Many people will try to give away some or much of their assets in an effort to qualify for Medicaid. However, if done within five years of applying for coverage for long-term care, Medicaid will count this as a gift given in attempt of qualifying for Medicaid benefits. Thus, a period of ineligibility will begin, as Medicaid will think that those assets could have been used to pay for care.

You should know that not all transfers or gifts will usher in a period of ineligibility though. There are, in fact, a number of exceptions to the rule against gifting during that five-year period. Some of the most common exceptions are as follows:

The Home: A person’s house is subjected to a very special set of rules that have been put in place in both state and federal Medicaid laws. A home is usually exempt (in that it doesn’t count toward an asset limit and is not required to be sold to pay for care) if it meets the following conditions:

• It is currently occupied by the applicant or his or her spouse.
• The equity value of the home totals out at less than $543,000 (or $814,000 in states like CA, NY, CT)
• The title must be held in the applicant’s name or that of his or her spouse.

In many cases, however, the home can’t be gifted to someone without penalty (since home exemption requires an applicant or spouse to live in and own the home). There are exceptions to this too, though, and as per federal law, a period of ineligibility begins when the home is transferred unless it is to one of the people listed below:

• The spouse of the applicant
• A child of the applicant under the age of 21
• A child who is permanently blind and/or totally disabled
• The sibling of an applicant who has equity interest in the home and has lived there for at least a year immediately prior to the date the applicant is institutionalized
• A son or daughter of the applicant (other than that previously described) who has been in the home for a period of at least two years before the date of institutionalization and who (as determined via the state) gave care to the applicant, which let him or her reside at home rather than in a facility or institution.

Transfers for the Benefit of the Spouse

Such transfers are not penalized by Medicaid since assets held in the name of either spouse are included when determining eligibility. There is no penalty under federal law if:

• The asset was transferred to the spouse or another for the sole benefit of the spouse, or
• The asset was transferred from the applicant’s spouse to another for the sole benefit of the applicant’s spouse.

Transfers to a Child

The applicant may transfer any resources (including the home) to a disabled child without fear of penalty. Penalties will not be incurred when the asset was transferred to the applicant’s child, or to a trust solely for the benefit of the child, so long as he or she is either blind or otherwise permanently and totally disabled, as defined by the individual state programs, or by Supplemental Security Income.

Undue Hardship Exception

There is a possibility to convince Medicaid that transfers made that resulted in a period of ineligibility would cause undue hardship on the applicant. Undue hardship is defined as depriving a person of medical care that endangers his or her life, according to federal laws. This means that you must prove that you cannot afford a nursing home without Medicaid, and without that nursing home, you might die. This is just an example, but each state has its own rules regarding hardship, so if you think that you or a family member may qualify for the exception, the nursing home can file a request for a waiver with the applicant’s consent.

If you or someone you love needs assistance with Elder Care law issues, call 856-281-3131. Let us help ease your stress and give you a plan.

 

In most all cases, Medicare Part B DOES NOT cover any type of adult day care. It will, however, cover some of the services the adult day care provides, though normally in limited circumstances. Medicare Part B covers mental health treatments that have been prescribed by a physician and provided by an outpatient mental health facility. If that place also happens to be an adult day care center, the patient will have the added benefit of those types of services while also receiving mental health treatments. You should be aware that Medicare will only cover care if said care involves actual medical treatment—like administration and monitoring of medication, treatment to recover from a medical crisis, or either individual or group psychotherapy.

Medicare Part C Medicare Advantage plans cover everything that’s included in Parts A and B. Though, sometimes a part C plan will cover more than that, with any extra services or an expanded amount of coverage. Co-payments for Part C plans may also be different from those for Part A or B. Contact your plan directly to see if your plan provides this extra coverage or requires different co-payments.

If Medicare Part B covers some adult day care as a part of mental health care, it only covers around 50% of the approved amount that they have allotted to perform the service. In some states, Medicare partners up with Medicaid to sponsor what’s known as the PACE program, or the Program of All-Inclusive Care for the Elderly. This program provides comprehensive in-home and community care—including adult day care—for any elders who may otherwise need to be put into nursing home care. In those states that have the PACE program, only those with low income and few assets, who are also eligible for both Medicare and Medicaid can participate in the program.

No matter the rules regarding any specific type of care, in order for any Medicare plans to provide coverage (whether Parts A, B, or C), the care has to meet the following requirements:

• The care has to be “medically necessary.” This means that it must be ordered or prescribed by a licensed physician or other authorized medical provider, and that Medicare (or Medicare Part C) agrees that it is both necessary and proper.
• The care must be performed or delivered by a healthcare provider that participates in Medicare.

