Brian, his mother Betty and Medicaid
Brian had been caring for his mother, Betty, in her home for years, filling two essential roles: essentially doing the work of a certified nursing assistant as well as managing all homemaking tasks including laundry, cooking, cleaning, and running errands. It was a lot of hard work, but Brian persevered because he loved his mother and felt her quality of life would be better if she stayed in her own home, and had regular interaction with him and their other family members.
When Betty suffered a stroke requiring her to be hospitalized and admitted to a nursing home, Brian believed that she would, at some point, be able to return home. But when Betty’s health didn’t improve, Brian reluctantly accepted that the safest place for his mother to be was in the nursing home, where twenty-four-hour a day care was provided by professionals. While this did relieve much of the physical demand on Brian, soon it was apparent that the financial demands were just as great. Brian made an appointment with us to see if we could help him do something about the nursing home bill his mother would now be facing.
Betty, like most people, was a hard-working middle class American who had no experience with needs-based public benefits like Medicaid. Betty and her late husband worked their entire lives, saved what they could, not anticipating that they would need the services of a nursing home. When nursing home care became a necessity, Betty found herself faced with a bill of nearly $9,000 per month. Not many people, Betty included, could sustain the burden of this payment for very long.
And so, it is at this point – a difficult, emotionally charged time of their lives – that most people encounter Medicaid, the public benefits program which pays the cost of most residents in nursing homes. But most people quickly learn that they may not qualify because their assets do not fit within the strict requirements for Medicaid eligibility.
This was the case for Brian working on behalf of his mother Betty. He didn’t know what to do: he understood that he couldn’t care for his mother at home anymore, but even with Betty’s savings, he knew that she couldn’t afford the nursing home.
When Brian came to see us, we asked him to gather Betty’s bank and other financial records, and together we developed a plan. We sat down with Brian and reviewed all the withdrawal transactions from Betty’s bank accounts and made notes about the purpose of these withdrawals. We needed to make sure that none of the withdrawals were transfers that prevented Betty from being eligible for Medicaid.
When we had completed the Medicaid application, we submitted it to the Rhode Island Department of Human Services (DHS). We also communicated with Betty’s nursing home, stating our belief that Medicaid would cover the outstanding bill and the future expenses. For the next few months, our office acted as a buffer between Brian, the State, and the nursing home’s financial office.
Brian felt a weight lifted from his shoulders. Even though he didn’t yet know what the outcome of the application would be, he felt as if he had done his best to handle the situation. He also stopped dreading the arrival of the nursing home’s bills in the mail, knowing that we were working to have Medicaid cover them.
A number of months later, we learned the outcome of our application. Thanks to Brian’s diligence and the skill and work of our legal team, Betty achieved Medicaid eligibility on the date we requested. Medicaid agreed to pay the nursing home’s outstanding bills, and to pay the bills for Betty’s ongoing care.
Although Brian still wishes he’d been able to help Betty stay in her own home, knowing that she is receiving professional, twenty-four hour care that is paid for by Medicaid offers him great peace of mind. At Heffner & Associates, helping families get that peace of mind is our top priority. We were privileged that Brian trusted us to help them resolve this challenging time in Betty’s life.