As a general rule, all countable resources owned by the Institutionalized Spouse are considered available to pay his or her nursing home bills. It does not matter whether the resource is co-owned with someone else unless co-ownership makes it impossible to liquidate the resource. Georgia ABD Manual § 2300 states that resources include cash, other […]
One strategy used when planning for Medicaid eligibility is called “spousal refusal.” It is authorized under 42 U.S.C. § 1396r-5(c)(3). There, the federal statute provides: (3) Assignment of support rights The institutionalized spouse shall not be ineligible by reason of resources determined under paragraph (2) to be available for the cost of care where— (A) the […]
The answer is, yes, maybe. At USA.gov, there are tips for caregiver support including links to programs that could pay you to serve as a family caregiver. That site offers the following insight: A caregiver helps a person with special medical needs in performing daily activities. Tasks include shopping for food and cooking, cleaning the […]
Let’s assume Betty, a widow, will go to a Georgia nursing home in the near future (using 2022 eligibility rules and limits) and has the following resources: A home A retirement account A CD designated for burial in the amount of $14,000 One vehicle Savings of $15,000 Checking of $1,600 In addition to her resources, […]
Several overriding rules control the creation and application of Medicaid eligibility criteria by the states. These rules are applicable to all mandatory and optional coverage groups, as well as all medically needy individuals. First, a state may not impose any eligibility requirements prohibited by Title XIX. Next, the state must base coverage or optional coverage […]
In a recent case (Dep’t of Tenncare 4/20/2022), Appellant’s application for nursing home Medicaid was denied due to ownership of a life insurance policy with a cash value of $2,184.66. She had been under a limited conservatorship since June 2, 2021. The Medicaid application was filed on July 21, 2021. Neither Appellant nor the limited […]
In Geyen v. Commissioner of Minnesota Department of Human Services, 964 N.W.2d 639 (2021), Dorothy Geyen’s application for Medicaid was denied. In 2011, Geyen established two substantially identical irrevocable trusts. Each trust provided that the trustee could not make loans to Geyen and could not make gifts to her. Nonetheless, the Department took the position […]
In American National Life Insurance Company v. Breslouf (Mass. Super. 6/3/2021), a Community Spouse named Julius Breslouf purchased a Medicaid annuity as part of the plan to secure Medicaid eligibility for his wife. The annuity named the Commonwealth of Massachusetts as the remainder beneficiary, followed by his daughter, Jennifer Brouslouf. Mr. Breslouf died before the […]
General News Sources: Oldest person in the US reportedly dies at 115 Supreme Court declines to hear case of Delphi retirees over lost pensions Big pensions are nearly 100% funded, the healthiest they’ve been since 2008 financial crisis Pre-tax vs. Roth 401(k): There’s more to consider than you think Widow’s dilemma: When to claim Social […]
The standards for the 2022 Community Spouse Resource Allowance and Community Spouse Monthly Income Allowance have been updated in the document below:
Gifting is usually a last resort when creating a Medicaid Plan. The reason is gifts trigger a transfer of resources penalty. The Medicaid Transfer Penalty Worksheet can be used to calculate the penalty, but an additional worksheet is helpful when calculating the amount of income a Medicaid applicant must generate to private pay through the […]
Sometime people assume monthly income counts toward the $2,000 resource limit. Assets (anything of value) are either income or resources. ” An asset cannot be considered income and a resource during the same month.” Georgia ABD Manual 2300-1 and 2300-2. See also POMS SI 01110.600 B.3.This confuses many people because they are trying to keep bank […]
Every year the Supplemental Security Income (SSI) benefit rate and Medicaid resource allowances are updated. For 2022, the federal benefit rate increased by 5.9%. There was no change in the SSI benefit rate. The SSI monthly benefit increased to $841. This means the Medicaid income cap increases to $2,523 of gross monthly income. The one-third […]
H.R. 1717, known as the Protecting Married Seniors from Impoverishment Act of 2021, and a companion bill in the Senate (S.1099) would require States to extend Community Spouse Resource and Income allowances to couples needing in-home care. A temporary modification extending these protections was already in place through the Consolidated Appropriations Act, 2021 (Pub. L. […]
What are people talking about when they say you have to “spend down” to become eligible for Medicaid? Well, it can describe two different things. Most of the time elder law attorneys are referring to to resource spend-down where the applicant is trying to get below the resource eligibiity threshold. But it can also refer […]
The spreadsheet included below can be used to help total your countable and exempt resources when evaluating your eligibility for public benefits like Medicaid.
