You may not need us for every resident—and we don't expect you to.

Experienced Business Office Managers and facility staff successfully manage many routine Medicaid applications every day. HMS isn't here to replace your BOM, admissions team, social services department, or corporate Medicaid staff. We're here for the cases that need more.

Maybe the resident has significant resources that require planning before an application should be filed. Maybe there's a community spouse, questionable transfers, real estate, a trust, an inaccessible account, missing authority documents, or five years of financial history that doesn't quite make sense.

Or maybe the application has already been filed and something has gone wrong. A verification request isn't getting resolved. The case has been denied or suspended. Liability doesn't look right. The family isn't cooperating or doesn't understand what is needed. The Medicaid-pending balance keeps growing while everyone tries to figure out what happens next.

That's where HMS can step in.

We can work alongside your existing staff, take responsibility for the Medicaid-focused pieces we've been engaged to handle, communicate with the family and appropriate agencies, organize documentation, identify potential eligibility issues, and help keep the case moving toward resolution.

And when the problem requires legal work—such as a Power of Attorney, guardianship, deed, trust, estate-planning issue, or another matter outside our role—we recognize it and help coordinate with qualified legal counsel rather than allowing the Medicaid case to stall while everyone waits for someone else to identify the problem.

Think of HMS as an additional Medicaid resource for your team—not another layer of bureaucracy.

Your staff doesn't have to send us every Medicaid case.

Send us the ones keeping you awake at night.

The difference is in what happens before—and after—the application is filed.

There are companies that provide high-volume Medicaid application services to facilities. Those services may work well for straightforward cases, and not every resident requires individualized Medicaid planning.

But HMS is not simply an application-processing service.

We don't believe the Medicaid application should be used to find out whether someone is eligible. We want to know that before we file it.

Our goal is to understand the case before FSSA begins asking the questions.

Before submitting an application, we evaluate the financial information available to us—income, resources, ownership, marital status, transfers, real estate, trusts, insurance, retirement accounts, and other factors that may affect eligibility. We review the history, identify transactions that may require explanation, gather supporting documentation, and address planning issues whenever possible.

Ideally, when FSSA asks a question, we already know the answer—and we have the documentation to support it.

We also don't rely on Medicaid's Asset Verification System (AVS) to conduct our financial investigation for us. AVS is an important verification tool, and occasionally it will uncover something neither the family nor HMS knew existed. But it shouldn't be the first time anyone has taken a serious look at the applicant's financial picture.

If AVS does identify something unexpected, we investigate it, understand it, and determine how it affects the case.

That preparation matters. Filing first and trying to solve eligibility problems as they appear can lead to repeated verification requests, unnecessary delays, denials, reapplications, and a Medicaid-pending balance that continues growing while everyone tries to figure out the case.

HMS takes a case-management and eligibility-planning approach rather than an application-processing approach. We analyze the case, identify barriers, develop the financial eligibility strategy, gather and organize the documentation, and file when we believe the applicant meets the applicable financial eligibility requirements.

Then we stay involved. We monitor the application, respond to verification requests, troubleshoot unexpected issues, follow up when necessary, and work the case through the eligibility determination.

Our work is also focused specifically on Indiana Medicaid. We work with Indiana policy, Indiana eligibility processes, Indiana long-term-care providers, and the practical realities of navigating these cases here.

And when something requires legal, tax, medical, or other professional expertise outside our role, we recognize it and bring the appropriate professional into the process rather than trying to force the issue through Medicaid.

A high-volume application service and HMS may ultimately submit some of the same forms.

The difference is that submitting the application isn't our strategy. It's one step in a strategy we've already developed.

Absolutely. We don't expect you to sell our services for us.

We understand that the person who recognizes the need for HMS may not be the person who has authority to approve the expense. Administrators may answer to regional leadership, corporate offices, owners, governing boards, or other decision-makers who reasonably want to understand what HMS does, what it costs, and what value it provides to the organization.

We're happy to help with that conversation.

HMS can provide information describing our services, scope of work, pricing, and how we can complement the facility's existing business-office and Medicaid processes. We're also happy to speak directly with the appropriate decision-makers, participate in a phone or video meeting, or meet in person when practical to answer questions.

And we don't need an hour-long sales presentation to do it. Give us an opportunity to understand the facility's Medicaid challenges, and we'll explain specifically where we believe HMS can help—and where we don't think you need us.

If leadership wants to start small, that's fine too. A facility doesn't have to commit to sending every Medicaid case to HMS. We can begin with one difficult case, a review of existing Medicaid-pending cases, or another clearly defined project and allow the organization to evaluate our work firsthand.

