Category

Uncategorized

4 Reasons Why You Should Consult an Elder Law Attorney on Medicaid Issues.

By Uncategorized

Why Should You Consult an Elder Law Attorney on Medicaid Issues?

Many people are reluctant to consult attorneys on legally-related matters due primarily to inexperience in working with attorneys. This is doubly true with respect to issues related to Medicaid coverage of nursing home care for the following reasons:

  • The cost of consulting with an attorney.
  • Medicaid eligibility is seen as a non-legal matter that should be straightforward and not require legal assistance.
  • Nursing homes often offer to prepare Medicaid applications for residents for no charge at all.
  • Discomfort with using a public benefits program.

Let’s discuss each obstacle to legal representation in turn.

Cost

There is no getting around it. Lawyers are expensive. But the bottom line-since that’s what we’re talking about here-is that they’re a lot less expensive than nursing homes. In the Rhode Island area, nursing homes generally charge $9,113 or more a month. If the consultation with the lawyer saves even a month of nursing home fees, the legal costs will be more than justified. At stake can be a lifetime of hard work and savings.

Medicaid as Law

Certainly, public benefits should be available to those who qualify without having to resort to hiring an attorney. Unfortunately, this aspiration and the reality of the Medicaid rules are far apart. The eligibility requirements are defined in a conflicting set of state and federal laws, regulations, bulletins and practices that make it impossible even for attorneys to fathom unless they specialize in the field. Your case may be simple and may not require the depth of knowledge needed to plan for a more complicated estate. However, you cannot be sure of that without first meeting with a specialist. Again, a lot is at stake and given the cost of nursing homes, it’s not difficult for a qualified attorney to save the client more than the attorney’s fee.

Free Application Services

Yes, the nursing home provides application assistance at no charge. In addition, in the majority of cases there is no risk in using these services if you’ve checked it out with an attorney ahead of time. However, there is a great risk to using the nursing home’s services without first consulting an elder law attorney. We have seen countless examples of incomplete or improper advice leading to significant lost planning opportunities for our clients, no matter how well-intentioned the advice giver may be. Rectifying the situation may cost more in legal fees than would have been the case with a proper plan. In any event, the nursing home and the resident’s family often have conflicting interests since their private-pay rates are typically $4,000 a month more than they receive in Medicaid reimbursement. In other words, every month that a resident pays privately rather than receives Medicaid coverage is additional money going to the nursing home and less preserved for the resident’s spouse and family.

In addition, to the extent that the application raises legal issues, it makes sense to have an elder law attorney prepare the application. This would be the case, for instance, if a trust were involved or if you were seeking an exception to the usual penalties for transferring assets.

Medicaid as Welfare

Medicaid serves a number of different populations, including poor recipients of Supplemental Security Income (SSI) and disabled people receiving Social Security Disability Income (SSDI). No one would argue that when Medicaid was created it was meant to be the main system of paying for long-term care for older Americans. But in the absence of any other program to fill that need, Medicaid has become the nation’s long-term care financing system by default. Medicaid planning permits nursing home residents to be covered by the program under its rules. Congress can change the rules, and often does. Consulting with an attorney permits seniors and their families to understand the rules as they are and the options available to them. It does not require them to take any particular steps. It can be vital to preserving the financial security of a healthy spouse continuing to live at home.

Ready to have the conversation about how Medicaid Planning fits into your long term plan?  Contact our office for a free consultation to learn how Medicaid Planning will work for you.

practice-elder_law

Long-Term Care Insurance: 4 Must Follow Rules

By Uncategorized

Long-Term Care Insurance – To get or not to get?

For those who can afford it, Long-Term Care Insurance is becoming increasingly popular as a means of paying for nursing home or home care. The problem is choosing a good policy and being able to afford it.

