What You Need to Know About Medicaid And Partners Entering Relationships with Different Assets

Getting married later in life raises a number of different confusing aspects associated with estate planning. An estate planning attorney might be the only person who can help you navigate the legal maze of health care and estate plans. If one party enters this late in life marriage with significant assets whereas the other does not, this can cause major issues when qualifying for Medicaid.
For example, if the wife in the marriage has ample assets when entering but the male partner does not have as many, Medicaid will evaluate the couple’s assets overall. Older adults face unique estate planning concerns such as guardianship, probate estate planning and Medicaid.
When you get remarried, you need to update your estate planning materials anyways because your estate planning tools can affect your children from previous marriages. However, you must also factor in Medicaid.
If you do not have long term care insurance policies, you essentially might be self-insuring yourself and a spouse. This is because Medicaid will look at all of the couple’s assets in determining whether or not if a person who needs assistance will qualify through Medicaid. A wife who brings in a great deal of assets to the marriage might have to use her own assets and spend down in order to pay for the care needed for a partner unless other financial plans, such as the purchase of a long-term care policy has been made.
Legal documentation is essential when it comes to Medicaid planning, and the further in advance you can show that this work has been done, the easier it will be to accomplish your various concerns and goals. Medicaid can be very complicated, but the support of an attorney is instrumental in outlining what you do and don’t need.
Don’t hesitate to schedule a consultation with an attorney who is highly knowledgeable about best protecting your interests.
 

It Won’t Be Much, But in Some Cases Caregivers Can Get Paid

Senior woman with her caregiver

Senior woman with her caregiver

The estimates vary between 66 and 70 million, when it comes to the number of people in the United States serving as unpaid caregivers for family members with disabilities.
The good news is that in some instances, these overworked and stressed out people may at least be able to get something for all the effort they spend on behalf of a loved one.
While the potential for being reimbursed for caregiver services varies widely from state to state programs do exist, according to articles on the websites Carepathways.com and Caring.com.
“Some states offer limited programs that pay family members to take care of an elderly parent,” the entry at carepathways.com states. “Budget cuts at the state level, however, have further reduced options. Programs within the 50 states vary as to what if any programs exist, who pays for them and even what they are called. ‘Participant and Consumer Directed,’ ‘Cash and Counseling’ are a few of names that refer to programs which allow folks to choose and pay a family caregiver. Many of these programs offer inadequate wages and strict income eligibility requirements including those compensated by Medicaid.”
“If you’re one of more than 70 million people who provide unpaid caregiving for a family member or friend, either in that person’s home or in your own, you know that the time and energy burden can be enormous, caring.com begins. “In fact, you may have cut back or given up your paying job. Your smaller, or now nonexistent, paycheck may be pinching you hard. If so, it might be possible for you to get a small but regular payment for your caregiving work.
“Here’s how: If the parent, spouse, or other person you’re caring for is eligible for Medicaid, its Cash and Counseling program, available in some states, can provide direct payments that could go to you. A few other states have similar programs for low-income seniors, even if the person receiving care doesn’t quite qualify for Medicaid. Also, if the person you’re caring for has long-term care insurance that includes in-home care coverage, in some cases those benefits can be used to pay you.”
The Caring.com entry goes on to advise that in instances where the family member receiving care is willing and able to pay the caregiver, “it may be a good idea, for both of you, to draft a short written contract setting out the terms of your work and payment.”

