Life Insurance Snafu. Petitioner and Respondent stipulated facts in this case. Petitioner applied for nursing home Medicaid in March 2008. DFCS denied the application because Petitioner had three life insurance policies with a cumulative face value of $13,831. Since the face value exceeded $10,000, the cash value of the policies was counted toward Petitioner’s $2,000 […]
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No Penalty For Transfer to Disabled Child. DFCS imposed a transfer of resources penalty where Petitioner transferred cash assets to a disabled daughter. DFCS’s reasoning was that cash assets were transferred to the disabled child outright as opposed to transferring them to a trust for her sole benefit. Citing 42 U.S.C. § 1396p(c)(2)(B)(iii) and Section 2342 of the […]
No QIT means No Medicaid If Income Exceeds Cap. Petitioner entered the nursing home in July 2007 and applied for Medicaid in August 2007. No one told Petitioner a qualified income trust was needed. A denial was sent in October and Petitioner reapplied in November 2007, establishing the QIT by December 17, 2007. Eligibility was denied for […]
Determining Which Property is the Exempt Homeplace; Whether Jointly Owned Second Property was Exempt. Petitioner lived at her residence in DeKalb County from 1960 until 2002 when she moved to her daughter’s home on Klondike Road in DeKalb County. From there, Petitioner went to an assisted living facility and then, in December 2006, a nursing […]
Penalty Reversed Where Home was Given to Caregiver Child. In 2002, Petitioner’s daughter moved into Petitioner’s home to provide care. In 2003, Petitioner was bedridden after back surgery; the daughter continued providing care on a full-time basis and also paid some of Petitioner’s expenses. On December 25, 2004, Petitioner gave her home to her daughter, […]
No Penalty Where Transfer Reimbursed Third Party for Paying Applicant’s Expenses. Petitioner was admitted to a nursing home on May 7, 2008 and remained there until her death on July 24, 2008. Petitioner filed an application for Medicaid on July 3, 2008, seeking retroactive coverage. The application was denied after DFCS discovered a $22,668.56 transfer […]
The Limit is the Limit, Part 2. Petitioner entered the nursing home on April 17, 2007 and applied for Medicaid on February 22, 2008. Petitioner sough retroactive coverage for November 2007 through January 2008. Unfortunately, Petition was over resourced. After designating stock as a burial resource, she still had $5,569.73 on November 1st, $4,077.13 on […]
Calculation of Cost-Share. As of November 1, 2008, Petitioner’s gross monthly income was $2,385.54. DGCS calculated the cost-share as $2,189 after allowing deductions of $9.25 for federal taxes, $136.72 for health insurance premiums and $50 for Petitioner’s personal needs allowance. The decision does not indicate what additional deduction Petitioner sought, but the DFCS calculation was […]
Corpus of Irrevocable Trust was Countable Resource. Two trusts Petitioner created in 2000 held a cumulative balance of approximately $64,000. Petitioner was settlor and a co-trustee of each trust. On April 21, 2008, Petitioner filed an application for nursing home Medicaid. DFCS determined that the trusts were available resources causing Petition to be ineligible for […]
Cost-share deduction for health insurance premiums. The ALJ stated the issue as whether a nursing home resident is entitled to a deduction from her patient liability for Medicaid for Health insurance premiums paid by her spouse who resides in the community. DFCS disallowed IME coverage for health insurance premiums paid y the Community Spouse, taking […]
The Limit is the Limit. An 84 year old applicant was denied Medicaid for the months of December 2007 through February 2008. She had sold her home in August and after paying debt, used the remaining $18,686 in equity paying for nursing home care until she ran out of funds in December 2007. Her son […]
Where application was lost, eligibility retroactive eligibility related back three months from date of original application. After receiving a personal injury settlement in May 2007, Petitioner was ineligible for Medicaid until she spent down. She spent down before July 1, 2007, reapplying for Medicaid by hand delivery on October 30, 2007. Petitioner did not receive […]
DFCS directed to determine eligibility where application was pending for over one year. Petitioner filed an application for Medicaid on May 22, 2007. On June 18, 2007, a verification package was given to Petitioner’s daughter. On July 1, 2007, the application was denied for failure to provide verification. On July 25, 2007, Petitioner requested a […]
Sole Benefit Trust rejected and transfer penalty imposed. An 86 year old applicant established an irrevocable trust for the benefit of his 64 year old daughter. However, the trust was not submitted to DCH Legal for approval and Petitioner submitted no evidence that the trust comported with Section 2346 relating to special needs trusts. Further, the […]
Transfer Penalty Reversed Where Home Was Returned. Three months prior to a nursing home admission, a 98 year old Petitioner purchased her daughters home for $406,300, plus personal property valued at $26,775. She paid by transferring securities valued at $484,766.78, and $51,691.78 was returned to Petitioner as an over-payment. Petitioner’s alleged hope was that she […]