We're also happy to provide the information an Administrator needs to take the proposal back to leadership rather than leaving them with the job of trying to explain our services themselves.

If you need to make the case for HMS internally, we'll help you make it—with clear services, clear costs, and realistic expectations.

It depends on what you need us to do—and we'll make the cost clear before we begin.

Facilities can use HMS in different ways. You may need help with one difficult Medicaid-pending resident, a pre-admission financial eligibility review, an appeal or suspended case, ongoing monitoring, or assistance reviewing multiple pending cases. Other facilities may want a more consistent working relationship for Medicaid support.

Because those needs are different, we don't believe one pricing model makes sense for every facility.

For individual matters, we can provide a defined fee or hourly arrangement based on the scope and complexity of the work. When a facility anticipates referring multiple cases or wants ongoing Medicaid-pending support, we're happy to discuss a customized arrangement that makes financial and operational sense for both organizations.

And we believe the cost should be considered in context.

A complicated Medicaid case that remains unresolved for several months can represent tens of thousands of dollars in unpaid care, in addition to the staff time spent trying to manage it. Sometimes the value of experienced Medicaid assistance isn't simply getting an application completed—it's identifying and resolving the problem before the receivable becomes substantially larger.

There are no surprises. We'll explain what we recommend, what HMS will be responsible for, and what it will cost before the facility agrees to move forward.

Our goal is to provide a service that makes financial sense for the facility—not become another expense that doesn't.

We understand why this is one of the biggest concerns for nursing facility Administrators.

Many people who need nursing-facility care simply don't have the resources to privately pay while waiting for Medicaid eligibility to be established. For those residents, a Medicaid-pending admission may be the only realistic path to placement. At the same time, the facility is being asked to provide thousands of dollars in care without knowing when—or whether—Medicaid payment will ultimately be approved.

That's a legitimate financial risk, and we don't minimize it.

HMS can become involved before or around the time of admission to evaluate the prospective resident's Medicaid financial eligibility. We don't simply ask whether the family thinks Mom will qualify. We examine the income, countable and exempt resources, marital status, real estate, prior transfers, trusts, annuities, life insurance, accounts, applicable spousal protections, and other factors that may affect eligibility.

And this is an important part of how we work: we do not knowingly submit an application before we believe the applicant meets the applicable financial eligibility requirements. If planning is necessary first, we develop the plan, complete the appropriate steps, document what was done, and apply when the case is ready.

That means when HMS tells a facility that, based on the financial information and documentation available to us, we believe the resident meets Medicaid's income and resource requirements, that conclusion comes from an actual eligibility analysis grounded in Medicaid policy—not simply an assumption that the resident will eventually “spend down.”

There is an important limitation. HMS does not determine medical Level of Care. We are not medical professionals, and the appropriate entity must determine whether the individual satisfies the medical and functional requirements for nursing-facility Medicaid. Our assessment is focused on the financial and Medicaid-policy side of eligibility.

If we identify a financial problem, we don't automatically consider the case a lost cause. We start looking for the lawful solution. That may involve Medicaid-compliant resource planning, additional documentation, resolving AVS issues, working with the family, or coordinating with an attorney when legal work is necessary.

Once an application is filed, we stay with it. We monitor the case, respond to requests, troubleshoot problems, follow up, and challenge an adverse decision when appropriate.

We cannot guarantee Medicaid approval because the final eligibility determination belongs to the Medicaid agency, and the facility must make its own admission decision. But we can give the facility a well-supported assessment of the financial eligibility picture before that decision is made.

And when HMS accepts the case, we don't file an application and hope for the best. We stay with it. We follow up. We troubleshoot. We ask questions. We pursue every appropriate avenue available to resolve the case.

We can't eliminate every risk associated with a Medicaid-pending admission. But we can replace much of the uncertainty with informed analysis, careful planning, and persistent case management.

Absolutely. In fact, some of the cases where we can be most useful are the ones already in motion.

You don't have to refer a resident to HMS before the Medicaid application is filed. We can step into a case at almost any stage—whether the application is pending, verification requests are outstanding, deadlines have been missed, the family is struggling to provide documentation, or everyone simply seems unsure about what is holding things up.

We start by figuring out where the case actually stands.

Has an application been filed? What was reported? What documentation has been submitted? Are there outstanding verification requests? Has AVS identified additional accounts or resources? Is there an eligibility or transfer issue? Does someone actually have authority to access the information Medicaid is requesting? Has a notice been issued that nobody saw—or understood?

