Medicaid, as opposed to Medicare, is a health insurance program, jointly funded by the state and federal governments that pays for health care for America’s poor. See Medicaid Act (Title XIX of the Social Security Act), 42 U.S.C. § 1396 et seq. Not everyone is eligible for medical assistance; only those persons who fall within […]
Blog
In State of Idaho v. Beason, 546 P.3d 684 (2024), the Medicaid agency filed an estate recovery claim in Juanita Gilbert’s estate. she received Medicaid benefits from 1996 until her death in 2015, totaling $137,023.29 and, after she died, the State wanted its money back. Juanita and her husband, Robert, owned real property in Butts […]
The Centers for Medicare and Medicaid Services launched the Guiding an Improved Dementia Experience (GUIDE) Model on July 1, 2024. It is a voluntary nationwide model test that aims to support people with dementia and their unpaid caregivers. The GUIDE Model is an attempt to provide Medicare funded comprehensive, coordinated dementia care to improve quality […]
Medicaid Post Eligibility Treatment of Income and Incurred Medical Expenses After Medicaid eligibility is established, 42 C.F.R. § 435.725 addresses how income is treated. For clarity, if the Medicaid recipient is married,income of the non-recipient spouse does not count toward eligibility and is not part of the patient cost share. Specifically, 42 U.S.C. § 1396r-5(b)(1) […]
Medicaid’s Refusal to Provide 24/7 Care in the Community Might be Discrimination In Harrison v. Young (5th Cir. June 6, 2024), the Fifth Circuit considered Ms. Barbara Harrison’s claim challenging Medicaid‘s denial of funding for medical services that she claimed are necessary for her survival. Harrison has severe physical and intellectual disabilities. She cannot walk […]
From time to time federal regulations covering nursing home quality of care are updated. Thus far, the following updates have been published in May and June of 2024. Updates posted May 10, 2024 42 CFR Part 483 — Requirements for States and Long Term Care Facilities view changes § 483.5 Definitions. view changes § 483.10 […]
Nursing homes that accept Medicare or Medicaid are required to comply with quality of care regulations. Although we have blogged elsewhere on specific nursing home resident rights, the current federal regulations are linked below. 42 CFR Part 483 — Requirements for States and Long Term Care Facilities § 483.5 Definitions. § 483.10 Resident rights. § […]
On June 11, 2024, the Gerontologist published an article on Medicaid enrollment and Intergenerational transfers of wealth among older adults. The article was based on a review of data from 2008 through 2018 analyzing estate planning and family wealth transfers of older adults aged 65 and older who became Medicaid recipients. There were 8,347 respondents […]
Dementia affects more than 50 million people worldwide. The Virtual Dementia Tour is designed to allow participants to experience what dementia patients see, hear and feel so they better understand and empathize with individuals who have dementia. One website with the UNC Greensboro reports: “The simulation temporarily alters your physical and sensory abilities to replicate […]
In 2021, we blogged about a valuation case, Connelly v. U.S., 20 F. 4th 412 (8th Cir. 2023). We noted at the time that a Petition for a writ of certiorari was filed. On June 6, 2024, the U.S. Supreme Court decided the case, ruling for the United States. Justice Thomas, writing for a unanimous […]
Gun trusts were developed so gun owners can pass their firearms to beneficiaries or heirs at death (or disability) without creating unintended legal problems. Some people (e.g., convicted felons) are not allowed to own guns. Some weapons require a specific license. The trust is intended to prevent beneficiaries who are not allowed to own guns, […]
Medicaid’s “Any Circumstance” Test for Trusts In case you missed the memo, Medicaid doesn’t like trusts. The rules relating to trusts you create with your money or property are found at 42 U.S.C. § 1396p(d). To put this discussion in context, we’ll begin with the sections relevant to the “any circumstances” test, but the full […]
SNT Trustee Ordered to Reimburse Some Conservator Expenses In Weidner v. Stevenson (Cal. App. 2nd Dist. May 13, 2024), Roberta Davis established a special needs trust inside her living trust for her disabled adult son, Daniel. Daniel was under a conservatorship. Daniel’s aunt, Charlyne, was the successor trustee of the trust after Roberta’s death, while […]
In Agency for Health Care Administration v. Spence (Fla. App. 3rd Dist May 22, 2024) the Court of Appeals reversed a probate court order authorizing distributions from a special needs trust without first reimbursing the Medicaid agency. Ryan Spence was a disabled child adopted by Kathleen Spence. After Spence was killed, a settlement agreement allocated […]
When someone accepts the position of trustee, he (or she or it) must act for the benefit of the trust and its beneficiaries. In Bates v. Howell (Ga. App. 2019), Emily Howell decided that the trustee of her aunt’s trust breached his duties. She then went to court without giving anyone else notice (an ex […]