Incorrect Decision Reached Regarding Status of Community Spouse. A nursing home resident’s spouse was denied a Community Spouse Monthly Income Allowance when she moved to the Philippines after her husband was admitted to a nursing home. She was attempting to secure a visa to return to the U.S. at the time of the hearing and […]
Georgia’s Medicaid Manual cannot be enforced when it conflicts with federal law. Applicant resided in an assisted living facility until she went to a nursing home in 2008 and applied for Medicaid. Prior to that time, her vacant home was placed on the market and sold. To accomplish the sale, Petitioner conveyed her life estate […]
Ignorance of QIT Requirement Does Not Excuse Failure to Comply. Nursing home resident’s son assisted with her October 25, 2007 Medicaid application. At the intake interview on November 7, 2007, he disclosed that he opened a QIT with $50. He did not fund it further by transferring her excess income into the trust until that […]
Assessment of transfer penalty on sale of life estate affirmed. Conservators sold life estate for $1,500, then sold the applicant’s home for $55,000 after putting $13,397 into repairing the home. A transfer of resource penalty was assessed because the life estate interest was .58914 percent of the home value, which is well below $1,500. On […]
No penalty may be assessed where resources are transferred directly to a disabled child. A nursing home resident transferred approximately $24,000 to a disabled child. DFCS imposed a transfer penalty because the funds were transferred directly to the child instead of to a trust for the child. The caseworker’s decision was reversed because 42 U.S.C. 1396p(c)(2)(B)(iii) […]
Hire a Lawyer. An unrepresented nursing home resident applied for Medicaid on December 21, 2007. A 981 was issued after an intake interview on December 27, 2007. However, the 981 erroneously omitted a request for documentation regarding retirement income and social security benefits. The caseworker realized her error on February 5, 2008 (3 days after […]
Community Spouse Resource Allowance administratively raised. Evidence was stipulated that the combined marital income of the couple did not result in post-eligibility income for the Community Spouse that equaled or exceeded the MMMNA. Therefore, the Community Spouse Monthly Income Allowance (CSMIA), 42 U.S.C. § 1396r-5(d)(1)(B), was inadequate to raise the Community Spouse’s post-eligibility income to the […]
Valuation; value of transferable promissory note. Petitioner filed a motion for summary determination and respondent failed to answer. The issue was whether petitioner’s resources exceeded $2,000 during the month in question. Approximately six years prior to the application, in 2002, Petitioner had loaned $66,000 under a promissory note that paid $15 of principal, no interest […]
Transfer of resources penalty affirmed. Nursing home resident applied for Medicaid in January 2008. During review, caseworkers discovered a home assessed at $90,351, was transferred to a close friend for $40,000 within the lookback period. Additionally, $10,000 was withdrawn from the resident’s account and several small checks and a vehicle were issued to the friend. […]
Treatment of retirement accounts. Section Section 2332 indicates that an applicant must apply for periodic benefits, but does not indicate whether the individual must take a minimum distribution from “each” account or whether the individual can aggregate the retirement accounts for purposes of determining whether a sufficient minimum distribution was taken. The ALJ looked to 26 C.F.R. § […]
Resource limit firm; debt not a factor. Petitioner’s application for benefits was denied twice because the Petitioner’s agent was unable to secure information requested by the caseworker. Petitioner’s agent was not able to gain control over the resources until a conservatorship was approved in February, 2008. As of March 1, 2008, Petitioner had $23,453.89 in […]
Georgia State University College of Law Virtual Event (registered attendees will be sent WebEx link) The role of public health in protecting the health of communities has long been upheld in the law. However, measures implemented to prevent the spread of COVID-19 and mitigate its impact have been met with challenges to public health legal […]
Outline of Georgia Guardianship and Conservatorship Process and Timeline Process Begins When Petition is filed O.C.G.A. § 29-4-10(a). Any interested person, including the proposed ward, may file a petition for the appointment of a guardian. Such petition shall be filed in the court of the county in which: (1) The proposed ward is domiciled; (2) […]
In M.K. v. Division of Medical Assistance, Superior Court of New Jersey, Appellate Division (2016), the Division imposed a period of ineligibility for benefits because she transferred ownership of her home to her daughter, J.K., for less than fair-market value within sixty months of entering a nursing home facility (the look-back period). The applicant argued […]
