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 […]
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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 […]
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 […]
Harves V. Rusyniak In Harves v. Rusyniak, 23A-PL-671 (9/26/2023), the Indiana Court of Appeals found that the Family and Social Services Administration (FSSA) missed a step in finding that a trust rendered Natalie Harves ineligible for Medicaid. Harnes and her children signed a number of documents in January 2019 when she was 91 years old. […]
On October 12, 2023, the Centers for Medicare & Medicaid Services (CMS) released the 2024 premiums, deductibles, and coinsurance amounts for the Medicare Part A and Part B programs, and the 2024 Medicare Part D income-related monthly adjustment amounts. The standard monthly premium for Medicare Part B enrollees will be $174.70 for 2024, an increase […]
Sometimes you just have to say No “No” isn’t a four-letter word. Saying “no” isn’t necessarily bad and you shouldn’t feel bad when you say it. Part of saying no means taking a stand. It can mean standing up to injustice. For example, our legal system is, for the most part, dependent on people saying […]
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 […]
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 […]
Medicare includes a nursing home benefit of up to 100 days following a qualifying hospital stay. The Medicare rehabilitation benefit is per spell of illness. On reason we say “up to” is because the Medicare benefit is a rehabilitation benefit and it ends when the need for skilled therapy ends. Historically, that meant Medicare coverage […]
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 […]
Medicare Open Enrollment takes place each year between October 15th and December 7th. During the Open Enrollment period, you can check to see whether you have the right Medicare plan to cover your physicians and pharmaceuticals. You can check to see whether a Medicare Advantage Plan would give you similar or better coverage for a […]
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 […]
During the week of May 1, 2023, the VA updated its Adjudication Procedures Manual to clarify that a claim in which funds were withheld pending a fiduciary appointment is a claim pending at the time of death and may be paid as accrued benefits. The updated section is M21-1, Part XI, Subpart ii, Chapter 3, […]
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, […]
On April 25, 2023, the VA issued the following announcement: The Caregiver Support Program (CSP) is introducing a new nationwide service offering comprehensive legal and financial planning services to Primary Family Caregivers enrolled in the Program of Comprehensive Assistance for Family Caregivers (PCAFC). A network of licensed attorneys and certified financial counselors are readily accessible […]
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 […]
On April 5, 2023, the VA posted (presumably to remind everyone) regarding its comprensive assistance for family caregivers. The VA said “Support for caregivers means making sure you’re informed about the programs, resources, and services available to you. The Caregiver Support Program (CSP) provides clinical services to caregivers of Veterans who are enrolled in the […]
The new Aid and Attendance enhanced pension rates for 2023 are: Surviving Spouse $1,432 Monthly / $17,184 per year Single Veteran $2,229 Monthly / $26,748 per year Married Veteran $2,642 Monthly / $31,704 per year Two Vets Married $3,536 Monthly / $42,432 per year If you qualify for these benefits, the VA will base your […]
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, […]
