How to Apply and Qualify for Medicaid in Virginia

I met one of my clients, Claire*, several months ago. Claire loves her father, Robert**, but one day Claire realized Robert’s health was declining and could no longer live alone. Being a loving child, Claire invited Robert to live with her. In Claire’s mind, taking care of Dad was the right thing to do.

After a few months of living together, Claire realized that she could not care for her dad on her own. Unfortunately, Robert fell several times while no one else was home and made Claire realize that Robert needed round the clock care. However, it would be impossible for Claire to care for her dad full time and support her children and family. To make matters worse, Robert had minimal assets to help pay for the care he needed.

After some research, Claire decided that Medicaid was Robert’s only feasible option because Robert could not afford to pay out of pocket to stay at a Long-Term Care Facility. Additionally, Robert’s insurance was unwilling to foot the bill. As a result, Claire went to her local Department of Social Services and filed a Medicaid Application on behalf of her dad.

When I first met Claire, I could tell that she was beyond frustrated with the Medicaid application process. She told me that she had filed five Medicaid Applications for her father and Claire was denied each and every time. Claire lamented that the case managers assigned to Robert’s case were difficult and unwilling to help her get her dad approved.

I told Claire that pursuant to the Virginia Medicaid Manual, the case managers are expressly prohibited from helping you qualify. The Department of Social Services is fearful of litigation and, as a result, takes a firm stance on not answering hypothetical questions or rendering any form of legal advice.

How is a person to qualify for Medicaid when the Department of Social Services in charge of Medicaid approval fails to help you when you are in need? Moreover, how are you supposed to qualify for Medicaid when judges have described the Medicaid laws as “one of the most completely impenetrable texts within human experience” Rehab. Association of Virginia v. Kozlowski, 42 F.3d 1444, 1450 (4th Cir. 1994). Too much is at stake for you to attempt navigating this complicated area of the law alone.

After meeting with Claire and discussing Robert’s case, I determined that there were three central issues:

1. Robert was admitted to a hospital due to a recent fall he had. The hospital was trying to discharge her because all of his Medicare days were used up. Furthermore, the hospital kept trying to pressure Claire to sign financial responsibility paperwork which would render Claire financially responsible for all of Robert’s medical bills.
2. Robert’s Social Security was being garnished by the IRS. Under no circumstances would a Medicaid eligible facility be willing to take Robert with the IRS garnishment still in place.
3. Robert’s assets were above the $2,000 minimum asset threshold set by Medicaid.

After our meeting, I devised an Action Plan which addressed each issue above in order to qualify Robert for Medicaid.

• I advocated Robert’s behalf to stay in the hospital because the discharge proposed was an unsafe discharge. Additionally, I was able to effectively navigate the Medicare appeal process to fight for Robert’s right to stay in the hospital. I also counseled Claire that she should under no circumstances sign any forms unless and until she received approval from me.
• I advocated for Robert and received a Release of Levy/Release of Property from Levy from the IRS for over $100,000 of penalties and interest that Robert owed. This release allowed us to more easily find Robert a Medicaid bed.
• I helped Robert meet the “Asset Test” by utilizing Medicaid exemptions and other Medicaid planning techniques.

After we submitted Robert’s Medicaid application, I handled all correspondence with Robert’s Medicaid case manager which gave Claire peace of mind in a very stressful period of her life. Ultimately, Claire and Robert were very happy when we received notification that Robert was finally approved for Medicaid benefits.

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Contact us today to learn more about Medicaid and Long-Term Care Planning

If you are interested in learning more about the legal services we provide in the area of Medicaid and Long-Term Care Planning, please feel free to contact Speedwell Law, PLLC at (703) 553-2577 or [email protected]. We look forward to answering your questions and helping you and your family navigate this challenging time.

*Claire’s name is used to preserve this person’s identity
**Robert’s name is used to preserve this person’s identity

The information on this site is for general informational purposes only. The information presented in this site is not legal advice or a legal opinion. You should seek the advice of legal counsel of your choice before acting upon any of the information in this site.