Deeming Terminates After Eligibility Is Established. Four years later, the Duprees were back in Court. At the annual review on February 29, 2012, DFCS denied eligibility due to a failure to submit documentation. The documents were then submitted and eligibility was denied with DFCS alleging petitioner was over resourced. Petitioner had not acquired any new […]
Which Home is the Homeplace? Pernie Dupree entered a nursing home on September 11, 2009. Prior to her admission, she had lived with her husband at 1 Bragg Circle since 1949. The Bragg Circle property was valued at $45,411. After hs wife entered the nursing home, due to his declining health Mr. Dupree moved into his […]
Pooled Trust Subaccount Established for Individual Over 65yo. An 83 year old deposited $12,320 into a pooled trust in August 2008. In November 2008, he applied for Medicaid. His application was denied. The parties stipulated the trust complied with 42 USC 1396p(d)(4)(C), but the Department took the position a transfer penalty should be applied. The […]
Direct Transfer to Disabled Child; Previously Unknown Resource. Applications for Medicaid were filed on November 24, 2008 and January 8, 2009. The first application was denied for failure to provide documentation. The second was approved on April 16, 2009 with assessment of a penalty through 2009. The transfer was directly to a disabled child rather […]
Annuity; Transfer Penalty for Failing to Name State as Beneficiary. Petitioner, a 95 year old nursing home resident, applied for Medicaid on December 15, 2008. DFCS denied eligibility and imposed a transfer of resources penalty because she had purchased an annuity without naming the State of Georgia as a beneficiary. The annuity was irrevocable and […]
Single Premium Life Insurance Contract; Penalty Reversed. On November 5, 2008, Petitioner filed an application to purchase a Single Premium Pure Endowment Life Insurance Contract. She paid $89,500 for the policy which, in five years, would pay her children $91,327. The contract stated there was no cash surrender value and that no benefits would be […]
No Retroactive Application of Policy Changes Permitted; Payments for Renovations to Accommodate Petitioner Permitted; Payments Consistent with Prior Accepted Obligation Permitted. Petitioner was hospitalized with a stroke in 2008, after which she went to live with one of her sons until she was re-hospitalized in November 2008. Thereafter, she remained in a nursing home. Petitioner […]
Direct Transfer to disabled child allowed from date ALS was diagnosed. Petitioner made transfers directly to a disabled child with ALS. However some transfers were made prior to the determination of disability and others were made after the disability determination. DFCS attempted to penalize all transfers since they were directly to the disabled child rather […]
Increase CSRA in Superior Court, followed by Application and Fair Hearing. After admission to a nursing home, but prior to application for Medicaid, the Superior Court in Glascock County issued an order setting aside all of Petitioner’s marital resources for the Community Spouse’s benefit for the purpose of generating sufficient income to reach the MMMNA. […]
The Limit is the Limit, Part 3. Petitioner was originally admitted to Ridgewood Manor, a nursing home in Dalton, and later transferred in July 2007 to Shepherd Hills in Lafayette. Meanwhile, in May of 2007, her Community Spouse was admitted to a hospital and remained either hospitalized or in a nursing home until his death […]
Cash Value of Life Insurance Cannot Be Designated as Burial Fund. Denial of eligibility was affirmed where Petitioner had a life insurance policy with a face value of $25,000 and a cash value of $2,354 because cash value cannot be designated as a burial fund. Note: compare old Section 2312 with current Section 2312. OSAH-Unknown-Teate-3-2008.pdf (March 13, 2008).
When Determining Value, Equity Value is CMV Minus mortgages and Liens. Petition created a revocable living trust in 2006. In July 2006, her granddaughter charged in excess of $30,000 on Petitioner’s credit cards before the granddaughter was hospitalized. Thereafter, Petitioner fell behind on the mortgage and her home was in danger of foreclosure. Petitioner and […]
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 […]
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 […]
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 […]
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 […]
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 […]
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 […]
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) […]
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 […]
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 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 […]
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 […]
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 […]
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