On October 24th and 25th, 2023, the Tennessee Justice Center will present its annual two day virtual training event on Medicaid eligibility. This event is designed for health care providers and advocates. Information regarding what’s covered and how to register is below: Medicaid Eligibility Boot Camp – A Virtual Training Event Navigating the Red Tape […]
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We’re just getting to the point where we’re producing videos for EZ Elder Law. There are, after all, only so many hours in the day. This video published on September 17, 2023, runs through basic Medicaid eligibility in Georgia under the 2023 rules. It focuses on nursing home Medicaid and home health Medicaid. Slides for […]
Join the Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) for Medicaid and Children’s Health Insurance Program (CHIP) Renewals webinars focused on special populations. This webinar series will provide partners with strategies to reach out to diverse communities and audiences to share information about Medicaid and CHIP […]
In United States v. Florida (Case No. 12-cv-60460-MIDDLEBROOKS/Hunt), decided in the United States District Court for the Southern District of Florida on July 14, 2023, the Court found that unjustified institutionalization of individuals with disabilities is unacceptable. The Court’s opinion included the following case overview: The children at issue here are under 21 years old […]
The FDA has approved Leqembi (Lecanemab) for patients with mild dementia and other symptoms caused by early Alzheimer’s disease. Approval followed a determination that a confirmatory trial verified clinical benefit. Leqembi is the first amyloid beta-directed antibody to be converted from an accelerated approval to a traditional approval for the treatment of Alzheimer’s disease. In […]
Until recently, the IRS has said little (if anything) regarding whether assets the beneficiary of an irrevocable trust receives get a step up in basis following the Grantor’s death. With issuance of Revenue Ruling 2023-2, that has changed. The IRS has spoken. In RR 2023-2, the IRS posed the following hypothetical which I’ve edited slightly: […]
In PR v. Division of Medical Assistance and Health Services (NJ. App. Div. 6/8/2023), the State was authorized to recover Medicaid benefits incorrectly paid. It was not, however, authorized to play fast and loose by withdrawing a waiver of a portion of its claim as part of the Commissioner’s review. Peter and Uma, an unmarried […]
The collateral estoppel (issue preclusion) rule is part of the finality doctrine along with Res Judicata (claim preclusion). It general prevents a party from re-litigating the same issue in a second court. In other words, you don’t get a second bite at the apple in another court simply because you were dissatisfied with the result […]
The SSI rules are a good beginning point because Medicaid cannot impose rules more restrictive than the SSI rules. SSI excludes burial funds up to the exemption limit which is currently $1,500 for the applicant and the applicant’s spouse. POMS SI 01130.410. Burial funds can be: revocable burial contracts; revocable burial trusts; other revocable burial […]
Obviously, if you follow the law, get a license and have the event officiated, you’re married. See O.C.G.A. § 19-3-1 (Requiring parties able to contract, an actual contract and consummation according to law). And with marriage goes the benefits and liabilities. Although not a traditional case, Justice Kennedy concluded Obergfell v. Hodges with the following […]
The following is a mishmash of information on various Elder Law, Special Needs Law, and Estate Planning issues. It also includes anything else we found interesting during the month of June, 2023. We will continue updating from time to time throughout the month. Last updated 6/8/2023. Keep in mind, you are using linked content at […]
In McGee v. State Dep’t of Health Care Servs., 2023 Ca. App. LEXIS 409 (Cal. Ct. App., 3d Dist. 5/24/2023), Diana McGee established a special needs trust under the provisions of 42 U.S.C. § 1396p(d)(4)(A). This followed a malpractice action and settlement. Dianna suffered from short bowel syndrome, which impaired her ability to care for […]
“In general, in order to maintain an action, a party “must establish standing to sue on the ground asserted, which requires showing an injury in fact that was caused by the breach of a duty owed by the defendants to the plaintiffs and that will be redressed by a favorable decision from the court.” Ames […]
In L.U. v. Division of Medical Assistance (N.J. Superior Court Docket A-2937-20, May 23, 2023), the Superior Court affirmed denial of L.U.’s request for a fair hearing. How, you ask? “I thought everyone had a right to a fair hearing!!! Well, apparently not. L.U. was an unrepresented Medicaid recipient. He appealed from a May 11, […]
