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Long-Term Care Insurance Market Issues

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Traditional Insurance Market Declines

Forbes is reporting that only about 89,000 people bought private long-term care insurance in 2016, a nearly 14 percent decline from 2015, according to an industry survey.  Nearly all were bought in the individual market, though about 15,000 people purchased coverage through their jobs.

The sales decline continues a stunning trend. At the market’s peak in 2002, consumers bought 750,000 traditional policies, eight times what they purchased last year. For the second year in a row, the total number of people covered by long-term care insurance fell slightly as more dropped coverage, died, or exhausted benefits than bought new policies. Roughly 7 million people currently own traditional policies, a number that has not changed in a decade even as the population of those 55 and older (those most likely to buy or use long-term care insurance) has grown by 30 million.

While fewer people bought traditional insurance last year, more purchased policies that combined life insurance with long-term care benefits. More than twice as many consumers bought policies that typically add long-term care benefits to annuities or whole life plans than purchased stand-alone coverage. Some consumers continue to want to hedge against personal care costs in old age, but not with traditional, stand-alone policies.

Traditional Long-term care insurance market is crumbling.

 The authoritative industry survey by the actuarial firm Milliman Inc. reported that 17 carriers sold traditional long-term care policies in 2016. Measured by premium, the top two carriers, Northwestern Mutual and Mutual of Omaha, accounted for nearly half of all sales last year. Strikingly, Genworth, the long-time industry leader that generated nearly one-third of all new premium dollars as recently as 2014, sold only 12 percent in 2016. The survey results were published in the trade journal Broker World (firewall).

Average premiums fell slightly in 2016, from $2,497 to $2,480. That may reflect a mix of several factors. They include slightly younger buyers and slightly less generous daily benefits, though the average length of policy benefit period rose a tick from 2015. Consumers also purchased less generous inflation protection, with many choosing a feature known as Future Purchase Option that allows them to buy more coverage in future years instead of getting automatic annual benefit increases.

 About 40 percent of buyers bought three-year policies last year. Eighty-five percent bought coverage for five years or less. While most insurers focused on shorter-tem policies, one reported selling eight-year coverage, though those policies accounted for less than five percent of those sold.

One carrier, using a back-to-the-future marketing strategy, sold single-premium lifetime policies. This product, popular a decade ago, allows consumers to make one upfront payment and avoid future premium increases. But nearly all carriers abandoned the design because of the big, and difficult to predict, risks they were taking on.

In 2016, insurers were also underwriting prospective customers more strictly, with more carriers reviewing consumer’s medical and medication records and doing telephone interviews and cognitive assessments. Other research suggests that as many of one-third of those who want to buy long-term care insurance are unable to do so because they cannot pass underwriting.

Traditional long-term care insurance is disappearing as a way for middle-income people to prepare for their personal care needs in old age. It is too expensive for many consumers, and too difficult to buy, especially for those who wait until their 60s when they are likely to have pre-existing conditions that may disqualify them. At the same time, most large life insurance companies — which were once the core of the business — are unwilling to sell long-term care coverage at all.

The rise of combination products suggests that people still want protection against long-term care costs. But without big changes, stand-alone long-term care insurance is likely to play only a modest role in this market for the foreseeable future.

READ THE FULL ARTICLE ON FORBES HERE.

If Long-Term Care Insurance is not an option for you, then planning to qualify for Medicaid benefits is critical. Contact our office to discuss what planning to qualify for Medicaid would mean to you.

Trump Signs Bill to Fund Veterans Medical Care Program

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Veterans to receive private medical care

President Donald Trump

President Donald Trump has signed an emergency spending bill that will pump more than $2 billion into a program that allows veterans to receive private medical care at government expense. Trump, who made improving veterans care a central campaign promise, signed the VA Choice and Quality Employment Act while at his New Jersey golf club on Saturday.

The bill, which addresses a budget shortfall at the Department of Veteran Affairs that threatened medical care for thousands of veterans, provides $2.1 billion to continue funding the Veterans Choice Program, which allows veterans to seek private care. Another $1.8 billion will go to core VA health programs, including 28 leases for new VA medical facilities.

Why the new Veteran program?

The Choice program was put in place after a 2014 wait-time scandal that was discovered at the Phoenix VA hospital and spread throughout the country. Veterans waited weeks or months for appointments while phony records covered up the lengthy waits. The program allows veterans to receive care from outside doctors if they must wait at least 30 days for an appointment or drive more than 40 miles to a VA facility.

VA Secretary David Shulkin has warned that without legislative action, the Choice program would run out of money by mid-August, causing delays in health care for thousands of veterans. The bill will extend the program for six months. Costs will be paid for by trimming pensions for some Medicaid-eligible veterans and collecting fees for housing loans.

Veterans Benefits

Veterans benefits are questions that all people who have served should seek the information to fully understand their options. Many who have served, while having the option to receive benefits in established Veterans hospitals and facilities, often choose to participate in private facilities. Veterans needing skilled nursing care have the option of receiving the care inside the VA hospital program, or, as with any private citizen, can qualify for Medicaid to pay for those medical needs. Speaking to a person who is certified in VA planning is a critical step in understanding what option is right for you or your loved one.
Source: ABC News

Palliative Care: 10 Facts To Know

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What Is Palliative Care?

