Medicaid Eligibility

Spousal Refusal – Just Say No

Published on: April 12, 2024 | by Ettinger Law Firm

Spousal refusal is a legally valid Medicaid planning option in New York. By way of background, certain income and assets are exempt from Medicaid if there is a spouse. Generally, the spouse at home, known as the “community spouse” may keep about $3,850 per month of the couple’s combined income and up to about $150,000 of the assets or “resources”. Not included in those figures are any other exempt assets, such as a home (up to about $1,000,000 of the equity only) and one automobile. The spouse who is being cared for in a facility is known as the “institutionalized spouse”.

Many a spouse has advised us that they simply cannot afford to live on the allowances that Medicaid provides. This is where spousal refusal comes in. We start by shifting excess assets into the name of the “community spouse”. He or she then signs a document which the elder law attorney prepares and files with the county indicating that they refuse to contribute their income and assets to the care of the ill spouse since they need those income and assets for their own care and well-being. Note that you may not refuse your spouse’s own income over the $3,850 per month exemption as it is not coming to you.

Once the “community spouse” invokes their right to refuse, and all of the other myriad requirements of the Medicaid application are met, the state Medicaid program must pay for the care of the institutionalized spouse.

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.

Audits Could Leave Many People Without Health Insurance

Published on: June 22, 2022 | by Ettinger Law Firm

State audits have the potential to impact 15 million individuals including 6 million children losing their health insurance. Some state workers are concerned that they might lack the resources to aid people in finding new insurance coverage.

The existing federal public health emergency will expire this year, which will subsequently trigger a requirement that state workers must examine Medicaid to determine who qualifies as eligible. Over the last two years, these audits have been suspended. With the resumption of these adults, up to 15 million individuals are losing their medical insurance.

The Role of the Biden Administration

Postal Service Switches Retirement Benefits to Medicare

Published on: June 22, 2022 | by Ettinger Law Firm

Congressional efforts to revise the country’s mail service might come at the cost of an even more nuanced issue involving Medicare.

The Postal Service Reform Act of 2022 would help to free post office costs by resolving the unusual and challenging legal requirement to fund 75 years of retirement health benefits in advance. In return, this Act would require future Postal Service retirees to participate in Medicare.

The Congressional Budget Office reports that the movie would save postal retirement as well as healthcare programs more than $5 billion and add more than $5 billion in costs to Medicare from now until 2031.

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.

How Medicare and Medicaid Are Addressing Long-Term Care Issues

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

Deciding how to receive the medical care that a person needs is a critical part of the elder law process. Unfortunately, the unpredictable nature of aging and medical issues can make it challenging to determine what lies ahead. Various states have also begun to attempt to resolve financing challenges associated with elder care that a growing number of Americans will face in the next couple of decades as a growing portion of the baby boomer generation requires medical care.

The Growing Need for Assistance

Any person can end up needing assistance as they age. This is true regardless of whether a person ends up facing dementia, a significant drop in eyesight, or mobility issues. The degree of assistance and how long a person faces these issues can vary substantially. A person might end up needing assistance with meals, other daily living activities, or total care for the months or years before they pass away. Other times, people end up needing total care for years. The unpredictable nature of a person’s future makes it challenging to plan ahead.

Preserving Income with Medicaid Pooled Trusts

Published on: November 8, 2017 | by Ettinger Law Firm

Medicaid is a safety net for millions of senior citizens across the country, providing funding to pay for home care, adult day care, or prescription drugs. However, the program is designed for low income individuals and can leave many on the fence financially over whether to choose to spend down assets or pay for these necessary services themselves.

Currently, the threshold to receive Medicaid services is only a few hundred dollars for individuals and just over $1,000 for married couples, which leaves these individuals with little income to pay rent, utilities, or buy groceries. Even financially secure seniors can find themselves needing vital Medicaid services like in-home or nursing home care in the event of a catastrophic health event, making planning for the future and keeping options open all the more vital.

One option that may be viable for certain individuals is joining a Pooled Supplemental Needs Trusts, also known as a Pooled Income Trust. Pooled income trusts work by the individual sending his or her income from Social Security, pensions, or annuities to non-profit organizations to pay bills and other expenses to stay below the Medicaid threshold. Any income left over after the individual passes away goes to the non-profit.

New York Medicaid Law – Pooled Trusts

Published on: August 23, 2016 | by Ettinger Law Firm

Pooled Trusts Eligibility

Pooled Trusts are a type of trust applicable to those individuals who are seeking public assistance benefits, such as Medicaid, to become eligible financially by setting aside funds in a trust for additional needs. The trust allows its beneficiaries to preserve a specified amount of money in a trust to pay for supplemental care not covered by public assistance programs. For the elderly, many need public benefits assistance as they continue to age but do not qualify based on higher income. In these situations, a pooled income trust will benefit an elderly person by allowing them to continue their lifestyle, which is usually seeking to stay in the home, while also obtaining homecare services and paying for what their budget requires.

New York Medicaid Rules

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.