left at the poverty level or below the poverty level. It's I'm not gonna say fair, but that's why it's so important to be informed.

Mary 24:34

And again, we go back to going to a professional that can guide you through it, someone with legal knowledge to help you navigate all of this. That's why we exist. Yes.

What Happens To Monthly Income

Shannon 24:45

Yeah, absolutely. What will happen to that recipient of Medicaid's income monthly once they go on Medicaid in the facility?

Lisa 24:52

Really, really good question because that's what everybody wonders. So let's talk about if that person is not married. If that person is not married, their income, with the exception of something called a cost share, which is a portion of that income that they get to keep for their personal needs on a monthly basis. And that number is different if they are receiving Medicaid in the home, if they are receiving Medicaid in assisted living, or if they are receiving Medicaid in a nursing home environment. But that cost share, um, I'm sorry, with the exception of something called a personal needs allowance, the rest of that income is called the cost share. And that is their buy-in. That's what goes over to the facility every month. They get to keep something called the personal needs allowance, which is that amount that differs. I said I used the wrong terminology. I apologize. They get to keep that on a monthly basis for their personal needs. And then the rest is considered the cost share that goes over to the community. The other portion that they may be able to keep out is anything that they pay for a supplemental insurance. Because another one of the things that people don't understand is that even though you're on Medicare, I'm sorry, Medicaid, Medicare and your supplemental insurance that you've been paying all those other years, they still stay in play.

Shannon 26:13

Okay.

Lisa 26:14

So let me just explain one thing really quickly because this is something that almost everyone asks. When you're on Medicaid, Medicaid is actually the last payer. So you keep your Medicare and you keep your supplemental, and Medicaid lets you hold that money back out to continue paying that supplemental. A lot of times it's through AARP, has sure things like that. So when the payout starts, the first payer source is Medicare. And then things get submitted to your supplemental.

Mary 26:53

Right.

Lisa 26:54

Now normally, if you didn't have Medicaid, you would be responsible for the rest of that bill. But where Medicaid comes in is that Medicaid swoops in and pays everything else, including the room and board, because those first two aren't going to pay any room and board.

Shannon 27:08

Right.

Lisa 27:09

Medicaid comes in, and instead of a bill getting sent to the individual, Medicaid comes in and pays the rest of it. And that's how it works. Now, there's a little confusion because Medicare and Medicaid are both federally, although Medicaid is only partially federal, they're both federally run, but the budgets are different. And so they kind of each cancel and pay each other out, which is why, which is why when you go on Medicaid, that buy-in amount in your social security stops coming out because those two start talking to each other behind the scenes.

Shannon 27:47

Gotcha.

Lisa 27:47

Gotcha.

Medicaid As Last Payer Explained

Shannon 27:48

Okay. Wow. So much information here. I mean, like there's so many things like a QIT, which we talk about all the time. Like, can you explain what a QIT is? Because it kind of goes into this whole thing of like replanning and when you actually get to the actual Medicaid time. So please talk about a QIT, what it is, what it does, what it means,

Qualified Income Trusts And Bank Issues

Shannon 28:08

the whole nine yards. Sure.

Lisa 28:09

QITs came about in 2014, which is about when I started doing this. And it first started up as the Miller Trust. That's what a lot of people will still know it as, but it's a qualified income trust and it's a special trust that is opened up when someone's income exceeds a certain amount. And that amount for 2026 is actually $2,982. So when your gross income all combined, pensions and everything else exceeds that number, it doesn't preclude you from being eligible for Medicaid, but you do have to open a qualified income trust to house the excess income. Now, if you ask me why, I'm going to tell you because it's the government. Because it truly, truly meaningful.

Mary 29:03

It's like when a parent says, because I said so.

Shannon 29:06

That's Mary, that is perfect. That's a good way to put it, Mary.

Lisa 29:10

I'm going to start using that because I often get this bug-eyed look when we have to explain it to the clients. And our stock answer is just roll with it. Because so what it does is we open an account the month that someone is seeking el that we're seeking eligibility for a client, we open a qualified income trust account. And the excess income every month when the income comes in, the client has to deposit their excess income into that account. That account gets paid directly to the community once it's funded. There are special rules with that account. It can't go any place with the exception, with very few exceptions. It can't go any place other than the community.

Shannon 29:58

Okay.

