Cona Elder Law Secures Over $500,000 in Medicaid Reimbursement for One Resident

A.D., a 20-year-old long-term resident of a skilled nursing facility, had permanent physical and mental disabilities suffered at birth. A.D. lived in the community and received Medicaid community benefits through New York City HRA. In July 2010, A.D. was relocated from his home in Brooklyn to a skilled nursing facility upstate. The facility submitted a Medicaid conversion application to HRA on his behalf. Medicaid benefits were denied twice and the balance due was hundreds of thousands of dollars because A.D.’s care was provided at the $800/day level.

An interjurisdictional dispute commenced as neither NYC HRA nor the upstate county DSS would accept fiscal responsibility for A.D.’s care. Further, financial information and statements were not produced and numerous personal documents were outstanding. Even though A.D. had two court-appointed legal guardians, neither guardian was an elder law attorney, neither understood the Medicaid process and neither was able to secure all required records and statements. When the matter was referred to Cona Elder Law, we secured the guardians’ authorization to handle all aspects of the Medicaid application, including the authority to collect all required information and documentation and authority to deal with HRA’s Office of Legal Affairs. Cona Elder Law submitted a new Medicaid application as well as a Reconsideration Application as a means of protecting the earliest possible Medicaid pick-up date.

In the process, it was discovered that A.D. had a Special Needs Trust but that the trust was not funded. Again, the guardians, not practicing in the field of Elder Law, were not versed in Special Needs Trusts. Cona Elder Law instructed the guardians as to how to fund the trust and then had to prove that A.D. was considered disabled pursuant to federal Social Security Law, Social Services Law and Medicaid regulations such that the trust funds would be exempt assets. Next, Cona Elder Law argued in the guardianship court that the trust should be deemed funded nunc pro tunc, that is, retroactively, so that A.D. could be deemed Medicaid-eligible upon the date he entered the nursing facility. Cona Elder Law requested a fair hearing to secure the earliest possible pick-up date, which hearing was ultimately unneccessary as Cona Elder Law prevailed at the agency level by working with HRA’s Office of Legal Affairs.

Cona Elder Law acted as a liaison between the nursing home, the guardians, the upstate Department of Social Services and HRA. Through Cona Elder Law’s zealous advocacy, A.D.’s application for institutional Medicaid benefits was approved as of the date of A.D.’s admission to the nursing facility in July of 2010. The outstanding bill of $546,368 was paid by Medicaid.

Resolving complicated Medicaid applications with creative advocacy is just one of Cona Elder Law’s best attributes. We are pleased to put our legal skills to the test for the benefit of our healthcare facility clients.