As some of you may know, the guidelines surrounding eligibility for Medicare or Medicaid can be fairly rigid. They exist to ensure people aren’t gaming the program, but sometimes even who aren’t gaming the program (and have legitimate need) can unintentionally run afoul of the rules. For another example of what not to do, the case of Jackson v. Director of Office of Medicaid (Mass. App. Ct., No. 10P706, July 19, 2011). When Raymond Duclos was entering a nursing home, his wife was making transfers to their children: $176,000 to their daughter, Susan; $11,787.83 to their son, Raymond, Jr.; and…
Being responsible for an elderly loved one can mean adopting a rather rigid schedule and lifestyle, especially if you are the primary caregiver. How, then, do you travel? It can be a logistical nightmare, whether the travel is elective or necessary. Regardless, understanding some of the challenges and workarounds in advance can make the travel more manageable. The New Old Age blog at The New York Times recently offered some food for thought on this important subject. The big question is whether your elderly parent is traveling with you. If the travel involves you alone for business or pleasure, then…
Here’s another important reminder on how much of a stickler Medicare and Medicaid can be when it comes to denying benefits: the Matter of Komanoff Ctr. for Geriatric & Rehabilitative Medicine v Daines (N.Y. Sup. Ct., App. Div., 2nd Dept., No. 2010-05776, June 28, 2011) (here summarized on ElderLawAnswers.com.) It’s the case of Bernadette Jordan and how she entered a nursing home and filed for Medicaid only to find that the State ruled her ineligible for a period of 14.31 months. Apparently, Mrs. Jordan had transferred funds from a revocable trust to her daughter, to repay expenses that her daughter…
Hospice care can provide a great benefit to many families and their dying loved ones, and Medicare has been generally praised for its support through reimbursements to providers over the past 28 years. However, according to a recent article by Kaiser Health News and The New York Times, there is growing concern now about misuse of the program by for-profit hospice providers. Hospice care is intended to provide dying patients with palliative care in their own homes, or in a hospice facility or nursing home. But, as hospice has moved into the mainstream, concerns about excessive costs and misuse have…
Medicare does not pay for all the nursing home costs. Medicare Part A covers up to 100 days of "skilled nursing" care per spell of illness. However, the definition of "skilled nursing" care and the other conditions for obtaining Medicare coverage are rigorous. Consequently, few nursing home residents receive the full 100 days of coverage. Therefore, Medicare pays only about 9 percent of nursing home care in the United States. Medicaid will pay for nursing home costs. However, their are stringent qualifications. Check out the 2011 Medicare and You Handbook on the Medicare website ensure you receive the nursing care…
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…
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