Lisa 29:59

Here's the thing. Upon death, anything left in that account goes directly to the government. The way that the QIT was actually supposed to work, and the way that the QIT actually works are very different. Because the way that it is supposed to work, people found very quickly was not working. It was creating so much more, it was so much more labor on part of the Board of Social Services, on part of the client, on part of the facilities, that it just stopped working that way. We actually stopped advising our clients to work it the way that it was supposed to be done very early on. Because it the math wasn't mathing. And so they just but as soon as the income comes into the host account, which is the bank account that the clients use on a regular basis, our clients fund this QIT account and then it gets paid directly to the community every month. And that QIT account sits at a zero at the end of every single month.

Shannon 31:12

Okay.

Lisa 31:14

But again, the goal is that whatever is in that qualified income trust upon death doesn't get paid any place else, not to the community, not back to the client. It gets paid directly to the government upon death. If it had worked the way that it was supposed to, there would be a lot of money in there at any given time upon death. Right now, there's no money in there at any given time. But that is a qualified income trust. There are there is a lot of problems with it now because banks make no money. So now they're we have a lot of banks telling us they will they refuse to open them. And banks will not open them without an attorney. And the problem is people that are doing their own Medicaid applications now are finding difficulty having an attorney open a quali just a qualified income trust. Because I know our law firm, our law firm will not do it because unless we have done that application, sure. Sure. I will not verify that it's not. That's like walking in on something that you didn't start. I will not verify that a QIT is being funded funded properly if I have not chosen what's supposed to go in there.

Shannon 32:21

Gotcha. Gotcha. So I mean, let's I kind of want to just touch about that because we we keep talking about attorneys getting help and all that stuff, right? Do

Do You Need An Attorney

Shannon 32:29

people need to hire an attorney? Can we talk about what exactly that means or that looks like when we're talking about getting this whole process done?

Lisa 32:36

Okay. So do they need to hire an attorney? No. Everyone has choices. I am going to stand on a soapbox for a minute if you will allow me to do that. Here's the thing: there are now communities that are actually advising people not to hire an attorney. I don't think that that's right either. Everyone has the right to seek counsel. There are a lot of people, there are a lot of ways to do a Medicaid application. You can do them yourself. You can hire an attorney who hopefully has a lot of experience in doing Medicaid applications. Or you can hire a service that does Medicaid applications. I'm going to tell you the benefits of each one of them. Hiring the community to do Medicaid applications, basically, when you do that, you're hiring a service because communities very rarely do their own Medicaid applications. They actually enlist a service to do the Medicaid applications. Sure.

Shannon 33:34

They say they'll do them, but it really is someone else that's doing it for them.

Lisa 33:37

Yeah, absolutely. I'm going to ask a question that's a rhetorical question. And I'm going to say, who's working in whose best interest is being worked there? Okay. So next place is you can hire a service. Who who is going to cover you if something goes wrong there? That's another rhetorical question. Then I'm going to say the third choice is you're hiring an attorney. First of all, if you're hiring an attorney, you are the only one that attorney is getting money from. No facility is paying them to do anything. Even if that attorney happens to have helped place you in a facility, place your loved one in a facility. If it's an attorney worth their salt, they have not been paid to do that. They take no money from a facility. So now you've hired them to do a Medicaid application. You are covered with legal representation. You should be the only person that that attorney is concerned with.

Shannon 34:42

Covered with legal representation is a great nugget. Yes, that's huge. That's a big deal. Yeah.

Lisa 34:47

You think?

Shannon 34:48

Yeah.

Lisa 34:49

You should be the only person whose best interest that attorney cares about and that team. Right there is a good reason to care about who does your Medicaid application. Yeah. And if you look and see when you're looking to have someone do your Medicaid application, and if you're looking to hire an attorney, take a look at what else that attorney does, and then take a look and do a little bit of research. And this is where I will say Google helps. What is that attorney's reputation built on? Because there's attorneys that do a whole bunch of stuff.

Shannon 35:26

Right.

Lisa 35:27

Sure. Do some Google research and find out what that attorney's reputation is built on. Because an attorney can do a lot of things, but what did they actually build their reputation on? So that's do you need an attorney? No. Medicaid has gotten really hard. It's gotten very complicated.

Mary 35:44

Well, when you're talking about funding somebody, their care, their housing for the rest of their lives.

Shannon 35:50

Yeah.

Mary 35:51

There's, I mean, we see it now in other aspects with government. There's going to be roadblocks. There's going to be it's not going to be an easy process.

Lisa 36:00

And I don't blame Medicaid. Please understand that. I know.

Mary 36:03

I think it's the reality of just all that is giving out, you're going to have to do a lot of work to get on the program. And this system has been taken advantage of.