Half of seniors eligible for drug benefit don’t apply

A little Extra Help could do senior citizens a world of good, literally and figuratively.
That’s the name for a Medicare benefit that can greatly help low-income elderly people pay for their prescriptions, but one that far too many of those eligible for it don’t know exists.
“More than 2 million people on Medicare could be getting their prescription drugs nearly for free, but don’t,” according to a recent story by Mark Miller of Reuters news service. “That’s because they have not signed up for Extra Help, an important Medicare benefit that subsidizes drug costs for low-income senior citizens.
“Extra Help can pay nearly all of the prescription drug costs a senior incurs in a Part D drug plan. It is provided automatically to seniors receiving Medicaid or Supplemental Security Income benefits. In some states, Extra Help also is automatic for people receiving benefits through the Medicare Savings Program, which helps subsidize Medicare Part A (hospitalization) and Part B (outpatient) premiums.”
However, for those who qualify but just not automatically, less than half are enrolled in Extra Help, Jack Hoadley, a research professor at the Health Policy Institute of Georgetown University who tracks the program, told Reuters.
“The government reaches out with information on this from time to time,” Hoadley was quoted as saying. “What’s harder is to figure out how to reach out specifically to people who are eligible.”
“The benefit is substantial – annual savings can easily total $800 on premiums and deductibles, and can be much higher for seniors with high drug spending,” Miller wrote. “Two factors determine your eligibility for Extra Help: income and assets. Your income cannot exceed the federal poverty level guidelines. For seniors with incomes of 135 percent of the federal poverty level or lower, Medicare pays the entire annual premium, expected to average $480 next year, according to the Kaiser Family Foundation. Extra Help also covers deductibles, which typically run $310 for the year.”
Seniors who wish to learn more about Extra Help may do apply online at secure.ssa.gov/i1020/start or call 1-800-772-1213 to get the process started.

Court sides with nursing home against woman’s grandchildren

An elderly New York State woman thought she was doing the right thing for her grandchildren.
A court ruled otherwise, in a case of estate planning gone horribly wrong.
The woman, Lillian Hellman, sought to have four annuities, which she obtained in her name with her in control of the accounts, transferred to each of her grandchildren, making her insolvent and eligible for Medicaid once she had entered a nursing home.
Not so fast, nursing home officials said, and a court agreed with them, according to an article on the website elderlawanswers.com.
“In 2000, Lillian Heather purchased four annuities for each of her grandchildren as part of her estate plan,” the website stated. “The annuities named the grandchildren as annuitants and beneficiaries, but Ms. Heather retained control of the accounts. Ms. Heather also appointed her grandchildren as her attorneys-in-fact under a power of attorney. In 2006, Ms. Heather entered a nursing home. One granddaughter, Kristin Goldman, signed the admission agreement as her designated representative. After entering the nursing home, Ms. Heather annuitized the annuities and the full value was transferred to the grandchildren. She applied for Medicaid benefits, but the state denied benefits because she had transferred assets for less than fair market value.
“The nursing home sued the grandchildren for fraudulent conveyance, arguing that they had transferred Ms. Heather’s assets for no consideration, rendering her insolvent. The nursing home also sued Ms. Goldman for breach of contract, arguing that Ms. Goldman had access to Ms. Heather’s assets and should have used them to pay for her grandmother’s care.”
The New York Supreme Court in Queens County sided with the Chapin Home for the Aging to the tune of $287,893.95.
“According to the court, it was undisputed that the transfers were made without consideration,” elderlawanswers related. “Moreover, the grandchildren did not present any evidence that the transfers did not make Ms. Heather insolvent. Nevertheless, the court rules that Ms. Goldman is not personally liable for breach of contract because the admission’s agreement did not make the designated representative personally liable.”

Novel program brings legal assistance to people who need it most

A recent blog on the website of The New York Times highlighted a fine program in California that provides legal help for the elderly while giving real-life experience to law students.
The piece by Paula Span, author of “When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions,” also brings a focus on an important issue, that of a segment of the population greatly in need of a great deal of legal assistance often not getting it.
“Consider the geriatricians working at the Lakeside Senior Medical Center, an outpatient clinic at the University of California, San Francisco,” Span writes. “Many of their patients, despite multiple chronic diseases and advanced age, have never filled out power-of-attorney documents or appointed someone to make health care decisions if they are unable to. Sometimes, the doctors suspect their patients might qualify for public benefits they are not getting, like food stamps or MediCal, the state’s version of Medicaid. Perhaps they face problems with landlords or appear to be victims of financial abuse, or they ought to have a simple will.
“In other words, they need lawyers. But trying to get frail, low-income seniors to consult an elder attorney can seem an insurmountable problem. How will they travel to a law office? Or pay a fee that can reach $300 an hour? Even if the doctors can refer them to a legal aid office, will their elderly patients actually make an appointment? Then remember to go?”
The solution at this particular location, and one that deserves to be duplicated all across the country, is that each semester eight students from the University of California Hastings College of the Law spend 12 to 15 hours a week at the clinic under a program called the Medical-Legal Partnership for Seniors.
“The physicians do the initial screenings, hear what their patients’ problems are, take the history and they essentially write a prescription: ‘Go down the hall and see my friends at U.C. Hastings for help with this housing issue,’ ” Sarah Hooper, who teaches at the University of California Hastings College of the Law, was quoted as saying.
“On the one hand, we have an aging population, for whom understanding a legal document and getting it witnessed and notarized can be daunting, even if people don’t have to do battle over benefits,” Span wrote in conclusion. “On the other, we have law schools scrambling for ways to give their students hands-on experience.
“These folks need each other.”