Long-Term Care Partnership Policies One example of good planning is purchasing long-term care insurance. The greatest risk to non-taxable estates (those under $12.9 million) is the cost of long-term care. With long-term care insurance, you can shift that risk to an insurance company. A partnership policy is a special long-term care insurance policy that protects […]
In ____ v. Brock, Judge Schwall, Fulton County Superior Court), affirmed an administrative law judge’s Final Decision as supported by the administrative record. Here, the most interesting portion is the language discussing how a Superior Court reviews the appeal of an ALJ decision. The case began when DHS found suspicious transactions on a food stamp […]
On May 14, 2024, the Georgia Supreme Court entered an Order in The Matter of James W. Davis, III, disbarring him from the practice of law. Mr. Davis, who was listed in Martindale.com as practicing elder law, estate planning, Wills and other areas, was accused of intercepting more than $3 million intended for his client […]
During the 2024 legislative session, HB 1247 morphed into SB 420, which passed both houses and was signed by the governor. The new law creates a new Chapter 17 within Georgia’s Title 44 and authorizes the creation of transfer on death deeds. Previously, these deeds, commonly known as Lady Bird Deeds (although technically LBDs are […]
On November 28, 2023, the IRS Office of Chief Counsel published a memorandum addressing whether modification of an irrevocable grantor trust to add a tax reimbursement clause not previously in the trust constituted a taxable gift. The IRS concluded that it does constitute a taxable gift by the trust beneficiaries because the addition of a […]
In a Texas case decided on May 3, 2024, the Texas Supreme Court reversed the Court of Appeals and trial court, siding with the Medicaid agency on whether a home purchased after admission to a nursing home was exempt. Clyde and Dorothy Burt sold their home to their daughter and moved into a rental property. […]
In Parker v. Louisiana Department of Health (April 30, 2024), the U.S. District Court for the Eastern District of Louisiana granted a motion for preliminary injunction prohibiting the State from terminating a grandmother’s QI Medicaid based on the State’s determination of family size. The Plaintiff, a 71 year old widow who was raising her grandchild, […]
In Farmer v. Farmer (decided March 15, 2024), the Georgia Court of Appeals reversed the trial court’s grant of summary judgment in favor of a land owner, finding that his aunt could present her claim to a jury that a life estate was given to her. The ordinary rule is that contracts involving land must […]
The federal Medicaid statute authorizes the use of individual self-settled special needs trusts for individuals under the age of 65. See 42 U.S.C. § 1396p(d)(4)(A). It also authorizes any applicant, regardless of age, to establish a self-settled pooled special needs trust sub-account. 42 U.S.C. § 1396p(d)(4)(C). An open question not addressed in (d)(4)(C) is whether […]
If someone is receiving Medicaid and was injured through the negligence of others, Medicaid asserts a third-party claim against any recovery, whether by settlement or verdict. This is sometimes known as a Medicaid lien. The form shown below is one currently used by Georgia Medicaid when investigating whether a third-party claim exists.
[Note: Section 71111 of The One Big Beautiful Bill Act placed a moratorium on enforcement of the nursing home minimum staffing standards through September 30, 2024] On April 22, 2024, the Centers for Medicare and Medicaid Services announced a new final rule requiring minimum staffing levels in nursing homes. The new rule applies to all […]
In Creamer v. Manley, decided March 14, 2024, the Court of Appeals affirmed summary judgment upholding the validity of a Will. In summary, Willifred Thompson executed a Will leaving substantially all of her estate to Mable Manley, her caregiver. Two second cousins, Barbara Creamer and Gordon Lowe, filed a caveat alleging that Thompson lacked testamentary […]
On February 21, 2024, the Georgia Court of Appeals decided the case of In Re Estate of Anne Smith Florance. In that case, Florance had executed a revocable trust during her life and a Will pouring the remainder of her estate into the trust. The trust was first established in 1997 and amended several times […]
The Georgia Court of Appeals decided the case of In re Bessie Mae Blake on February 20, 2024. Willis Blake was appointed as his mother’s conservator in 2000, but he was a poor record keeper. Although he was required to set up a separate account for Bessie Mae, keep records of expenses and file annual […]
Effective April 1, 2024, the statewide averaged nursing facility private pay rate used in determining the penalty period for institutionalized individuals (nursing facility and home and community-based waiver programs) who transfer assets for less than the fair market value will increase from $9,584.00 to $10,025.00.
