What Can Happen, and What Can You Do?

If you lose Medicaid coverage, you may be responsible for paying the full cost of your long-term care services. This situation can be financially challenging, as long-term care expenses can be significant. Finding an alternative payment source is an immediate concern, even if you plan to reenroll for Medicaid coverage. The application process takes some time to complete.

Tap Into Existing Resources

For the short term, you may need to seek family help. If you previously did Medicaid planning, you may tap into personal savings or sell assets. If you qualify, you may need to explore other government programs providing financial assistance for long-term care, such as veterans benefits. Medicare policies traditionally don’t cover long-term care, but they do cover some skilled nursing home care in specific situations for a limited time.

Negotiate with the Care Facility

If you can’t cover the full cost of your long-term care, you may need to negotiate with the care facility, nursing home, or in-home services to find a solution. Some facilities may be willing to work out payment plans to avoid resident churn or make other arrangements to help you continue care. It’s in your best interest to seek the counsel of a disability or elder law attorney specializing in long-term care to negotiate a solution.

Care Facility Discharge

When a short-term fix isn’t available, or negotiations to alter payment obligations fail, the loss of Medicaid coverage may result in discharge from the facility or denied in-home or community-based care services. However, a facility is legally obligated to provide notice before discharging a resident. During this time, the facility and your elder law attorney can work with you or your family to arrange a safe and suitable transition to another living arrangement.

Disenrollment Numbers

The number of Medicaid cutoffs for previously existing beneficiaries has surpassed one million, with the expectation to increase between 14 to 18 million. So far, Medicaid-dependent facilities, nursing homes, and at-home and community-based services are not widely affected. Still, the law of large numbers indicates disenrollment can significantly impact some beneficiaries requiring long-term care.

Many Medicaid beneficiaries who have been released due to procedural issues or technicalities anticipate being reenrolled. However, according to Medicaid, states have up to “twelve months to return to normal eligibility and enrollment operations.” The permitted time frame creates havoc for many Americans who rely on Medicaid benefits. However, it’s catastrophic for beneficiaries receiving Medicaid for long-term care as costs in a facility may range from about $4,000 – $8,000 per month, depending on the location.

If You or a Loved One Are in Long-Term Care

Understand that the unwinding of Medicaid continuous enrollment happens by state. Some long-term care beneficiaries may be unaware that continuous enrollment has stopped. Beneficiaries or their loved ones may neglect to return Medicaid paperwork or omit required documents consistent with current Medicaid qualifiers.

Some long-term care providers raise concerns that staff shortages in state agencies that handle reenrollment will create delays in processing required patient paperwork. The twelve-month grace period Medicaid provides to the states creates a slow reenrollment process that affects providers who continue to care for residents without reimbursement.

Consult a Disability or Elder Law Attorney

If you have been cut off from Medicaid and need to reenroll, an attorney can guide you through the general steps to ensure your benefits begin again as soon as possible. Your lawyer can help you confirm the reason for the discontinuation of benefits. It may be a failure to provide required documentation since the end of continuous enrollment or changes in eligibility requirements.

Once you understand why it has happened, your attorney can gather the necessary documentation for the reenrollment process. Documents may include:

• Proof of income
• Identification documents
• Proof of residency
• Social Security number
• Other documents your state’s Medicaid office requests

Your disability or elder law attorney can ensure all relevant financial documents and medical records are included to support your application. They may contact the state’s Medicaid office and advise them that you have been receiving long-term care benefits in an effort to flag your application for expedited processing.

Because short-term loss of benefits can make maintaining residency in a long-term care facility difficult, your attorney can strategize a short-term solution that addresses your unique situation.

Appeals and Advocacy

If your Medicaid reenrollment application is denied or you face challenges during the reenrollment process, an elder law or disability attorney specializing in long-term care can help you through the appeals process. They can gather additional information, advocate on your behalf, and represent you in administrative hearings or appeals.

If you are in long-term care and lose Medicaid benefits, specific consequences will depend on individual circumstances and your state’s regulations. Pay close attention to your Medicaid status. Disenrollment may continue to affect long-term care beneficiaries for some time due to the end of the requirement in FFCRA legislation requiring continuous enrollment.

