The Achieving a Better Life Experience (ABLE) Act of 2013 (S. 313/H.R.647) was introduced in the 113th Congress by a bipartisan group of Congressional Champions that included Sens. Robert Casey, Jr. (D-PA) and Richard Burr (R-NC), and Reps. Ander Crenshaw (R-FL), Chris Van Hollen (D-MD), Cathy McMorris Rodgers (R-WA) and Pete Sessions (R-TX). The ABLE […]
On December 9, 2022, the Center for Medicare Advocacy and the National Association for Home Care & Hospice announced development of a new hospice resource. The resource is entitled “Questions to Ask When Choosing a Hospice.” You can access this resource on the CMA page or the NAHCH page.
The Medicaid Spousal Impoverishment allowances are updated annually. Below are some of the annual allowance figures we’ve saved. The most current figures are usually posted here. 2026 2025 2024 2023 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 1998 – 2011
The Centers for Medicare and Medicaid Services released the 2023 SSI and Spousal Impoverishment Standards. Among the highlights are the following: Community Spouse Resource Allowance: $148,620 Maximum Monthly Maintenance Needs Allowance: $3,715.50 Income Cap: $2,742 (used to deterine whether a QIT is needed) Individual SSI rate: $914
The Press Release below is re-posted as circulated to the Conasauga Bar Association. Our personal comments are that Judge Boyett, though soon retired, will continue to be an icon of the community. Through 40 years of service, he gave of himself tirelessly to rule impartially, deliver justice and uphold the law. Judge Boyett is a […]
First, if someone you know shows signs of stroke, call 9-1-1 right away. A stroke is a medical emergency so don’t mess around. Get to the hospital. Quick action can reduce brain damage and future complications. A stroke (cerebrovascular accident) occurs when blood flow to the brain is interrupted or stopped. There are two types of […]
Nursing home residents have the right to who they will spend time with and how they will spend it. Specifically, 42 C.F.R. § 483.10(f)(1) – (3), (8) provides that residents have the right to and the facility must promote and facilitate resident self-determination through support of resident choice, including but not limited to the rights […]
Nursing home residents have a right to refuse unnecessary transfers within the facility. Specifically, 42 C.F.R. § 483.10(e)(7) and (8) provides that the resident has a right to be treated with respect and dignity, including: (7) The right to refuse to transfer to another room in the facility, if the purpose of the transfer is: […]
Nursing home residents have a right to share a room with whomever they wish as long as both residents agree. Specifically, 42 C.F.R. § 483.10(e)(4) – (6) provides that the resident has a right to be treated with respect and dignity, including: (4) The right to share a room with his or her spouse when […]
Nursing home residents have a right to reasonable accomodation of needs and preferences. 42 C.F.R. § 483.10(e)(3) provides that the resident has a right to be treated with respect and dignity, including: (3) The right to reside and receive services in the facility with reasonable accommodation of resident needs and preferences except when to do so […]
42 C.F.R. § 483.10(e)(2) provides that the resident has a right to be treated with respect and dignity, including: (2) The right to retain and use personal possessions, including furnishings, and clothing, as space permits, unless to do so would infringe upon the rights or health and safety of other residents. Appendix PP: All residents’ […]
Nursing home residents have the right to visitation. Specifically, 42 C.F.R. § 483.10(f) provides that residents have the right to and the facility must promote and facilitate resident self-determination through support of resident choice, including but not limited to the rights specified in paragraphs (f)(1) through (11) of this section. (4) The resident has a […]
Nursing home residents have the right to make their own choices. This includes basic life choices, the right to information and to socialize, and rights concerning financial matters. Specifically, 42 C.F.R. § 483.10(f) provides that residents have the right to and the facility must promote and facilitate resident self-determination through support of resident choice, including […]
Nursing home residents have the right to make their own choices. This includes basic life choices, the right to information and to socialize, and rights concerning financial matters. Specifically, 42 C.F.R. § 483.10(f) provides that residents have the right to and the facility must promote and facilitate resident self-determination through support of resident choice, including […]
Nursing home residents have the right to choose his or her attending physician. The physician must be licensed to practice, and if the physician chosen by the resident refuses to or does not meet requirements specified in this part, the facility may seek alternate physician participation as specified in paragraphs (d)(4) and (5) of this […]
Appendix PP provides the following additional guidance regarding treatment of residents with impaired, or potentially impaired decision-making capacity: Definitions: “Court of competent jurisdiction” means any court with the authority to hear and determine a case or suit with the matter in question. “Resident representative” For purposes of this subpart, the term resident representative may mean […]
Appendix PP provides the following guidance regarding a resident’s right to self-administer medications as provided in 42 C.F.R. §483.10(c)(7). If a resident requests to self-administer medication(s), it is the responsibility of the interdisciplinary team (IDT) (as defined in §483.21(b), F657, Comprehensive Care Plans) to determine that it is safe before the resident exercises that right. […]
