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Four Ways Elder Financial Abuse Leads to Medicaid Denials and How Legal Aid Can Help

Today, June 15, is World Elder Abuse Awareness Day. Financial exploitation is one of the most common forms of elder abuse, with studies showing that 1 in 20 older adults are currently experiencing financial exploitation.  Financially exploited older adults may have significant problems getting needed health care and long-term services and supports through Medicaid.Here are four ways that financial abuse affects older adults who need Medicaid, and how legal advocates can help:

  1. Being denied eligibility. Medicaid can require significant financial documentation, especially for long-term care.  Older adults who are victims of financial exploitation may be denied because they do not provide their financial documents, are missing documents, or have questionable records. Without the necessary bank records, becoming eligible for Medicaid is extremely challenging. Legal advocates can help individuals and their representatives access bank records that are needed, or argue why such records are not actually needed.
  2. Penalty periods based on “gifts.” When someone applies for Medicaid long term care, they can be penalized if they gave away assets without receiving fair market value. Financially exploited older adults may appear to have given away cash, real estate or other valuables, when really those resources were stolen, or the person faced undue influence and duress. Legal advocates can represent older adults in Medicaid fair hearings to argue that those transfers were not actually “gifts,” and help eliminate or reduce any penalty periods.
  3.  Eviction of involuntary discharge from nursing homes. Individuals may also be threatened with eviction or involuntary discharge from a nursing home because of nonpayment – either because they did not qualify for Medicaid or because they did not pay the resident’s share of costs that was assessed by the Medicaid program. These older adults need legal help to represent them to challenge these discharges. When I worked in Maryland, this was the most common way that financial exploitation cases came through the door of our legal services office.
  4. Need for a hardship waiver. In order to become eligible despite financial exploitation, people with Medicaid may need to apply for a hardship waiver to explain why it appears they gave away money, and now they can’t get it back. Legal advocates can represent clients with their state Medicaid agencies to access hardship waivers and gain needed health and long term services and supports.

For more information on how Medicaid denials intersect with elder financial abuse – I participated in a National Legal Resource Center with our partners at the National Consumer Law Center and Pro Seniors, Inc., that focused on elder financial exploitation and how it affects low-income older adults who require safety net programs to meet their basic needs. The full webinar recording and slides are available here. The Department of Justice also offers free online training for legal services advocates, including What Every Legal Services Lawyer Needs to Know About Elder Abuse.

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