Consult with one of our experienced elder law or disability attorneys specializing in Medicaid and long-term care issues. They understand the laws and regulations and help you reenroll in Medicaid, securing the necessary coverage to continue your long-term care benefits.

We hope you found this article helpful. Contact our office at (740) 947-7277 and schedule a free consultation to discuss your legal matters. We look forward to the opportunity to work with you.

The post Medicaid Disenrollments Could Threaten Long-Term Care Patients appeared first on Seif & McNamee.

About half of US adults have gone without or delayed medical care in the last year due to a lack of affordability. Even with insurance benefits, many are still unable to afford the high cost. Approximately one-third of insured US adults are worried about being able to afford their monthly premiums. Additionally, 44% worry that they can’t afford their deductible. Health care costs are rising globally, but the US accounts for more than 40% of total global spending.

The Cost of Avoiding Treatment

Delaying or avoiding annual checkups or treatment for a seemingly minor illness may seem like an easy way to cut expenses. However, it may result in significant physical and financial costs later. For example, minor problems can become chronic illnesses as we age and eventually lead to the need for long-term care. This financial burden can carry over to other family members or result in losing a home or a lifetime of savings.

Complications from minor illnesses can easily be avoided with basic treatment. Otherwise, infections can worsen, potentially leading to hospitalization or other serious conditions.

Annual checkups and preventative care are the first line of defense against disease and provide early detection for better health-related outcomes. Routine cardiovascular exams and various cancer screenings save thousands of lives every year.

Preparing for Health Care Costs with Employee Savings Plans

It’s hard to predict the cost of doctor’s visits if you’re uninsured or have a high-deductible health insurance plan without copays. Health care bills are usually higher than anticipated, which creates financial strain and debt. Many people turn to family and friends to borrow money or deplete retirement accounts or home equity to pay medical bills. Unexpected accidents or illnesses can cause lasting financial damage.

One way to prevent medical debt is by contributing to a health savings account (HAS) or flexible spending account (FSA). A payroll deduction puts tax-free funds directly into your account to use for out-of-pocket medical expenses, including vision and dental needs. HSAs have annual contribution limits and are usually only available to those with high-deductible health insurance plans. FSAs may have a slightly lower annual contribution limit and a requirement to use the funds within that calendar year.

Creating Your Own Savings Plan

You can create your own savings account to use for medical and financial emergencies. Research different financial institutions to find the best interest rate. Then stretch your savings by comparing treatment prices on your insurance provider’s website or checking with customer service. You can also look at third-party sites like Clear Health Costs, FAIR Health, and Healthcare Bluebook for average costs.

Also, let your doctor know if you are having trouble affording your medications. They won’t offer low-cost options unless you tell them it’s a concern.

Many Americans avoid treatment regardless of income level and access to health insurance. Our elder law and estate planning attorneys help families plan ahead to avoid the financial devastation that can result from high health care costs in medical emergencies and the need for long-term care as they age. We hope you found this article helpful. Contact our office at (740) 947-7277 and schedule a free consultation to discuss your legal matters. We look forward to the opportunity to work with you.

The post The Cost of a Doctor’s Visit Is Out of Reach for Many Americans appeared first on Seif & McNamee.

Early January of 2023, the Department of Health and Human Services (HHS) released a Medicaid federal policy guide covering key dates for the end of the continuous enrollment provision no longer linked to the end of the public health emergency. In fact, the expiration has already occurred. As of April 2023, states may terminate Medicaid coverage and request a beneficiary redetermination.

Previous Spike in Medicaid Enrollment

Medicaid enrollment increased substantially during the pandemic. Now that continuous enrollment is ending, millions of Americans are at risk of losing their existing Medicaid coverage. Medicaid disenrollments happen at the state level, but states must comply with the federal rules to conduct renewals. Each state’s process may vary slightly.

The Kaiser Family Foundation (KFF), a non-profit focusing on national health issues, estimates between 5.3 to 14.2 million people will lose Medicaid coverage. HHS estimates as many as 15 million people may be disenrolled, including 6.8 million who may remain eligible but need to re-enroll.

