Medicaid Applications

Tax and Medicaid Law Changes for 2025

Published on: January 10, 2025 | by Ettinger Law Firm

For 2025, the exemptions for estate taxes rise to $7.16 million for New York estate taxes, and to $13.99 million for Federal estate taxes. The annual gift tax exclusion rises to $19,000. If your estate is, or may become, greater than the New York threshold, early intervention can avoid the hefty New York estate taxes, which start at over $600,000. Some of the techniques are (1) setting up two trusts, one for husband and one for wife, and using them to double the New York exemption, (2) gifting out so much of the estate so as to reduce it below the New York exemption, at least three years before the death of the donor, and (3) using the “Santa Clause” providing that the amount over the threshold be donated to a charity or charities of your choosing so as to reduce the estate to no more than the exemption.

For Medicaid, the house is an exempt asset so long as a spouse is residing there, up to $1.1 million of equity for 2025. Seeing as over 80% of nursing home residents do not have a spouse, it is better to plan ahead with a Medicaid Asset Protection Trust (MAPT) to get the five year look-back for nursing facility care. In that case, the house would be protected by the trust rather than the unreliable spousal exemption. Unless your other assets have been protected by the MAPT, an individual may keep about $31,500 and a spouse at home can keep up to about $158,000.

The often-delayed imposition of the new two and a half year look-back for home care, is not on the horizon for 2025. Currently there is no look-back for home-care and you do not have to worry about getting home care until you actually need it. Nevertheless, this may change in the future so the MAPT remains as an important as a tool to qualify you for home care as well as protecting your assets from a nursing home. Assets should be moved into the MAPT years ahead of time if you want to be able to afford to stay in your own home and get home health aides for assistance with the activities of daily living, should the need arise.

Qualifying for Medicaid to Pay for Long-Term Care

Published on: June 1, 2023 | by Ettinger Law Firm

Spend-down. Look-back. Penalty Period. Uncompensated Transfer. These are just some of the terms Medicaid uses to determine eligibility for long-term care coverage. Medicaid is a combined federal and state program that pays for long-term care at home (community Medicaid) or in a nursing facility (institutional Medicaid). Asset, income and gift rules vary for community Medicaid versus institutional Medicaid.

To qualify for community Medicaid, an individual cannot make more than about $1,700 per month and cannot own more than about $30,000 in assets. A married couple cannot make more than about $2,300 per month and cannot own more than about $40,000 in assets. Applicants can “spend down” excess income to the allowed amount by paying for medical expenses.

To qualify for institutional Medicaid, an individual can keep $50 per month (the excess goes to the nursing home) and cannot own more than about $30,000 in assets. For married couples, the spouse at home can keep about $3,700 per month and can own between about $75,000 and $130,000 in assets. If the spouse at home makes more than $3,700 per month, she may have to contribute some of the excess to the spouse’s cost of care. For married couples, the residence, up to value of about $1,000,000 and one car are exempt (not counted as assets). Everyone can have a burial trust worth up to $1,500 or any amount in an irrevocable pre-paid funeral trust.

Trump Administration Medicare Faces Increased Scrutiny

Published on: June 2, 2022 | by Ettinger Law Firm

Biden-era legislatures are currently debating improving a Trump administration regulation associated with Medicare due to increasing pressure from Democrats. Also called a direct contracting model, the program implemented during the Trump administration lets private companies enroll in Medicare as health department members to revise and better care while keeping government costs as low as possible.

The measure has fallen under scrutiny from Democrats who are concerned that the Biden administration is laying a path for Medicare to become private by keeping the measure intact.

Senator Warren Criticizes Model

The Role of the Stop Unfair Medicaid Recoveries Act

Published on: April 18, 2022 | by Ettinger Law Firm

Current federal regulations require Medicaid programs run by states to try to recoup the cost from estates of recipients who have since passed away even if the state would rather not pursue such recovery.

Medicaid programs must pursue compensation for the cost of nursing home services as well as home and community-situated services in addition to other associated services if a person who receives Medicaid was at least 55 at the time the services were provided. States have the choice to pursue recovery for other services due. The recovery is restricted by the size of the deceased individual’s estate. No other public benefit program requires that correctly paid benefits be received from a deceased Medicaid recipient’s family members. The minimum revenue created by estate recovery is surpassed by the burden it places on low-income individuals. The burden unfairly falls on families whose loved one’s experience

The Stop Unfair Medicaid Recoveries Act was introduced by an Illinois representative and if passed into law would revise the Social Security Act’s Title XIX to repeal requirements that states create a Medicaid Estate Recovery Program and restrict the circumstances when a state can institute a lien on property owned by a Medicaid beneficiary.

Commonly Asked Questions about Over-the-Counter Tests and Medicare

Published on: March 10, 2022 | by Ettinger Law Firm

It’s almost an understatement to say that the Covid-19 pandemic has changed our lives and how we live in a range of ways. While Medicare did not pay for Covid-19 tests that were available over the counter, the Center for Medicaid Services is in the process of executing an effort in the spring of 2022 that will offer payment directly to qualifying pharmacies as well as other business entities that participate in this program to help Medicare recipients receive up to eight Covid-19 tests free each month.