Shannon 36:14

And I also just think it's one of those things where to all those important things, like you said, Mayor, you want to have this done the proper way, right through the proper channels to make sure that there are no issues. And that if there are any issues, like you said, you have the backing of an attorney that's going to be able to help advocate for you if anything comes up.

Lisa 36:31

And I'm not going to say you only get one chance at this because you can reapply. But man, each time that you don't hit it the first time, you're building up a bill at a community.

Shannon 36:45

Right.

Lisa 36:45

Or you're building up medical bills that aren't getting paid if you're doing this while you're staying at home. It's not like you just, oh, well, I don't get it the first time, I'll just try again. You're accumulating bills. So if you're looking for your loved one to be paid for and they're in a community, you're looking at $13,000, $14,000 a month that are accumulating while you're going through the process of applying for Medicaid. Because during the pending process, you're in stasis and that bill is accumulating. Now, if you get approved, they'll go back and pay that entire bill. But if you don't get approved, that entire time that you were pending is accumulated a bill.

Mary 37:23

And I think that's a good point to make that if you do get denied, if you went through a process that wasn't with an attorney, is there can you speak? Is there any recourse? Like have you heard of companies being able to send in a new one? Explain what that process is. Sure. Because I always get the term wrong. So I don't want to say it.

Lisa 37:48

So if you put through a Medicaid application and let's say you're pending for six months, and I married an accountant because I'm don't do math well. Let's say you were pending for six months at $10,000 a month, you get denied. That community is going to come back looking for that $60,000 bill and they're going to do it immediately.

Shannon 38:07

Right.

Lisa 38:07

Because they get a notice that you've been denied.

Denials And Fair Hearings

Lisa 38:10

You can do something called a fair hearing. So at a fair hearing, you can go back and say, I don't agree with my denial. Now, there are way there are reasons why you get denied. They can say that you were over asset at the time that you applied.

Mary 38:26

And they have to give you the reason that you were denied. So they have to give you the reason-ish.

Lisa 38:35

They can give you the reason, but it may not really be the reason. So we just we just had one that got denied for being over asset, and we were like, no way, our client was not over asset because we are fastidious. I mean, we make sure that we do the forensic accounting, we do the forensic accounting accounting on our clients. And there is one thing that we know, unless a client has hidden an account from us, which is also very hard. So PS just a little, don't ever try to hide money from the government.

Shannon 39:04

It will be found. It will be found.

Lisa 39:06

So they they run your social security numbers. They have this magic software that maybe other government entities that have letters in their name use to find people. So they actually run your social security number. And so they're going to find accounts that are in your name. I don't care. Just like people that have accounts over in other countries, they will find that money. They will find that you have other accounts. So we have had people try to hide money and it's been found.

Mary 39:36

Right.

Lisa 39:36

So you can get denied for being over asset if you don't disclose everything. Now we will also find it because I can almost guarantee you that at some point in the past five years, because it's a five-year look back, you have moved money from that account into another account or another financial holding, or you've paid a credit card with that money from that account. Because we do a forensic accounting line by line, one of my caseworkers is going to find the last four digits of that account number mentioned somewhere in the past five years. And we're going to ask you about it. But if you get a denial for being over asset or for failure to provide, meaning they've asked you for something in a timely fashion, because they give you about five to seven days to get it to you if you don't give it to them the first time and they ask you for it, there's really nothing you can do about that. That's an outright failure and a denial. But if you go to fair hearing because they've given you a failure, a denial that you don't agree with, you can take it to trial. You can go to fair hearing, you go before a judge, and you have the opportunity to argue that. Exactly. And you're gonna have a lawyer that's gonna want to go to fair trial for you if they haven't done that application? That's a hard thing.

Mary 40:58

I don't think people, again, realize uh you do have recourse if there is a denial, but are you prepared to be the one to answer the questions, or would you rather have the attorney and the firm that helped you do the application? Right. Answer the question.

Lisa 41:14

And are you prepared to pay some random person that you don't know that has really no vested interest, whether you win or lose? Because now, for us, our reputation's on the line.

Mary 41:25

Exactly.

Shannon 41:27

How

How To Prepare Before Crisis

Shannon 41:28

can families prepare for this as they, you know, deal with their aging loved ones? How can they get ahead of doing this so that when the time comes, everything is pretty seamless?