Palliative care is an approach that improves the quality of life of patients (adults and children) and their families who are facing problems associated with life-threatening illness. It prevents and relieves suffering through the early identification, correct assessment and treatment of pain and other problems, whether physical, psychosocial or spiritual.

This care is a crucial part of integrated, people-centered health services, at all levels of care: it aims to relieve suffering, whether its cause is cancer, major organ failure, drug-resistant tuberculosis, end-stage chronic illness, extreme birth prematurity or extreme frailty of old age.

Fact 1: Palliative care improves lives

Worldwide, only about 14% of people who need care currently receive it. The quality of life of patients and their families who are facing problems associated with life-threatening illness, whether physical, psychosocial or spiritual are greatly improved by palliative care.

Fact 2: Pushing policy will drive palliative care forward

World Health Assembly resolution 67.19 on strengthening palliative care, adopted in 2014, emphasizes the need to create national care policies, to ensure secure access to opioids for pain relief, training for all health care staff in palliative care, and the integration of palliative care services into existing health care systems.

Fact 3: Most people in need of palliative care are in their own homes

Therefore, the most effective models of palliative care link supervised home care and care at community health centres to hospitals with more palliative care expertise.

Fact 4: Palliative care benefits everyone

Patients during treatment for serious illnesses, not only patients at the end of their lives, can take advantage of what palliative care can offer. For example, it can improve the quality of life of patients receiving radiation therapy for cancer or chemotherapy for cancer or drug-resistant tuberculosis.

Fact 5: Oral immediate-release morphine is an essential palliative medicine

Opioid laws and prescribing regulations must balance the prevention of illegal use of opioids with ensuring accessibility to morphine to relieve moderate and severe pain.

Fact 6: Children have little access to palliative care

They are at a higher risk than adults to face inadequate pain relief. For children, 98% of those needing palliative care live in low- and middle-income countries with almost half of them living in Africa.

Fact 7: Palliative care is “people-centered”

For example, it respects the values and confidentiality of patients, seeks to protect patients and their families from financial hardship due to the illness, and provides emotional support both during the illness and for the bereaved.

Fact 8: Palliative care shows global disparity

Lack of access to palliative care and pain control is one of the largest inequalities in global health. Most people in high-income countries have access, but only a small percentage of people in low- and middle-income countries do. Each year an estimated 40 million people are in need of palliative care, 78% of whom live in low- and middle-income countries.

Fact 9: The need for palliative care has never been greater

It continues to grow with the increase of chronic diseases and people living to an older age.

Fact 10: Integrating home care has multiple benefits

Palliative care that includes home care can improve the quality of life of patients and their families while also saving money for health care systems by reducing unnecessary hospital admissions.

Long Term Care

http://www.who.int/features/factfiles/palliative-care/en/

Home Placed In Massachusetts Trust Protected

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Ability to Use House Placed In Massachusetts Trust Does Not Render Trust Available

Reversing a lower court, Massachusetts’ highest court rules that two Medicaid applicants’ trusts were not available assets even though the applicants retained the right to use the houses that were put into the trusts. Daley v. Secretary of the Executive Office of Health and Human Services (Mass., No. SJC-12200, May 30, 2017) and Nadeau v. Director of the Office of Medicaid (Mass., No. SJC-12205, May 30, 2017).
James and Mary Daley created an irrevocable trust. They conveyed their interest in their condominium to the trust, but retained a life estate in the property. Seven years later, Mr. Daley was admitted to a nursing home and applied for Medicaid benefits. The state denied him benefits after determining that the trust was an available asset. Lionel Nadeau and his wife created an irrevocable trust and transferred their house into the trust. The trust provided that the Nadeaus had the right to use and occupy the house, which they did until Mr. Nadeau entered a nursing home and applied for Medicaid benefits. As with the Daleys, the state considered the trust a countable asset and denied benefits.

The Daleys and the Nadeaus appealed but following hearings, the state ruled that the trusts were available assets because the Daleys and Nadeaus had the right to occupy and use the properties that were in the trusts. In separate rulings, Massachusetts trial courts held that both trusts were available assets. [Daley v. Sudders, Mass. Super. Ct., No. 15–CV–0188–D; Dec. 23, 2015; and Nadeau v.Thorn, Mass. Super. Ct., No. 14-DV-02278C, Dec. 30,2015]; see The ElderLaw Report, March 2016, p. 5.) The Daleys and Nadeaus appealed and the Massachusetts Supreme Judicial decided both cases together.

The Massachusetts Supreme Judicial court reverses, holding that the trusts are not available assets. According to the court, “where a trust grants the use or occupancy of a home to the grantors [as in the Nadeau’s case], it is effectively making a payment to the grantors in the amount of the fair rental value of that property.” The court adds that these payments “do not affect an applicant’s eligibility for Medicaid long-term care benefits, but they may affect how much the applicant is required to contribute to the payment for that care.” In the Daleys’ case, the court rules that because the Daleys hold a life estate, their use of the home is not considered income and “the continued use of the home by the applicant pursuant to his or her life estate interest does not make the remainder interest in the property owned by the trust available to the applicant.”