Here are a few Long-Term Care Insurance rules of thumb:

  • Only buy policies that are approved in your state. Generally, these are individual, as opposed to group, policies. A group policy may be just as good, but since it is not regulated you must be extra careful in seeking professional assistance in examining it. In addition, if you do require Medicaid assistance despite the fact that you own a Long-Term Care Insurance policy, owning an individual policy will protect you from estate recovery; owning a group policy will not.
  • Buy enough coverage. It will not do you much good to have insurance coverage if it is insufficient to meet your cost of care. Anticipate your need for the insurance to occur at least ten years off and anticipate the inflation in Long-Term Care Insurance costs to exceed the growth in your income by at least 5 percent a year. However, there is another school of thought that recommends purchasing enough coverage to pay for assisted living if you can only afford the lower premiums.
  • Buy home care coverage. If you have nursing home coverage and not home care coverage you may feel compelled to move to a nursing home in order to save money. Do not put yourself in that bind.
  • Only buy the insurance if you can afford it. The guidelines above will all increase the cost of the policy. But if you cannot afford them, then do not buy the insurance. How do you know if you can afford a certain premium? A rule of thumb is that payment of the premium should not affect your standard of living. So you can afford the premium if you are using money that you would otherwise set aside to add to your savings. An alternative would be to purchase an annuity that pays sufficient benefits to cover the long-term care insurance premiums.

Long-Term Care Insurance is not an option for you? You can still qualify for nursing care without spending your entire life savings. How? A properly drafted estate plan using Income Only Trusts can achieve the same goal.

Want to lean more? Contact our office for a free consultation.

Long-term care insurance information, form, Folders and stethoscope.

Long Term Care Insurance Policy

MJL Blog Footnote

4 Reasons To NEVER Give Your Home To Your Children

By Uncategorized

Many people plan to continue to live in their home as long as they are able to do so. If they eventually ever have to go to a nursing home, your house and its contents would NOT have to be sold in order to qualify for Medicaid. However, it is still at risk because the state has a right to recover whatever it pays for your care from your probate estate. Your home may be protected from such estate recovery by keeping it out of your probate estate.

The simplest approach to doing so would be to deed it to your children. There are four problems with doing this:

  1. You lose control over your house. Your children now are the tile owners of the home and as such it would be subject to and vulnerable to your children’s debts or if they were sued or divorced.
  2. This would be a transfer which would make you ineligible for Medicaid for the following 60 months.
  3. Your children would lose the opportunity of getting a “step-up” in basis by receiving the property through your estate. Your children would be subject to potential capital gains taxes that could be avoided.
  4. Selling the home later can become problematic. Many clients expect at some point to need to sell their home and possibly downsize. By transferring the home to your children you have added complexity with title issues and taxation issues with any sale.

So how do you keep the house out of  your probate estate so that the state has no access to place a lien on it? How do you ensure your heirs get a stepped-up basis in the house? How should you own the house that allows for a ease of downsizing? There is one SOLUTION: using the Irrevocable Income Only Grantor Trust.

This trust allows you to keep the property out of your children’s hands, allows them to received a step-up in basis, allows you the freedom of selling the property without a hassle, avoids estate recovery and five years after the transfer is completely protected for Medicaid.

Want to lean more? Contact our office for a free consultation.elderly-couple-in-front-of-home-960x683

Can Long Term Care Insurance Work For More People?

By Uncategorized

Long Term Care Insurance is a product known by few and used by fewer.

New research looks at trade offs in participation rates, cost and Medicaid savings. These factors must be reviewed when deciding on what is the best way to protect assets. But where does a person start?

The first step in the process is consulting with an estate planning attorney. During that consultation, an elder law estate planning attorney will be able to make an initial assessment of the client, their assets, prospective needs and overall goals. Clients should be advised during the consultation if long term care insurance is an option and then the elder law attorney should make a recommendation to you to meet with a long term care insurance representative to review products available. Unfortunately, because of economic or health reasons few people can consider pursing long term care policies.

Follow the below link that discusses the findings of some recently completed new research that looks at tradeoffs in long-term care insurance participation rates, cost, and Medicaid savings.