Lisa 41:36

Okay, really fast because this is one of my favorite questions, because it's proactive. So don't wait until the last minute, please. If you have a diagnosis and you have money, there are things that you can do to protect yourself. Or even if you are aging, if you are in that like fine wine period of your life and you have a family history, you go to your financial person and you check in with them on a regular basis to make sure that everything is fine. Why wouldn't you speak to an elder law attorney? Maybe not as regular, maybe not as every year, but talk to somebody about maybe a five-year plan because that's the Medicaid look back. Talk to somebody about that. Because we do things like that. There's no reason not to. Check in with them every now and then. Carl and I started this and I said, why can't we be those people that are family attorneys, that people come in and check with us and let us help them prepare for this stage of their life? Okay, so there's that. So let's talk about what we do that everybody can do. There are actual apps out there that you can download where you can start storing information for five years. But we're let's talk about non-tech savvy people, my dear husband. So let's talk about this. You know those accordion folders that are most annoying things in the world, that if you let them go, God forbidden, you're on the edge of the table, the whole thing falls off. So let's get one of those. And when you reach that aging like fine wine period, you start gathering information. So you're gonna make a copy of the front and back of all of your medical cards and you're gonna put it in there. Copy of the front and back of your birth certificate, your marriage certificate, your divorce certificate, your all of those certificate things, right? Everything from vital statistics, you're gonna put it in there. Every year when you're on Social Security, you get an awards letter, that annoying thing that you have to rip off the sides of. You're gonna put it in there. When you make a copy of it and put it in there. Or just put that in there. Don't throw it away, put it in there. You get the new one the next year, you're gonna take the old one out, you're gonna put the new one in. You're gonna do the same thing if you get a pension letter, or if you're have a pension, you're gonna get a new pension letter every year. Put the new one in, take the old one out. That pension letter tells you what. Gonna get for the coming year and what's gonna be taken out of it, taxes, etc. Put the new one in, take the old one out. Let's talk about financials. Keep your bank statements. Everybody says, Oh, I can get them online, usually for only two to three years.

Shannon 44:17

Oh, I didn't know that.

Lisa 44:18

Yep. They don't go back. They go back in the records, but online you can usually only get them for two to three years. Print your bank statements out. Especially if you're a daughter or a son or a grandchild and you're responsible for your loved one. Do yourself this favor because it is so much more aggravating when you gotta do it all at once because you have to do a Medicaid application. Print them out. We say five years, it is actually 60 months. So from that day, from that month, start counting. Keep the bank statements. And we also need, you're also gonna need copies of every check, which a lot of them come from the bank.

Mary 44:58

Right.

Lisa 44:59

So if you're writing out a check for your grandmother, grandpa, your loved one, just throw it in a copy machine. Everybody's got a copy machine now. Printers do copies, everybody's got a scanner. Just make a copy of it. You may think it's a pain in the butt now, but it's gonna be more of a pain in the butt when you've got it. Sure. Absolutely. And if you try to get copies of this stuff from the bank when you need it, they're gonna charge you for it, or they're gonna try to charge you for it. If you hire an attorney like us, we're gonna fight for it and so that they don't charge you for it. Put it inside that folder. And we're talking your 401k is the all of your financial holdings, whether it's a 401k, whether it's an investment, keep all of it. This way, if you need to do this thing, you're gonna have that folder and all you're gonna have to do is hand that to somebody. Because in order for a law firm or someone you hire to do your Medicaid application to get this stuff for you, you have to give them a POA. Because only these financial institutions will only speak to a POA. You're gonna have those other people I mentioned that are gonna do this Medicaid application

Power Of Attorney In Plain Terms

Lisa 46:03

for you if you want them to, they're gonna need to get a POA from you. Why would you give anyone else a POA over you?

Shannon 46:12

Right.

Lisa 46:12

Why would you do that? Right.

Shannon 46:13

That's not a legal entity, absolutely.

Lisa 46:15

Why would you do that?

Shannon 46:16

Yeah.

Lisa 46:17

Even in a legal entity, why would you give anybody that much power? So just put all that stuff in that folder. Doesn't even have to be neat. Doesn't even have to be neat. We'll take it as messy as you've got.

Shannon 46:31

Can you explain what is a power of attorney, just so that people are aware?

Lisa 46:35

Power of attorney, well, there's a couple of different types. There's which I'm not going to explain. Listen to Carl's podcast. Yes, I was like, I know we forgot some of them. That's a part of our escape presentation.

Shannon 46:44

I could list them all off for you.

