Whose looking out for your best interest?

Families facing the daunting task of applying for MassHealth will often where they can turn. There are a number of entities that can assist with filling out the application. You can fill out the application. It may be long, but it is your information. Completing the paper application is the easy part. It is understanding the regulations and presenting the last 5 years of your financial history in a manner where you weren’t “giving away” your assets, that is the hard part.

The application process is difficult. There is a misguided idea that ANY time you give money away over the age of 65 you should have anticipated your need for a skilled nursing home and “saved it.” I have many clients come to me because of outstanding circumstances they are told will guarantee they're not eligible for MassHealth. If this is you and your family please contact us so we can help you avoid what almost happened to this client.

A family called Medicaid Planning Group, Inc. because the facility their mother was at told them to use company x to assist them with the application process. The family had been caring for the mother for years keeping her out of a nursing home. The mother, being frail and elderly, didn’t have a license, however, being frail and elderly, she had doctor’s appointments she had to get to. The family had one vehicle for their household, so they leased a second car to be able to assist Mom with her daily traveling needs. Mom insisted on paying the lease payments since the vehicle was ONLY used to drive Mom around. The 3-year lease was expiring 2 months after Mom entered the skilled nursing home. The family was returning the car as they no longer needed it due to Mom’s placement in a skilled nursing home.

The family explained the above situation to company x. Company x told the family they would need to pay back the money of every monthly payment that Mom made, or she would not be eligible for MassHealth. The family did not have the money to pay Mom back. The family was told to take a personal loan out to pay Mom back and that money would need to be spent down on Mom’s care to the facility. The money was going to cover 3 months of private pay and then company x would file the application. Thankfully, the family was panicked and called their attorney who told them to reach out to us.

Upon the family explaining to me the situation. I had one question; how many miles are on the car? 12,000 miles was the answer. The average person travels 12,000 – 15,000 miles in 1 year. There was 12,000 miles on this car after 3 years. Clearly this car was barely used. If Mom had not paid those monthly lease payments for a vehicle that was only being used for her, she would have had to pay a service provider to provide those rides. Mom saved herself money by paying for a leased vehicle for the family member who was helping to keep her out of the nursing home.

Ultimately, it is up to a caseworker to determine the intent behind these transfers. The family was happy with my reasoning and decided to move forward with us instead of paying back Mom. We filed an application with a letter from the family and the Mom explaining the times the vehicle was used for Mom. We provided proof of the mileage on the vehicle and the mileage to the doctor’s, hair salon, grocery store, and families house. The car was returned during the months it takes the MassHealth process, so we showed proof of that as well. We were APPROVED with no penalty period and no need for an already struggling family to take out a personal loan. Always know who you are talking to and whose interest they have at heart.

If you or a family member are facing this difficult time, please contact us. It is never too late to prepare. At a minimum, you can understand what the regulations allow you to do, not what facilities want you to do. Contact us today at 978-372-1722 to S.M.I.L.E (Seek Masshealth Information for Long-term Eligilibity.)