The attached article suggests that when someone turns 65 in America today, there’s about a 50-50 chance he or she will need not just medical care as they get older, but extensive help with basic activities like dressing, bathing, walking and eating. Expenses associated with caring for individuals on average are between$91,000 and $182,000, but they can range much higher, too.

People who seek out long term care insurance cite the peace of mind knowing they are prepared for whatever life brings them. The long term care insurance industry struggles to make these policies viable for more individuals and if successful, it will have broad impact on Medicaid.

http://www.nextavenue.org/how-to-get-more-people-covered-by-long-term-care-insurance/

Document of Insurance Policy, Life; Health, car, travel, for background

MJL Blog Footnote

Who Receives Skilled Nursing Care and Where in Rhode Island?

By Uncategorized

Skilled Nursing Care Demographics in Rhode Island

Nearly 8,000 people reside in Rhode Island’s 84 nursing homes and skilled nursing care facilities at any single point in time.

They are mostly independent facilities (60.7%), although a large minority belong to a multi-facility organization (39.3%). Nearly eight in 10 (78.6%) RI nursing homes are for-profit.

Residents are predominantly female (72.1%) and non-Hispanic white (93.4%).

More than half (55.5%) are aged 75 or older.

In 2012, RI nursing home costs averaged $8,517 per month for a shared room and $9,277 per month for a private room. Source: Rhode Island Journal of Medicine: The Nuts and Bolts of Long-Term Care in Rhode Island: Demographics, Services and Costs (March 2015)

WHAT ABOUT BEING ABLE TO RECEIVE CARE AT HOME UNDER THE MEDICAID WAIVER PROGRAM?

Rhode Island has a program called SSI Enhanced Assisted Living Program that provides up to approximately $1,200 / month to be put toward the cost of assisted living. However, this is not a Medicaid program. RI does have a Medicaid program called RIte @ Home which offers 24/7 personal care in a residential environment but not in assisted living communities. Finally, the state’s Home and Community Care Medicaid Waiver also covers assisted living.

NursingHome

Nursing Home Demographics

Elderly Rhode Island residents can receive a variety of care services and support through the Home and Community Care Program. This program is intended as an alternative to nursing homes.  The services are provided to individuals living at home or “in the community”. By the rules of the program, “in the community” includes assisted living residences. The benefits of the program are designed to support individuals at home. This program provides adult day care, in-home care, meal delivery services and medical alert services.

This program is under the jurisdiction of the Rhode Island Division of Elderly Affairs and is funded through a combination of state and federal monies.

Want to learn more about how nursing home skilled nursing and the Waiver Program may impact you and your family? Contact our office for a free consultation.

MJL Blog Footnote

 

How Do People Pay For Nursing Home Care In Rhode Island?

By Uncategorized

What do you mean my health insurance does not pay for nursing home care?

There are 3 major ways on how people pay for nursing home care in Rhode Island:

First is by accessing and using an earlier purchased long-term-care insurance policy. Unfortunately, very few people have them as they are for many people cost prohibitive.

The second way is by private pay, which means you write a check directly to the nursing home from your life savings to pay for the room and board to live there. Per the Rhode Island Department of Human Services, the average cost per month for skilled nursing home care in Rhode Island is $9,113.

The third way to pay for nursing care is to qualify for Medicaid coverage under the Medicaid program. By qualifying for Medicaid, an individual will not be required to spend their life savings on skilled nursing care.

Unfortunately, medical insurance does not pay for long term care. Most plans will only pay a portion of the first 100 days of skilled care. After the 100 days is used, individuals will need be responsible for paying for their own room and board – their medical insurance will continue to pay for doctor visits and prescriptions, but individuals will need to pay for the bed, meals and roof over their head in nursing home.

How do I qualify for Medicaid?

