Not all work is charged on an hourly basis. Most work is billed on a flat fee, depending on what the work is. This way you can know exactly what the cost is and make a coordinating financial plan. When work is done on an hourly basis, different rates apply depending on who is working in the file. There is a different hourly rate for each attorney and the legal support staff. Efforts are always made to conduct work in the most efficient manner, while preserving the quality of the work. Written fee agreements are always used, so you will know, up front, what your legal work will cost.
Call our office and speak with the office administrator to set up an appointment. At this time, appointments cannot be set by email — (515) 986-2810.
Yes. Evening and weekend appointments can sometimes be arranged.
Yes. Since we practice in the area of elder law, some of our clients are unable to come to our offices. If you need an attorney to visit you at your residence, please call our office to see whether or not that can be arranged.
We are proud of our commitment to make legal services accessible to the average person. In furtherance of our mission, we will prepare a health care power of attorney and living will for any person who requests it, without charge or obligation. Additionally, in most cases, the initial consultation is without charge. There are several workshops scheduled throughout the year.
Yes. Cynthia Letsch has extensive experience speaking on a variety of topics. Please call the community outreach coordinator to make arrangements.
It depends on your situation. If you intend to leave your assets to real live adults (as opposed to a trust or charity) then we usually recommend avoiding probate. So, if you have a probate trigger (see the section on Probate) then you may want a revocable living trust, instead. If you have a young family and plan to leave everything to your spouse if s/he survives you, or else to a trust you have set up for your children, them maybe a Last Will and Testament is a proper planning tool. We will not be able to know for sure until we know more about your situation.
Whether you are married or single, if you are having difficulty at home, that is the time to have a financial review of your assets and income, in order to get a clear understanding of what benefits might be available to you and when the timing would be right to apply for them. This could be years before you might ever need to be in a nursing home. In fact, there is specialized planning that can be used to protect assets, if you have at least 5 years to plan.
Also, if you are already in a nursing home, married or single, and have not had an elder law attorney conduct a financial review, NOW is the time to do that, even if you plan to private pay for your care for years to come. Attorneys have tools that can be used to preserve many of your assets from being completely spent down. Generally, there is no cost for this type of review.
Practically, yes. Legally, no. It is a very complicated process, especially in the case where the Medicaid applicant is married. Often the nursing home social worker and/or business office manager will offer to help you get the paperwork completed. We recommend that you just say no. There are laws that an attorney can use that others are not trained to use, and often do not even know are available to use, to help you qualify for benefits without impoverishing your spouse and/or that may allow you to set aside money for a disabled relative.
No. This is a highly technical area of the law, and an attorney who does not routinely practice in this area may not understand all of the nuances. This area of law is called “Elder Law.” Elder Law is a specialized area of legal practice that deals with the situations where your medical needs, your financial resources, and your age overlap to cause very specific problems. Very few attorneys have actual experience obtaining Medicaid benefits for people. An elder law attorney will have experience, generally. Ask the attorney how long he or she has been working in the area of obtaining Medicaid benefits and whether or not he or she is a member of the Elder Law section of the Bar Association. If you are not convinced the attorney is knowledgeable in this area, keep looking (or call us.)
An elder law attorney is quite skilled at identifying resources that you did not know could be used to pay for legal service, can often identify legal opportunities for gifting some assets (in the case of a single person), and setting aside a much more significant amount of resources for the spouse of a married person in a nursing home.
This often has the effect of shortening or eliminating any need to privately pay for nursing home care, thus saving an average of $30,000 in nursing home costs.
At Letsch Law Firm, the initial review is complementary, so it is well worth your time to visit with us. If we determine that you do not have the funds to pay for legal services, or that you have funds but your situation is such that legal services are not necessary, Letsch Law Firm will refer you to a Certified Medicaid Planner who would be able to assist you in the Medicaid application process for a lower cost than what the law firm would need to charge.
The length of time it takes to get Medicaid is highly dependent on your situation. Once you meet the financial requirements, you have to gather all the documentation needed to satisfy the Department of Human Resources that you really have met the income and resource limitations. Usually, however, DHS is able to reach its decision within 3 months of receiving the initial application. Every case is different. If you are successful in getting the Department of Human Services to agree with you, then they will back date the benefits.
It is illegal for the nursing home to charge you the full daily rate once you have notified them that you are applying for Medicaid. The amount you pay during the time between applying for Medicaid and getting your award letter from the state, some people have to pay some of their income and others do not. It is very dependent on whether or not you are married, and if so, how much income your spouse already has. If we are managing your application, we will instruct you on how much to pay, if any. Once the state has awarded you benefits, they will pay the nursing home for the difference between what you paid and what the nursing home charges (up to the limit that the state allows them to charge.)
The short answer is no. If you are married, your spouse can continue to live there, and the house is a non-countable asset. The same thing is there if you are single, but a disabled child lives there. If you are single and your home is not occupied by a disabled child, then it can still be a non-countable asset, for the time being, and you can get Medicaid. However, you will only have $50 a month discretionary money, once you are on Medicaid, and you cannot support a house very well on that. You and your family will need to make a plan of when the best time is to sell it, what to do with the money from the sale, and what sale price will be acceptable to the Department of Human Services. You will want to visit with an elder law attorney to get good advice in this area.
All banking and investment accounts of any nature, cash value in all life insurance policies (with minimal exception), any real estate or time-share that are not the applicant or the applicant’s spouse’s primary residence (with minimal exceptions), every vehicle except one, anything tangible that is not personal belongings. It does not matter whether the property is titled in your name or your spouse’s name, or whether the property was an inheritance. It all counts.
A single person can have no more than $2,000 in COUNTABLE assets. We recommend a number closer to $1,500.00.
For a married person, the number varies depending on the value of the COUNTABLE assets the couple had on the date of attribution. (See the FAQ of What is the date of attribution) While the state does list a maximum amount of COUNTABLE assets your spouse can have, an elder law attorney can direct you in restructuring countable assets into non-countable assets and/or income. So, in reality, there is no limit to assets your spouse can keep.
No. Only the Medicaid recipient’s income is used to pay for nursing home care. And, in some cases, the spouse is entitled to some or all of the income of the Medicaid recipient.
No. Unless you agree (don’t do that) to personally guarantee payment, the nursing home cannot make you financially responsible for a bill that is owed by someone else.
No. One car is a non-countable asset. Leave it in your name until after you have secured Medicaid benefits, and then we can discuss disposition of it. Keep insurance on the car. No one should be driving it, unless he or she is your spouse, an owner (do not add an owner not already there) and an insurance driver. If there are two cars, and you are single, one will need to be sold for fair market value. If you are married, your spouse may decide to keep the second vehicle as part of his/her countable allowance.
If an appraisal was done at the time of sale, and the sale price was the same as or more than the appraisal value, that may satisfy the Department of Human Services. If there was no appraisal, you will need a letter from at least one independent real estate agent that meets the requirements of the Department of Human Services. An elder law attorney can assist the real estate agent to ensure the letter covers all the topics necessary.
SPIA stands for Single Premium Immediate Annuity. The Medicaid rules allow you to liquidate countable assets and then reinvest the proceeds into a SPIA that will provide an income for either the spouse of the Medicaid recipient or the Medicaid recipient, if it is structured according to the rules. This is a VERY useful tool saving tens, even hundreds of thousands of dollars on what would otherwise be spent on long term care. However, the use of a SPIA is a very sophisticated and complicated way of restructuring assets to become Medicaid eligible and should only be done with the guidance of an elder law attorney and a licensed insurance agent who is very knowledgeable in the Medicaid rules.