Recently we received a document we haven’t seen before which informs Medicaid recipients that their special needs trust accounting was approved. Obviously, there is probably a different form telling some individuals that their accounting was not approved, but we haven’t seen that form yet. The new form is below:
On March 27, 2024, the Social Security Administration published a final rule in the Federal Register which changes its calculation of In-Kind Support and Maintenance (ISM). Under the prior rule, if food and/or shelter is provided to a recipient of Supplemental Security Income (SSI), the income is deemed to the recipient, reducing his or her […]
The following is a re-post of David E. Hultstrom’s Financial Foundations April 2024. You can reach Mr. Hultstrom at 770-517-8160. It’s tax season once again and time for the annual summary of the state of the fisc. I have no political point, this is just data. The causes of the numbers below are thoroughly bipartisan. […]
On April 1, 2024, the Washington Post published an article titled “Algorithms guide senior home staffing. Managers say care is suffering.” The article indicates that a system, called Service Alignment, was developed more than two decades ago when assisted living facility (ALF) executives began timing caregivers performing tasks. That data was fed into a computer […]
In February 2024, Justice in Aging released a new report based on California’s “performance measure” data from the state’s Medicaid assisted living program. Aging in Justice concluded that the quality of care measures provide no meaningful information. A perfect score tells you nothing about the quality of care residents receive. The report concludes that the […]
Recently the Special Needs Alliance published a new handbook for individuals with disabilities and their advocates. The SNA states: “The intent of this handbook is to explain some of the terms related to services and supports for people with disabilities, to introduce the process of transitioning from child services to adult services, and to provide […]
Each year statutory provisions require the IRS to adjust tax rates based on inflation. Although we’re a bit tardy posting the numbers, here are the ones that matter most for our purposes. Gift Tax Annual Exclusion: $18,000 per recipient or $36,000 per recipient for a married couple. This is not a limit on gifting, but […]
Recently a notice was published concerning a class action where the Plaintiffs alleged that real estate brokers engaged in anticompetitive practices, essentially violating federal antitrust law. This, by the way, is the law that broke up Ma Bell and gave us dozens of different phone providers. The case is Burnett et al. v. The National […]
Historically, unborn embryos have not been considered children. Recently, in LePage v. The Center for Responsive Productive Medicine, P.C., the Alabama Supreme Court found otherwise. Ordinarily this would not be an “elder law” issue, but the law considers unborn children to be potential heirs of an estate. For example, O.C.G.A. § 53-2-1(b)(1) provides: Children of […]
Guardianship Evaluation In most cases I’ve been involved in, the evaluator’s report is stipulated into evidence or the evaluator is called as a witness. The reason is that the report cannot be cross-examined so the thought was that it’s subject to a hearsay objection. A recent case taught me otherwise (at least in Georgia). In […]
A Petition for writ of certiorari in the case of Dermody v. Massachusetts Executive Office of Health and Human Services is pending in the U.S. Supreme Court. The issue is “Whether an annuity that satisfies the condition in 42 U.S.C. § 1396p(c)(2)(B)(i) determining the Medicaid eligibility of a married institutionalized person must name the state […]
On November 17, 2023, Georgia issued Manual Transmittal 71, updating its Medicaid Manual, making technical changes to the following sections. The following sections were updated: 2054 – Emergency Medical Assistance 2060 – ABD Medicaid Application Processing 2101 – ABD Medicaid Classes of Assistance Overview 2111 – SSI Medicaid 2135 – Hospice Medicaid 2143 – QMB […]
For many years, Genworth has produced a Cost of Care Survey tracking the cost of long-term care in America. According to the survey, the projected national monthly median costs will be as follows: Homemaker Services: $5,417 Home Health Aide: $5,625 Adult Day Health Care: $1,847 Assisted Living Facility: $4,917 Nursing Home Semi-Private Room: $8,641 Nursing […]
We’ve posted some of David Hultstrom’s thoughts before and here we go again since he says “Feel free to pass this along.” The following, from his November, describes why he doesn’t try to predict movement in the financial marketplace: You may have noticed that I rarely comment on the market or economy in this monthly […]
On November 14, 2023, the Centers for Medicare and Medicaid Services announced the 2024 SSI and Spousal Impoverishment Standards. The SSI rate for 2024, which was previously announced by the Social Security Administration, will rise to $943. The Medicaid Income Cap will rise to $2,829. The minimum MMMNA will be $2,465 and the maximum MMMNA […]
Effective January 1, 2024, the federal Supplemental Security Income payment amount will increase by 3.2 percent. The amounts paid to individuals and couples are below: Recipient Unrounded annual amounts for— Monthly amounts for 2024 2023 2024 a Eligible individual $10,970.44 $11,321.49 $943 Eligible couple 16,453.84 16,980.36 1,415 Essential person 5,497.80 5,673.73 472 Impact on Medicaid This […]
Am I Eligible for Medicaid? Recently we were asked about the following fact pattern. Parent had multiple properties in different counties. More than 60 months ago, parent gave these properties to children reserving a life estate. The question, initially, was whether parent is eligible for nursing home Medicaid. The follow-up question was whether the property […]
Georgia Adult Protective Services Authority for Adult Protective Services is found at O.C.G.A. § 30-5-1 et seq. The stated purpose of the Act ” is to provide protective services for abused, neglected, or exploited disabled adults and elder persons. It is not the purpose of this chapter to place restrictions upon the personal liberty of […]