Qualifying for Medicaid is like filing a very complicated tax return over a series of years. For a person to take advantage of the tax rules the taxpayer needs to make decisions as to their assets and income, perhaps transferring assets or claiming some while using others. So too is it with qualifying for Medicaid. As a CPA helps with a Tax Return, and Elder Law Attorney helps with understanding and advising as to what needs to be done to qualify for Medicaid. It is a lengthy process that for it to be optimized requires 5 years!

Want to learn how to qualify for Medicaid? Contact our office and schedule a no-cost meeting!Nursing Home Image

MJL Blog Footnote

One Quarter of America’s Caregivers Are Millennials

By Uncategorized

Who are the caregivers looking over our loved ones?

Caring for older relatives is usually a task associated with Baby Boomers, the 50- and 60-somethings who find their aging parents need assistance. But almost a quarter of the adults who take care of older people — on top of their regular jobs and responsibilities — are between the ages of 18 and 34, according to research by the AARP Policy Institute and the National Alliance for Caregiving.

As millions of Americans are expected to live longer than they used to — often losing the ability to do so independently — their families and communities are grappling with how best way to take care of them. Kaiser Health News focused on the problem in a Dec. 2 webinar with advocates and policymakers. About 40 million Americans considered themselves caregivers in 2013, according to an AARP report, said Susan Reinhard, senior vice president at the AARP and one of the webinar’s panelists. Those people are typically women, and their median age is 49. The work they do caring for older relatives — usually parents and grandparents — was estimated that same year to be worth about $470 billion.Caregiver

The study underlines the importance of having a plan in place.

As we live longer lives, it is up to each person to ensure they have
a plan on how they will handle those years. Discussions need to include topics of domicile, care givers, support with daily activities of living, financial and medical.

Need to start your conversation? Contact us to schedule a meeting.

Source: Kaiser Health News

 

MJL Blog Footnote

 

Leaving Nursing Home During Medicare-Covered Stay

By Uncategorized

LEAVING NURSING HOME WHILE STILL BEING TREATED – IS IT POSSIBLE?

Nursing home residents often want to participate in holiday gatherings but may worry they will lose Medicare coverage if they leave the facility to do so. Residents and their families and friends can put their minds at ease. According to Medicare law, nursing home residents may leave their facility for family events without losing their Medicare coverage.leaving hospital

However, depending on the length of their absence, beneficiaries may be charged a “bed hold” fee by their skilled nursing facility (SNF). The Medicare Benefit Policy Manual recognizes that although most beneficiaries are unable to leave their facility, “an outside pass or short leave of absence for the purpose of attending a special religious service, holiday meal, family occasion, going on a car ride, or for a trial visit home, is not, by itself evidence that the individual no longer needs to be in a SNF for the receipt of required skilled care…Decisions in these cases should be based on information reflecting the care needed and received by the patient while in the SNF and on the arrangements needed for the provision, if any, of this care during any absences.”

Source: Center for Medicare Advocacy

MJL Blog Footnote

Couples Fight More About Finances as Retirement Draws Closer

By Uncategorized

Couples Fight More About Finances before Retirement – No Duh?!

Interesting article about the stress retirement and finances can put on couples.  It is CRITICAL that couples put together a PLAN that address their concerns with specific details to protect and preserve their finances and assets.  We are happy to meet with you to discuss how we can protect your assets and take the stress out of retirement.

http://www.nbcnews.com/business/retirement/couples-fight-more-about-finances-retirement-draws-closer-n473551?utm_source=PBN+Master+List+-+All+Subscribers&utm_campaign=ea799b1b17-2015_1204_call12_3_2015&utm_medium=email&utm_term=0_0e86591c9b-ea799b1b17-29917329

as-retirement-approaches-article

 

There is an old adage: A FAILURE TO PLAN IS A PLAN TO FAIL.

This is true with most aspects of life but most especially with finances. Too often people wait too long to face the economic realities of retirement. The thought being I will just earn as much as I can during my working days and hope it holds me is simply not enough. People do not need to live in the dark or in fear. Meeting with a financial planner who can model out your lifestyle and the costs associates with it will be helpful in determining if you need to make adjustments.