Nursing home residents have the same right to participate in the informed consent process as any other patient. 42 C.F.R. § 483.10(c) provides: The resident has the right to be informed of, and participate in, his or her treatment, including: (1) The right to be fully informed in language that he or she can understand […]
Nursing home residents have a right to exercise his or her rights as a resident of the facility and as a citizen or resident of the United States. Speficially, the facility must ensure that the resident can exercise his or her rights without interference, coercion, discrimination, or reprisal from the facility. The resident has the […]
Nursing home residents have a right to a dignified existence, self-determination, and communication with and access to persons and services inside and outside the facility, including those specified in this section. A facility must treat each resident with respect and dignity and care for each resident in a manner and in an environment that promotes […]
42 C.F.R. § 483.5 defines the following terms: Abuse Abuse is the willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm, pain or mental anguish. Abuse also includes the deprivation by an individual, including a caretaker, of goods or services that are necessary to attain or maintain physical, mental, and psychosocial […]
Nursing homes, also called skilled nursing facilities, provide a wide range of health and personal care services. Their services focus on medical care more than most assisted living facilities. These services typically include nursing care, 24-hour supervision, three meals a day, and assistance with everyday activities. Rehabilitation services, such as physical, occupational, and speech therapy, […]
Cash and Accounts Monetary resources can typically be liquidated within 20 days. These include cash, savings accounts, checking accounts, money market accounts and the like. Medicaid always “counts” monetary assets when determining Medicaid eligibility. Specifically, 20 C.F.R § 416.1201(b) provides: “Liquid resources are cash or other property which can be converted to cash within 20 […]
One of the issues families consider as loved ones age is whether an elder is susceptible to financial elder abuse. When trying to protect mom or dad (or another elderly loved one), sometimes famlies overstep. Paternalism is not appropriate when an elder is capable of making his or her own decisions; if the elder has […]
Government Bonds are debt instruments issued by a government entity. The most common form of government bond owned by a Medicaid applicantis U.S. Savings Bonds. Savings bonds are not transferrable. They can only be sold back to the government. If they are owned solely by the applicant or the applicant’s spouse, they are countable. However, […]
General Rule One vehicle of any value is exempt. If the applicant has more than one vehicle, then the most valuable vehicle will be exempt and other vehicles will count toward the $2,000 resource limit. In Georgia, “Automobile” means any vehicle used for transportation. These include cars, trucks, motorcycles, golf carts, animal-drawn vehicles and animals. […]
The Uniform Partition of Heirs Property Act (“UPHPA”) has been enacted in 21 States. It is designed to preserve family wealth passed to the next generation in the form of real proeprty. In Georgia, the Act is codified at O.C.G.A. § 44-6-180 through § 44-6-189.1. Initially, when a partition action is filed, the Act requires […]
POMS SI 01120.010 provides that an individual must have some form of ownership interest in property in order for the property to be considered a resource. [For presumably liquid resources (SI 01110.305), assume that the person whose name is shown as owner owns the entire resource. If more than one owner is shown, assume that […]
Today the Office of Financial Research announced that it added a third data source to it’s Financial Instrument Reference Database. The full press release is below: WASHINGTON –The Office of Financial Research has added a third data source, the Financial Information eXchange (FIX) Protocol, to its Financial Instrument Reference Database (FIRD), an important enhancement that will allow […]
In Georgia, O.C.G.A. 53-7-40 provides that claims are paid in the following order: Unless otherwise provided by law, all property of the estate, both real and personal, shall be liable for the payment of claims against the estate in the following order: (1) Year’s support for the family;(2) Funeral expenses, whether or not the decedent […]
Assets are things you own that have value. Assets include all income and all resources. 42 U.S.C. § 1396p(h)(1). They are one-half of a net-worth calculation (the other half being liabilities). Medicaid treats different types of assets differently, with some being countable and others being non-countable (or exempt) during the eligibility determination. Recall that you […]
It really doesn’t help to worry. The simple answer is “don’t do it.” In Matthew 6: 25-34, Jesus said: Take no thought for your life, what ye shall eat, or what ye shall drink; nor yet for your body, what ye shall put on. Is not the life more than meat, and the body than […]
Another “option” that may be considered in appropriate cases is divorce. Deeming between spouses terminates when the marriage terminates. In most cases, this “option” should be avoided because the emotional turmoil associated with divorce is significant and the CSRA can be set by court order, see § 1396r-5(f)(2)(iv) and (f)(3). Divorce also prevents an applicant […]
MCCA includes a mechanism for increasing both the CSRA and the MMMNA in certain cases. The methods by which this can be effected are described in 1396r-5(e), (d)(5) and (f)(3). Blumberg v. Tennessee Department of Human Resources, 2000 WL 1586454 (Tenn.Ct.App.) was a case where a Community Spouse sought a court adjustment of the default […]
