Articles Posted in Elder Law

Nursing homes have been substantially impacted by the COVID-19 due to its outbreaks leading to high mortality rates among the elderly. Understandably, aggressive attempts were made to restrict the risk of Covid-19 exposure as much as possible. 

In March 2020, the Centers for Medicare and Medicaid Services issued a memorandum guiding restricting visitation of all visitors and non-essential healthcare workers. Several months later, in May 2020, the Centers for Medicare and Medicaid Services released its reopening recommendation for nursing homes which provided additional guidance in dealing with Covid-19 and reopening. 

The Center notes that physical separation from loved ones has taken a substantial physical and emotional toll on nursing home residents as well as their loved ones. The Center for Medicaid Services appreciates that nursing home residents find value in the support they receive from visitations by their loved ones. Consequently, the Center recently revised its guidance addressing visitation in nursing homes during the pandemic. 

A family with a disabled child faces countless obstacles. For many years, one of the best estate planning tools for parents in such a situation was a special needs trust. These trusts provide resources to care for disabled children while making sure that the child remains eligible for means-tested government benefits. 

Many people lately have realized that Achieving a Better Life Experience (ABLE) Accounts can also be helpful. Signed into law in 2014, ABLE Accounts were created by Internal Revenue Code Section 529A which authorizes the state to offer tax-advantaged savings accounts for blind and disabled individuals.

How ABLE Accounts Are Structured

When people in the United States qualify for Medicare on reaching the age of 65, they often notice a substantial decline in medical costs paid out-of-pocket.

A new study recently discovered that reducing the eligibility age would save even more for people. The study’s lead author, an assistant professor of cardiac surgery at the University of Michigan’s Medical School, found that these savings would be most profoundly felt by those who most need financial protection.

The study examined out-of-pocket health care costs including co-pays and deductibles for individuals in their late 50s to early 70s. The average out-of-pocket cost declined 27% between the ages of 64 to 66 even though income remained the same. Meanwhile, average health costs paid by individuals and insurance increased 5%. Meanwhile, the percent of older individuals lacking health insurance decreased from 5% to almost 0% from ages 64 to 66. The study made note of older individuals whose health care costs consumed 40% of their income after food and housing. This category included 9% of uninsured 64-year-olds but dropped by 35% for 66 year olds. Not having medicare benefits likely contributed to the fact that approximately 6% of 66-years-old spent more than 40% of their disposable income on health care costs. 

The Center for Medicaid Services recently issued a notable statement requesting that parties conform with the duties and obligation of third-parties found in existing law. The Center recently reviewed each state’s Medicaid plan to make sure that states complied with recent statute changes. The Center for Medicaid decided that many states are yet to revise their guidelines to meet regulations found in the Bipartisan Budget Act as well as the Medicaid Services Investment and Accountability Act. Regulations found in the Bipartisan Act include statements that impact regulations connected to the treatment of some kinds of care. 

The Background of These Changes

Medicaid often disperses funds only as a “last resort”, which means that Medicaid issues payment for treatment and services only when it is assessed that no other payment sources exist. The Social Security Act’s Section 1902 requires all 50 states to take measures deemed reasonable when deciding on third-party payer liability.  The Act also specifies what the term “third-party payer” means. The definition of “third-party payer” encompasses various entities including health insurers, qualified health plans, and any other entity that are classified as legally responsible for certain medical treatment. The Bipartisan Act revised section 1902 to require all 50 states to utilize standard cost avoidance methods rather than paying the total amount allowed under the appropriate payment schedule then seeking third-party reimbursement. 

Deciding how to best care for elderly parents is never easy, particularly when they face difficulties in performing daily living activities for themselves. In an effort to resolve your responsibilities as well as meet your parents’ needs, you can unexpectedly end up facing various challenges, particularly if your loved one resides in a nursing home. Data currently suggests that only 4.5 percent of older adults or 1.5 million people live in nursing homes.

 At the end of the day, you likely desire for your parents to reside in a facility which may very well be a nursing home where they will be able to thrive as well make the most of their remaining time. With these issues in mind, it’s a good idea to review and plan around all aspects of nursing home life. 

Adapting to a Schedule