The other aspect of finances is seeking to protect them. If you learned that you would need to spend over $109,000 per year on a spouse and their care in 3 years, would you do anything different today? The answer to that is a most definite YES. Should one of you require skilled care, it costs over $109,000 per year and is not covered by insurance, thus a plan for that expense is critical for the healthy spouses financial future.

Want to discuss your plan? Contact us for a free consultation.

MJL Blog Footnote

 

What is the Medicaid Global Waiver?

By Uncategorized

What is the Medicaid Global Waiver?

The Medicaid Global Waiver is an agreement with the federal government about how Medicaid money is spent. Medicaid, a program that funds health services for qualified elderly, disabled, children, and families, is paid for by both the federal and state governments. Under this new agreement, the federal government will relax its Medicaid rules to allow Rhode Island to spend federal Medicaid money on a broader range of services through streamlined administrative processes that would not have been possible without the Medicaid Global Waiver.

Why the Waiver program?

The significance of this is intended to provide greater flexibility to provide services to needy Rhode Island residents in a lower cost setting. Allowing for state provided services in home with the hope of providing better care for the individual and greater savings to the taxpayer.

Want to learn how to qualify for Medicaid benefits? Contact our office for a free consultation.rhode_island_medicaid_waiver

Global Waiver Questions & Answers

What is the Medicaid Global Waiver?

The Medicaid Global Waiver is an agreement with the federal government about how Medicaid money is spent. Medicaid, a program that funds health services for qualified elderly, disabled, children, and families, is paid for by both the federal and state governments. Under this new agreement, the federal government will relax its Medicaid rules to allow Rhode Island to spend federal Medicaid money on a broader range of services through streamlined administrative processes that would not have been possible without the Medicaid Global Waiver.

 

  • Why does Rhode Island need this waiver?

Under the current system, federal rules governing how Medicaid money can be spent do not allow for the healthcare innovations Rhode Island envisions. The Global Waiver will facilitate increased consumer responsibility and choice, more emphasis on prevention and wellness, greater reliance on home and community based care as opposed to institutional care, and simplified administration of the Medicaid dollars.

 

Along with improved health care the waiver is needed to ensure that Medicaid programs remain affordable. Medicaid spending accounts for 25% of the state budget and is growing at a rate of 7% a year. With state revenue only growing at a 1.8% rate, it is easy to see that Medicaid spending is outpacing our ability to pay. That means that without changing the way we provide and pay for Medicaid services, those services are in danger of being lost. By receiving this Global Medicaid Waiver, Rhode Island will be able to preserve and improve services while keeping them affordable.

 

  • What if the recession worsens and more and more people become eligible? Will RI run out of money?

The secondary purpose of the Global Waiver is to make Medicaid programs more affordable. So, the expectation is that RI will be saving money and, ultimately, be able to serve more people. In other words, RI will better handle an influx of people into Medicaid programs through the Global Waiver than under the existing system. Although the Global Waiver has planned for many contingencies, if unforeseen and emergent conditions arise that make the Global Waiver unworkable, the State may suspend or terminate the Global Waiver.

 

  • Will people who now receive Medicaid-funded services lose them?

No. The State of Rhode Island is bound to follow the eligibility rules that were in place as of November 1, 2008. These eligibility rules cannot be easily changed; any changes must be approved by the state legislature and the federal government.

  • Will the Governor unilaterally change eligibility for certain populations?

The Governor cannot act alone without public input and legislative approval.

 

  • Will people in nursing homes be forced to leave?

No. Anyone who is in a nursing home and continues to need a nursing home can stay in the nursing home. With this new waiver, the goal is that people will not be forced to go into nursing homes because they lack choices. The Global Waiver will enable the State of Rhode Island to develop options for people so that more can stay in their homes with the proper supports if they so choose. Under the old Medicaid rules, this was not possible; now, Medicaid money will pay for more home and community-based care options.