As eligibility is being determined, if the Community Spouse’s monthly income falls below the Minimum Monthly Maintenance Needs Allowance (“MMMNA”), then MCCA contemplates two methods of raising her income up to the MMMNA. First, a portion of the Institutionalized Spouse’s income may be transferred to her to bring her income up to the MMMNA. Second, […]
Income and resources are treated differently. Unlike resources, income is not pooled in determining eligibility; the Community Spouse’s separate income is never considered available to the Institutionalized Spouse. Thus, the standard income eligibility process for one person applies. First, all income earned by the Community Spouse is always unavailable to pay nursing home bills, regardless […]
In Dullard v. Minnesota Department of Human Services, 529 N.W.2d 438, 443 (Minn. App. 1995), Minnesota was allowed to reevaluate eligibility after a couple moved from Illinois to Minnesota. There, Illinois (like Georgia) allowed the Community Spouse to keep the maximum CSRA, while Minnesota (like Tennessee) applied a formula resulting in a lower CSRA. The […]
Some couples might consider reducing the size of the marital estate by giving their resources away. Frequently this is the result when the plan is “home-made.” However, transfers for less than fair market value, including complete and partial gifts) trigger a period of ineligibility. 42 U.S.C. 1396p(c). It does not matter whether the applicant or […]
Federal law protects the healthy (or healthier) spouse of a nursing home resident. The healthier spouse is known in Medicaidland as the Community Spouse. The protections, known as the Spousal Impoverishment Rule (but logically be called the anti-impoverishment rule) were passed as part of the Medicare Catastrophic Coverage Act of 1988, P.ub. L. No. 100-360 […]
The following the committe report for the Medicare Catastrophic Coverage Act of 1988 (MCCA): The leading cause of financial catastrophe among the elderly is the need for long-term care, especially the need for nursing home placement. The expense of nursing home care–which can range from $2,000 to $3,000 per month or more–has the potential for […]
While nursing home bills accrue, the healthy or well spouse, known as the “Community Spouse,” [Note 1] struggles to identify and keep income and resources that are necessary to support herself. [Note 2]. To remedy this situation, Congress enacted spousal impoverishment provisions as part of the Medicare Catastrophic Coverage Act of 1988 (“MCCA”). [Note 3]. […]
If you agree to file a client’s Medicaid application as part of your representation, here are a few practical considerations. Keep in mind, these suggestions are how we handle matters in our office. If you have a different approach, that’s fine. If you have suggestions on other ways to approach applications, we’d love to hear […]
We regularly post links to news articles and other resources related to Elder Law and Special Needs Law. We focus on general news, health and healthcare news, special needs news, events, government sources, financial and retirement news and legal news. Some cited resources are for professionals, but most are news or other helpful articles we […]
We regularly post links to news articles and other resources related to Elder Law and Special Needs Law. We focus on general news, health and healthcare news, special needs news, events, government sources, financial and retirement news and legal news. Some cited resources are for professionals, but most are news or other helpful articles we […]
In States where Medicaid disability determinations are performed by the Social Security Administration, the eligibility rules cannot be more restrictive than the SSI eligibility Rules. Section 1902(r)(2) [42 U.S.C. § 1396a] indicates a State’s Medicaid eligibility criteria can be no more restrictive than the SSI program. Specifically it states: (2) (A) The methodology to be employed […]
Medicare is a nationwide health insurance program for individuals aged 65 and over and certain disabled individuals. The basic Medicare benefit package (termed “original Medicare” in this report) provides broad protection against the costs of many health care services. However, Medicare beneficiaries may still have significant additional costs, including copayments, coinsurance, deductibles, and the full […]
On December 8, 2003, the President signed the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, P.L. 108-173. On November 22, 2003, the House of Representatives voted 220 to 215 to approve H.R. 1, the Medicare prescription drug and modernization conference agreement. The Senate voted 54 to 44 to approve the conference agreement on […]
The Children’s Health Insurance Program (CHIP) was created in 1997 to give health insurance and preventive care to nearly 11 million, or 1 in 7, uninsured American children. Many of these children came from uninsured working families that earned too much to be eligible for Medicaid. All 50 states, the District of Columbia, and the […]
The 2010 Affordable Care Act (ACA) brought the Health Insurance Marketplace, a single place where consumers can apply for and enroll in private health insurance plans. It also made new ways for us to design and test how to pay for and deliver health care. Medicare and Medicaid have also been better coordinated to make […]
There are five levels in the Medicare claims appeal process: Level 1: Your Health Plan. If you disagree with a Medicare coverage decision, you may request your health plan to redetermine your claim. Level 2: An Independent Organization. If you disagree with the decision in Level 1, you may request a reconsideration by an independent […]
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