The History Channel looks at the Great Depression and the birth of Social Security.
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This CMS webinar explains Medicare administration, eligibility, covered services, and reimbursement.
Being sick or impaired is not enough to qualify for Social Security Disability. Under the Social Security Act, whether you are seeking disability or Supplemental Security Income, “disability” means you are not able to engage in any substantial gainful activity (SGA) because of a medically determinable physical or mental impairment(s) that is either: Expected to […]
Many people believe Medicare will pay for their long-term care costs. That’s not true. Medicare will pay for UP TO 100 days if you had a qualifying hospital stay, if you are discharged to a nursing home for skilled therapy, and then only while you’re receiving skilled therapy. See Center for Medicare Advocacy, Medicare Skilled […]
The Centers for Medicare and Medicaid Services (CMS) discusses different parts of Medicare.
The Administration for Community Living announced that it will host a Medicare Virtual Fair on Wednesday, June 23, 2021 Open 3:00-7:00 PM ET. Agenda and Registration (available in English and Spanish) This virtual fair is for people turning 65, retiring, or joining Medicare because of a disability. Learn about Medicare and all its parts to help […]
The Massachusetts Supreme Court recently limited Medicaid estate recovery claims to three years as discussed in the following video:
The following resources appeared in a post by the Consumer Financial Protection Bureau sent at 04/26/2021 12:00 PM ED. We are re-posting them for your convenience. Misadventures in Money Managament (MiMM): MiMM is a virtual learning experience that fills a critical gap in financial education topics for all servicemembers. The training uses the style of […]
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 […]
The Veterans Health Administration has posted a video series called Gerofitexercise. https://www.youtube.com/hashtag/gerofitexercise This seven episode series features different low-impact exercises designed to keep you healthy and fit. We’ve posted one below so you can check it out.
If you’re trying to stay current on the law, you can sign up for email alerts from Justia, or you can search their blogs or topic oriented facebook pages. For example, check out their Public Benefits Blog or their Georgia Law Updates Facebook Page. To receive the summaries, subscribe by email at daily.justia.com. You can […]
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/ […]
“With the memory of the pandemic’s toll in nursing homes still raw, the COVID-19 relief law is offering states a generous funding boost for home- and community-based care as an alternative to institutionalizing disabled people.” However, funding for the current bill is temporary, “raising concerns it will have just fleeting impact…” For the full story, […]
Medicaid, just one of the sets of rules applicable to most older adults, is one of the most complex laws ever enacted. Even Judges have difficulty understanding it. What follows are a few quotes from court decisions: “The Social Security Act is among the most intricate ever drafted by Congress. Its Byzantine construction, as Judge […]
The husband died six months after the decedent. The decedent had required nursing home care, and she received Medicaid assistance to pay for the care. The estate’s personal representative allowed $ 63,880 as a claim against the estate but disallowed $ 44,533. The county contended that it was entitled to full recovery because the value […]
Plaintiffs were a group of couples with one spouse in the nursing home and other spouse still in the community. In each case, the Community Spouse was the beneficiary of a Community Spouse Annuity Trust (“CSAT”). Some institutionalized spouses had been denied Medicaid, while others had applications pending. The Plaintiffs challenged the State’s treatment of […]
Guardians of two nursing home residents brought suit contending that the State erred by beginning a transfer penalty on the first day of the month after a transfer, rather than on the month of the transfer. The Court found the claims barred by the Eleventh Amendment. It dismissed the remainder of the Complaint for failure […]
Hazel Wilson and her husband executed and funded a revocable living trust in 1991. The trust became irrevocable at her husband’s death in 1998, forming an A/B trust. Hazel had access to the principal and income from trust A, but only the income from trust B. In 1999, Hazel transferred $636,638 in property to her […]