 

  • Will the global waiver offer protection from a waiting list for seniors currently eligible for nursing home services?

There is no waiting list now for nursing homes and no waiting list is anticipated under the waiver. Anyone who needs nursing home level of care will receive it.

 

  • How will this relate to residents in assisted living that are currently on an existing waiver now?

Residents in assisted living can remain in assisted living if they so choose. Under the current system, there are limited assisted living slots. Because the Global Medicaid Waiver merges all waivers, it will open up the number of assisted living slots. In addition, the “selected contracting provision” in the Global Medicaid Waiver has the potential of paying certain kinds of assisted living differently, further opening more assisted living beds.

 

  • What is the timetable for these programs?

The Medicaid system as we know it has grown over the last forty years. Reforming that system and making it more affordable will not happen overnight; that will take a few years. The first order of business is legislative approval. After that, the Assessment Team will be assembled and new levels of care will be drafted so that Assessment Services will be operating by July 1. In the meantime, departments will be working with providers to offer more home and community based services.

 

  • Will there be public hearings?

Yes. This is really a community effort and the input of the public will be sought – as it has been – in addition to the legislative hearings.

 

  • Does the waiver conflict with any state laws?

No. The waiver must conform to all state and federal laws. Changes in the Medicaid program cannot be made without public notice and legislative approval.

 

  • How many different waiting lists will there be?

There are already waiting lists for some Medicaid-funded services. That will not change initially, but the goal of the Medicaid reforms made possible by the Global Waiver is to eliminate waiting lists.

 

  • Who will decide whether or not a person requires nursing home or residential care?

There are already state regulations that dictate whether or not a person requires residential care. The new Global Waiver will make two differences. First of all, there will now be more alternatives to residential care so that even if a person requires a high level of care, it may be possible for him/her to receive that care in the home and community. Secondly, an assessment team of medical and social service professionals will be created that will now include the individual and family in the decision-making so that all the options can be studied and the best one chosen.

 

  • What happens if a person or family disagrees with the assessment team’s decision about what kind of care is recommended and would be paid for?

People will be able to appeal any decision to an independent board.

 

  • What criteria are used to decide if a person needs residential care?

People are assessed for their skilled needs or their ability to perform what are called, Adult Daily Living Skills. If they require extensive or total dependence they are eligible for nursing home care. Now, with the Global Waiver, more supports will be created that will assist people with these Daily Living Skills in their home or in less restrictive settings.

 

  • If more than one person in the family qualifies for Medicaid help is there a preference given to keep them in their homes?

The advantage of the Global Waiver is that families can be assessed as a unit and not according to separate programs. Standards will be set for these sorts of situations, but the family will also be able to weigh in on the decision.

 

  • Are there any built-in preferences in this system? (Who gets help first?)

Priority is based on medical necessity; those in need of the highest level of care get priority.

 

  • We’ve heard that you’re considering a proposal for the Alliance for Better Long Term Care to send staff into nursing homes to identify candidates for return to the community and do assessments. Is that so, and what can you share with us about that?

The Alliance for Better Long Term Care has been contracted to bring good news to people in nursing homes who might want to live in their own homes or more independently. No one who is in a nursing home will be asked or forced to leave. However, those who want and are able to leave nursing homes due to new home and community based options may do so if they so choose.

 

  • Isn’t there a nursing shortage in RI? Where will all these home care professionals come from?

Now that money is available for a different range of services, agencies and companies will make the commitment to expanding services and staff. With new opportunities created, smart companies will move toward training and recruitment to take advantage of the Global Waiver.

 

  • What kinds of home and community based services are envisioned by this Global Waiver?

They would include: housekeeping, nutrition, nursing care, medication management, financial management, medical transportation, physical and occupational therapy, day care, home companions, coordinated medical care, assisted living and other non-institutional living arrangements.

MJL Blog Footnote