Case Illustrates Hidden Danger Of Fund Transfers

It’s a cautionary tale, and proof that it’s rarely possible to have your cake and eat it, too.
A recent court ruling taught a Virginia woman a harsh lesson about trying, basically, to scam the system. The woman sought to be able to qualify for Medicaid by transferring a large sum of money to her daughter, but then sought to say the money was actually still hers when the daughter declared bankruptcy.

The case was recently summarized on the website elderanswers.com.
“In 2002, Dorothy Stutesman transferred $142,742 to her daughter, Holly Woodworth, so that she would not have assets in her name if she ever needed Medicaid,” the account states. “In April 2010, Ms. Woodworth transferred the money to a trust designed to protect the assets from creditors. The entire corpus of the trust was used to purchase an annuity to benefit Ms. Woodworth. In February 2011, Ms. Woodworth filed for bankruptcy. The bankruptcy trustee sought to void the trust, arguing it was a fraudulent transfer under bankruptcy code. Ms. Woodworth did not dispute that the transfer was fraudulent, but she argued that the property was never part of her estate because she was holding it in trust for her mother.
“The U.S. Bankruptcy Court for the Eastern District of Virginia enters judgment for the bankruptcy trustee, holding that Ms. Woodworth clearly had complete ownership of the funds. According to the court, ‘Ms. Stutesman can’t have it both ways; she can’t part with title for purposes of Medicaid eligibility, and at the same time claim that she retained an equitable title to the asset. To allow this kind of secret reservation of equitable title would be to sanction Medicaid fraud.’ ”
While transferring funds to relatives as part of sound financial planning can be a worthwhile practice, quite obviously it includes some risks that older people need to consider beforehand.

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How the Supreme Court Ruling on Health Care Reform May Affect Seniors

The recent Supreme Court ruling of the constitutionality of the new health care reforms has many seniors breathing a sigh of relief. The ruling has ensured that, at least for the time being, senior citizens will continue to receive their currently existing benefits from programs such as Medicaid and Medicare; but the ruling also paves the way for changes—some good and some not so good—in the way various home-based and long term care services are paid for and provided.

This article in Forbes explains some of the ways that the ruling on the Affordable Care Act will impact senior citizens or adults with disabilities:

According to the article, Medicaid “currently funds nearly half of all paid long-term care services.” This current coverage will continue under the 2010 health law, but states can refuse to provide new coverage to individuals if they choose.

The Medicare program is currently under some considerable financial strain, and the Affordable Care Act “includes a small increase in the payroll tax that is aimed at increasing revenues for Medicare.” This should be a great help to the program, and a relief to seniors who receive benefits from Medicare.

For seniors and adults who require long-term care services and have been frustrated by numerous roadblocks to getting that care at home instead of in a nursing facility, good news is on the horizon; the ACA “includes important new incentives for states to expand Medicaid long-term care services for people living at home.”

And finally, the law is giving more attention to seniors and adults with chronic and long-term illnesses. The ACA “creates a new office to coordinate the health and long-term care of people who receive both Medicare and Medicaid. . . It also includes important incentives to encourage hospitals, nursing homes, doctors, and other providers to work together to improve care for people with chronic disease.”

The High Emotional—And Financial—Cost of Alzheimer’s Disease

Alzheimer’s is a disease that affects everybody it touches—husbands, wives, children and grandchildren—they all bear witness to their loved one’s slow demise.

Sadly, emotional stress is not the only stress that accompanies Alzheimer’s disease; those loved ones serving as caretakers may carry a huge amount of financial stress as well. The cost of caring for an Alzheimer’s patient can run anywhere from $64 a day to $77,380 a year, and because Alzheimer’s disease can be such a long-lasting disease (a person can suffer from Alzheimer’s for up to 20 years) the costs of care can end up being astronomical. It’s obvious that people can’t do it alone.

