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An Innovative Solution To Address Medicaid Challenges, With Michael Steinberg

Qualifying for Medicaid is a very tedious, extremely overwhelming process. It can also be a dangerous process for the following reason: often, someone will apply on his own, and assume that the process is going well. Say you have a Mr. Johnson who’s going into a nursing home and doesn’t have any more money to pay privately, so he applies for Medicaid. Mr. Johnson and his family may not find out for a few months that Mr. Johnson was denied. Even worse, Medicaid may not have been approved because he was missing a simple piece of documentation. Now the whole process is three months behind but Mr. Johnson is already in the nursing home and the family is faced with a huge bill, in addition to applying again, and waiting to be approved again.

I had the pleasure to interview Michael Steinberg, of Senior Planning Services. He discussed the problem people face with the current Medicaid system, and one step they have taken to address it.

Michael, thank you so much for being with us. Your company helps process Medicaid applications. Don’t people do that themselves? Why would someone pay for that service?

To be eligible for Medicaid, there are two criteria; the applicant needs to be clinically eligible as well as financially eligible. Proof of clinical eligibility is not complicated, but proof of financial eligibility can be very difficult. Firstly, an applicant’s total assets and resources need to be at a certain number, and then the applicant needs to show proof of how he reached that eligible figure. It’s not as simple as going to the Medicaid office and presenting your ”magic number.”Essentially, Medicaid says, ‘It’s very nice that you’re at the $2,000 mark today, but how did you get there?.”

Medicaid has something called the five year look back. They would like to see every single one of an applicant’s financial statements from the past five years, and that’s including but not limited to checking accounts, savings accounts, money markets, IRAs, 401ks, annuities, sometimes even life insurance policies. In other words, anything that has any kind of cash value. They want to see clarifications of exactly where all of the money came from, and where it went. Qualifying for Medicaid is a very tedious, extremely overwhelming process. This is where we come in. We lift the burden off the shoulders of these seniors and their family members, as well as the organization that we are working with, to ensure that our clients gets the help that they need and can relax knowing that their financial future is secure.

Interesting. So do you have a general number of how many people apply, and get approved, because of your help? Is it a higher percentage than those who try to do it on their own?

It’s very hard to know exactly how many people are applying and not getting approved. As far as I know, we cannot put an exact number on it. But it can be a dangerous process for the following reason: often, someone will apply on his own, and assume that the process is going well. Say you have a Mr. Johnson who’s going into a nursing home and doesn’t have any more money to pay privately, so he applies for Medicaid. Mr. Johnson and his family may not find out for a few months that Mr. Johnson was denied. Even worse, Medicaid may not have been approved because he was missing a simple piece of documentation. Now the whole process is three months behind but Mr. Johnson is already in the nursing home and the family is faced with a big bill, in addition to applying again, and waiting to be approved again. As you can see, it can be extremely difficult to try and do this on your own. Even if an individual would like to attempt this process on their own we encourage people to educate themselves. Learn as much as you can about the process and understand what Medicaid is and exactly what’s needed for the application.

At Senior Planning Services, we provide a free Medicaid education and consultation. Prior to taking on a case, we ensure that we have a very good understanding of all of the intricacies of that particular situation.

My understanding is that there are other companies that do what you do. What makes your company unique? What makes your company stand out? And do you have any stories or examples that can demonstrate that?

Yes, our company does stand out. We’ve been doing this for nine years now. We are the innovators in most of the states that we currently service. At the same time we also have a sister company called LTC Consulting which is basically the back business office for skilled nursing facilities. So we have a very good understanding of the whole picture of what goes into a nursing home and all of the challenges involved. We are very knowledgeable of all of the Medicaid rules and guidelines, and make sure to stay current in an ever-evolving field. Unfortunately, the rules are always changing, so staying up to date is critical. We have a very streamlined process on how we handle our Medicaid applications. Each of our clients has a designated case manager who will handle the entire case on their behalf. There may be some people out there who do Medicaid applications, but our company takes full responsibility to gather all the documentation, put all the verification together and submit a complete and clear application to Medicaid. This ensures that the family and the senior that they will get their Medicaid approval quickly and efficiently.

You mentioned nursing homes. Is your company a B2b company or a B2C? Do you also service individuals, or is it primarily businesses like the nursing homes?

No, we do both. We do B2B and B2C. Most of our clients come through B2B; in other words, most of our clients are coming into a nursing home or into assisted living or are already there and are introduced to us through that nursing home or assisted living, simply because most people are not thinking about Medicaid ahead of time and they’re only thinking about it once it’s a need. Once it becomes a need, that’s where the assisted living or nursing home would say “Hey, I think it would be a very good idea for you to be in touch with Senior Planning so you can at least start off with that free Medicaid education and consultation.”

Do you work with lawyers who understand the laws of all the relevant states? Or do you do it on your own?

