Archive for the ‘Elder Law’ Category

New York Medicaid and Medicare Part D: Working Together

Wednesday, May 8th, 2013

The state of New York has several major public health insurance programs, including Medicaid, commonly known as “Regular Medicaid.”

While Regular Medicaid in New York offers extensive health care services including: dental care; diagnostic testing; home care; hospitalization; mental health support; out-patient care at hospitals and community clinics; and physical therapy, clients of Medicaid in New York must receive their prescription drugs via Medicare Part D.

Any individual currently receiving or about to begin receiving New York State Medicaid must join a Medicare prescription drug plan, or they will lose their Medicaid benefits. When an individual becomes eligible for both Medicare and Medicaid, he or she will automatically be assigned to a Medicare Prescription Drug Plan in order to not miss even one day of coverage. Though a prescription drug plan is mandatory, enrollment in Medicare Part D is not; enrollment in another plan which better meets prescription drug needs is allowed. Patients are able to switch to another plan at any time.

Typically, as part of Medicare Plan D, the patient must pay a nominal amount, like a copayment, for the medication. Individuals who have full coverage from Medicaid while living in a residential home, an adult living or assisted living facility will likely be required to pay a small medication copayment for each  medication. If an individual has full Medicaid coverage and resides in a nursing home, he or she will not be required to pay anything for covered prescription drugs.

Medicare’s State Pharmacy Assistance Program (SPAP) for prescription drug coverage is determined by each state.  New York State’s Medicare’s State Pharmacy Assistance Program may determine that a patient should receive additional coverage when they join the Medicare Prescription Drug Plan, or may require the patient to enroll in a separate state program for prescription payment assistance.

Clients of New York Regular Medicaid must receive health care services through their managed care plan. Regular Medicaid in New York is available to single adults, childless couples at lower income levels, caretaker adults, the elderly, the disabled, and children, subject to some restrictions. Regular Medicaid may also provide retroactive coverage.

 

For more information, visit www.elderlawnewyork.com.

An Extreme Case of Poor Estate Planning

Thursday, May 2nd, 2013

Last year, Roman Blum died at the age of 97, leaving an estate valued at nearly $40 million. He also died without a will. Blum made millions building hundreds of houses in the vicinity of Staten Island. He had no known living family members, and if none are found, then his estate will escheat to the state of New York, making it the largest unclaimed estate in the state’s history.

This is an extreme example of poor estate planning, in which a man very successful in business nonetheless neglects the relatively straightforward task of directing where his money should go upon his death. It is unfortunate that this person missed the opportunity to leave bequests to his friends or charitable organizations that he cared about.

Blum’s estate is being handled by a public administrator overseen by the Richmond County Surrogate’s Court.  The administrator is in the process of selling Blum’s property, paying his taxes and conducting an extensive search for any living relative. If that search fails, the money goes to the state government.

Although this case is unusual, many people do not properly prioritize estate planning and fail to take full advantage of the choices they have in deciding how they would like their assets distributed when they die.  In addition, proper estate planning can save your heirs money by structuring your estate in a way that is most advantageous in terms of taxes and probate costs.

 

For more information about our estate planning services, visit www.littmankrooks.com.

Put Your Accounts in Your Daughter’s Name — What Could Go Wrong?

Wednesday, April 24th, 2013

 

By: Bernard A. Krooks, Certified Elder Law Attorney®

Seniors are subjected to a constant drumbeat of advice: make sure you have no assets in your own name, or you will lose them to the nursing home. Transfer everything to your children to “protect” your assets. Sound familiar?  Is it good advice?

We usually counsel against such transfers.  They are a bad idea for several reasons, but chiefly for these two reasons:

  • 1.    Such transfers are not likely to work, given the five-year look-back period for Medicaid eligibility. In other words, if you make such a transfer shortly before you go to the nursing home, you won’t be eligible for government assistance with your long-term care costs for up to five years — or even longer, in some cases.
  • 2.    Even if you successfully “protect” your assets from your own nursing home costs, you have just subjected them to the recipient’s creditors and claims.

