Estate Recovery: Sections 1902(a)(18) and 1917(b)(1) of the Act require States to pursue estate recovery when a Medicaid beneficiary received medical assistance under the State plan: 1) in cases where a lien has been imposed under the State’s lien authority, and 2) for recipients age 55 and over, who received nursing facility services, home and community-based services, or related hospital and prescription drug services. States may optionally seek recovery to pay for costs of other approved State plan services provided to those 55 and over, except Medicare cost sharing paid on behalf of Medicare Savings Program beneficiaries on or after…
Transfers of Assets: States are required to have provisions regarding transfers of assets for less than fair market value under sections 1902(a)(18) and 1917(c) of the Act. A State Medicaid plan must provide that, if an institutionalized individual or the spouse of an individual transfers assets for less than fair market value after the “look-back” date defined in the statute, the State will calculate and impose a period of ineligibility. Medicaid payment is not available for the long-term care services the individual receives during the period of ineligibility, although the individual remains eligible for Medicaid coverage of non-long term care…
Liens Section 1917(a) of the Social Security Act (the Act) allows, but does not require, States to impose liens on the property of a Medicaid beneficiary under certain circumstances. More specifically, liens are permitted in two instances prior to a beneficiary’s death: 1) when there has been a court judgment that benefits were incorrectly paid; or 2) when the lien is imposed against the real property of an individual a. who is an inpatient in a nursing facility, intermediate care facility for the mentally retarded, or other medical institution, if the individual is required to spend for medical care all…
A national Medicaid study projects Maryland's Medicaid program underfunds the actual cost of providing skilled nursing care by $64.8 million annually. Maryland's long-term care leaders today expressed deep concern for the impact potential further cuts to Medicaid would have on the state's poor and elderly. "The gap between the actual cost of providing skilled nursing and rehabilitation care and what Medicaid pays continues to widen," warned Joseph DeMattos, president of the Health Facilities Association of Maryland (HFAM). "Our lawmakers in Annapolis must carefully consider the substantial shortfall in funding that long-term care providers are already operating in when making…
Growing numbers of families are compensating relatives who serve as caregivers. According to a report by the National Alliance for Caregiving and AARP, 43.5 million Americans looked after a friend or relative age 50 or older in 2009, 28% more than in 2004. In a survey conducted for Home Instead Senior Care, a home-care franchiser, nearly 7% of respondents said they receive compensation for providing care to a relative. Feeding this trend is the high unemployment rate, the costs of nursing-home care, and the 2006 changes in Medicaid law that affects asset protection strategies. Some 37% of caregivers surveyed by…
If you have an elderly loved one living in a nursing home, especially if they suffer from dementia, you may want to double-check their prescription medications. A recent government audit on Medicare spending shows some rather alarming practices in regard to the use of powerful atypical antipsychotic drugs. As The New York Times reports, nearly 1 in 7 nursing home patients, nearly all of them with dementia, are given powerful antipsychotic drugs even though the drugs are not approved for such use and are known to increase the risk of death, especially in patients with dementia. Ostensibly, the purpose of…
If you (like most of us) were counting on Medicare to provide for your health care needs in retirement, it seems you may be standing on shaky ground. Medicare’s sustainability has been questioned for some time, and as the country turns toward the business of debt reduction Medicare cuts seem inevitable. The future of Medicare and Medicaid, as well as the source, quality, and type of care that seniors receive is in the hands of politicians now, so you may want to keep a weather eye on Capitol Hill. I’ve previously directed your attention to the House Republican plan for…
Your mother has tithed (gifted) to her religious organization in the amount of $50 per week for years. Additionally, she has given her 10 grandchildren $20 every Christmas and on each of their birthdays. Thus, she has made charitable and small family gifts totaling $15,000 throughout the course of the last five years. Your mother has savings of less than $2,000 and now requires nursing home care. Therefore, your mother will qualify for Medicaid benefits to help pay for her care. However, she will not qualify for benefits because all gifts, even small ones, even charitable gifts, made within the…
In 2009, your father was 80 years old and in reasonably good health. He gave $20,400 to his grandson to pay for college in 2009. However, last month he has a stroke. As a result of the stroke, he is totally incapacitated and in need of nursing home care. However, he is not yet in a nursing home, but his total assets are $2,000. During this month, you inquire about his placement at a nursing home. The nursing home questions you about your father’s finances and any past transfers, and you report the $20,400 gift made for his grandson’s education….
A five-year look-back period retroactively for all gifts or other transfers made for less than fair market value (FMV). Grandfather made gifts of $200 to each of his five grandchildren on each of their birthdays and on one of their religious holidays in 2006, 2007, 2008, 2009 and 2010. He is unaware of the Medicaid laws. Grandfather requires nursing home care. Under the Medicaid rules, Grandfather is penalized for all gifts made within a five year period. Therefore, Grandfather is penalized for approximately one and a half months, during which time Medicaid will not pay for his care in the…
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