We have very strong working relationships with attorneys. We have attorneys on retainer who can definitely help our clients. We are not attorneys, so we don’t practice law at all. If we feel that it is necessary, we will let a client know that they should be speaking to an attorney as opposed to utilizing Senior Planning Services, as there are specific situations that do require an attorney.

Michael, I understand that your company has been around for about nine years now. However, what I’m hearing is that as the years go on, there’s a bigger need for this. What has changed?

Medicaid rules and guidelines are forever changing. Any nursing home that takes Medicaid will have, on average, 55 percent of their patients on Medicaid. In the state of New Jersey, for example, your average Medicaid reimbursement per month is anywhere between $6,000 and $10,000. In the state of New York, it’s an average between $10,000 and $15,000. So if you think about it, there are more and more people who need Medicaid and the amount of money that Medicaid is laying out every single month for the individuals in the skilled nursing facility is a whole lot of money. Therefore, Medicaid needs to clamp down. They need to ensure that individuals who are applying for Medicaid are truly eligible before they go ahead and start paying for them.

Being that every state is always looking to cut the budget, this is a way for them to try and save money by making it difficult. It’s unfortunate but true. Medicaid makes it very difficult for individual applications to get approved. In short, the Medicaid rules and guidelines are constantly changing, they’re becoming more and more difficult and that’s really why there’s more of a need for Senior Planning Services.

Can you tell us the most interesting, meaningful or funniest story that occurred to you in the course of this career of Medicaid applications?

It’s not necessarily one story, but it’s many, many stories. We are constantly seeing that our hard work allows our elderly clients to receive the help that they need. We hear from their incredibly grateful families, thanking us for removing the burden from them. Just knowing that every day you’re helping people improve their lives is meaningful in itself.

If Congress were to pass a law that made Medicaid more simple, do you think that Senior Planning Services would be redundant?

I don’t think it would ever come to a point that it would be so simple for people to apply, that your average individual could successfully do it, without outside help. But there are definitely some things that Congress can do that can make it a little easier for everybody. Unfortunately, there are too many people getting denied for reasons that, in my opinion, they should not be denied for. I don’t see that the rules and guidelines are ever going to be that simple that your average individual can handle.

How did you get into the Medicaid application industry? What is your backstory?

I grew up in New Jersey, started my working career and wanted to get involved in something that would not only allow me to support my family but, at the same time, would allow me to help other people. Coming home with a paycheck is great, and I’m grateful for it, but I wanted to come home feeling good about how I had spent my day. So in 2006, I started working for Jersey Shore Adult Daycare, where I was responsible for the marketing and sales. My responsibility was to go out there, create new opportunities and maintain client relations, making sure that the seniors were being taken care of and that everybody was happy with our services. I worked there for three years until 2009.

From 2009, I worked for Ocean Home Healthcare, helping people out with equipment that they needed to go home from the nursing home, back to living at home. So we provided wheelchairs, hospital beds, oxygen etc. My responsibility was to make sure that both the actual clients and the skilled nursing facilities were happy and all the services that they needed were being provided.

In 2011 I started working for Senior Planning Services as Director of Business Development. We help prepare Medicaid applications, so my responsibility is to develop new business and oversee the current business. That’s where I am today.

None of us are able to achieve success without some help along the way. Is there a particular person that you’re grateful for that helped you to achieve the success that you have?

I’m very grateful for the company that I work for today, Senior Planning Services. Before I started working here I really didn’t have a full understanding of what it means to apply for Medicaid and actually get approved. Now that I work here, I understand the Medicaid rules and guidelines, the roadblocks and pitfalls that so many individuals face on a daily basis. We have to understand that when someone is admitting their loved one into a skilled nursing home, or an assisted living facility, there’s already so much going on and they’re so overwhelmed. To get that understanding and realize what they’re truly going through, and have the opportunity to help them, it’s an amazing feeling.

I really appreciate the company that I work for. Our CEO, Ben Mandelbaum, is amazing and I think we provide a great, great service. It’s a great feeling knowing that you are truly helping individuals accomplish their goals, that their loved one has a payer source and now can live in peace and be taken care of in assisted living or a skilled nursing facility.

We always learn from the school of hard knocks, so looking back, what do you wish somebody told you before you started this job? What do you wish somebody told you that you know now?

There are two sides to the answer. One regarding organizations that we work with, like nursing homes and assisted living facilities, and two, to the actual clients we work with.

For the assisted living and nursing facilities, I wish I’d known how much of a challenge they are faced with. How much bad debt they’re creating simply because individuals are not getting approved in a timely fashion.

And on the family end of it, I wish I knew how difficult it truly is to apply for Medicaid. I think there’s so much more that we can be doing out there and I think there are a lot more people we can be helping both on the client’s end and on the organization’s end.

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