That second item was the one that cost Deborah Block (not her real name) her entire life savings. In 2002 Ms. Block transferred her brokerage account, worth about $200,000, into her daughter’s name. Why would she do such thing? She later testified that it was because she understood that she could not have any assets in her own name if she later wanted to qualify for Medicaid assistance with her long-term care costs. She wanted to protect her money from that possibility, and also from any “scammers” who might try to talk her out of her funds.

Ms. Block, 71, lives and still works as a nursing assistant in a small town. She and her husband owned a pharmacy there, and sold their business to a large chain store ten years ago, just before her husband’s death. The proceeds went into an account in their joint names, and were transferred to Ms. Block’s name upon her husband’s death.

Later in that same year, while visiting her daughter in New York, Ms. Block decided to put her entire life savings into a brokerage account in her daughter’s name. The daughter’s Social Security number was listed on the account, the daughter paid taxes on the income, and she was listed as the sole owner. Ms. Block did have a debit card on the account, which she could (and did) use to pay for purchases.

In 2010, after the stock market dropped precipitously, Ms. Block’s daughter moved the money into a new investment vehicle. She paid over $18,000 for a complicated trust arrangement in order to protect the money from creditors. Although she initially contacted the purveyors of the trust instrument, she received documents for her mother’s signature from them.  The documents included a trust naming a third person as trustee, and a private annuity agreement.

Meanwhile, Ms. Block’s daughter was having trouble with her own investments. She owned a piece of investment real estate with a second mortgage. When that loan’s balloon payment came due, the property had diminished in value to the point that she could not refinance — so she declared personal bankruptcy. The question then became whether her mother’s brokerage account was part of her bankruptcy estate.

The bankruptcy court ruled that yes, the account did belong to Ms. Block’s daughter. Although both women testified that they thought of the money as belonging to Ms. Block, and that the daughter was just holding it in a sort of trust arrangement for her mother, the bankruptcy court noted that Ms. Block had said she transferred the money in order to make sure he had no assets and could qualify for Medicaid if she ever needed it. Here is the bankruptcy judge’s telling analysis:

“After all, [Ms. Block and her daughter] argue, why would a woman who was advancing in years, nearing retirement and working for an hourly wage, give the entirety of her retirement nest egg to her daughter? The answer lies in Ms. [Block]’s own testimony — she wanted to remove the funds from her own name and place them into the name of her daughter, in order to be eligible for Medicaid and other publicly available benefits, should the need arise. Ms. [Block] can’t have it both ways — she can’t part with title for purposes of Medicaid eligibility, and at the same time claim that she retained an equitable title to the asset. To allow this kind of secret reservation of equitable title would be to sanction Medicaid fraud.”

The bankruptcy judge, incidentally, also completely dismissed the effect of the trust arrangement established by Ms. Block’s daughter. The end result? Ms. Block’s life savings were swept into the bankruptcy proceeding to satisfy her daughter’s investment losses.

The moral of this story is that if you are serious about wanting to protect your assets from the catastrophic cost of long-term care, it is imperative that you consult with a certified elder law attorney who can guide you on the best course of action for you.


For more information, visit www.elderlawnewyork.com.

Senior Apartments: An Option For Active Independent Elders

Tuesday, April 23rd, 2013

Our latest guest post has been written by Joe Nevins, the Administrative Coordinator at Kittay House

When considering living options for elders, there are choices beyond nursing homes and assisted living facilities. Senior Apartments allow elders to live independently and to have an active vibrant community around them.  In a Senior Housing setting there will be elders who are still working or volunteering, as well as those who need extra help managing and make individual arrangements for support services.

Senior housing is all about community. At Kittay House Senior Housing, for example, tenants can be involved in activities as diverse as the city itself – from trips to Shakespeare in the Park, the Culinary Institute, New York’s Lower East Side or the Apple Store to visits from local artists and entertainers, on-site movies, lectures and workshops, and even live broadcast from the 92 Y.  Meals can be shared (Kittay House offers three daily meals included in the monthly fee).
Physical well-being is another important aspect of senior apartments. Tenant units should be equipped with emergency call bells, and senior-friendly physical activity should be available.  At Kittay House, tenants may participate in a walking club, in movement classes, Yoga, Tai Chi or a special falls prevention series, all designed to help seniors stay fit and active.
Of course convenience is important, too.  Tenants in senior apartments appreciate the housekeeping and linen services – at Kittay they’re included in the fee – as well as proximity to transportation, shopping and medical services.  Kittay, conveniently located near public transportation, has on-site medical professionals and is across the street from the VA Hospital.