Currently, Medicare Advantage Plans sometimes cover and pay for over-the-counter (OTC) Covid-19 tests as a supplement in combination with providing Medicare Part A and Part B coverage. If you’re enrolled in a Medicare Advantage Plan, you should review the terms of the plan to check whether the plan will cover and pay for Covid-19 tests.

All Medicare beneficiaries with Part B qualify to receive eight free OTC Covid-19 tests, despite whether a person is enrolled in a Medicare advantage plan.

Protecting Assets With Caregiver Agreements

Published on: November 15, 2020 | by Ettinger Law Firm

Family members as caregivers overwhelmingly provide for elderly and disabled loved ones at home. Although a labor of love, taking care of ailing loved ones also has a market value, meaning that caretakers may be paid as a way to protect assets.

Through the use of a Caregiver Agreement, also known as a Personal Services Contract, the disabled or elderly person may transfer money to family members as compensation rather than as a gift. Gifts to family members made in the last five years before applying for Medicaid to pay for nursing home costs disqualify the applicant from receiving Medicaid for a certain period of time, known as a “penalty period.”

For example, mom depends on daughter Janice for her care. If mom gifts $100,000 to Janice, then goes into a nursing home in the next five years and applies for Medicaid, the gift to Janice will result in about a ten month penalty period. Janice will have to give the $100,000 back to mom to pay nursing home costs during the penalty period, or mom will have to use other resources to pay.

MEDICAID TRANSFER AFTER ADMISSION TO A RETIREMENT COMMUNITY

Published on: May 10, 2016 | by Ettinger Law Firm

THOROUGH PLANNING NEEDED IN ADVANCE

This blog has discussed the necessity of proper and thorough planning to ensure a smooth transition into a continuing care retirement community. This requires, among other things, that a person properly and legally transfer all of their assets, or a substantial portion of their assets that is, to people or entities that would enable them to be eligible for Medicaid. As many people know, there is a look back period where the state examines all transfers of assets or money over a certain period of time for purposes of Medicaid eligibility purposes.

If during that time a person transferred any aset for less than full market value or did not transfer the assets to a proper investment vehicle that is otherwise exempt from Medicaid assets, the Medicaid applicant will likely be denied for financial reasons. In other words Medicaid will claim that the applicant has too many assets or their income is too high to qualify. Some examples of a Medicaid exempt transfer is the purchase of a graveyard plot, prepayment for funeral services or the purchase of a short term Medicaid annuity. An interesting case from November, 2015 out of Broome County, entitled Good Shepherd Village at Endwell v. Peter Yezzi shows the many problems that can result when people start their Medicaid planning after admission to a continuing care retirement community.

MEDICARE’S OBSERVATIONAL STATUS

Published on: April 8, 2016 | by Ettinger Law Firm

SOME LIMITED RELIEF

Patients who rely on Medicare sometimes experience sticker shock after being released from the hospital only to find out that because some hospital administrator classified their stay as “observational” that they must pay a large portion of the final bill. Many times a doctor will seek to have a patient admitted for any number of reasons, only to have a bureaucrat reclassify the patient’s time at the hospital as observational. Such a designation will mean that Medicare will not pay for this time in the hospital. For Medicare to pay for a hospital stay, the patient has to be an admitted patient for at least three days (three midnights in the hospital).

Observational status does not equate to an admitted patient in Medicare’s own set of self defined definitions. That may be quite different to the patient who went to the hospital and received a number of drugs and tests during their time their and was consistent with the majority of their non-surgical stays in a hospital in life. In an effort to address these obvious problems that will only grow with time, President Obama signed a bill that required hospitals to warn patients that their stay will be considered observational in nature and that they are not being admitted under Medicare’s rules, which may result in a bill from the hospital that they will have to pay. The Notice of Observation Treatment and Implications for Care Eligibility Act would have to inform the patient that they are going to receive outpatient services under Medicare’s rules which requires cost sharing from the patient and that the observational status does not count towards the necessary three day inpatient in order to transition to a skilled nursing care facility.

Benefits and Programs for Elderly New Yorkers, Pt. 2

Published on: February 3, 2015 | by Ettinger Law Firm

The first part of this article explained that there are many programs and benefits available to seniors that live in New York. The second part of the article continues to explain various services that are available to the state’s elderly population.

Temporary Assistance

This program provides cash benefits for senior citizens with limited income for essential food, clothing, and shelter items. You can be any age to apply, but people over the age of sixty do not have to meet the program’s work requirements. The resource limit for an individual is $2,000 and $3,000 if any household member is ages sixty or older. Employed applicants may be able to disregard some of their earnings and still qualify for the program. There is a sixty month limit on this program, and it applies for the lifetime of the applicant.

Couples Divorcing to Save on Long-Term Health Costs

Published on: September 5, 2014 | by Ettinger Law Firm

Elderly couples are divorcing at a higher rate than ever before for a surprising reason: soaring medical and long-term care costs. These expenses are being aggravated by longevity and uninsured risk from a lack of long-term care insurance. Although these senior couples still care for each other very much, the cost savings from divorce are inflicting the least amount of damage when compared to other financial options.

Medicare and Medicaid

Seniors are now turning to divorce to stave off financial ruin trying to qualify for Medicare and Medicaid coverage. In terms of Medicare coverage, the program only covers 100 days of nursing care. If you or your spouse needs long-term nursing care you must either pay out of pocket until your assets fall beneath a certain threshold or tap into your long-term care insurance if you have it.