In Henderson v. Dept. of Health and Human Services (May 18, 2023), a Medicaid applicant transferred significant resources, including the full value of her retirement account, to an irrevocable trust. When she applied for Medicaid during the 60 month look back period, the Medicaid agency found the resources were not countable, but imposed a transfer […]
The following Georgia Medicaid cases were litigated outside the context of an administrative hearing, or were appealed beyond that point. Of course, we are not representing there are no other published decisions on point. United Cerebral Palsy of Georgia v. Ga. Dep’t of Behavioral Health and Dev. Disabilities, 331 Ga. App. 616 (2015). A provider […]
July 18, 2011 Paul A. Kryglik, Director Office of Regulations Social Security Administration 6401 Security Blvd Baltimore, MD 21235 Re: Program Operations Manual System SI 1120.220, cash loans Dear Director Kryglik: I am requesting a ruling from your office on an issue involving Program Operations Manual System (POMS) SI 1120.220, cash loans, with respect to […]
On May 4, 2023, the Department of Community Health announced the new state-wide average nursing facility private pay rate increased from $9,034.00 to $9,584.00. This rate is the divisor when calculating the length of a transfer penalty when resources or income are transferred for less than fair market value.
When applying for Medicaid, the nursing home spouse (called the Institutionalized Spouse) is often a joint owner (or sole owner) on checking, savings and other acounts. Should those resource be taken out of the name of the Institutionalized Spouse? The answer is generally “yes,” but it requires some context and some qualifications. The context and […]
In the Matter of the Medical Assistance Pooled Special Needs Trust of Scott Hewitt (Iowa 2023), the State Medicaid agency had a contigent interest in the trust remainder due to the payback requirement in 42 U.S.C. § 1396p(d)(4)(C). However, after the beneficiary died, the master trust informed the Department that it would retain the remainder, […]
One of the most fundamental, but often overlooked issues when planning for – or evaluating – Medicaid eligibility is this: Medicaid does not alter property rights, contract rights or other legal rights with value. Medicaid simply measures those rights to determine whether they cause an applicant to be eligible or ineligible. In other words, if […]
Each year, most Medicaid eligibility limits are adjusted for inflation. The 2023 Georgia Medicaid income and resource limits are: SSI Medicaid: Income: $914 per month, Countable Resources: $2,000 QMB Medicaid: Income: $1,235 (100% FPL + $20), Countable Resources: $9,090 SLMB Medicaid: Income: $1,478 (120% FPL +$20), Countable Resources: $9,090 CCSP/EDWP/Nursing Home Income Cap: $2,742; Applicant […]
As of this writing, the following pooled trusts are authorized by the Department of Community Health to provide trust services in Georgia: Georgia Community/Trust/Bobby Dodd Institute Anita Gardner Decatur, GA 404.809.2914 Anchor For Special Needs, Inc. Annie Warner Cincinnati, OH 844.526.2467 Advocates and Guardians for the Elderly & Disabled (AGED) Thad A. Joseph Longwood, FL 888-277-1826 The Center […]
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 […]
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
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 […]
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. […]
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 […]
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 […]
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 […]
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 […]
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 our August 26, 2022, News Roundup, we reported that Talevski v. Health and Hospital Corporation of Marion County (HHC) was headed to the Supreme Court. The case concerns the rights of nursing home residents. The Plaintiff argued the nursing home violated his rights under the Federal Nursing Home Reform Act (FNHRA). The nursing home […]
The Centers for Medicare and Medicaid Services (CMS) regularly records and posts informational workshops on a variety of subjects. For example, the workshop recorded on August 2, 2022, regarding Social Security addresses a range of retirement issues for students. To participate live, or to hear a previously recorded program, you will need to create a […]
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 […]
Medicaid beneficiaries cannot “fix” eligibility by giving away resources. A transfer of resources without receipt of fair market value will trigger calculation of a transfer penalty. “The penalty for an institutionalized individual consists of ineligibility for certain services for a period or periods of ineligibility that equal the number of months calculated by taking the […]