Those who temporarily lose Medicaid coverage and re-enroll quickly are called “churn.” Churn may account for those individuals who experience short-term changes in circumstances or income that temporarily render them ineligible or face barriers in maintaining coverage because of the redetermination process that the end of the continuous enrollment provision brings.

Eligibility Checks

The federal government required states to develop plans to resume routine operations during the unwinding of the continuous enrollment process. Each state has renewal priorities and estimates for the time needed to complete the redetermination process and apply updated standards to reduce inappropriate coverage loss.

Streamlining renewal processes can help the continuity of coverage under the Affordable Care Act (ACA). Medicaid agency services can check eligibility through available data sources like the state wage databases before sending renewal forms or document requests to an enrollee. These electronic data checks can verify ongoing eligibility. However, of the 42 participating states, only 11 report completing 50 percent or more redeterminations using this process. The renewal process will be lengthy and cumbersome for most beneficiaries.

Medicaid Redetermination Process

Individuals who don’t renew automatically must go through the Medicaid redetermination process to continue receiving coverage. Absent the FFCRA provision for ongoing enrollment, the process will return to its annual renewal basis to ensure individuals receiving Medicaid benefits are still eligible.

The Medicaid agency will request that beneficiaries provide updated income, assets, and household information. They may also require the beneficiary to provide documentation such as pay stubs, tax returns, and bank statements to verify eligibility.

If the agency determines a beneficiary is no longer eligible for Medicaid, they may send a notice of termination and allow the individual to appeal the decision. If the beneficiary disagrees with the appeal decision, they can request a fair hearing to have their case reviewed by an impartial hearing officer.

Medicaid beneficiaries must respond promptly to any request for information from the Medicaid agency and keep their contact information current to receive important notices about their eligibility for benefits.

An Elder Law Attorney Helps with Redetermination Approval

An elder law attorney with disability experience can help during the Medicaid redetermination process in several ways, including:

• Assisting a beneficiary in preparing and submitting the necessary documentation and information to the Medicaid agency to support their continued eligibility for benefits. Preparation may include obtaining medical records, documenting changes in income or household composition, and responding to additional requests for information from the Medicaid agency.
• Helping a beneficiary understand their rights and options if their Medicaid benefits are terminated or reduced due to the redetermination process. Options may include appealing the decision, requesting a fair hearing, and advocating for the beneficiary’s rights and interests throughout the process. The attorney may represent and speak for them at an agency hearing.
• Assisting a beneficiary in navigating the complex rules and regulations of the Medicaid program, including any changes in eligibility criteria or program requirements. These changes may impact their ability to receive benefits, particularly since the end of the ongoing provision prompted requirements to change. Keeping current with program rules and regulations and any changes is particularly important for individuals with disabilities or chronic health conditions who may require ongoing medical care and support.

The prediction for millions of individuals to lose their Medicaid coverage, some temporarily and others more permanently, as the system returns to pre-pandemic annual eligibility reviews may be a costly disruption for some. For others, losing Medicaid coverage may be catastrophic to their health.

Medicaid is a joint federal and state program, and while the federal government has general rules which all state Medicaid programs must follow, each state runs its program. All states can now terminate Medicaid coverage and request a beneficiary redetermination process putting many at risk.

Contact one of our elder law attorneys at (740) 947-7277 to represent you if you are a Medicaid beneficiary facing the redetermination process. We protect your rights and access to vital healthcare services needed to maintain health and wellbeing.

The post The Redetermination Process for Medicaid Benefits appeared first on Seif & McNamee.

Spousal Impoverishment Laws in 2023

Medicaid eligibility is based on medical conditions, income, and resources. A spouse may require hospitalization, nursing home care, or the equivalent in-home care for assistance with daily living activities like bathing, dressing, and more.

The spouse requiring assistance must have an income of $2,742 monthly or less. However, if they exceed the limit, it’s still possible to qualify for benefits that will pay for long-term care.