If you or someone you love needs assistance with Elder Care law issues, call 856-281-3131. Let us help ease your stress and give you a plan.

Many people all over the country take advantage of the benefits that Medicaid provides for them. However, those same people may not even fully understand all of the benefits they are receiving or can receive, exactly what Medicaid covers, or they may lack a general understanding of Medicaid overall.

So, what is Medicaid? Simply put, Medicaid began in 1965 after it was signed into law as a joint state and federal program. The point of Medicaid was to provide health insurance to both low-income families as well as individuals. And while it began its life as a way to provide coverage to those recipients of government welfare, its reach has extended beyond simply low-income individuals and families to certain sections of the country’s elderly and disabled population. Today, there are approximately 60 million people on the receiving end of Medicaid benefits and CHIP benefits (Children’s Health Insurance Program), and is the largest health insurance program in the nation, costing upwards of $400 billion per year.

Eligibility for benefits is determined at state level and is based on income, so each individual and family should check the Medicaid site to find the policy for their state. Those adults without children, who are between 18 and 65, are eligible to receive coverage thanks to the Medicaid expansion in the Affordable Care Act, but there are some states that may not provide coverage to those individuals.

Those who live in states implementing the expansion will qualify for benefits if they earn up to 149% of the federal poverty level. Children, pregnant women, parents, seniors and those with disabilities will qualify so long as they meet both residency and immigration requirements and are documented citizens of the United States.

Benefits

All enrollees are entitled to receive the following mandatory benefits:

• Inpatient hospital services
• Outpatient hospital services
• EPSDT: Early and Periodic Screening, Diagnostic, and Treatment Services
• Nursing Facility Services
• Home health services
• Physician services
• Rural health clinic services
• Federally qualified health center services
• Laboratory and X-ray services
• Family planning services
• Nurse Midwife services
• Certified Pediatric and Family Nurse Practitioner services
• Freestanding Birth Center services (when licensed or otherwise recognized by the state)
• Transportation to medical care
• Tobacco cessation counseling for pregnant women

Some states also provide the following optional benefits as well:

• Prescription drugs
• Clinic services
• Physical therapy
• Occupational therapy
• Speech, hearing and language disorder services
• Respiratory care services
• Other diagnostic, screening, preventative and rehabilitative services
• Podiatry services
• Optometry services
• Dental services
• Dentures
• Prosthetics
• Eyeglasses
• Chiropractic services
• Other practitioner services
• Private duty nursing services
• Personal care
• Hospice
• Case management
• Services in an intermediate care facility for the mentally retarded
• Self-directed personal assistance services
• TB Related Services
• Inpatient psychiatric services for those under 21
• Other services approved by the Secretary

If you or someone you love needs assistance with Elder Care law issues, call 856-281-3131. Let us help ease your stress and give you a plan.

Despite the name, a Medicaid bed isn’t an actual bed. Instead, it refers to what is known as a bed-hold policy. This means that certain residents of nursing homes can return to their beds if they are temporarily absent from the facility.

The Nursing Home Reform Act allows those who qualify for Medicaid benefits to take advantage of “Bed-Hold and Readmission rights. These rights are not available to Medicare beneficiaries, so what this means is that those who get Medicaid and who are required to leave the facility for hospitalization or therapeutic reasons, they have the right to return, and the nursing home must hold the bed for them for a certain period of time. Although, if the absence should go beyond the bed-hold period, and if the person still requires skilled or intermediate nursing care, he or she will then be entitled to the first bed available in a semi-private room at the facility.

There are both federal and state laws in place, along with regulations, that require nursing facilities to give out written information to the elder and his or her family members that goes into detail regarding the bed-hold policy as outlined in the State Medicaid plan. However, this isn’t normal procedure for those who get reimbursed by Medicare for their care. Those individuals might be required to pay any bed-hold fees that have been instituted by the facility.

This means that people insured by Medicare aren’t protected by the above rules and regulations. However, those who aren’t protected aren’t completely left out in the cold. They have the option too either pay the daily rate in order to keep the bed or take the chance that a bed will be available elsewhere once the elder is covered by Medicaid—though this is understandably more difficult.

If you or someone you love needs assistance with Elder Care law issues, call 856-281-3131. Let us help ease your stress and give you a plan.