Carl Bergman had an annuity account which he transferred to his wife after he was admitted to a nursing home. After Lucille, his wife, was diagnosed with cancer, she gifted those assets to their children. Following Lucille’s death, the State filed an estate recovery claim in Lucille’s estate relating to payments made for Carl’s care. […]
Prior to his death, Harold Ullmer was on Medicaid. At his death, Harold and his wife, Agnes, owned their home in joint tenancy. Agnes continued to reside in the home. The State recorded a notice of lis pendens against the property, and filed a petition seeking to impose a lien in the amount of $144,475.76 […]
Beverly Tutinas’s husband, Julian, was on Medicaid, but she was not. When Beverly died owning a home valued at $69,641.89 and a car worth $2,000, the state of Illinois filed a claim against Beverly’s estate, seeking to recover what Medicaid had invested in Julian’s care. The court found that, although the state clearly had a […]
Seeking to increase the Community Spouse Resource Allowance (CSRA), the Staffords conveyed their home to a trust. After Mr. Stafford was institutionalized, the trust conveyed the home to Mrs. Stafford. The purpose of the transaction was to make the home countable during the resource assessment, thereby increasing the value of the marital assets; in Idaho […]
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 assets, Josephine purchased a $250,000 single premium immediate irrevocable annuity from General Electric Assurance Company. She then purchased a new vehicle for $8,550 and filed […]
HUD provides capital advances to finance the construction, rehabilitation or acquisition with or without rehabilitation of structures that will serve as supportive housing for very low-income elderly persons, including the frail elderly, and provides rent subsidies for the projects to help make them affordable. The Section 202 program helps expand the supply of affordable housing […]
Greene appealed denial of his application for Medicaid. The denial was affirmed by an administrative law judge. After review, the Commissioner adopted the findings of fact of the ALJ. The Commissioner addressed Greene’s specific arguments by explicitly noting the underlying evidence in the record supporting the ALJ’s decision and citing two cases: Atkinson v. Ledbetter […]
In Cruver v. Mitchell, Medicaid had paid many of Mitchell’s expenses until shortly before the hearing. Appellants, however, had decided to stop her benefits and “just pay for [the expenses] out of pocket,” using money from Mitchell’s bank accounts. Appellants explained that they removed their mother from the Medicaid program so that the State would […]
The undisputed record shows that in April 2004, Gladowski qualified for Medicaid assistance to pay for nursing home care, but the Department of Community Health delayed her benefits until September 2006 on the ground that Gladowski improperly transferred assets to qualify for Medicaid coverage. Gladowski appealed the decision to an administrative law judge (ALJ), who […]
White, a British citizen and a legal permanent resident of the United States entered the United States in 1991.She was issued a green card and resided in the U.S. continuously. When she applied for Medicaid, she was denied eligibility because she had not resided in the U.S. cotinuously for five years as provided for in […]
The Georgia Supreme Court granted certiorari to consider whether the Court of Appeals properly interpreted 42 USC § 1396p with respect to whether a Medicaid applicant’s purchase of an annuity was subject to an asset transfer penalty. In this case, the Georgia Department of Human Services, Family and Children Services (“DFCS”) granted appellee Jerry L. […]
In November 2002, Mrs. Medder’s husband died. Her husband left her real estate and personal property in his Will. In May, 2003, Mrs. Medders filed a renunciation and disclaimer “renouncing” the gift in her husband’s Will. Less than three years after the renunciation, Mrs. Medders applied for Medicaid. When Mrs. Medders applied for Medicaid, the […]
Richard J. Medalie, brought suit under the Medicare Secondary Payer statute (the “MSP”) against the drug companies that developed, manufactured, and marketed the drug Baycol. Following its decision in Stalley v. Catholic Health Initiatives, Nos. 06-3884, 06-4121, 2007 U.S. App. LEXIS 27331, 2007 WL 4165751 (8th Cir. Nov. 27, 2007), the Court held that an MSP […]