The spouse in need of care must not have countable resources (money and personal property) valued over $2,000. However, the well spouse (community spouse) can keep up to $148,620 of their combined countable assets. If those assets exceed the limits, resources can be spent down to become eligible. This can be done in several ways:

• Use resources to pay for nursing home care
• Pay off debts
• Make home repairs and improvements
• Buy a new car or other personal property
• Prepay funeral and burial plans
• Pay for necessary non-medical equipment
• Purchase an annuity to provide income for the community spouse

Protecting Assets in an Irrevocable Trust

For many couples where one requires Medicaid benefits and the other remains at home, transferring assets to an irrevocable trust may be the best way to protect their home and savings while still qualifying for financial help with long-term care needs. But reorganizing assets must be done legally or it will result in penalties that delay coverage. If benefits are delayed, you will be responsible for out-of-pocket expenses until the benefits are approved.

The timeframe for delayed benefits is based on the value of the asset transfers made during Medicaid’s lookback period and the monthly cost of nursing home care in your state. An elder law attorney can review your situation and avoid mistakes that lead to these penalties with pre-planning for care. However, when there are immediate needs for long-term care, the goal is to qualify for benefits quickly, find out the best ways to pay for care until benefits begin, and reduce costs as much as possible.

Are You Caring for a Spouse at Home, or Is Your Spouse in a Skilled Nursing Facility?

When you’re caring for a loved one and serving as their support system, you shouldn’t have to worry about making ends meet, losing your home, or depleting a lifetime of savings. Spousal impoverishment protections help families stay together and get the care they need. Legal strategies can help you meet federal and state Medicaid eligibility requirements while protecting assets for a spouse and even preserving a legacy for your children.

Long-term Medicaid planning can help families avoid a medical or financial crisis. The sooner you start, the better. For immediate needs, time is of the essence. Either way, reach out to an elder law attorney today to discuss your options. You and your family will gain peace of mind knowing you’ve handled a potentially stressful and emotional situation.

To learn more about Medicaid eligibility criteria that protect against spousal impoverishment for recipients of home- and community-based services, contact our office at (740) 947-7277 and schedule a free consultation to discuss your legal matters. We look forward to the opportunity to work with you.

The post Provisions for Spousal Impoverishment appeared first on Seif & McNamee.

Consult With Your Physician

Before the travel planning begins, it is necessary to get approval from your doctor. Be sure to include an accurate picture of the entire trip, including location, means of travel, climate, potential activities, etc. This is especially important because it’s possible to overlook a factor that can be a potential risk to your health. For example, traveling to higher altitudes may not seem like a risk factor. However, due to the lower concentration of oxygen, it can be dangerous for someone with a lung condition or compromised breathing. A thorough conversation with your physician is the first step to safely planning disabled travel.

In addition to ensuring your destination and plans are safe, your doctor can also help plan for medical needs during your trip. They can ensure that you have access to any medication you may need, prescribe measures for ease of travel, and even provide a medical statement to carry in the event of an emergency.

Know Your Rights

When planning for disabled travel, it is important to know the rights of people with disabilities. The Transportation Security Administration (TSA) has procedures in place for travelers with disabilities and medical conditions. It is wise to understand these procedures before getting to the airport.

Airport assistance is available for disabled individuals. To request assistance, you can call the TSA helpline at 855-787-2227. They can also answer questions about procedures, screening policies, and security checkpoints.

It’s important to note that rights vary in different countries. If you are traveling out of the country, it is advised that you speak with a travel specialist who is familiar with the rights in your desired destination.

Americans with Disabilities Act (ADA) can also provide information about laws for people traveling with disabilities. Unfortunately, many employees of airlines, theme parks, cruises, and other travel destinations don’t know the disability laws, so check for information ahead of time.

Plan Ahead

Planning ahead is the most important tip for a disabled traveler. The easiest way is to hire a travel agency specializing in accessible travel. These agencies check for specific accommodations for travelers with disabilities and special needs.

If you are planning your own travel, begin early. First, research and create an itinerary for your trip. Websites can offer information about accessibility and services offered. Even with the ease of websites, calls should be made to schedule the necessary accommodations. This includes hotels, rental properties, transportation services, rental cars, excursions, and activities. Clear communication is essential. Be detailed when describing your disability so everyone understands what needs must be met.