Sometimes the problem is relatively simple. Other times, we discover that the pending application is only a symptom of a much larger eligibility, financial, or legal issue.

Once we understand the problem, we develop a plan and start working it. That may include communicating with the family, gathering and organizing documentation, responding to agency requests, following up on the pending case, addressing eligibility concerns, or helping coordinate with an attorney or another professional when the solution falls outside our role.

We also understand what a prolonged Medicaid-pending case means to the facility. While everyone is trying to figure out what went wrong, the unpaid balance doesn't stop growing. Resolving the underlying issue benefits the resident, the family, and the provider.

So don't assume a case is too far along—or too messy—for us to become involved.

If it's already in motion, we'll start where it is. If it's stuck, we'll figure out why.

That depends on who engages us, and we make that clear from the beginning.

HMS works with both families and long-term care providers, but we believe everyone involved should understand who our client is and what we've been hired to do.

When a resident or family hires HMS, our responsibility is to the client who engaged us. We can—and usually will—communicate and collaborate with the facility when authorized, because good communication between the family, facility, and Medicaid representative often makes the process much smoother.

Facilities may also engage HMS directly for Medicaid-pending support, case review, eligibility troubleshooting, staff consultation, or other services. In those situations, the facility is our client, and the scope of our work is defined accordingly.

Either way, our goal isn't to create an adversarial relationship between the facility and the family. In most Medicaid cases, everyone ultimately wants the same thing: appropriate care for the resident, accurate Medicaid eligibility, clear communication, and payment issues resolved as efficiently as possible.

There may occasionally be situations where the interests of a facility and a resident or family diverge. If that happens, we don't blur the lines. We'll identify the issue, communicate about the appropriate next steps, and avoid acting in conflicting roles.

We also aren't attorneys and don't provide legal representation. When a matter involves legal rights, competing interests, or another issue requiring legal advice, we'll say so and recommend that the appropriate party obtain independent legal counsel.

Good collaboration starts with everyone knowing whose interests they're responsible for—and respecting the roles of everyone at the table.

Yes—and sometimes a different voice makes all the difference.

Families don't always understand what is at stake when a Medicaid application is pending. They may be overwhelmed, grieving, working full-time, caring for another family member, unable to locate records, or simply confused about why Medicaid keeps asking for information they thought they already provided.

Sometimes they are avoiding the situation altogether.

We can step in and help determine what is actually needed, what has already been provided, what is still missing, and who has the ability and authority to obtain it. Then we work directly with the family to break the process into manageable pieces and explain why particular information matters.

We're persistent about follow-up, but we also recognize that most families aren't intentionally trying to create a problem. Sometimes they need someone who has the time to walk them through it instead of another voicemail telling them their paperwork is overdue.

If the problem is more significant—such as family conflict, inaccessible accounts, lack of legal authority, suspected financial exploitation, or someone who simply refuses to cooperate—we'll identify that rather than allowing the case to sit indefinitely while the facility's receivable continues to grow.

We can then help determine whether another resource or professional needs to become involved.

Our goal is to turn “the family isn't cooperating” into a specific problem we can actually work on.

Because once we know why the case isn't moving, we have a much better chance of figuring out what will move it.

Yes. A denial or suspension doesn't automatically mean the case is over—or that the decision was correct.

When Medicaid takes an adverse action, we start with the same question we ask in every difficult case: Why?

We review the notice, application history, verification requests, financial information, prior communications, and other available records to understand what happened. Was information missing? Was something submitted but not processed? Did Medicaid identify an eligibility issue? Was a resource or transfer treated incorrectly? Did the family miss a notice? Or does the agency's decision appear inconsistent with the facts or applicable Medicaid policy?

Then we determine the appropriate response.

Sometimes the problem can be resolved by supplying documentation, correcting information, or communicating with the agency. Other cases may require a formal appeal and fair-hearing process.

HMS can assist with Medicaid administrative appeals within the scope of our services, including reviewing the adverse action, organizing the administrative record, identifying relevant Medicaid policy, preparing supporting documentation, communicating with the agency, and helping the client prepare for the hearing process.

We also pay close attention to deadlines. Appeal rights can be time-sensitive, and in some circumstances the timing of an appeal may affect whether existing benefits can continue while the dispute is being resolved.

If an appeal raises legal issues that require an attorney, we'll recognize that boundary and help get legal counsel involved. We don't try to turn a Medicaid administrative matter into something it isn't—or handle legal work outside our role.