For seniors who are still active – working, volunteering, involved in cultural pursuits senior apartments offer community and convenience.  If you’d like to consider senior housing, contact Director Arlene Richman at (718) 410-1441 or read more at http://www.kittayhouse.org.

For more information, visit www.elderlawnewyork.com.

Paying for Long-Term Care at Home

Monday, April 15th, 2013

By Susan Yubas

Receiving long- term care is expensive.  If you or your loved one wants to stay at home but requires assistance to function, how will you pay for it?

Medicare determines whether or not care provided at home will be covered based on whether or not the type of care required is considered medically necessary, or is considered to be more supportive in nature.  Medicare calls this type of supportive care “custodial” care.

Custodial care includes support and assistance with activities of daily living (also called ADLs), which include a range of activities from shopping, light housekeeping, and laundry to meal preparation, dressing, bathing, toileting, and help transferring to or from a chair or bed.  These services do not require the skills of a nurse, and are usually provided by companions and home health aides.  Medicare can cover medical social services, some medical supplies and durable medical equipment like a wheelchair or walker. Each of these requires a referral or prescription from your doctor.

When you need custodial care to help with bathing, dressing, and assistance with household chores, you will have a choice between hiring help through a Medicare certified agency or hiring an independent caregiver on your own. There are pros and cons of each, and you will want to consider the different options in your community.

Long-term care insurance is an option that can help provide a way for you to pay for this care. There may also be community services available that will supplement in-home care and help you make the most of your financial resources.

Skilled care is usually provided by licensed professionals such as nurses and physical and occupational therapists and may also include social workers, some laboratory services and medical equipment. These services, provided under the supervision of a doctor, are considered to be “medically necessary.” Sometimes, this type of care is needed at home when a patient is discharged from a hospital and is part of a treatment plan of care ordered by your doctor.  Examples of skilled care include wound care, tube feeding, respiratory therapy and the administration of IV medication.

Get more information on Medicare coverage for home health services here.

Medicaid provides coverage for some long-term care services at home and in the community. Eligibility for Community Based Medicaid is determined by income, resources, age, and disability levels.  Medicaid can pay for a number of medical services that can help you continue to live in your home, including home care, personal care aides, adult day care, physical, occupational and speech therapy, and medical equipment such as wheelchairs  The need for these services must be certified by a physician and you must receive these services from a Medicaid certified provider.

Get more information about Medicaid eligibility for long-term care here.

Again, it is important to think about long-term care, regardless of whether it is provided at home or in a residential facility, before care is needed.  Deciding how and where you receive care is a major decision and it is important to examine all of your options and choices.

Susan Yubas is Director of Business Development at The Bristal Assisted Living.  She is also a Certified Senior Advisor and the founder of FYI Senior Living Solutions, Inc.
For more information, visit www.elderlawnewyork.com.

Sequester Cuts Will Harm Seniors, Veterans

Monday, April 1st, 2013

As Congress failed to take action, the cuts required by the Budget Control Act, commonly referred to as the sequester, began taking effect on March 1.  Spending cuts of $85 billion are being imposed across federal programs, both military and domestic.  While many of the core programs that seniors and veterans rely on are exempt from the cuts, other programs will be affected, some of which protect the most vulnerable.

First, the good news: funding for the Department of Veterans Affairs (VA), Social Security, Medicaid and Medicare is exempt from the cuts.  However, while those benefits will not change, the federal workforce that administers them will be reduced, causing delays and limits to access.

In the case of Medicare, for instance, there will be no change in benefits, but doctors and other Medicare providers will see a two percent reduction in their payments.  This could lead some doctors to drop Medicare patients, resulting in longer waits for doctors who do accept Medicare.

While Social Security benefits will not change, services provided by the Social Security Administration may be cut back, including closing some offices.  The large backlog of disability claims will likely grow even larger.