Be Mindful

Travel provides a great opportunity for adventure and spontaneity. But this does not mean you should disregard your day-to-day needs or routine. For example, if your disability causes you to tire in the afternoon, then schedule activities in the earlier part of the day. Or, if you usually take a nap after lunch, then schedule a daily nap into your plans.

Traveling is exciting, and it can be easy to push our limits or overdo it. Therefore, it’s important to be mindful of your needs and normal routine to avoid excess stress on the body or potential worsening of medical conditions.

Prepare for the Worst Case

Even with proper precautions and planning, travel doesn’t always go as planned. So while we hope for the best, it is vital to be prepared for an unexpected event.

Some of the most common woes of travel are flight cancelations, delays, and lost luggage. If you are traveling by plane, make sure you have extra medication and any necessary supplies in your carry-on. If you are separated from your luggage or become stuck at the airport, you want to ensure your health needs are taken care of.

Should you become ill during your travel, you want to be aware of resources in the area. Research physician availability in your travel area. That way, you are prepared and know where to seek care if necessary. Healthcare Abroad is a helpful resource. In addition to familiarizing yourself with the healthcare resources available, it’s smart to keep your medical alert information and primary physician’s contact on you during travel. When traveling with a disability, you want to take extra precautions regarding health and safety.

Safe Travels!

We are so fortunate to live in a time when travel is accessible for most people. Even with a disability, taking the proper precautions and appropriately planning can open up a world of possibilities. If you find a property or service that does not accommodate people with disabilities be sure to contact a special needs or elder law attorney regarding your rights. No matter where your destination may be, travel well and enjoy every moment!

We hope you found this article helpful. Contact our office at (740) 947-7277 and schedule a free consultation to discuss your legal matters. We look forward to the opportunity to work with you.

The post The Disabled Traveler’s Guide to Accessible Travel appeared first on Seif & McNamee.

Reason Seniors May Continue Working

Many US adults plan to continue working in retirement. Some will work out of necessity to earn more money because of increased longevity, health care costs, and reduced Social Security payouts, while others will leave their career and strike out in a different direction, often pursuing a lifelong dream or spending time and energy in volunteer work or philanthropy. Whatever the senior individual’s pursuit, it’s clear that new patterns have emerged in the past 10 years, and it has a profound budgetary effect on individual US states.

Seniors Prefer to Age in Place

Baby boomers want to age in place and are committed to staying vital, fit, and independent for as long as possible. They want to die in their own homes, not in a hospital or long-term care facility. An  AARP survey of 2,826 US adults found that about 75% of people over 50 want to stay in their homes or communities for as long as possible.

The Impact on State Health Care Budgets

So why does this demographic and economic shift put a strain on so many state budgets? The answer is twofold; there is an increase in healthcare burdens while tax revenues decline since Americans tend to pay fewer taxes as they get older. This is due partially to senior retirement but also because seniors tend to spend less money than younger generations. This means more health services are needed, and fewer tax dollars are available to fund the programs.

Even the states that are best rated for aging, ranked by overall health, senior unemployment, life expectancy, and nursing home quality, are challenged because of health care costs. Rising healthcare costs have been taking a large portion of each state’s government budget and will most likely continue to do so.

Healthcare costs are also hitting baby boomers hard. There is a trend in people aged 50 to 65 having more incidence of disability, obesity, and diabetes, increasing their need for medical care and services. The average 65-year-old couple retiring in 2022 needs $315,000 to cover health care costs alone over the remainder of their lives. That is a 5% increase from the previous year, and with no substantive healthcare pricing reform on the policy horizon, that amount will continue to increase.

Have an Elder Law Attorney Speak with Your Financial Advisor

Now is the time to work with a legal and financial professional to work on a personal retirement plan that considers your future care needs. Our estate planning and elder law attorneys would be honored to work with you on this important planning step.

We hope you found this article helpful. Contact our office at (740) 947-7277 and schedule a free consultation to discuss your legal matters. We look forward to the opportunity to work with you.

