With Medicaid, one small detail can cost you thousands. Take, for example, the recent case of a woman whose husband was on Medicaid for long-term care. She thought she had to spend the money in her bank account, so that’s what she did. Only the problem wasn’t her bank account at all.

You can read all about it at Elder Law in Wisconsin, where I publish Medicaid decisions for other elder law attorneys. The problem was one of those Medicaid details few people understand, even those who work with long-term care and Medicaid daily: the rules about a married couple’s assets are different when you first apply and when you first renew.

When a married couple first applies for long-term care Medicaid, it doesn’t matter whose name is on the assets. With only a few exceptions, the Medicaid office adds up the assets in either spouse’s name. If the total is over the asset limit—which can be anywhere from $52,000 to about $160,000—the application is denied. The Medicaid Eligibility Handbook (the rule book for the county Medicaid office) says: “Count the combined assets of the institutionalized person and his or her community spouse. Add together all countable, available assets the couple owns.”

After the application is approved, however, the rule changes. Now it does matter whose name is on the assets. The couple has one year to get the institutionalized spouse’s name off everything above $2,000. This is called the “asset transfer period.” At the first renewal (Medicaid benefits have a “renewal” every year where you have to update your information and prove you are still eligible), the only thing that matters is that the name of the spouse on Medicaid is on less than $2,000 worth of assets. In fact, the other spouse (the “community spouse”) could have a million dollars and it wouldn’t affect the Medicaid benefits, as long as that million was in his or her sole name. The Medicaid Eligibility Handbook says: “The institutionalized spouse must transfer the assets to the community spouse by the next regularly scheduled review (12 months). If their assets are above $2,000 on the date of the next scheduled review, they will be determined ineligible.” (That’s the singular they, by the way.)

So what happened to the woman in this case? Her husband had his first yearly Medicaid renewal, where it was discovered he still had his name on some stocks. She was told they had too much money to be eligible. Her mistake was thinking that she had to spend down her own bank account rather than the stocks. It’s an understandable mistake, because that would have worked when they first applied. But at the first renewal the rules are different.

In fact, she didn’t have to spend down anything. The problem could have been solved by simply transferring ownership of the stocks from her husband’s name to hers. One phone call with an experienced elder law attorney would have told her that. We don’t know how much money was in her bank account that she spent down. The stocks were worth more than $16,000. Her husband lost Medicaid for two months because of the mistake, so she also had to pay for his long-term care during that time. So, this small detail, this simple, understandable mistake likely cost her several tens of thousands of dollars.

That’s the difference one small detail can make. That’s the difference good advice from an elder law attorney can make. And that’s why one of my core values is be correct. With Medicaid, being correct requires attention to the details.