While these core programs are spared the full force of the cuts, other needed programs will be drastically affected.  Meals on Wheels and other senior nutrition programs will see cuts resulting in 18.6 million fewer meals being served to needy people, according to the National Association of Area Agencies on Aging.  The Low Income Home Energy Assistance Program will discontinue help to approximately 400,000 households, often low-income seniors that rely on the assistance to heat and cool their homes.

The Area Agencies on Aging reports that other important services to seniors will also be cut, including in-home help with bathing and dressing and transportation to medical appointments or to buy groceries.  Seniors are put at risk by these cuts, and any savings to the federal government are offset by the cost to society of the inevitable increase in health care needs when seniors are not able to get help with daily living.

While there will be no change in VA benefits, some veterans will still be affected by the cuts.  Some homeless veterans will no longer be able to receive assistance from a housing program run by the Department of Housing and Urban Development that provides grants to the states to help people find housing.

In addition, because of the sequester, some job-training programs for veterans will no longer receive funding from the Labor Department, affecting tens of thousands of vets.

Active duty personnel will also be affected by the suspension of the Tuition Assistance Program, which helps service members with the cost of courses toward high school and college diplomas.  The program provided hundreds of thousands of active duty military personnel with up to $4,500 per year for tuition at accredited schools.

These arbitrary spending cuts are more onerous because they were never supposed to happen and are the result not of careful lawmaking but of Washington gridlock.

For more information, visit www.elderlawnewyork.com.

Choosing the Best Residential Options for Seniors

Monday, March 25th, 2013

By Susan Yubas

While there are lots of reasons that an older person may decide to move from their home, a main reason for considering a move is the social isolation that can be common among seniors. Often, older adults find that their social network has diminished and it can be very difficult to initiate new friendships especially if they are no longer driving and do not have access to good public transportation.

Being house bound without social contacts can cause loneliness, anxiety, and depression. While more and more seniors are using personal computers and Skype, social isolation remains a problem.  Moving to a residential community can help.

Many families do not have a clear understanding of the types of residential options available and often confuse senior living residences and assisted living with nursing homes. Others think they must require a lot of assistance in order to move to a senior community.

Senior Residential Living may or may not provide hospitality or support services. Under this living arrangement, senior adults, generally those aged 55 and over, lead an independent lifestyle that requires little or no assistance.  These communities are usually rental apartments or townhouses where residents have complete choice as to whether or not to participate in any services or programs that may be offered.

Independent living refers to housing designed exclusively for seniors who require little or no assistance with the activities of daily living.  Geared to older adults who enjoy some degree of socializing and community activities, these communities usually offer services for residents such as housekeeping, laundry and meals and opportunities for social events.  If residents require home health care services they are usually arranged for by the individual resident, provided by an outside agency and paid for privately.  These residents pay a rental rate or monthly fee.

Continuing Care Retirement Communities (CCRCs) may be an option if you or your spouse are relatively healthy now, but anticipate significant health problems in the future.  These communities offer a continuum of care from independent living to assisted living to skilled nursing home care on the same grounds. Many have their own home care agencies to provide services to community residents.  CCRC’s normally require a one-time entrance fee and monthly service fees thereafter.

Assisted living communities are designed to provide individuals with assistance with basic activities of daily living such as bathing, grooming, dressing, and transferring.  They may offer medication assistance and/or reminders.   Assisted living communities do not provide 24 hour skilled nursing care.  Usually, assisted living communities offer their residents prepared meals three times a day and help with light housekeeping and laundry.  As with Independent Living, communities will also plan events, activities and trips that residents can participate in.  Some communities recognize that being able to keep a pet is very important to the resident, and will allow the senior to bring a pet as long as he or she is able to take care of it.

In New York State, Assisted Living communities that provide services for individuals with Alzheimer’s disease or dementia are called Special Needs Assisted Living Residences or SNALRs.  SNALRs staff members are specifically trained to work with individuals who have some form of dementia. It is important to find out what level of care is provided, as some assisted living communities will accept individuals with Alzheimer’s or related dementia through the entire disease progression and others will only accept individuals who are in the early stage of the disease.

Assisted living is usually paid for privately, but some long-term care insurance policies cover licensed assisted living.   New York State offers Medicaid funds to help with assisted living costs through the Assisted Living (ALP) program, but there are a limited number of ALP communities.  Most assisted living residences charge on a month-to-month lease arrangement based on the level of assistance required, but some require long-term arrangements.

