NEGAS Presentation (06.19)

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  • Refer to OMR tool Practice pointer: don’t assume, as in past, that just because client in nh, will qualify for Medicaid LTC benefits in nh
  • Refer to OMR tool Practice pointer: don’t assume, as in past, that just because client in nh, will qualify for Medicaid LTC benefits in nh
  • Refer to OMR tool Practice pointer: don’t assume, as in past, that just because client in nh, will qualify for Medicaid LTC benefits in nh
  • Refer to OMR tool Practice pointer: don’t assume, as in past, that just because client in nh, will qualify for Medicaid LTC benefits in nh
  • Refer to OMR tool Practice pointer: don’t assume, as in past, that just because client in nh, will qualify for Medicaid LTC benefits in nh
  • Highlight FOM concept
  • Illustration of “legal ability to make resource available” and a resource not subject to “a legal impediment which precludes applicant from making resource available. Gship or conservatorship--evidence inability to make resource available. Asset unavailable to to refusal of joint tenant to sell, and hence partition suit (ask JK + law school case)
  • Illustration of “legal ability to make resource available” and a resource not subject to “a legal impediment which precludes applicant from making resource available. Gship or conservatorship--evidence inability to make resource available. Asset unavailable to to refusal of joint tenant to sell, and hence partition suit (ask JK + law school case)
  • no notes
  • Highlight FOM concept
  • Highlight FOM concept
  • no notes
  • no notes
  • no notes
  • no notes
  • NEGAS Presentation (06.19)

