Medicare does not pay for long-term care, except for 100 days of rehabilitation in a nursing home. Nursing home care falls primarily to Medicaid, the jointly funded state and federal program. The program now is shouldering 40% of the country's long-term-care spending, according to the Kaiser Family Foundation. To be eligible for Medicaid in Maryland, can have no more than $2,500 in cash and investments. (Spouses are allowed to keep a home, a car and up to approximately $110,000.) In the past, regulators looked at any gifts you made up to three years before applying for Medicaid. However, in 2006,…
A U.S. bankruptcy court finds that a woman who was contractually bound through a nursing home admissions agreement to apply for Medicaid benefits on her husband's behalf and failed to do so cannot discharge the debt owed to the nursing home through bankruptcy. In re Plybon (U.S. Bankr. E.D. Ky., No. 11–10146, March 9, 2012). When Glenna Plybon admitted her husband to a nursing home, she signed an admissions agreement as the responsible party. The agreement stated that Mrs. Plybon was required to pay a co-insurance amount and apply for Medicaid benefits on Mr. Plybon's behalf. Mrs. Plybon applied for…
Community Spouse, Community Spouse Resource Allowance (Minimum and Maximum), Monthly Maintenance Needs Allowance (Minimum and Maximum), Penalty Divisor, Resource Limit, Exempt and non-Exempt Resources — should you care what these terms are? Well, if you're part of a married couple and you're concerned about the possible need for nursing home care for you and/or your spouse, you should. The option for paying for the nursing home are discussed in our previous article “Who will pay for the nursing Home?” Let's start first with the average monthly cost of nursing home care is approximately $10,000 per month, i.e. $120,000 per year….
Unfortunately, most people do not plan for the nursing home, until the crisis occurs. As an elder care attorney I see this situation time and again. Therefore, it is important to educate my clients on the options they have available. The nursing home is a strong possibility for most Americans. People are now living longer than they ever have before. Consequently, for most they cannot care for themselves. Therefore, you will need some form of long-term care, usually, the nursing home. We, if the need occurs, help you plan for how to make this possibility happen. Medicare does not pay…
Medicaid eligibility rules are extremely complex and confusing, and impossible to understand without legal assistance. The United States Supreme Court has called the Medicaid laws “an aggravated assault on the English language, resistant to attempts to understand it.” Schweiker v. Gray Panthers, 453 U.S. 34, 43 (1981). Additionally, the United States Court of Appeals for our own Fourth Circuit (just below the U.S. Supreme Court), in a case arising out of Virginia, has called the Medicaid Act one of the “most completely impenetrable texts within human experience” and “dense reading of the most tortuous kind.” Rehab. Association of Virginia v. Kozlowski,…
Pursuant to the applicable provisions of the Federal Deficit Reduction Act of 2005 (DRA 2005), the look back period for Medicaid is five years (60 months). That federal statute requires that any uncompensated transfer that occurred during the relevant look back period will cause a penalty period with regard to the receipt of Medicaid benefits. The penalty period is the amount of the uncompensated transfer ( say gifts of $68,000)divided by the state's reimbursement rate (Maryland is $6,800). The result is ten (10) months that will constitute the penalty period. The penalty period begins in the month in which the…
If you need nursing home care, how will you pay for it? The average cost of nursing home costs can easily exceed $100,000 per year. This makes it a challenge to pay for care, let alone leave an inheritance for future generations. The Medicaid program can provide nursing home coverage – but only if you qualify i.e your assets are below $2,500. Therefore, most people do not have automatic Medicaid eligibility, until all their assets are spent down. Consequently, people need Medicaid Planning. Medicaid Planning involves repositioning assets in accordance with strict rules, so that you meet Medicaid eligibility requirements….
One of the many issues that you may be faced with is the need for placement, for your loved one or aging parent, in a skilled nursing facility and the problem of financing that care. We will assist you with obtaining Medical Assistance (Medicaid) coverage for such placement. We work with you and your loved one or aging parent to structure the elder’s assets so that the elder is eligible for such coverage. We also advise you and your family about family coaching and care management to ensure that the elder obtains the best quality of care which he or…
“Up to 100 days” of coverage for rehabilitation does not guarantee 100 days. Up to 100 days of coverage rarely means 100 days. Often insurers discontinue therapy benefits after 2 to 8 weeks. They might say the patient has “plateaued” in treatment, not showing measurable improvement on a weekly basis. However the correct legal standard is aslong as the patient shows improvement or the therapy prevents deterioration. Many times therapy ends before it should. When Medicare therapy ends, if the resident stays in rehab or in a nursing home, then she must pay privately or, if assets are low enough,…
Adult daycare centers and in-home senior care are both excellent choices that permit elderly and disabled adults to live at home rather than move into a nursing home or assisted living facility. In order to make the best choice for your family, it’s helpful to learn what each offers before deciding which best suits your situation. Either choice allows family caregivers to: • Keep a full or part-time job; • Have help with the physical needs involved with care; • Obtain respite from what can be a 24-hour responsibility; • Reclaim your relationship as spouse, son or daughter rather than…
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