Lisa 46:46

Yeah. But a power of attorney is giving someone else the right to act as your financial person, your financial decision. Right. Fiduciary to make your financial decisions for you and to, in for the purposes of Medicaid, to gather financial documents for you. You walk into the bank and it's just like you're walking into the bank and saying, hey, give me a copy of this, give me a copy of this. And it also allows them to pay your bills for you. That's as far as I'm going to go into it because I'm not an attorney. But if again, listen to episode one, Carl does or episode two, whatever it is, Carl does an amazing job at explaining it and it's important.

Shannon 47:24

Yes, very, very important.

Mary 47:25

And I also think just a quick note like you said, to put the information and start gathering it when you're not in crisis. Yeah. Correct. When nobody is ill, when you are just thinking down the road, or you have certain conditions that could progress, to just start collecting. So that way it makes it easier and you're not trying to do everything while being a caregiver.

Lisa 47:46

Agreed. I cannot stress for the listeners enough how important it is just to have a, even if it's a one-time conversation with an elder law attorney about how to do this. My girlfriend has a saying, work smarter, not harder.

Shannon 48:04

Yep. Right.

Lisa 48:05

And I know a lot of people say it, but you don't realize the importance of that simple saying.

Shannon 48:11

Carl says it too.

Lisa 48:12

Oh my gosh. Just have a conversation because you don't realize how difficult this stuff is, especially when you bring in the emotions of having this happen to your loved one. And then you're trying to just keep all of these compartments in your brain and get all of this stuff done. Have the conversation about how to do this thing. And I'll tell you, I do Medicaid applications all day, every day, and they are complicated and they are entangled and they are frustrating. And you just find somebody who knows what they're doing.

Shannon 48:47

Yeah. Right. Lisa, thank you so much. I mean, we could probably go to the city. Thank you. I know. My gosh, we're done. It's so much good information here. Maybe we'll have to have you back on for part three.

Lisa 48:57

I know season two. Yeah, but just bring an air

Lisa’s Why And Closing

Lisa 49:01

mattress.

Shannon 49:01

At the end of every episode, we always ask them ruin their why. This is your second time on the podcast, but we still want to ask you again, because we're all crazy for doing this, right? Working in this industry. Why do you love what you do? You know, why why why are you here today? That's true.

Mary 49:13

You gave your why before, but now it's why do you love it? Or keep coming back to do it.

Lisa 49:19

You know what? So listen, I already said my why once, but I'm gonna now do my Tom Callahan why. So, my dear friend who's no longer with us, who I did this shoulder to shoulder with for so long. There is so much in this industry that is difficult, and we can't help everyone. And some because they just won't seek the help, they still think they can do it themselves, and some because they can't get the help. But you know, you look at this stuff, and there's just so many people that need the help, and every day we get up and we just know that there's people that we're not gonna be able to help. But it's like the little girl that walked along the beach and she was throwing the starfish back in the ocean, and somebody said, Why are you doing this? There's just so many, you can't possibly help every single one. And she looked him in the eye and she picked up a starfish and she threw it back in the ocean, and she looked at him and she said, But today I helped that one. And that's it. That's that's my why. Yeah, because maybe today I can help that one get on Medicaid. Yeah, and we can help that family feel less stress, and we can help that person feel less anxiety. And so, as hard as it gets, and as overwhelming as it is for me sometimes, and for my team, and for everybody that works in this firm, and as devastating sometimes as the losses are that we suffer, if we can just help one starfish. Love that.

Shannon 51:06

That's powerful. I mean, I just got goosebumps listening to you because it's just something about helping out a family that just is so fulfilling for your heart. Let's just go back to the city. Absolutely. You know what I mean? It's just what a great response.

Lisa 51:21

And isn't that what we always say at our staff meetings, right? It's a hard thing.

Shannon 51:24

Yeah.

Lisa 51:25

It's a hard thing.

Shannon 51:26

What it's all about. Lisa. Thank you again. Absolutely fantastic. And stay tuned for part three.

Lisa 51:34

Thank you. Thank you guys so much.

Shannon 51:37

If you found this episode helpful, please be sure to subscribe, leave a review, and share it with someone that it could benefit.

Mary 51:43

Just remember, you don't have to navigate aging or caregiving alone.

Shannon 51:47

If today's conversation raised questions about elderlaw, long-term care, or planning ahead, please visit jerseyelderlaw.com or call 609-842-9200 to find resources and support.

Mary 52:01

This is for mature audiences only, presented by Archer Law Office. Until next time, keep pushing forward and keep the conversation going.