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Persistence Pays Off, Especially When It Comes to Medicaid!

Persistence Pays Off, Especially When It Comes to Medicaid! by Frank L. Buquicchio

Recently, we resolved a case regarding a Medicaid nursing home application for a 62-year-old woman, Jane, who suffered a severe stroke in 2011. A healthy woman otherwise, Jane had no health issues prior to suffering the stroke. Unfortunately, she also had no advance directives (health care proxy or durable power of attorney).

Since she did not have a durable power of attorney, and she had assets in her name, we also had to petition for a guardian to be appointed to handle Jane’s health care decision-making and finances. Once appointed, this allowed Jane’s guardian, her daughter, Mary, to proceed with a plan to protect her assets for Jane’s husband, Robert, who also has some health issues.

Eventually, Mary was appointed guardian and was authorized by the judge to transfer Jane’s assets to Robert. The complication arose with an annuity that Jane and Robert purchased in 2010 in the amount of $400,000. Under the current Medicaid law, because the annuity was purchased in the “look back” period (i.e. within 60 months prior to the Medicaid application), the contingent beneficiary of the annuity needed to be changed to Medicaid.

Mary, as guardian for Jane and agent for Robert under his power of attorney, had difficulty dealing with the annuity company when she attempted to change the beneficiary. The Medicaid application was approved in November of 2013, but because the beneficiary had not been changed, Medicaid assessed a transfer penalty of almost 34 months (based upon the value of the annuity).

Our office requested a Fair Hearing, and at the same time, Mary persisted in attempting to change the beneficiary. After several months, Mary was finally able to change the beneficiary and we went to a Fair Hearing in May of 2014 to provide that information. A few months later, Medicaid advised us that the beneficiary designation language was not correct. It again took Mary a few months to get the beneficiary designation changed. We provided the corrected beneficiary designation at another Fair Hearing in September of 2014.

In October, we received a decision on the Fair Hearing upholding the Medicaid penalty because, according to the decision, the beneficiary designation was never provided to Medicaid. This decision also failed to mention the May hearing where the first beneficiary designation was provided.

I then wrote a letter to Albany requesting a review of the Fair Hearing decision because the decision was clearly incorrect, as the beneficiary change was provided in person at the May hearing and the corrected beneficiary at the September hearing.

Again after a few months, we received a revised Fair Hearing decision upholding the previous decision. Unfortunately this decision also incorrectly indicated that the beneficiary designation was never provided to Medicaid.

After a second letter to Albany, together with proof of the change in beneficiary, we finally received another revised Fair Hearing decision reversing the transfer penalty. Shortly thereafter, we received a revised Medicaid approval without the penalty and with retroactive coverage back to our original requested Medicaid pick-up date of April 2012!

When applying for Medicaid, it is important not only to exercise diligence in obtaining information for the application, but to be persistent when you feel a Medicaid decision was reached in error. To help with your Medicaid planning needs, contact Vincent J. Russo & Associates, P.C. today.

Russo Law Group, P.C.
100 Quentin Roosevelt Blvd., Suite 102
Garden City, NY 11530
800-680-1717

This Post Has One Comment

  1. Frank, Good job and truly persistant handling of this case. Hope my case comes out just as well, but not as long. It’s so very difficult for
    Mike and I to not know how all will work, he as he is not well and I’s
    So overwhelmed not knowing our future. Keep your Newsletter going
    It’s good information.

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