When your parent needs nursing home care and you’re facing a Medicaid application, one of the first questions that arises is whether you need legal help. Elder law attorney Kellen Bryant explains that the answer depends on several key factors: the applicant’s marital status, income level, and total assets.
Understanding these factors can help you determine the right level of professional assistance for your family’s situation, from basic nursing home help to comprehensive legal representation.
The Three Levels of Medicaid Application Complexity
Florida Medicaid applications fall into three general categories, each requiring different levels of professional assistance:
Basic Case: You May Not Need an Attorney
In the simplest situations, the nursing home itself can often handle the Medicaid application at no additional charge, as they do this as part of getting paid for their care services.
A basic case typically involves:
- Monthly income under $2,000
- Bank account balance under $2,000
- Minimal assets (perhaps a house but no life insurance)
- No significant asset transfers in the recent past
Even in basic cases, it’s helpful to ensure your parent’s legal documents are current—durable power of attorney, healthcare surrogate, and living will should all be up to date and properly executed. However, for the Medicaid application portion specifically, attorney involvement may not be necessary.
Intermediate Case: Consider a Consultation
The intermediate level involves more assets and potential complications that benefit from legal guidance, even if full representation isn’t required.
An intermediate case might include:
- A single person with a house and $8,000 to $15,000 in cash
- Married couples where the healthy spouse has some income shortfall
- Situations requiring asset preservation for home maintenance
- Cases where you want to preserve funds for “essential extras” beyond basic nursing home care
The key concern in intermediate cases is avoiding the mistake of spending all available cash on care, leaving nothing for house upkeep or additional needs. An elder law attorney consultation can help you navigate these decisions properly, even if the full application process isn’t overly complex.
For intermediate cases, you might be able to get help with the application preparation from someone other than an attorney, but legal review ensures everything is set up correctly from the start.
Advanced Case: You Need Full Legal Representation
Complex Medicaid situations require attorney involvement throughout the entire process to avoid costly mistakes that could derail your application.
Advanced cases involve:
- Significant total assets over $15,000 to $20,000
- Multiple types of assets (stocks, life insurance, annuities)
- Married couples with assets above $130,000 to $150,000
- Situations where the healthy spouse needs substantial income from the nursing home spouse
The complexity in advanced cases comes from managing various asset types and ensuring compliance with intricate Medicaid rules. What you don’t want is to have extensive planning work become worthless because the application process gets denied due to a technical error or oversight.
Why the Right Level of Help Matters
Choosing the appropriate level of professional assistance is crucial because:
- Under-preparation in complex cases can lead to application denial and loss of benefits
- Over-preparation in simple cases wastes money on unnecessary legal fees
- Proper assessment ensures you get qualified help without overpaying
Key Factors in Your Decision
When evaluating whether you need legal help, consider:
- Asset complexity: Multiple asset types require more expertise
- Total asset value: Higher values generally need more protection strategies
- Marital status: Spousal cases involve additional rules and opportunities
- Income levels: Both spouses’ income affects planning options
- Transfer history: Any recent asset transfers require careful analysis
Finding the Right Attorney
If you determine that legal assistance would benefit your situation, you can typically find a qualified elder law attorney in your local area by searching online for elder law attorneys in your region. Look for attorneys who specifically focus on Medicaid planning and nursing home issues.
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Author Bio
Kellen Bryant, Esq.
Founder
Florida Bar Board Certified Elder Law Attorney, Kellen Bryant focuses his law practice on advising and helping caregivers with a particular focus on asset protection and preservation from long-term care costs, creditors, and predators. Kellen Bryant is AV Preeminent® Rated, meaning his attorney peers rated him at the highest level of professional excellence. Kellen Bryant was nominated and selected as a Super Lawyer, Rising Star: 2022.
