Illinois court decision underlines importance of an attorney guiding your Medicaid application

A recent court ruling in Illinois underlined the importance of being in a Medicaid bed when applying for Medicaid coverage.

The situation played out like so…

Lady Blindfolded Holding Scales Justice Front RetroWhile in a nursing home, Mary Slepicka’s Medicare coverage expired. Until that coverage could be restored, Mary signed a new contract with the facility as a private-pay resident. The agreement stipulated that while Mary continued to seek Medicaid benefits, she would nonetheless be liable for any services not covered.

The hospital had a policy of transferring patients to Medicaid certified beds in such a way as to dovetail the transition as to when the patient would be eligible for Medicaid benefits. The hospital had determined that Mary’s assets would cover up to four years of private-pay coverage.

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When Mary’s Medicaid coverage kicked in, however, it was discovered that it could not be retroactive in her case as she was not in a Medicaid-certified room.

Usually the  facility worked to place residents in Medicaid-eligible beds within a few months of when they calculated she could be eligible for Medicare coverage. But because of her calculation of income, Mary wasn’t in a Medicaid certified bed when her coverage kicked in and as such, Medicaid wouldn’t retroactively cover her expenses as far back as they might have.

The reasons why the court weighed in favour of the nursing home are interesting but the most important aspect of this case is that Mary didn’t have counsel assist with her Medicaid application.

If she had done so, things might not have happened this way.

File this case under ‘an ounce of prevention’.

Read the case here: Slepicka v. State of Illinois, 2015 WL 4094269 (July 7, 2015)