    1. 1. HEFFNER &ASSOCIATESELDER LAWMark B. Heffner, Esq. , CELAHeffner & Associates615 Jefferson BoulevardWarwick, Rhode Island401-737-1600www.hefflaw.comMedicaid & Medicaid Planning:Stuff you will want to know &tell your clients
    2. 2. HEFFNER &ASSOCIATESELDER LAWDisclaimer•Materials are for general education and should notbe substituted for consultation with a competentelder law attorney in your jurisdiction•Materials presented from the perspective of RhodeIsland Medicaid regulations and practice•Rules and practice vary significantly from State toState (and occasionally within the same State) andare subject to change
    3. 3. HEFFNER &ASSOCIATESELDER LAW•Practicing elder law since 1988•CELA (Certified Elder Law Attorney) by National ElderLaw Foundation (accredited by ABA for specialization)•Served in Rhode Island House of Representatives for 10yearsWho is this guy?•Harvard College; Boston College Law School•Adjunct Professor, Roger Williams University LawSchool•Friend of Tom Grennan’s
    4. 4. HEFFNER &ASSOCIATESELDER LAWWhat is Medicaid?•It is not Medicare!•Medicaid: in addition to general criteria (age, blind,disabled) & needing a level of care, must also fallwithin financial criteria (assets, income, transferrestrictions)•Medicare: insurance model; no asset or incomequalification requirements
    5. 5. HEFFNER &ASSOCIATESELDER LAWWhy do should we (and our clientscare about) Medicaid?•Medicare--limited long term care (LTC) coverage20 days full payment, up to 80 additional days withco-pay ($148/pay)•Continues to require skilled (vs. custodial) care•Medicare LTC coverage initially applicable ifindividual has a three day prior hospital admission &
    6. 6. HEFFNER &ASSOCIATESELDER LAWWhy do should we (and our clientscare about) Medicaid?•Once Medicare ends (if it began at all), absent longterm care insurance, individual pays privately•Rhode Island: $8516/month• Genworth 2013 cost of care survey (www.genworth.com/corporate/about-genworth/industry)•Massachusetts: $10,493/month•Connecticut : $12,638/month
    7. 7. HEFFNER &ASSOCIATESELDER LAWResources vs. IncomeAsset available toapplicant to support,maintenance or medicalcareAvailable as of the firstmoment of a month(FOM) of desiredeligibilityAnything received incash or in-kind that canbe used for food,clothing or shelterThat which is receivedduring a monthIncome received within amonth and not spentwithin the monthbecomes a resource as ofthe FOM of the followingmonth
    8. 8. HEFFNER &ASSOCIATESELDER LAWResourcesExcluded (Single Person)•Home (equity value limit:$525K) if “intent to return”•Household goods & personaleffects( no value limit, unlessexceptional)•Vehicle (limit: $4500, unlessused for transportation tomedical appts)•Life Insurance ($4000 facelimit)•Irrevocable Burial Contract,or funds set aside for burial($1500)•Funds otherwise available(limit: $4000)AvailableEVERYTHINGELSE
    9. 9. HEFFNER &ASSOCIATESELDER LAWResourcesExcluded (Married Couple)•Home: no equity limitation ifresidence of “CommunitySpouse” (CS)•Vehicle: if used by CS, nolimitation on value•CS retains “CommunitySpouse Resource Allowance”(CSRA)
    10. 10. HEFFNER &ASSOCIATESELDER LAWResources: Married CoupleWhat is Community Spouse Resource AllowanceDetermine couple’s total joint resources as of firstmoment of the month (FOM) of the beginning of aperiod of continual institutionalization (POCI)Total joint resources: combined resources of theinstitutionalized spouse & community spouse, to extent ofeither’s ownership interest in the resourceMaximum CSRA 2013: $115,920Minimum CSRA 2013: $ 23,184Community Spouse Resource Allowance (CSRA)calculated by dividing total joint resources in half;however, CSRA is subject (in RI) to the followingminimums and maximums
    11. 11. HEFFNER &ASSOCIATESELDER LAWIncome-GenerallyAnything received during a month in cash or in-kindthat can be used for food, clothing or shelter.Recurring payments such as the following:•Gross Social Security•Gross Pension•Net--according to Medicaid--rental incomeIn addition, “one-off” or non-monthly payments--e.g.:•Inheritances & receipt of life insurance proceeds•Income tax refunds•Annual distributions from IRAs and other retirementplans
    12. 12. HEFFNER &ASSOCIATESELDER LAWIncome-Single IndividualAll gross income must be used for cost of care, minus:$50/month personal needs allowance; and$Pro-rata monthly payment of Medicare supplementinsurance (e.g. Blue Cross Plan 65)
    13. 13. HEFFNER &ASSOCIATESELDER LAWIncome-Married ApplicantsCommunity Spouse Allocation (“spousal slide over”) may beallowed as additional deduction from IS income. Twofactors:•CS gross income; and•Amount of spousal allowance, consisting ofIncome of CS,--whether regular (e.g. Social Security), orperiodic (e.g., inheritance) is not a factor in eligibility ofinstitutional spouse (IS), except in following calculation•Basic monthly allowance to CS (currently $1,891.25); and•If there are shelter expenses, and if so whether standardshelter allowance or excess shelter allowance
    14. 14. HEFFNER &ASSOCIATESELDER LAWTransfers of AssetsPost-DRA’05, any transfer occurring on or afterFebruary 8, 2006 is subject to five year lookback periodQ: What types of transfers fall within lookback period?A: Uncompensated (UV) transfers--i.e., those for whichfair market value (FMV) not received by applicant or theapplicant’s spousePenalty period (P): period of time--expressed in months--for which Medicaid LTC benefits are denied as result of aUC, calculated as follows:P=UV/C (average cost of a private resident in a NF)Ex: Applicant’s spouse “sells” summer cottage with FMVof $100K to child for $25K.UV ($75K)/C ($8,643)=P(8.68 months)Note: “C” varies from State to State, changesperiodically
    15. 15. HEFFNER &ASSOCIATESELDER LAWResources: Transfers--Exceptions to Imposition of P•Applicant’s spouse;P (penalty period for LTC services) not created if:•Applicant’s son or daughter who (a) was residing inhome for at least two years prior to the parent’sinstitutionalization, and (b) can demonstrate that he orshe provided care which prevented parent from enteringan institution for the two year periodAsset transferred is principal residence & transferred to:•Applicant’s child under age 21, or child who is blind ortotally and permanently disabled•Applicant’s sibling who has an equity interest in theresidence and resided there for at least one yearimmediately prior to the institutionalization of theapplicant
    16. 16. HEFFNER &ASSOCIATESELDER LAWResources: Transfers--Exceptions to Imposition of P•Applicant’s spouse, or to another for the sole benefit ofthe spouse, or from the spouse to another for the solebenefit of the spouse;P not created if:Asset transferred is other than a principal residence andtransferred to:•Applicant’s child who is blind or totally and permanentlydisabled, or to another for the sole benefit of such child,or to a trust established for the sole benefit of such child•Trust for sole benefit of an individual who is under age65 and is permanently and totally disabled
    17. 17. HEFFNER &ASSOCIATESELDER LAWResources: Transfers--Exceptions to Imposition of P•Individual can prove his/her intention was to receive fairmarket value or other valuablecompensation/considerationP not created if:•Applicant’s can prove transfer was exclusively for somepurpose other than to qualify for MA•Asset is returned to applicant (in whole or in part)•Asset transferred for fair market value or other valuablecompensation/consideration•Denial of LTC payment would work an undue hardship
    18. 18. HEFFNER &ASSOCIATESELDER LAWEstate Recovery•Federal and RI law require recoupment on funds spenton MA for individuals age 55 or older•Recovery initiated by State’s filing a claim in probatecourt (in RI):•State may create lien against decedent’s real estate byfiling notice of statement of claim in land evidencerecords•State is priority creditor under many probate statutes•If probate estate not initiated by recipient’s fiduciary,State as a creditor can initiate the opening of probateunder probate statutes
    19. 19. HEFFNER &ASSOCIATESELDER LAWMark B. Heffner, Esq. , CELAHeffner & Associates615 Jefferson BoulevardWarwick, Rhode Island401-737-1600mheffner@hefflaw.comwww.hefflaw.comNational Elder Law Foundationwww.nelf.orgProvides interactive state map of CertifiedElder Law Attorneys (CELA) in each state

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