Long-term care insurance can be very helpful in paying for the costs of care necessary for a loved one suffering from Alzheimer’s… if your loved one has thought ahead and purchased the policy before they or their spouse began suffering from symptoms of Alzheimer’s. Some people may not have thought ahead and hope that government programs will be able to help with the high cost of care. Medicaid can be helpful … if you fall in the right category and know how to navigate the complex system. (Medicare doesn’t cover the cost of long-term care.)

Unfortunately, learning how to navigate the system is not something you can do in an hour or two. Because your experience will depend on a number of unique factors we can’t give you an easy set of instructions to follow. The best advice we can give is to say that right now, the best way to navigate the Medicaid/Medi-Cal system is to find someone who knows the system to assist you. Most estate planning and elder law attorneys help their clients with these issues on a regular basis. If you want to ensure that you and your loved ones will be cared for no matter what the future may bring, don’t be afraid to ask your attorney for help.

A Woman’s Work Is Never Done

Do you know who will take care of you when you are unable to take care of yourself? Studies show that most caregivers for aging seniors are likely to be women, and most likely to be your daughter or daughter-in-law. What this means is that unless parents have a plan for their future long term care, the financial burden of caring for these aging parents will fall to daughters and their families.

Serving as a caregiver for elderly parents includes more than just driving to doctor appointments or helping with the shopping, it often includes paying for food and medical costs, as well as taking time away from careers to care for family members. In fact, it’s not unusual for female caregivers to experience a significant loss of income over a lifetime in reduced salary and retirement benefits.

Many seniors think that they will have government programs such as Medicare and Medicaid to fall back on, but these programs don’t always provide as much as expected or hoped. Relying on government programs can leave your children or family members footing just as much of the bill as they would without the programs. Instead, seniors may want to consider investing in long-term-care insurance, which can provide more flexible and comprehensive coverage than government programs, and save seniors and their families much time and money.

If you are a daughter of aging parents, now is the time to talk to your parents about the future. Studies show that you are the one who is likely to shoulder the responsibility of caring for parents as they age. Doing so will affect your family, your career, your finances, and even your health.

The subject of aging and elder care is a difficult one, but not one to be left to the last minute. Talk to your family about your wishes and plans for the future, then bring your estate planning attorney into the discussion. Once you have an idea of your wishes, an expert can help you feel better about your options, and put you on the right path for keeping your family healthy, happy, and financially secure in the years to come.

Lawsuit Alleges Florida Wrongly Denied Medicaid benefits to VA Pension Recipients

According to a recent article in the Miami Herald, thousands of VA pension recipients may have been wrongly removed from receiving Medicaid benefits in violation of a 1987 injunction. Attorneys have filed a class action suit seeking reinstatement of Medicaid benefits for those who have been wrongfully denied benefits, as well as damages for the state’s failure to provide Medicaid benefits in the past.
In 1987, Judge Sidney Aronovitz ordered the Department of Health and Rehabilitative Services (HRS) not to consider VA pension benefits as “countable income” for Medicaid eligibility purposes. When Florida’s appeal of this decision was denied, the injunction became settled law. However, according to lawyers now involved in the case, the Department of Children and Families (DCF), which now determines Medicaid eligibility, has violated the ruling by continuing to consider VA benefits for Medicaid eligibility purposes.
Because so much time has elapsed since the injunction was issued, the suit is a unique one. None of the suit’s primary parties are still living, and neither is the judge who issued the injunction. The state agency that was originally sued, HRS, no longer exists, but was broken into two different departments in 1996. The original plaintiff, Marilyn Jones, filed the suit in 1987 on behalf of a friend, Rebecca Mitson. Neither woman is still living. The named defendant, Gregory Coler, then the secretary of HRS, is also deceased.
As this case demonstrates, the laws behind Medicaid and VA benefits can be complicated and confusing. Lawsuits regarding these benefits can drag on for years, causing seniors to lose out on benefits that are vital for their care and financial well-being. It is important to educate yourself on these topics so that you will be aware if you are not receiving the benefits you deserve. Consulting with an experienced elder law attorney can allow you to determine which benefits you are eligible for and which benefits best fit your financial and long-term care needs.