Medicaid matters to elders and individuals with special needs because it is the only government program providing substantial help paying for significant long-term care. Yes, some long-term care is paid for by Medicare, but only when there is a skilled need, and usually limited to no more than 100 days. Although anyone accessing this website can view The Medicaid Book, it is primarily intended for attorneys and other professionals interested in understanding Medicaid. We have other pages on this website written in more general terms for non-attorneys. These materials are
presently being updated and chapters will be published as they become available. Once that is done, we will attempt to keep them as current as possible. If you have any questions, suggestions or corrections regarding the content, please refer them to david@ezelderlaw.com.
Chapters
- Chapter 1 – Overview of Medicaid
- Chapter 2 – Eligibility Basics
- Chapter 3 – Financial Eligibility, Generally
- Chapter 4 – Issues When there is a Community Spouse
- Chapter 5 – Working with the Client
- Chapter 6 – Planning with Real Property
- Chapter 7 – Planning with Personal Property
- Chapter 8 – The Medicaid Application
- Chapter 9 – Medicaid Fair Hearings
- Chapter 10 – Post-Eligibility Issues
- Chapter 11 – Home and Community Based Waivers
- Chapter 12 – Medicaid Estate Recovery
- Chapter 13 – SSI Eligibility and How it Relates to Medicaid
Appendix
BLOG POSTS
Burial Resources and Life Insurance
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 […]
Marriage, Living in Sin and Common Law Marriage
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 […]
Elder Law Mishmash June 2023
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 […]
Court Cannot Substitute its Judgment for SNT Trustee’s Judgment as long as the Trustee Act Within Proper Limits
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 […]
Standing in Medicaid and Other Cases
“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 […]
No Right to Fair Hearing Unless You Complain About Something
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, […]
Transfer to Trust Subject to Medicaid Transfer Penalty
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 […]
Selected Georgia Medicaid Decisions
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 […]
Callinan Letter to Kryglik – Cash Loans Must Be Legally Valid Under State Law
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 […]
2023 Georgia Medicaid Penalty Divisor Increases
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.