An applicant filed three Medicaid applications from February 7 through November 26, and all of them were denied for failure to submit necessary financial verification. A fair hearing was conducted on November 26, 2018 where the ALJ gave the applicant additional time to supply verification. Once that verification was supplied, on May 14, 2019, the […]
In a Memorandum decision, the Supreme Court of New York, Appellate Division, Fourth Department, held that a nursing home may bring a plenary action in its own right against the agency designated to declare Medicaid eligibility. A transfer of resources penalty of 11.74 months had been imposed and the nursing home sought a declaratory judgment […]
Next week GPB will examine the life of a titan with a two-part American Experience, learn what made Jimmy Carter the man he became and much more. GPB lineup for next week
2022 Special Needs Planning Symposium We don’t always give a shout-out for symposiums sponsored by others, but we’ll make an exception here. The 2022 Special Needs Planning Symposium looks like an all-star cast for anyone on the West Coast who works with special needs individuals (especially if you can’t make it to Stetson). Two sessions […]
In Maryland Department of Health and Mental Hygiene v. Centers for Medicare and Medicaid Services, 542 F.3d 424 (2008), the State of Maryland petitioned for review of a final decision of the Centers for Medicare & Medicaid Services (CMS) disapproving an amendment to the Maryland State Medicaid Plan (SMP). Maryland’s SMP would have eliminated deductions […]
In Timm v. Mont. Dep’t of Pub. HHS, 2008 MT 126 (2008), Linda Timm entered the nursing home in July 2002. The Timm family applied for Medicaid on November 1, 2002 reporting, among other resources, the Community Spouse’s one-third interest in J & R Transportation, Inc., worth roughly $20,150. The Department completed its first resource […]
On July 1, 2021, the Biden-Harris Administration, through the U.S. Departments of Health and Human Services (HHS), Labor, and Treasury, and the Office of Personnel Management, issued “Requirements Related to Surprise Billing; Part I,” an interim final rule that will restrict excessive out of pocket costs to consumers from surprise billing and balance billing. Surprise billing […]
Selected articles from Current Awareness in Aging Research E-Clippings: Staff Shortages Are Hammering Long-term Care Facilities, Home Care Agencies, and Families Pandemic-inspired retirement may be short-lived for many More than 41million dementia cases globally are undiagnosed – study Signs of Early Alzheimer’s May Be Spotted in Brain Stem The quality, not quantity, of cardiovascular fat […]
Attorney General Chris Carr is warning Georgians about the latest version of the grandparent scam. The scam still starts with a phone call from someone pretending to be your grandchild, one of his/her friends, a lawyer or a law enforcement officer. The caller then describes an urgent scenario requiring that thousands of dollars be sent immediately, […]
The Office of the Attorney General, on September 17, 2021, announced that the office’s Medicaid Fraud Control Unit has indicted Dr. Guy Jordan for Medicaid Fraud and for False Statements. The Hall County Grand Jury returned the indictment on September 15, 2021. “We will not stop protecting taxpayer dollars, and we thank the Hall County […]
Attorney General Chris Carr, on September 20, 2021, released an update on telecom companies’ progress in implementing the Anti-Robocall Principles he signed onto in 2019. Since September 2019, companies that agreed to these Principles have identified more than 52 billion spam or spoofed numbers calls, authenticated the caller ID numbers of hundreds of billions of […]
CMS Press Release 9/21/2021 The Centers for Medicare & Medicaid Services (CMS) is making it easier to check COVID-19 vaccination rates for nursing home staff and residents with a new feature on Medicare.gov. Today’s announcement makes vaccination data available in a user-friendly format to help people make informed decisions when choosing a nursing home for […]
News Sources: ThinkAdvisor, 4 Signs your Client is Ready for a Roth IRA Conversion Morningstar, The ABCs of Estate Planning for IRAs Under the Secure Act Financial Advisor, Gray Divorce and Avoiding Retirement Ruin Health Affairs, Care for Elders, Prices and More (September 2021 issue) KHN, Telehealth’s Limits: Battle Over State Lines and Licensing Threatens […]
Divorce is one of the most aggressive Medicaid planning tools. Divorce should not be approached lightly and should not be attempted without an attorney. Most Medicaid plans can be completed without the necessity of divorce. Even when divorce appears to be the answer, a simpler procedure, commonly known as a “Catholic divorce” (e.g., an action […]
On September 1, 2021, the Administration for Community Living posted a guest blog titled “BE WITH: Combating Social Isolation, Loneliness, and Suicide Risk. The blog post describes “how one project is helping build capacity within the aging network to help address social isolation and loneliness and prevent suicide amongst older adults.” Contributors include Laura Shannonhouse, […]
As you plan for your future, there are steps you can take to make life easier for yourself and your loved ones. Here are a few to consider: Issue Yes No N/A Do you have a financial power of attorney? If so, is it broad enough to address issues such as retirement accounts, stocks, and […]