At Scott Counsel, we pride ourselves on our extensive knowledge of difficult subjects, such as Medicaid, for example. It can be incredibly mind-boggling to try and understand when you already have so much on your mind as it is. So, we want you to know that what you think you know about Medicaid exclusion gifts and how they relate to the Medicaid look back period could be wrong.

To illustrate, many people often are under the mistaken belief that by gifting (or giving away) an amount of money that is equal to the annual gift tax exclusion ($15,000 as of 2018), that gift will then be excluded from Medicaid’s look back period, thus phasing out a waiting period prior to receiving Medicaid benefits.

Unfortunately, this is not true.

What you need to know about the gift tax is that it is a rule imposed by the IRS. This means that anyone who gifts an amount of $15,000 or less doesn’t need to report it to the IRS. They do, however, have to file a gift tax return if any amount above that number is given to anyone other than a spouse. Keep in mind, though, that you won’t necessarily pay a gift tax, and you’ll only need to do that if your total lifetime exemption is $5.49 million.

It is also important to note that this rule from the IRS is not related in any way to the asset transfer rules imposed by Medicaid. So, while the $15,000 that you can gift to a grandchild or someone else will be exempt from a gift tax, it will still be counted as a transfer by Medicaid, and this could create an ineligibility period for you when it comes to receiving benefits—though only if you apply within the next five years.

As we said, this can be a very confusing topic, but you don’t have to worry.

If you or someone you love needs assistance with Elder Care law issues, call 856-281-3131. Let us help ease your stress and give you a plan.

We all would like to think that Medicaid will be there for us without question if we happen to need it later on in life. However, there is something called a Medicaid Look Back period that can potentially affect your eligibility to receive Medicaid benefits.

What this means is that you cannot transfer any assets to any person, be they family members, loved ones, friends, or even any charitable organizations within five years of applying to receive benefits from Medicaid. This is what is known as the Look Back period mentioned above. New Jersey doesn’t want its citizens to have to move into a nursing home when you’ve given all your money to your family, children, or anyone else, and then qualify for Medicaid shortly thereafter. To make sure it doesn’t happen, Medicaid has instituted a penalty period—a length of time in which someone who transfers any assets will be rendered ineligible to receive benefits.

Let’s see an example:

The average cost of care per month in New Jersey is $9,369 (or more). So, if you give away property that has a worth of $100,000, you will then be ineligible for Medicaid for 10 months (as $100,000 divided by $9,369 =10.67 months).

Someone applying for Medicaid has to disclose any and all of his or her financials (both income and expenses) within five years of filing the application, again referring to the Look Back period. The Board of Social Services will then determine whether or not the applicant has transferred any assets for less than fair market value.

However, not all transfers will be penalized. If you transfer assets to any of the following, you will be exempt from ineligibility:

• A spouse
• A blind or disabled child
• A trust for the benefit of the blind or disabled child under the age of 65 (even if said trust is to benefit the Medicaid applicant, under specific circumstances).

What’s more, there are special exemptions that apply to transferring a home. You can transfer your home without incurring penalty to the following:

• The applicant’s spouse
• A child under the age of 21 who is also blind or otherwise disabled
• A trust for the sole benefit of the blind or disabled child under the age of 65 (even if said trust is to benefit the Medicaid applicant, under specific circumstances)
• A sibling who lived in the home during the year before the applicant’s institutionalization who already has equity interest in the home.
• A “caretaker child,” one who is defined as a child of the Medicaid applicant who lived in the house for a minimum of 2 years before the applicant was institutionalized and who cared for the applicant so he or she could stay out of a nursing home.

If you or someone you love needs assistance with Elder Care law issues, call 856-281-3131. Let us help ease your stress and give you a plan.

Medicaid is a huge program, and one that can be incredibly confusing to figure out. Rules vary by state and change all the time, so a Medicaid Planner can be beneficial in helping you prepare to take the journey of Medicaid eligibility. While there are in fact public employees that can help you by offering free assistance to those qualified individuals, the unfortunate truth is that not everyone is qualified for free assistance, so hiring a Medicaid Planner is a necessity in those instances.

If you’re worried about the cost of hiring such a person, you should be aware that the average cost of a Medicaid Planner is less than what it costs for a one-month stay in a nursing home. While there can be numerous costs when it comes to hiring a Medicaid Planner, it really is dependent on the Planner him/herself, as well as the specific needs of the person or persons hiring the Planner.

If you or someone you love needs assistance with Elder Care law issues, call 856-281-3131. Let us help ease your stress and give you a plan.