A case in Connecticut shows how important it is to have your Medicaid application done properly and quickly.
In the case of Glastonbury Healthcare Center, Inc., v. Esposito [Conn. Super. Ct. No. CV 01-0811032] the nursing home successfully sued the adult son of a resident for over $100,000. This sent up a loud warning for those families who are tempted not to plan ahead for their long term care needs. It also sends a warning to facilities that assume patients can handle the Medicaid process without professional help.
We do understand that this is not a recent case and we wrote this article for that specific reason. It is a case not very many people, if any, in the elder law and medicaid industry today are aware of and therefore don't realize that it has set a precedence for nursing homes and notice to everyone that the Medicaid application process must be taken very seriously.
In the Esposito case the adult son, Carmine Esposito, signed an Admissions Agreement when his elderly mother entered the nursing home. He signed it under the power of attorney from his mother. He did not sign it personally as the Responsible Party. Among other things, this document contained the provision that the Responsible Party agrees to “act promptly and expeditiously to establish and maintain eligibility for Medicaid assistance.”
Following his mother’s admission into the nursing home, Mr. Esposito applied for Medicaid benefits to cover the high costs of her nursing home care. In the application process, however, he failed to provide all the information and documentation that the State needed and he did not spend down his mother’s assets quickly enough, delaying the application’s approval. As a result, months of benefits that the nursing home would have received were irrevocably lost.
In response, the nursing home sued Mr. Esposito for their lost fees, to the tune of over $100,000, claiming that he had breached the contract formed when he had signed the Admissions Agreement. The son, in response, argued that he never signed the agreement so there was no contractual obligation on his part. The question is: is Carmine Esposito bound to the terms of the contract even though he never signed it as Responsible Party? The Court said “yes”, not because of the signed document, but because of an oral contract that was formed when he failed to object to the contract’s provisions.
The end result? The nursing home got their bill paid, but only after months in court and much lost in attorney fees and court costs. They still need to collect on the judgment, assuming Mr. Esposito doesn’t appeal the decision, dragging the matter out even further. Hardly a real victory for the facility. It certainly was a great loss for the family as well, since the son was forced to use his own assets to pay a huge nursing home bill.
How could Mr. Esposito have avoided such a mess? If the nursing home had encouraged him to retain a Medicaid and long term care specialist to represent his mother in the Medicaid application process and to advise him before entering into an agreement with the facility, things would have turned out much differently. Certainly, hiring competent legal help involves some expense. However, in the end the cost would have been just a small fraction of Mr. Esposito’s $100,000 judgment, and clearly a winning result for all.
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