Margie Mary Anderson started receiving Medicaid benefits on January 1, 1994. She died on February 21, 2004. Prior to Ms. Anderson’s death, benefits in the amount of $99,345.81 were paid to her medical providers on her behalf by the Tennessee Bureau of TennCare. In June, October and November of 2003, TennCare sent letters to Henkel’s […]
Mary Virginia Jones Henkel started receiving Medicaid benefits on July 1, 1991. She died on February 19, 2003. In March of 2003, her Conservator sent the Tennessee Bureau of TennCare a copy of the final accounting for Henkel’s conservatorship. TennCare responded by sending a printout of medical services paid by the State to the conservator, […]
In a “short” order, the District Court adopted the Report and Recommendation of the Magistrate finding that a medical malpractice settlement was not subject to any Medicare repayment or lien. It does not appear as though CMS was a party to the action. Thomas G. Golden of Bainbridge Island, Washington, represented the Plaintiff. Mr. Golden […]
Stalley brought a qui tam action against a group of skilled nursing facilities for failing to reimburse Medicare under the Medicare Secondary Payer Act (MSP). The action was removed and then the Defendants filed a motion to dismiss for lack of Article III standing. Because he was neither eligible for Medicare nor injured, the Court […]
Lakeridge is an Ohio nursing home that participates in Medicare and Medicaid. When it was surveyed, it was found out of compliance with several provider requirements. It was fined a civil monetary penalty of $80,300. The fine was upheld and affirmed on appeal. Among the violations cited were “one violation of 42 C.F.R. § 483.25(h)(2), […]
A Tennessee case decided November 1, 2006, addresses estate recovery for married individuals. In In re Estate of Smith, Mr. and Mrs. Smith had been married for more than 60 years. Mrs. Smith suffered a series of strokes in 2001. She was then admitted to a nursing home in Madison, Tennessee. She predeceased her husband. […]
This is a motor vehicle case where Plaintiff cited Ahlborn, seeking to avoid reimbursing Medicaid. Decedent was injured in a collision on June 30, 2005 and died intestate on July 4, 2005 at age 85. A proposed settlement of $50,000 constituted the defendant’s insurance limits. All medical expenses associated with the collision were paid by […]
In this Medicaid case, the State appealed from a trial court decision. The trial court’s finding that the applicant was eligible for Medicaid was affirmed Reed entered Blanchette Place Care Center in July of 2003. In September, she and her daughter entered into a “personal care contract.” The contract required Reed’s daughter to perform duties […]
Plaintiff contested Medicare’s claim under the MSP statute. Initially counsel informed Medicaid by letter that there was no duty to reimburse Medicare due to the holding in Thompson v. Goetzmann, 315 F.3d 457 (5th Cir. 2002). Medicare responded that even if Goetzmann was relevant, it would not apply to beneficiaries residing outside the Fifth Circuit. […]
Glover v. Liggett Group, Inc. Plaintiff brought a claim under 42 U.S.C. § 1395y(b)(3)(A) to recover funds for the Medicare program attributable to cigarette smoking. The trial court dismissed the claim. On appeal, the court found that “[u]ntil Defendants’ responsibility to pay for a Medicare beneficiary’s expenses has been demonstrated (for example, by a judgment), Defendants’ […]
CMS sought to impose a civil monetary penalty on the successor of a fined nursing home where the successor accepted assignment of the provider agreement rather than going through the certification process for a new provider agreement. This case includes a detailed discussion of the administrative process through which civil monetary penalties are imposed and […]
A community spouse purchased an actuarially sound single-premium irrevocable annuity for $250,000 for the purpose of spending down excess assets so her husband, a nursing home resident, would qualify for Medicaid. Pennsylvania denied eligibility, contending that the annuity was an available asset and that Medicaid eligibility could not be established until that asset was spent […]
A physician brought a qui tam action against two other physicians and several health care providers after a nurse showed him a progress note in a nursing home chart allegedly documenting a physician’s (Lachman’s) review of the chart. The problem was that the resident had died several weeks earlier. After seeing that record, the relator […]
