Medicaid Advice

Medicaid Advice

Medicaid is one of the most complex and confusing set or rules and regulations most professionals ever face. The Medicaid rules and regulations are always changing, often without notice.

One court said, "The Medicaid statute is an aggravated assault on the English language, resistant to attempts to understand it. The statute is complicated and murky, not only difficult to administer and to interpret but a poor example to those who would like to use plain and simple expressions." Another court stated, "As Medicaid has evolved, there has developed a degree of complexity in the Medicaid Act and particularly the regulations which makes it almost unintelligible to the uninitiated." Finally, a court said, "There can be no doubt that the Medicaid statutes are among the most completely impenetrable texts within human experience. Indeed, one approaches them at the level of specificity herein demanded with dread, for not only are they dense reading of the most tortuous kind, but Congress also revisits the area frequently, generously cutting and pruning in the process and making any solid grasp of the matters addressed merely a passing phase."

Unfortunately, all too often, clients and their advisors seek advice about Medicaid from the caseworkers in charge of evaluating Medicaid applications. What clients and their advisors do not know is they cannot rely upon the advice or recommendations of caseworkers. Most Medicaid caseworkers are good people with good intentions. They work hard at their jobs which involve administering many different programs including the Medicaid program.

Caseworkers either do not receive any training on the Medicaid rules and regulations, or they do not receive adequate training. As a result, caseworkers frequently misquote rules and regulations, and give erroneous advice to clients and advisors. Relying on advice from a caseworker can result in some very unexpected and serious consequences to the client. In some cases, caseworkers do know the rules but believe it their job to keep the client from qualifying for benefits. In those cases, the caseworkers intentionally mislead or refuse to help the client in receiving benefits. One client summarized it best by saying, "Taking advice from a caseworker is like asking an IRS agent to help you save on taxes."

Some clients are curious why their attorney did not discuss Medicaid planning with them. Medicaid planning is a highly specialized and very difficult area of the law. The Medicaid rules are a confusing combination of Federal and state law. Each state has a state Medicaid agency with a second agency administering Medicaid. Each agency has its own rules. To further complicate matters, the Secretary of Health and Human Services has the authority to waive provisions of the Medicaid statutes resulting state rules conflicting with Federal statutes and rules differing among states. In addition, many Federal and state procedural rules are not even documented.

An attorney practicing in this area learns the rules through the experience of handling cases. To remain updated on the latest rules and regulations, the attorney must handle a significant number of cases. Most attorney do not specialize in this area of the law. Clients must seek competent advice from a Medicaid attorney. Senior Resources & Benefits, L.L.C. ("SRB") uses the legal services of the law firm of Mitchel, Gaston, Riffel & Riffel, P.L.L.C. The law firm of Mitchel, Gaston, Riffel & Riffel, P.L.L.C. specializes in Medicaid. To learn more about this law firm, see the "Legal Services" item under the "Home" menu of this website.