The post States Prepare for Baby Boomer Retirement Challenges appeared first on Seif & McNamee.

Medicaid eligibility is needs-based, meaning both income and assets are counted when determining eligibility.  Both Medicare and Medicaid will cover a broad range of health care services, including hospital stays and physician office visits, yet Medicaid will cover nursing home care, in-home care services, long-term care, and transportation to receive medical care which Medicare will not pay for.  It is possible to qualify for dual coverage, which means both Medicare and Medicaid will work together to provide healthcare coverage and lower costs.

Regarding cost, Medicaid in most instances is free of cost though a small copay may be required depending on the plan.  Medicaid can also recover against assets in a recipient’s estate after the death of the recipient.  This could mean a lien is placed and executed on a recipient’s home, depending on whether a surviving spouse or blind or disabled child is residing in the home.   Medicare is not free in that premiums and co-payments may be required for some parts of Medicare, and may be larger for those with a higher income, but eligibility is not income-based.

With Medicare, one has to work for about 10 years (40 qualifying quarters), at which point no premiums are required for Part A,  which covers hospitalizations.   Premiums may be necessary if you sign up for a Medicare Advantage plan, which is different from Original Medicare where you are permitted to purchase supplemental coverage for out-of-pocket costs.   Because Medicare is not administered by each state, a Medicare recipient will usually have the same coverage and pay the same copays and deductibles regardless of the state of residence.   Co-pays and deductibles are required for Medicare’s Part B (outpatient services) and Part D (medication) plans.   Also, a financial penalty can be assessed if one does not sign up for Medicare  Part B when you first become eligible, and there may be a delay in getting coverage.

Though basic differences are covered here, there is much more information to know regarding both plans, so research is encouraged before you hit the age of eligibility for Medicare to determine which Medicare plan may be right for you.  Medicaid plans and coverage differ from state to state, and sometimes county to county.  We would be happy to answer any questions you have about your potential eligibility for either program.

We hope you found this article helpful. Contact our office at (740) 947-7277 and schedule a free consultation to discuss your legal matters. We look forward to the opportunity to work with you.

The post Medicare vs. Medicaid: What’s the Difference? appeared first on Seif & McNamee.

How can AI Technologies in LTC be Addressed Responsibly?

AI technologies use a set of defined objectives to make predictions, recommendations, or decisions to perform tasks such as image, speech and pattern recognition, and natural language processing. They can use pre-programmed or self-learning algorithms to execute activities.

In LTC, AI is designed to improve remote monitoring systems, support decision-making software, automated communications, and virtual assistants interacting with older adults and their caregivers. Monitoring systems can be programmed to evaluate actions such as lying, sitting, standing, and walking to predict potential risks that suggest declining mental or physical health.

More Safety, Less Privacy

Automated alerts sent to the older person or their caregiver may ensure timely care to prevent further problems and delay or avoid the need for a nursing home facility. This should inspire a greater sense of safety and well-being. However, it also affects privacy, dignity, autonomy, and trust concerning care.

The adoption of AI in LTC has sparked an ethical debate. While the use of AI can lead to more effective and efficient decisions, it can also lead to harmful consequences when finding the proper solution for specific problems, defining the need for medical treatment, and stigmatizing old age, not to mention the danger of depersonalizing and dehumanizing care. Innovators, users, and stakeholders must look at the social and ethical consequences of AI technologies for older people, their environment, and society. Would we feel comfortable using AI technology for LTC for ourselves, parents, and grandparents? If a skilled nursing facility replaced a portion of its staff with AI-powered monitoring systems, would we feel secure about the quality of our loved one’s healthcare experience?

Frameworks, Principles, and Guidelines for Responsible AI Innovation

Studies highlight the importance of high-level principles, such as transparency, justice, fairness, and quality of care. Problems arise when there is too much room for interpretation to determine proper and ethical LTC uses. It’s unclear how AI design in LTC will continue to unfold. We still need more studies evaluating the potential risks and impact of AI technologies used by older adults and their caregivers. Technology is advancing rapidly, but we must take the time to weigh the advantages and disadvantages. Adopting it too quickly and relying on it too heavily initially could have severe consequences.

