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Medicaid Power Point 2011
 

Medicaid Power Point 2011

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2011 New York Medicaid

2011 New York Medicaid

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Medicaid Power Point 2011 Medicaid Power Point 2011 Presentation Transcript

  • Elder Law & Medicaid Planning Futterman & Lanza, LLP 222 East Main Street, Suite 314 Smithtown, New York 11787 631-979-4300. Attorneys & Counselors at Law Copyright © 2011 Futterman & Lanza, LLP
  • Vision Statement
    • Preserving and protecting your family’s hard earned assets and passing them on to family members, not to the potentially catastrophic costs of long-term care (i.e., the nursing home).
  • What is long-term care?
    • Long-term care is a variety of services that include medical and non-medical care to people who have a chronic illness or disability. Long term-care needs can be provided through:
    • (1) Home health care;
    • (2) Assisted Living facilities;
    • (3) Skilled nursing home facilities.
  • What are the costs of long-term care?
    • Home health-care costs vary depending on the number of hours required and the hourly pay rate charged by the personal care aide.
    • Assisted Living costs range from $3,000/month to $8,000/month.
    • Skilled nursing care costs on Long Island range from $9,000 to over $17,000 per month.
  • Who is exposed to these costs?
    • EVERYONE!
  • How do you pay for long-term care?
    • (1) Medicare (limited benefit);
    • (2) Private pay;
    • (3) Long-term care insurance; or
    • (4) Medicaid.
  • Medic aid
    • Medicaid is a “means tested”
    • insurance program jointly
    • funded by the federal, state
    • and local governments
    • (DSS), and provides home
    • care and skilled nursing
    • home care services.
  • Medicaid Eligibility
    • Medical need
    • Financial need
  • Medicaid Financial Eligibility (Nursing Home)
    • Resources
    • Income
  • Resources
    • For 2011, an individual can have no more than $13,800 in resources.
      • ($218 increase)
    • Community (“well”) spouse may retain resources up to approx. $110,000.
  • Exempt Resources
    • Irrevocable Funeral Trust (no limit)
    • $1,500 burial fund
    • Primary residence (generally)
    • IRA’s or qualified retirement accounts if applicant is receiving RMD.
    • Personal property (jewelry, car, etc.)
    • Reparation payments
  • Income
    • 2011 Income Levels:
      • New York is a “spend down” state with regard to income. Income over the personal needs allowance ($50/month) must be contributed toward the cost of care.
      • UNLESS – there is a community spouse with income under $2,739/month.
  • Transfers
    • Look Back Period
    • Penalty Period
  • Look Back Period
    • Medicaid will now look back at applicant’s financial information for the 60 month period prior to the date applicant requests benefits.
    • THIS IS A CHANGE FROM 36 MONTHS!!!!!!!!
        • (THE RESULT OF THE DEFICIT REDUCTION ACT)
  • What is DSS Looking For?
    • Looking to see if the applicant (or spouse) made uncompensated transfers of income or resources (i.e., gifts )
  • What if DSS discovers a gift was made?
  • Penalty Period
    • When gifts are made during the look-back period, Medicaid imposes a penalty or period of ineligibility for benefits.
    • OLD LAW - Penalty period commences on first day of the month following the gift.
    • NEW LAW - Penalty period commences on THE DATE INDIVIDUAL APPLIES FOR MEDICAID, IS FINANCIALLY ELIGIBLE FOR MEDICAID AND IS RECEIVING INSTITUTIONAL CARE (IN NURSING HOME).
  • Penalty Period
    • WHEN THE APPLICANT IS AN “OTHERWISE ELIGIBLE INDIVIDUAL …. RECEIVING NURSING FACILITY SERVICES FOR WHICH MEDICAID COVERAGE WOULD BE AVAILABLE BUT FOR THE IMPOSITION OF A TRANSFER PENALTY.”
  • How long is the penalty period?
  • Penalty Period Calculation
    • Divide the total gifts transferred during the look-back period by the current average monthly cost to a private-pay patient in a nursing facility in NYS (as determined by DSS).
    • The quotient equals the number of months the applicant will be ineligible for Medicaid benefits.
  • Current Average Monthly Costs
    • SEVEN REGIONS
    • NYC $10,579
    • Nassau & Suffolk $11,445
    • Northern Metro $10,105
    • Central $7,688
    • Northeastern $8,323
    • Rochester $8,942
    • Western $7,863
  • Exempt Transfers
    • Transfers between spouses
    • Transfers to a disabled child of any age
    • Transfers to a Trust for the sole benefit of any disabled individual
    • Transfers for value (compensated transfer)
  • EXAMPLE
    • Facts: Suffolk resident gifts $100,000 cash to his son on January 1, 2011.
    • Calculation: $100,000 / $11,445 = 8.74
  • EXAMPLE
    • OLD LAW: penalty period starts February 1, 2011 and ends on September 30, 201. Partial month is calculated at a dollar value based on the regional rate and considered as an income overage for the partial month.
  • EXAMPLE
    • NEW LAW: 8.74 MONTH PENALTY PERIOD BEGINS THE DATE THE INDIVIDUAL APPLIES FOR MEDICAID, IS FINANCIALLY ELIGIBLE FOR MEDICAID AND IS RECEIVING INSTITUTIONAL CARE (IN NURSING HOME).
    • WHEN THE APPLICANT IS AN “OTHERWISE ELIGIBLE INDIVIDUAL …. RECEIVING NURSING FACILITY SERVICES FOR WHICH MEDICAID COVERAGE WOULD BE AVAILABLE BUT FOR THE IMPOSITION OF A TRANSFER PENALTY.”
  • Footnotes
    • Community (“well”) spouse can make transfers without affecting institutionalized spouse’s eligibility only AFTER acceptance.
    • No “cap” on penalty periods.
  • Options for the Homestead
    • Sell it
    • Transfer (gift) it
    • Life Estate
    • Transfer it into protective trust
  • Homestead – Sell it or Gift it
    • What if the the Medicaid applicant sells the homestead and then transfers (gifts) the sale proceeds to his/her children? Similarly, what if the applicant transfers title to the house to his/her children?
    • The gift creates a penalty or ineligibility period beginning … WHEN THE APPLICANT IS AN “OTHERWISE ELIGIBLE INDIVIDUAL …. RECEIVING NURSING FACILITY SERVICES FOR WHICH MEDICAID COVERAGE WOULD BE AVAILABLE BUT FOR THE IMPOSITION OF A TRANSFER PENALTY.”
  • Homestead – Life Estate
    • MA gifts remainder interest to the kids and retains a life estate for him or herself.
    • Penalty period is shortened (only gifting part of the real property)
    • Life estate in not considered a resource and is not attachable by Medicaid.
    • Life Estate does not afford the MA control of the ultimate disposition of the asset.
  • Homestead – Transfer Into Trust
    • Trust provides MA with more control over the ultimate disposition of the asset.
    • Trust requires the MA retain the right to receive income from the trust for life.
  • Homestead – Exempt Transfers
    • Spouse
    • Child under 21
    • Blind/disabled child
    • Adult child, residing in home (2 years), that provided care to MA.
    • Sibling of MA who has equity interest in house and who has resided in home one year immediately prior to MA’s institutionalization.