For the facility, our involvement also means someone is actively tracking the case, communicating with the parties, and working toward a resolution rather than simply watching the unpaid balance grow while everyone waits to see what happens.

A denial is a decision. It isn't necessarily the final decision.

And when the facts and Medicaid policy support the resident's position, we're comfortable challenging it.

Yes. An approval doesn't necessarily mean every part of the Medicaid determination is correct.

A resident may be approved for Medicaid and still have questions about the amount they're expected to contribute toward their care. Patient liability can be affected by income, allowable deductions, health-insurance premiums, spousal allocations, changes in circumstances, and other factors.

When the amount doesn't make sense, we don't recommend simply assuming Medicaid calculated it correctly—or assuming the facility calculated it incorrectly. We look at the numbers.

We'll review the eligibility determination and available financial information to understand how the liability was calculated and compare that with the circumstances of the case.

Sometimes the explanation is straightforward. Sometimes Medicaid is working with outdated information, a deduction hasn't been applied, a change hasn't been processed, or there is another issue that needs to be addressed.

This becomes especially important when there is a community spouse. The amount of income that may be allocated to the spouse at home can have a meaningful impact on both the resident's patient liability and the community spouse's ability to meet expenses.

We can help communicate with the resident or family, identify documentation that may be needed, and work through the appropriate Medicaid process when a correction or change is warranted.

Approval is important—but so is getting the approval right.

For the facility, getting the liability correct also helps prevent a different problem later: months of incorrect billing, an accumulating resident balance, and a very confused family trying to figure out why everyone has a different number.

Not necessarily. Medicaid approval is an important milestone, but it isn't always the end of the story.

After approval, circumstances can change. A resident may receive an inheritance, sell property, experience a change in income, lose a spouse, move between care settings, have a change in insurance, or receive a notice that requires action. Medicaid may request additional information, conduct a redetermination, change patient liability, or suspend or discontinue coverage.

Sometimes the first sign that something has gone wrong is when the facility stops receiving payment.

HMS can provide ongoing case monitoring and post-eligibility support when that service is appropriate. We can help track important Medicaid notices and deadlines, assist with redeterminations, review changes in financial circumstances, address verification requests, investigate unexpected changes in coverage or liability, and communicate with the resident, family, facility, and agency as appropriate.

We also encourage families to contact us before making significant financial changes after approval. Medicaid eligibility isn't frozen in time. A transaction that occurs after approval—or a change in the resident's circumstances—can affect continued eligibility.

For facilities, continued monitoring can be particularly valuable when the resident doesn't have a family member who is comfortable managing Medicaid, when the responsible party is overwhelmed, or when there is a history of missed notices or difficult communication.

And if something does go wrong, we want to know about it early. A notice sitting unopened for several weeks can turn a manageable issue into a much more difficult one.

Our goal isn't simply to get a resident approved. It's to help keep an eligible resident approved and address problems before they become months of unpaid care.

Keep it simple. Call us, send us a message, or give the family our contact information.

A referral doesn't need to involve a complicated process, and the facility doesn't need to determine exactly which HMS service the resident needs before contacting us. Tell us what's happening, and we'll help figure out the next step.

With the appropriate permission, facility staff can contact HMS to discuss the general situation and determine whether our services may be a good fit. You can also provide our information directly to the resident, responsible party, or family and ask them to contact us.

We offer a free initial 15-minute consultation, which gives us an opportunity to hear what's happening and determine whether we can help before anyone commits to services.

If the family will be engaging HMS directly, we'll explain our services, fees, and engagement terms to them. Once we're retained and have the appropriate authorizations in place, we can communicate directly with the facility and take much of the Medicaid follow-up off your staff's plate.

If the facility is interested in engaging HMS directly for a particular case or for broader Medicaid-pending support, we can discuss a separate facility arrangement and clearly define the scope of our work.

And referring someone to us doesn't mean you're handing the case into a black hole. Communication matters. When authorized and appropriate, we'll keep the relevant facility staff informed about meaningful developments, outstanding needs, and issues that may affect eligibility or payment.

We also respect the referral relationship. If a facility sends a family to HMS, our goal is to solve the Medicaid problem—not interfere with the facility's relationship with its resident.

You don't need to diagnose the Medicaid problem before calling us. Just send us the problem. We'll start there.

Our goal is to take work off your plate—not add another layer to it.

A difficult Medicaid case can consume an extraordinary amount of staff time. Your BOM may be calling family members for bank statements, tracking verification deadlines, checking portals, following up on applications, explaining the same request repeatedly, trying to locate missing documents, and troubleshooting financial issues—all while still being responsible for the rest of the business office.