If you have any questions regarding what you have read, please contact our office to speak with an elder law attorney. We are happy to help you evaluate in-home, assisted living, and skilled nursing facilities in your area to ensure you or a loved one are getting the care you need and deserve.

We hope you found this article helpful. Contact our office at (740) 947-7277 and schedule a free consultation to discuss your legal matters. We look forward to the opportunity to work with you.

The post An Artificial Intelligence Approach to Long-Term Care appeared first on Seif & McNamee.

Estate Planning

The main goal of estate planning is to choose legal documents that will determine what will happen to you and your assets once you have passed away or become incapacitated. An estate planning attorney will help you make important decisions, such as:

• Who makes medical and financial decisions if you are unable
• Who is allowed access to your medical records
• How assets are distributed after you are gone
• Who cares for minor children if you become incapacitated or die
• Who manages money for your minor children if you are no longer able
• How to handle your funeral arrangements and burial

Durable Powers of Attorney

By using a general durable power of attorney document, you can name a person, or persons, to make financial decisions on your behalf if you are no longer able to do so. Expressing your end-of-life wishes requires designating a person to make healthcare decisions for you by completing a healthcare directive. By completing a Health Insurance Portability and Accountability Act (HIPAA) form, you will give your healthcare providers permission to share your medical records with the people listed on your HIPAA form.

Wills and Trusts

In your will, you can name the beneficiaries of your estate as well as a guardian to care for any minor children you may have at the time of your death. You can also name a conservator to manage the money you leave for their benefit. Some people create a trust, or trusts, to hold their assets during their lifetime and after death. They then sign a pour-over will that moves assets into their trust(s) upon death. You can leave instructions concerning your funeral or memorial service and what you want to happen to your remains in your will or a separate document.

Elder Law

Whereas estate planning focuses mostly on what happens after a person dies, the area of elder law focuses on a person’s last years or months. This can include planning for long-term care and applying for government assistance, such as Medicaid, Medicare, and veterans’ benefits, if applicable. Using elder law tools and strategies, an elder law attorney can help you find ways to preserve your assets while preparing to apply for benefits.

Like estate planning, it is best to start the elder law planning process well in advance. To qualify for benefits, such as Medicaid, you may have to sell or transfer ownership of some assets years before applying for benefits. Gifting or transferring assets out of your name must be done according to government requirements, so applying for benefits can be a complicated process. Hiring a skilled attorney can make the difference between receiving benefits quickly or not at all.

Since seniors are at a greater risk for discrimination, neglect, and abuse, elder law attorneys can help seniors and their family members recognize when a senior’s rights are being violated and take legal action to counter and remedy the situation.

Tying Estate Planning and Elder Law Together

It is best to start your estate planning process as soon as possible since the decisions involved could come at any time due to an accident or an illness. Planning for end-of-life care and the benefits associated with it may come later in life, but preparing well in advance lets you legally reduce assets for an extended period to qualify for benefits, like Medicaid.

Even younger families just starting their estate planning process may look at elder law planning at the same time for senior family members’ needs. Some estate planning tools, such as trusts, are often used when helping a parent plan for Medicaid and other government benefits for long-term care expenses. An attorney experienced in both estate planning and elder law can advise you in these areas and help you navigate complicated processes.

This article offers a summary of aspects of estate planning law. It is not legal advice and does not create an attorney-client relationship. For legal advice, you should contact an attorney.

We hope you found this article helpful. Contact our office at (740) 947-7277 and schedule a free consultation to discuss your legal matters. We look forward to the opportunity to work with you.

The post What Is the Difference Between Estate Planning and Elder Law? appeared first on Seif & McNamee.

Forty-nine of the fifty states have a look-back period of five years (or sixty months). The exception is California, with a thirty-month look-back period. This period of Medicaid ineligibility is a penalty period with no maximum. To determine the penalty period, Medicaid takes the dollar amount of assets transferred and divides it by the daily private patient rate of nursing home care or the average monthly private patient rate.