Nursing homes are for those individuals who require care around the clock and at a much higher level than those who reside in an assisted living community. Skilled nursing facilities provide care of both chronic conditions and short term rehabilitative or sub-acute care as ordered by a physician.   Sometimes people are admitted for short time following hospitalization.  Parts of a nursing home stay are usually paid for by Medicare following a hospital stay, and then either by a family’s own funds or long term care insurance. If an individual is eligible for Medicaid, that program will pay for skilled nursing care.

Choosing the right residential setting for your loved one is an important decision and should consider lifestyle preferences, health care needs and financial implications.

Susan Yubas is Director of Business Development at The Bristal Assisted Living.  She is also a Certified Senior Advisor and the founder of FYI Senior Living Solutions, Inc.

For more information, visit www.elderlawnewyork.com.

Grappling with Alzheimer’s

Thursday, March 14th, 2013

By Lauren Foster, Enterprising Investor (February 2013)

Not long ago, I stumbled upon a touching essay in the New York Times. “My gray matter might be waning. Then again, it might not be,” it began. “But I swear that I can feel memories — as I’m making them — slide off a neuron and into a tangle of plaque. I steel myself for those moments to come when I won’t remember what just went into my head.”

Later, the author pointedly asks: “Am I losing track of me?” Her fear is palpable.

You see, Nancy Bercaw‘s father died of Alzheimer’s disease in 2012, at age 73 — the same age at which his father succumbed to the same disease. Now the worry is that she, too, may be on the “path of forgetting.”

The article lingered with me long after I finished it, perhaps because I had recently sat through a sobering session on elder law, part of the Heckerling Institute on Estate Planning. I also know family members who have suffered from dementia and understand the heavy toll that it exacts on finances and relationships.

Either way, understanding dementia and its financial implications, as well as a host of other eldercare issues, extends well beyond attorneys: It is something every financial adviser with elderly clients, or clients approaching retirement, should know more about.

As Robert DiQuollo, chief executive of Brinton Eaton Wealth Advisors, noted in a recent article on dealing with clients with dementia: “Advising elderly clients with deteriorating cognitive abilities is becoming an increasingly important issue for financial advisers. . . . [They] should become informed on issues surrounding cognitive disabilities — research the related laws, read up on the related medical literature and contact local elder-care lawyers.”

Another article, “Alzheimer’s Epidemic Puts Advisers — and Their Practices — at Risk,” pointed out that the number of Americans with Alzheimer’s disease is expected to nearly triple by 2050, adding: “This impending epidemic will put even more pressure on advisers as they try to help clients prepare for the possibility of a costly health crisis.”

In their session on elder law, Lawrence Frolik of the University of Pittsburgh School of Law and Bernard Krooks of Littman Krooks LLP, noted that as people live longer, the numbers of elderly with dementia or other memory/cognition impairments rise, along with the need for assistance (i.e., long-term care).

But the cost of long-term care can be crippling for many: In 2012, the national average daily rate for a private room in a nursing home was $248 — that’s $90,250 a year. Krooks mentioned that where he lives, there are long-term care facilities that cost $15,000–$20,000 a month. (For more on the costs, see: “The Rising Cost Of Long-Term Care Services” and “Retirement: How to Pay for Long-Term Care.”)

Alzheimer’s and other dementias are among the many scourges of aging. And as I have since learned, a staggering one in eight older Americans has Alzheimer’s, the most common type of dementia (it accounts for about 60–80% of cases). The greatest risk for Alzheimer’s — you guessed it — is advancing age.

Which is a scary fact if you look at the trajectory of the US population: In 2010, there were 40 million people age 65 and older living in the United States. That figure is projected to reach 72 million by 2030 — or nearly 20% of the total US population.

“Longer lives, more dementia and increased costs of care combine to create great fear in the elderly and their adult children that accumulated wealth may be spent depleting the estate or that the older person will not be able to afford to live in a dignified and comfortable manner,” Frolik and Krooks wrote in their Heckerling materials.

One important issue that financial advisers (and their counterparts when it comes to aging clients: elder care lawyers) need to raise is the question of who pays for what when it comes to long-term care, as it seems many people don’t know all the facts.