When HMS is engaged to manage the Medicaid case, we take ownership of the Medicaid-focused work within our scope.

We can communicate directly with the family, identify and organize the documentation needed, track outstanding items, monitor the application, respond to verification requests, follow up with the appropriate agencies, identify eligibility concerns, and coordinate with attorneys or other professionals when necessary.

That doesn't mean we shut the facility out.

With the appropriate authorizations, we'll establish a clear point of contact at the facility and communicate meaningful developments without copying your staff on every phone call, email, or document request involved in getting there.

If we need something from the facility, we'll tell you specifically what we need and why. If we need something from the family, we'll work with the family. If there's an issue affecting eligibility, payment, patient liability, or the expected timeline, we'll make sure the appropriate people know.

We also understand that your staff has other residents to serve. Your BOM shouldn't have to become a full-time detective because one Medicaid case has consumed the office.

The goal is simple: fewer loose ends, fewer repeated phone calls, better communication, and someone whose job is to keep the Medicaid case moving forward.

That's exactly the kind of case we want you to call us about.

Having resources doesn't necessarily mean a resident cannot qualify for Medicaid. It may mean planning needs to happen before an application should be filed.

HMS can evaluate the resident's financial picture to identify countable and exempt resources, potential transfer issues, spousal protections, real estate concerns, income issues, life insurance, retirement accounts, annuities, prior transactions, and other factors that may affect eligibility.

Then we work toward a plan.

Sometimes that means helping the resident appropriately use or convert countable resources into exempt resources for their own benefit before applying. Other situations may involve a community spouse, property that needs special consideration, an old transfer that needs to be analyzed, or financial transactions that require additional documentation.

This is also where our professional collaborations become especially valuable.

If the Medicaid strategy requires a deed, trust, Power of Attorney, guardianship, estate-planning document, or other legal work, we don't try to do the attorney's job. We identify what the Medicaid plan may require and collaborate with qualified legal counsel who can evaluate and implement the legal component.

Likewise, if the situation requires expertise from a financial, tax, healthcare, or other professional, we'll help bring the appropriate people into the conversation.

Our goal isn't simply to make the numbers fit on the day we file the application. We want the strategy to make sense under Medicaid policy, be properly documented, and account for what happens after approval as well.

And if someone has already transferred property, moved money, made gifts, changed ownership, or taken another action before HMS became involved, don't assume the case is ruined.

Let us evaluate what actually happened. Some transactions may be permissible, some may require additional documentation, and others may potentially be corrected or addressed with appropriate professional guidance.

Complex doesn't mean ineligible. It means we need to understand the problem before we file the application.

Absolutely. Collaboration is a big part of how we work.

HMS doesn't need to replace the professionals or systems your facility already has in place. We can work alongside your Business Office, corporate Medicaid team, outside counsel, resident's attorney, social services staff, financial professionals, and other members of the care or planning team.

Our role is to bring Medicaid-focused knowledge and case management to the table and help keep the different pieces moving in the same direction.

This becomes especially valuable when a Medicaid problem overlaps with a legal issue. A resident may need a Power of Attorney, guardianship, deed, trust, probate assistance, or other legal work before the Medicaid plan can move forward. HMS does not prepare legal instruments or provide legal advice, but we understand enough about the Medicaid strategy to recognize when legal work is needed and explain the Medicaid objective to counsel.

Likewise, if your facility already has corporate Medicaid resources, we're happy to coordinate rather than duplicate work.

We aren't interested in protecting territory. We're interested in solving the case.

When everybody involved understands their role and communicates, difficult Medicaid cases tend to become much more manageable.

Of course—and there is no obligation to hire us because we had a conversation.

Tell us what you're seeing.

Maybe you have several Medicaid-pending residents you're concerned about. Maybe your Business Office is overwhelmed. Maybe there's one case nobody can seem to resolve. Maybe you're reconsidering whether to accept Medicaid-pending admissions. Or perhaps things are working fairly well and you're simply interested in having another experienced Medicaid resource available when something unusual comes up.

We're happy to learn how your facility currently handles Medicaid, answer questions about HMS, and talk honestly about where we might be useful and where we probably aren't necessary.

If you need approval from corporate leadership, ownership, or a governing board, we're also happy to provide information, answer questions, or participate in that conversation.

You don't need to develop a proposal before contacting us, and you certainly don't need to commit to a long-term arrangement.

Sometimes the best place to start is one case.

Send us the Medicaid case that's been sitting on your desk making everyone scratch their heads.

We'll take a look and go from there.