There are certain look-back exceptions and exemptions, particularly for families in difficult situations. These are very often confusing options and often difficult to implement without the expertise of a Medicaid planning attorney. Certain common mistakes and violations can occur.

Gifts – The federal government’s annual gift tax exclusion amount per recipient is $16,000 in 2022 via the estate and gift tax exemption. However, Medicaid does not consider this transaction exempt from its look-back period. Even birthday gifts or other special occasions like holidays or weddings may result in a Medicaid penalty. Gifting rules change state by state, making things even more complex.

Lack of Documentation – If you transact an asset and receive a value equal to the fair market value without proper documentation, you may violate the rules of the look-back period. This situation is particularly relevant for assets with a government record like boats, motorcycles, or vehicles because of their registration requirements.

Irrevocable Trusts – Many individuals incorrectly assume that an irrevocable trust (sometimes inaccurately called a Medicaid Qualifying Trust) is automatically exempt from the look-back period. Creating an irrevocable trust during the look-back period is considered a gift and a countable asset. Irrevocable trusts created before the look-back period are not countable assets.

Because Medicaid is a federal and state program, look-back rules vary by state. Even the penalty divisor amount varies by state because the average cost of nursing home care varies. Some states calculate using a monthly average penalty divisor, while others use a daily average penalty divisor. In New York, the rules governing asset transfer under fair market value do not include home care, sometimes called community care. Instead, they only apply regarding nursing home care. Pennsylvania will permit an individual to gift $500 per month without violating the Medicaid look-back period. Understanding the nuances and differences between states and Medicaid rules is crucial to successful planning.

Strategies to avoid violating Medicaid look-back rules and avoiding penalties can help families keep some of their assets while still qualifying for Medicaid. A Medicaid planning attorney can help you identify which strategy is best to implement in your circumstance. These strategies can be extremely complex and require professional help. It is easy to have a loved one disqualified, but very difficult to rectify the problem.

Caregiver Agreements – Also referred to as Life Care Agreements, Elder Care Contracts, or Long-term Care Personal Support Services Agreements, the formal agreements permit compensation to the caregiver, spending down assets for services without violating the look-back period. These contracts between a caregiving relative, friend, or older adult permit a senior to receive necessary care that Medicaid does not cover while also providing the caregiver with needed compensation. This contract requires the services of an attorney to ensure its careful drafting.

Medicaid Exempt Annuities – This annuity type is common to avoid violating the Medicaid look-back period. An annuity is a lump sum payment in cash by an individual in return for a monthly payment for the duration of that person’s life or a set number of years. These annuities are Medicaid compliant because they turn assets into income, lowering the assets of the Medicaid candidate below the Medicaid eligibility limit. Some annuities qualify, while others do not, be certain to choose the right product if the goal is Medicaid qualification.

Irrevocable Funeral Trusts – This trust type sets aside a specific amount of money (within state limits) for the sole purpose of funerary and burial costs. This trust helps applicants spend down excess assets without violating the Medicaid look-back period.

Undue Hardship Waiver – Filing an undue hardship waiver request occurs when individuals violate the Medicaid look-back period, but it renders them without basic needs like shelter and food. It is difficult to receive this waiver as there must be an effort to exhaust all avenues of asset recovery, including legal options.

Recuperation of Assets – If previously transferred assets during the look-back period can be recovered, the previous penalty established can be reconsidered. Some states will review all assets transferred to all people. Partial recovery of said assets may shorten the penalty period in some states but not in others. Though the returned assets will put an applicant over the Medicaid asset limit, these assets can then pay for long-term care as the applicant reapplies.

The surest way to avoid violating a look-back period infraction and qualify for Medicaid is to consult a qualified Medicaid planning attorney before you gift or transfer any assets. If a violation has already occurred, a qualified attorney can also offer assistance to rectify what has gone wrong. The best option to avoid the Medicaid penalty period is to plan proactively.

We hope you found this article helpful. Contact our office at (740) 947-7277 and schedule a free consultation to discuss your legal matters. We look forward to the opportunity to work with you.

The post The Medicaid Penalty Period: How to Avoid It appeared first on Seif & McNamee.