An AARP report, “The Costs of Long-Term Care: Public Perceptions Versus Reality in 2006? (PDF), put it bluntly: “When asked whether or not Medicare, Medigap/Medicare supplemental insurance, or Medicaid/Medi-Cal covers various types of long-term care, Americans 45-plus demonstrate a low knowledge level. They often think that funding sources are available when they are not. In general, Americans 45-plus do not know what long-term care services cost and do not know about coverage.”

A common misconception is that Medicare pays for long-term care. “Truth be told, Medicare is not going to cover a lot of nursing home stays,” Krooks warned conference delegates.

Medicare’s website points out that “generally” Medicare does not pay for long-term care. It states: “Medicare pays only for medically necessary skilled nursing facility or home health care. However, you must meet certain conditions for Medicare to pay for these types of care. Most long-term care is to assist people with support services such as activities of daily living like dressing, bathing, and using the bathroom. Medicare doesn’t pay for this type of care called “custodial care.” Custodial care (non-skilled care) is care that helps you with activities of daily living. It may also include care that most people do for themselves, for example, diabetes monitoring. Some Medicare Advantage Plans (formerly Medicare + Choice) may offer limited skilled nursing facility and home care (skilled care) coverage if the care is medically necessary. You may have to pay some of the costs.”

I turned to Krooks’s lecture for more explanation: “Medicare only pays if it’s skilled nursing care: You’re on a ventilator, you have a stroke and need rehab, break your hip and need a replacement. With regard to nursing home coverage, the care has to be skilled care but some additional requirements have to be met: You have to have a three-day hospital stay. So if you don’t go into hospital for three days before nursing home, Medicare is not going to pay for any care in the nursing home, even if it is skilled care.”

He added that Medicare will pay for skilled nursing care for up to 100 days — 20 days in full, and then for days 21–100 there’s a co-payment that goes up every year (in 2013 it is $148 a day and most Medigap policies will cover it).

The average length of stay in a nursing home in the United States is about 2.5 to 3 years, Krooks said, but that number is skewed because many of the nursing homes have gotten into “the sub-acute business of short-term rehab,” so there are lots of people going to nursing homes who stay for 30 or 60 days, break their hip, have a knee replacement, and go home, and that counteracts the people who have Alzheimer’s or Parkinson’s disease or Lou Gehrig’s (ALS). “Any one these chronic diseases where you could be in a nursing home for 6–8–10–12–15 years, so while the average is 2.5 to 3 years, if you have one of these chronic diseases, it can be a long-term problem and a very expensive problem. You don’t need a calculator to do the math of what $150,000 or $200,000 a year times 10 years would cost for someone to be in a nursing home, and under federal law, you are legally responsible to pay for the health care costs of your spouse.”

So how does a client pay for long-term care? Krooks said he has thought of five ways:

  1. Out-of-pocket
  2. Medicare (not more than 100 days, and not viewed as a payer of long-term care)
  3. Veteran Affairs (VA) benefits
  4. Long-term care insurance
  5. Medicaid

Medicaid is where this all gets interesting.

“It was never intended to be for middle class people, it was supposed to be for poor people,” said Krooks. But Medicaid “has turned out to be a safety net for the middle class: The rich can self-insure, the poor go on Medicaid because they are poor, and the middle class are faced with a Hobson’s choice, where they can spend their life savings of $200,000 or $300,000, or whatever it is, and then go on Medicaid. Or they can go to lawyers like me and figure out how to restructure their assets so that on paper they meet the rigid income and asset eligibility requirements of the state Medicaid agency, yet are still able to keep some of those funds to pass on to their spouse and loved ones.”

To qualify for Medicaid in most states, you are not allowed to have nonexempt assets exceeding $2,000. Yes, you read that correctly, $2,000. (Krooks pointed out that in New York, where he lives, the exemption is $14,400 for individuals.)

The good news, he said, is that are two sizable assets that are exempt, to some or varying degrees, in most states: a person’s home and retirement account. “Other than that, no one gets on Medicaid if they have more than the Medicaid resource amount, which is $2,000.”

So the question is: How does one get a client’s assets down to $2,000?