Maryland elder law attorney Ron M. Landsman joined the briefing and argument. In reaching its conclusion in the Daley case, the court cites the Elder Law section of West’s Massachusetts Practice series, written by Harry S. Margolis and Jeffrey A. Bloom of the Boston firm of Margolis & Bloom, LLP. For the full text of this decision, go to: http://tinyurl.com/elr-Daley3

Pre-Planning versus Emergency Planning

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Pre-Planning vs. Emergency Planning

This video explains the difference between pre-planning and emergency planning when confronted with planning for long-term care and skilled nursing care and Medicaid qualification.

Posted by Rhode Island Medicaid Planning on Monday, June 5, 2017

Important Medicaid Trust Rules Update: R.I. Court Rules That Pre-1993 Trust Is Countable Resource

By | Medicaid Planning and Gifting, News | No Comments

Important Legal Update: Medicaid Trust Rules Machunis v. Rhode Island Dept. of Human Services (R.I., Super, No. PC 2016-0613, Jan. 9, 2017): 

A Rhode Island trial court affirms the denial of a nursing home resident’s application for Medicaid benefits based on excess resources, concluding that because a trust she established in 1991 allowed the trustee to make distributions of income and principal for her benefit, the entire trust was a countable resource.  

Nursing home resident Catherine T. Machunis applied to the Rhode Island Dept. of Human Services for Medicaid long-term care benefits. The agency denied the application because Ms. Machunis’ financial statement revealed that she was the beneficiary of a trust with a value of $78,149.57, exceeding Medicaid’s $4,000 asset limit.

Ms. Machunis requested a formal hearing, disputing the agency’s consideration of any money in the trust as a countable resource. Following an evidentiary hearing, a hearing officer determined that because Ms. Machunis had established the trust prior to August 1993, it was a Medicaid Qualifying Trust and the amount available to her was the maximum amount the trustee could distribute if the trustee used his or her full discretion under the trust’s terms. The hearing officer affirmed the denial of benefits, concluding that the trustee had the authority to disburse the entirety of the trust assets to Ms. Machunis and, therefore, the entire trust was a countable resource. Ms. Machunis appealed to the Superior Court of Rhode Island.

On appeal, Ms. Machunis argued that the trust assets were not countable resources for Medicaid purposes because the trustee’s discretion was limited to making distributions only from the income, and not from the principal, of the trust. The agency countered that the trustee had the discretion to make distributions from the principal for Ms. Machunis’ benefit and, therefore, the entire corpus of the trust was available to her.

The Superior Court of Rhode Island, Providence County, affirms the agency’s denial of Ms. Machunis’ application based on excess resources. The court finds that because the trust clearly
authorizes the trustee to make distributions from the income and principal for Ms. Machunis’ benefit, the entire trust is a countable resource and the agency properly denied her application.

For the full text of this decision, go to: http://tinyurl.com/elr-Machunis

Overwhelmed with the Medicaid Application process? Contact us for help.

NJ: Medicaid Planning Must Be Done By Lawyers

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Joining the states of Florida, Ohio, and Tennessee, the New Jersey Supreme Court has found that non-lawyers who apply the law to a Medicaid applicant’s specific circumstances are engaging in the unauthorized practice of law.

The state Supreme Court had received complaints that non-lawyers retained by families or nursing homes to assist with the Medicaid application process were providing erroneous or incomplete law-related advice, and a state attorney ethics hotline had received reports that non-lawyers have charged “clients” large sums of money for faulty Medicaid-planning legal assistance, causing the elderly victims significant financial loss.Lawyers

Asked by the state Supreme Court for an opinion specifying what activities non-lawyers may engage in and what activities are the unauthorized practice of law, the Committee on the Unauthorized Practice of Law has concluded that while non-lawyer Medicaid advisors may provide limited services, “[a]pplying the law to an individual’s specific circumstances generally is the ‘practice of law.’

A Medicaid advisor or Application Assistor may provide information on insurance programs and coverage options; help individuals complete the application or renewal; help them with gathering and providing required documentation; assist in counting income and assets; submit the application to the agency; and assist with communication between the agency and the individual. But the advisor may not provide legal advice on strategies to become eligible for Medicaid benefits, including advice on spending down resources, tax implications, guardianships, sale or transfer of assets, creation of trusts or service contracts, and the like.”

For the Committee on the Unauthorized Practice of Law’s Opinion 53, “Non-Lawyer Medicaid Advisors (Including ‘Application Assistors’) and the Unauthorized Practice of Law,” courtesy of New Jersey elder law attorney Donald D. Vanarelli, go to: Vanarellilaw.com

Rhode Island has not addressed this issue of Medicaid Planning and assisting with Medicaid applications as being activities that constitute legal advice and thus only to be dispensed by licensed attorneys. People are on notice that use of non-attorney’s for this planning is a risk that each person should weigh before embarking on planning with non-attorneys.

 

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