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Offering Comprehensive Long Term Care Solutions and Patient Advocacy

By Kathy Nitz
GolderCare Solutions

DHS is Not Your Friend

When it comes to paying for care in a nursing home, some research finds that approximately 63 percent of all
residents have to rely on some type of financial assistance, such as Medicaid. Unfortunately the stark reality is that few people can afford the $4,000 to $10,000 a month cost of nursing homes.

We meet with people every day in our offices that are facing this reality. Overwhelmingly we find that the general public believes that you spend all of your assets and then the “state” starts paying for your care somewhat automatically.  Not so! Often times they have been told by a well-meaning person to “just fill out the Medicaid application” and believe that is all it takes.

Did you know that when you apply for assistance to pay for long term care, you are subject to an investigation by the Attorney General’s Office of Inspector General in the State of Illinois? What does that investigation involve?  Are you ready to answer those questions?

In July of 2012, Illinois drastically changed the way Medicaid applications are processed. Illinois has also closed or cut staffing at local offices. There are no longer any long term care caseworkers in any of the local DHS offices.  Currently there are two offices in the state that process long term care Medicaid applications: Macon County in Decatur Illinois and Cook County in Chicago. What this means is that if you apply for Medicaid locally, you will have to work with a caseworker that is 3 hours away. It also means that the state caseworkers are overworked and understaffed for the sheer volume of applications they receive every day. DHS now expects you to scan and email all documents to them. If you don’t have this capability, you are at a severe disadvantage.  They assume everyone is technologically savy and has access to this technology readily. Gone are the days of driving to the DHS office to discuss the situation with your caseworker.  And forget trying to call a caseworker with questions. They never answer the phone and when you leave a voicemail, it seldom gets returned.  Even emails go unanswered a majority of the time.

My late aunt was the supervisor of a local Illinois DHS office for years. I remember growing up and her telling us about helping families through the process. She would go to their houses and help them get what they needed.  As a caseworker, part of her job was to help people so that they could pay for the care that their loved one needed.

That era has long since passed. Nowadays, it seems like the nameless and faceless caseworkers in some far away office spend most of their time putting roadblocks in your path to getting approved for Medicaid.  State rules dictate the information that must be documented. The rules seem to be made so incredibly difficult that unless you speak “Medicaidese” there is no way that you will understand what you need to do and what you need to provide. The rules change all the time and are interpreted differently between caseworkers. It is like suiting up to go out and play football, but when you walk onto the field, you find you are in the middle of a soccer game.

Our office has done hundreds of Medicaid applications.  Since 2012 we have received two decisions from DHS that were actually correct the first time. Doesn’t seem like a very good track record. Incorrect decisions then require that an appeal be timely filed or you lose your rights to benefits for the past months. That is not something that they tell you, however, it is printed in very fine printing on the back of the decision hidden among a whole lot of other information.

The bottom line is this: DHS is no longer your friend.  They have turned into adversaries that seem to be working against you. What do you do? You need an advocate on your side. You need somebody to help you through this maze that is Medicaid that knows the rules and knows the language. But, be careful! All too often well-meaning individuals give you advice. Every case is different and you cannot base your actions on what happened to somebody else. The nursing home is in the business of caring for your loved one. Are they in the business of advising you on what is the best financial course of action for you? Your financial advisor is well versed in investing your money but does he/she know Medicaid rules and how to save your money from the costs of long term care? You need professionals that deal with Medicaid every day and have years of experience. You need somebody on your side.

There used to be an old realtor’s commercial that stated, “Don’t go it alone.” I believe that statement is very appropriate for anybody embarking on their long term care journey today. Get professional advice.

Oh, and Iowa is a whole other story. We can talk about that in another article!

Kathy Nitz is a Benefits Advocate for GolderCare Solutions. She uses her wealth of knowledge and experience in benefits planning to advocate for seniors and those who are disabled.  You can reach Kathy at GolderCare Solutions Unlimited, LLC (309) 764-2273.