“There are two ways I have figured out to take somebody who has got more than $2,000 and make them have less than $2,000,” said Krooks. “Way number one: You can tell them, ‘Spend all of your money on nursing home care until you’ve got less than $2,000, and then go and apply for Medicaid. Spend it all.’ Not a very enticing possibility if you are the person writing the check. Or number two: ‘You can give away your money. Give it away.’”

The problem with giving it away is the government has imposed very strict rules on how much you can give away, when you can give it away, and to whom you can give it.

“So say you have a client with $100,000. You can’t tell the client, ‘Just give the $100,000 away today, and tomorrow go into the nursing home and say look at me, I’m poor.’ There is something called a look-back period. If you make a gift and it falls outside of the look-back period, Medicaid has no right to ask you about it, otherwise they are entitled to complete and full documentation of all your assets, resources, and income within the look-back period.” The look-back period is 60 months — five years.

All these technicalities underscore how important it is for financial advisers to stay abreast of the facts when it comes to elder law and advising clients about their retirement years. If you’d like to know more, here are some resources:

(Click here to view the original article).

Lauren Foster is a content director at CFA Institute, where she focuses on private wealth and behavioral finance. Previously, she worked as a freelance writer for Barron’s and the Financial Times. Prior to freelance work, she was an editor and writer for the FT, where she covered wealth management. Ms. Foster received her BA in political science from the University of Cape Town, and she has a master of science degree in journalism from Columbia University.

Many Options Are Available for Elder Care

Tuesday, March 12th, 2013

When an older person becomes unable to live alone without additional care, it is often unclear to both the older person and family members just what should be done.  Thankfully, there are many options available to meet the unique needs of each person needing care and each family’s budget.

The option that most older people prefer is to stay in their home, and this may be possible depending on the level of care the individual needs.  If a parent has recently fallen ill, you may not have a good sense of how much additional care is needed.  You may wish to consider hiring a geriatric care manager to help you assess what type of day-to-day care is needed, from occasional assistance to full-time care.  A care manager can also tell you about any changes that may be necessary to the person’s home for safety and/or wheelchair access.

An assisted living facility is an option that sometimes becomes necessary either for the older person’s health or because of the family’s budget.  An assisted living residence is generally less expensive than full-time at-home care, and the level of care can be adjusted as the person’s needs change.  Although some older people are trepidatious about entering such a facility, many find that the activities and the sense of community with other residents add to their happiness and mental health.

When a parent or other loved one needs care that is simply not available in an assisted living facility, then the task becomes choosing a good nursing home.  You want a nursing home that provides a safe and caring environment and all the medical care that your loved one needs.  Plan to invest time in doing your research to find the right facility.  Cost is another concern, but Medicare pays for medically necessary care and Medicaid can help with the other costs if the patient qualifies.  To help determine the best way to meet the cost, consult with an elder law attorney.

For more information about our elder law services, visit www.elderlawnewyork.com.

Medicaid Patients Could Face Higher Costs

Tuesday, March 5th, 2013

The Obama administration is trying to convince states to expand Medicaid, but a proposed policy intended to make that easier may result in millions of people paying more for health insurance.  The policy would allow states to charge higher premiums and co-payments for medical services, including prescription medicine and “nonemergency use” of hospital emergency departments.

As a result of the health care law passed in 2010, Medicaid was extended to adults without children and other people who had not been eligible before, but the Supreme Court ruled that the expansion was optional for states.  The administration is encouraging states to take that option by making it easier for states to charge patients more and thus hold down the cost to states.  Under the proposed policy, a three-person family with a $30,000 yearly income could pay up to $1,500 in co-payments and premiums.

Critics contend that it will be difficult for low-income families to bear the extra cost, and that the “nonemergency use” of emergency services is not well-defined.  Medicaid patients may have a reasonable belief that a particular condition constitutes an emergency, but this may not be borne out in the diagnosis.

Approximately 60 million people are covered by Medicaid, and that is expected to increase by more than 11 million as new patients qualify under the 2010 health care law.  More than half of Medicaid costs are paid for by the federal government, and it will pay an even greater share for the newly eligible patients.

For more information, visit www.elderlawnewyork.com or www.littmankrooks.com.