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 […]
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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 […]
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 […]
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 […]
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 […]
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 […]
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 […]
In Wilder v. Virginia Hospital Assn., 496 U.S. 498 (1990), the Supreme Court stated: Medicaid is a cooperative federal-state program through which the Federal Government provides financial assistance to States so that they may furnish medical care to needy individuals. § 1396. Although participation in the program is voluntary, participating States must comply with certain […]
In Georgia Department of Community Health v. Medders, 292 Ga. App. 439, 2008 Ga. App. LEXIS 804 (2008) the Court stated the appellate standard of review as follows: “In addressing this appeal, we are mindful of the narrow scope of judicial review applicable to administrative agency matters. A court cannot “substitute its judgment for that […]
TCA 30-2-310 was amended effective April 7, 2021. Tennessee Code Annotated, Section 30-2-310, is amended by adding the following as new subsection (c): (c) Notwithstanding subsections (a) and (b), § 71-5-116, and §§ 30-2-306 – 30-2-309: (1) If the bureau of TennCare receives a notice to creditors as defined in § 30-2-306(b) within twelve (12) […]
The general rule under 42 U.S. Code § 1396p(c)(1) is that any transfer for less than fair market value results in assessment of a transfer of resources penalty. There are, however, exceptions to the general rule. Subsection (c)(2)(A)(iv) is one of those exceptions and it provides that no penalty can be assessed if a home […]
Trust corpus found to be countable ( R.I. Super.) ————————————- Jeanne M. Biagetti established a revocable trust in 1998. According to counsel, it became irrevocable in 2001 when she became unable to manage her own financial affairs. When She applied for Medicaid in 2009, however, the trust was found to be a countable resource and […]
A filial responsibility law is one making relatives financially responsible for the care of another. Virtually every state requires parents to support minor children, but most states do not require anyone to support relatives who are over the age of 18. These laws are antiquated and can be traced back to the Elizabethan Poor Law […]
Cooperative federalism is not license to re-write clear federal rules (Co. App.) Ruth Koehler sued the Department after it terminated her benefits under its Medicaid Home and Community Based Services for the Elderly, Blind and Disabled (HCBS) program. Ruth, an elderly disabled woman, received HCBS as an alternative to nursing home care. Her husband resided […]
Hogberg v. State Dep’t of Soc. Servs., 2009 Conn. Super. LEXIS 50 (2009). Lynda Hogberg was admitted to a nursing home in September, 2004. Two years later, in September 2006, her husband, a community spouse, filed a Medicaid application. The application was denied in March, 2007. In April, 2007, he filed an appeal. On May […]
James v. Richman, 465 F. Supp. 2d 395 (M.D. Pa. 2006). Robert and Josephine James were married when Robert went to the nursing home. A resource assessment was done and Medicaid determined they had $278,343 in available resources. To reduce their resources, Josephine purchased a $250,000 single premium immediate irrevocable annuity from General Electric Assurance […]
The Deficit Reduction Act of 2005, Pub. L. No. 109-171 (Effective date February 8, 2006). The Deficit Reduction Act of 2005 (DRA) changed the Medicaid eligibility rules significantly. Most of the changes are (or will be) codified at 42 U.S.C. § 1396p. DRA lengthened the look-back from 36 to 60 months; changed the start date […]
Harris v. McRae, 448 U.S. 297 (1980). The Medicaid program created by Title XIX is a cooperative endeavor in which the Federal Government provides financial assistance to participating States to aid them in furnishing health care to needy persons. Under this system of “cooperative federalism,” King v. Smith, 392 U.S. 309, 316, if a State […]
CMS: Centers for Medicare and Medicaid Services. Community Spouse The spouse of an institutionalized spouse. 42 U.S.C. § 1396r-5(h)(2). CSMIA: Community Spouse Monthly Income Allowance. This is the amount of the institutionalized spouse’s income that is diverted, if necessary, to bring the community spouse’s income up to the MMMNA. CSRA: Community Spouse Resource Allowance. DRA: […]
On April 26, 2021, in a letter to Senators Brown, Casey, Hassan, and Representative Dingell, the National Academy of Elder Law Attorneys (NAELA) commented on the Home and Community-Based Services (HCBS) Access Act. Among other comments, NAELA supported the proposal’s expansion of the criteria for being medically eligible for Medicaid HCBS. One suggestion was including […]
Video from Pixorize describing Medicare and Medicaid as two different healthcare programs with different functions and beneficiaries.
The Massachusetts Supreme Court recently limited Medicaid estate recovery claims to three years as discussed in the following video:
The Kaiser Family Foundation published a fact sheet indicating that Medicaid spending is concentrated on the elderly and individuals with special needs. “Seniors and people with disabilities make up 1 in 4 beneficiaries but account for almost two-thirds of Medicaid spending, reflecting high per enrollee costs for both acute and long-term care.” “Medicaid is low-cost […]
In April, 2021, Justice in Aging, the Western Center on Law & Poverty, the National Academy of Elder law Attorneys (NAELA), the National Health Law Program, and the California Association for Nursing Home Reform submitted an issue brief to Congress calling for an end to Medicaid Estate Recovery. A NAELA Press Release dated April 16, […]
In 2012, PBS interviewed Phil Galewitz of Kaiser Health News. At that time, he said Medicaid consumes 10% of the federal budget and about 25% of each State’s budget. In that regard, not much has changed. If a State wants to cut taxes, or expand other programs, the Medicaid program is an easy target for […]
In Alexander v. Choate, 469 U.S. 287 (1985), the State of Tennessee reduced from 20 to 14 the number of inpatient hospital days it would reimburse for Medicaid beneficiaries. A class action was brought under Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. § 794), claiming the limitation would have a disproportionate effect […]
42 U.S.C. § 1396 et seq. https://www.law.cornell.edu/uscode/text/42/chapter-7/subchapter-XIX 42 U.S.C. § 1396p https://www.law.cornell.edu/uscode/text/42/1396p 42 U.S.C. § 1396r-5 https://www.law.cornell.edu/uscode/text/42/1396r-5 42 C.F.R. Part 431 https://www.law.cornell.edu/cfr/text/42/part-431 42 C.F.R. Part 435 https://www.law.cornell.edu/cfr/text/42/part-435 42 C.F.R. Subchapter C https://www.law.cornell.edu/cfr/text/42/chapter-IV/subchapter-C 20 CFR 416.1110 et seq. (SSI – Income) https://www.ssa.gov/OP_Home/cfr20/416/416-1100.htm 20 CFR 416.1201 et seq. (SSI – Resources) https://www.ssa.gov/OP_Home/cfr20/416/416-1201.htm Program Operations Manual System https://secure.ssa.gov/apps10/ […]
