The 2010 Affordable Care Act (ACA) brought the Health Insurance Marketplace, a single place where consumers can apply for and…
There are five levels in the Medicare claims appeal process: Level 1: Your Health Plan. If you disagree with a…
For more programmatic information, please see reports published by the Congressional Research Service. CRS works exclusively for the United States Congress,…
Initial Enrollment Period If you are receiving Social Security or Railroad Retirement Benefits, then you will automatically get Medicare Part…
Medicare Part D was created as part of the Medicare Prescription Drug, Improvement and Modernization Act of 2003, with an…
Medicare Advantage replaced prior programs, alternatively called Medicare+Choice or Part C, which originated in the Balanced Budget Act of 1997.…
Medicare part B is voluntary. All persons over age 65 and all persons enrolled in part A may enroll in…
Part A provides most of your institutional coverage. It covers inpatient care in hospitals, inpatient care in a skilled nursing…
On September 27, 2022, the Centers for Medicare & Medicaid Services (CMS) released the 2023 premiums, deductibles, and coinsurance amounts…
On September 29, 2022, CMS issued the following press release regarding 2023 premiums for Medicare Advantage and Prescription Drug Plans:…
We regularly post links to news articles and other resources related to Elder Law and Special Needs Law. We focus…
The dictionary definition of "signature" is "a person's name written in a distinctive way as a form of identification in…
On September 15, 2022, the Ohio Court of Appeals affirmed a Probate Court decision appointing a guardian despite a spotty…
We regularly scour the internet looking for information relating to elder care, special needs and elder law. Although we review…
In the late 1990s, Dr. Ed Wagner (and his team at the Macccoll Center - now the ACT Center), created…
We regularly post links to news articles and other resources related to Elder Law and Special Needs Law. We focus…
On September 21, 2022, the U.S. Department of Health and Human Services (HHS), through its Administration for Community Living (ACL),…
In our August 26, 2022, News Roundup, we reported that Talevski v. Health and Hospital Corporation of Marion County (HHC)…
The Centers for Medicare and Medicaid Services (CMS) regularly records and posts informational workshops on a variety of subjects. For…
We regularly scour the internet looking for information relating to elder care, special needs and elder law. Although we review…
We regularly post links to news articles and other resources related to Elder Law and Special Needs Law. We focus…
Medicaid planning is discussed in more detail in subsequent chapters. Planning is the process of restructuring an estate in a…
Medicaid beneficiaries cannot “fix” eligibility by giving away resources. A transfer of resources without receipt of fair market value will…
As with the income rules, the resource defaults may be changed. First, if all of the Applicant's income has been…
A Community Spouse is entitled to a resource allowance in addition to the income allowance. 42 U.S. Code § 1396r–5(f)(1)…
The SSI regulations describe deeming as the process of considering another person's income or resources to be your own. See…
As a general rule, all countable resources owned by the Institutionalized Spouse are considered available to pay his or her…
The law protects a Community Spouse with low income. It does this by diverting a portion of the applicant's income…
On the income side, there are three pathways to Medicaid eligibility for nursing home residents. First, SSI recipients are almost…
In evaluating financial eligibility for Medicaid, both monthly income and resources must be considered. The basic rule is everything having…
Categorical and medical eligibility is covered in Chapter 2. Here we begin an aerial fly-over of financial eligibility. In this…
42 U.S. Code § 1382c(a)(2) states: An individual shall be considered to be blind for purposes of this subchapter if…
Only those persons with a medical need are eligible for Medicaid and not all persons needing help receive Medicaid. In…
With few exceptions (such as the existence of an interstate compact), a Medicaid applicant must be a resident of the…
An applicant must be a U.S. Citizen or a legally admitted alien to receive Medicaid. 42 CFR § 435.406. In…
In addition, to establish technical eligibility for nursing home Medicaid, an applicant must be (i) a U.S. Citizen or lawfully…
Individuals who are aged (age 65 or older), blind or disabled may be entitled to Medicaid if they are medically…
The Rule 42 U.S. Code § 1382c(a)(3)(A) states: "an individual shall be considered to be disabled for purposes of this…
The remainder of this book focuses on long-term care Medicaid. Long-term care refers to a wide range of supportive and…
States may extend Medicaid to certain individuals with incomes too high to qualify for SSI, and who are eligible for…
The enactment of the Omnibus Budget Reconciliation Act of 1986 (OBRA 86) offered States an option for covering persons whose…
Many States provide SSP benefits with State-only dollars on a monthly basis. These payments are intended to cover such items…
With one important exception, States are required to provide Medicaid coverage to recipients of SSI. SSI, authorized under Title XVI…
The Federal Medicaid statute defines over 50 distinct population groups as being potentially eligible for States’ programs. Some groups (classes…
Medicaid was enacted in 1965, in the same legislation that created the Medicare program, the Social Security amendments of 1965…
The Medicare program (Title XVIII of the Social Security Act) provides hospital insurance (HI), also known as Part A coverage,…
The answer, like the answer to many legal questions, is maybe. Georgia has not outright abolished irrevocable trusts. However, O.C.G.A.…
We regularly scour the internet looking for information relating to elder care, special needs and elder law. Although we review…
We regularly post links to news articles and other resources related to Elder Law and Special Needs Law. We focus…
By: Judith Graham August 5, 2022 Eight months after falling ill with covid-19, the 73-year-old woman couldn’t remember what her…