True or False? try this New Jersey Medicaid Quiz

Test your knowledge about nursing homes and the Medicaid-MLTSS program that pays for nursing home care, assisted living and part-time home care.

  1. Does a person’s monthly income have to be less than $2,313 (2,349 in 2020) to apply for Medicaid-MLTSS?
  2. Will the State take one-half the house if a married person moves into a nursing home?
  3. Does a married person have to sign over or pay one-half  of the couple’s assets when the ill spouse moves into the nursing home, before applying for Medicaid-MLTSS?
  4. Does a nursing home resident have to allow a nursing home to auto-debit his bank account every month?
  5. Does a nursing home resident have to hire the Medicaid application compiler who is recommended by the nursing home business office?
  6. Is $15,000 per year an excluded gift under the Medicaid-MLTSS transfer penalty rules?
  7. Is it illegal for a nursing home resident to use his money to make gifts to family members or set up trusts for family members, if he is paying for his care?
  8. If a Medicaid-MLTSS applicant transfers his house to his disabled child, will he be denied Medicaid benefits?
  9. Does the State put a lien on the house while a NJ Medicaid-MLTSS recipient is alive if all benefits are properly received?
  10.  Is there an upper limit on the income that the community spouse of a NJ Medicaid -MLTSS recipient can have in New Jersey?

The answer to all these questions is No!  However, myths abound, and people may be surprised to learn how they can actually protect assets in these situations.

For more information about the requirements of the MLTSS program and how to work with them for your benefit, about how you or your loved one can become eligible for Medicaid or protect your assets if nursing home care is needed, call us at ……. 732-382-6070

New 2020 NJ Medicaid numbers just released

The NJ Division of Medical Assistance and Health Services (DMAHS) has just released Medicaid Communication #20-01 which provides the new numbers that are relevant to applications for Medicaid Long Term Services and Supports (MLTSS) benefits.   20-01_Medicaid_Only_Standards         MLTSS pays for nursing home care (skilled nursing facilities), Assisted Living Facilities and part-time home care for eligible individuals. Eligibility is based on income, resources, and clinical condition, and if eligibility is established, a determination is made about whether to delay the start of benefits due to transfers/gifts that were made during the 5-year look-back.

For a married couple, available non-excluded resources owned by the applicant cannot exceed $2,000. At the time of application, the available non-excluded resources owned by the community spouse cannot exceed $128,640 (the limit was $126,420 in 2019) or half the amount that the couple owned when the applicant became institutionalized, whichever is less. This is the CSRA or Community Spouse Resource Allowance. The CSRA need not be less than $25,728 ($25,284 in 2019).

After approval, the applicant can retain some of his/her monthly income as a Personal Needs Allowance (“PNA”). The new 2020 amounts for the PNA are as follows:  Skilled Nursing Facility – $50; Assisted Living – $116.35; Home Care $2,349.

Applicants whose income exceeds a certain limit (sometimes called the “income cap), are required to establish a Qualified Income Trust (QIT) for their excess income. There are no formal regulations and the program requirements are very tricky. The new income threshold that requires a QIT, ” in 2020 is $2,349.

In 2020, applicants in Assisted Living Facilities must have monthly income of at least $816.70, which is the room and board fee.

As readers of this blog are aware, the MLTSS program contains numerous legal traps for senior planning and and obtaining benefits for individuals with disabilities, but careful planning can preserve the assets and protect the applicant and their family while achieving eligibility and avoiding the tremendous risk of unpaid nursing home bills

Call for individualized legal advice and assistance with Medicaid applications and asset protection planning …………. 732-382-6070

Ways that the NJ Ombudsman can be helpful in nursing home problems

New Jersey has a state-level Long-Term Care Ombudsman (LTCO), previously known as the Ombudsman for the Institutionalized Elderly whose mission is to protect the rights of individuals who reside in facility settings which are nursing homes (skilled nursing facilities), assisted living facilities, group homes and continuing care retirement communities. Each of these facilities is highly regulated under state and federal statutes and regulations. Residents’ rights are established by law and readers of this blog are aware of many of these rights. When there is a dispute with the management of a facility which isn’t getting solved informally by the representative of the resident (whether that’s the resident’s spouse, adult child, guardian or lawyer, for example) and the internal lines of communication just don’t seem to be working, sometimes the answer is to contact the Ombudsman for intervention.

The process generally begins by making a phone call to the Ombudsman’s toll-free number which is 1-877-582-6995. Prepare a very concise version of the story so as to focus the Complaint. An example from a case I handled many years ago was this: “the resident lives in XYZ nursing home and wishes to move out to a different nursing home in another county, and she  has repeatedly requested that medical records and summary sheet be faxed to the potential new facility but the XYZ Director refuses to honor the resident’s request.” One call to the Ombudsman’s office got that problem solved in a flash.

There are many useful publications that they can provide to you. Click here.

Keep in mind that the role of the Ombudsman’s office is to solve disputes between residents and facility management or staff so as to safeguard the resident’s rights vis-à-vis the facility’s policies or conduct. Don’t expect the Ombudsman to be able to intervene in inter-family disputes, which sometimes do occur related to visitation, access and fiduciary responsibilities. For problems like that, a different strategy will be needed and mediators, family counselors, trusted advisors and attorneys may all play a role.

Call us for advice and assistance on elder care and long-term care planning and quality of life planning ………. 732-382-6070

Update on Irrevocable Funeral Trusts and Medicaid Eligibility

Earlier this year I wrote about problems that are cropping up for Medicaid applicants who purchased irrevocable funeral trusts. The problem is that certain County Boards of Social Services were/are counting some of the dollars in the irrevocable funeral trust as if they are available resources (assets). The theory was that the items are ‘for the living,” and not “for the funeral of the deceased.” The result is that a Medicaid applicant thinks he is eligible for MLTSS to pay for his nursing home care, but his application is rejected for “excess resources.”  This can cause catastrophic consequences, considering as the cost of a nursing home in New Jersey is at least $12,000 a month and the decision is received months after the expected date of eligibility, leaving the individual (and his spouse) exposed to enormous bills. Such a decision by a county welfare board creates a legal problem that requires adept legal representation to address.

Recently, one county advised us that the following items are “disallowed:”

  • Acknowledgement cards- $10
  • Crucifix- $25
  • Flower Car- $350
  • Gratuity- $30
  •  Limo- $425
  •  Register Book- $25
  • Specially:  Prayer Cards- $50

When you are setting up an irrevocable prepaid funeral trust, discuss these details with the funeral director and try to obtain current guidance from the funeral director or an elder law attorney regarding what will or won’t cause a “Medicaid eligibility problem.” The State issued a policy memorandum, but it does NOT inform the public of what the consequence is of making a mistake of this sort. This is an example of the numerous legal traps that are embedded within the MLTSS program and aren’t always obvious on the surface to people who are filing applications. Although appeals are possible (Medicaid Fair Hearings), it would be preferable if people could know in advance exactly what the rules are so they can plan accordingly.

Call for advice on NJ Medicaid eligibility, applications & appeals …..732-382-6070

Planning for Later

A long-term client of mine called to tell me that he had just learned that he had a terminal illness – it was a medical problem that appeared suddenly appeared. He was about 70 and his wife about the same. Their children were self-supporting adults, out of the house. Both he and his wife were retired – he was collecting Social Security and a pension. He had always handled the family finances. The house was paid off. His wife had a lot of local friends and many volunteer activities that she enjoyed. She was frantic and had become depressed, as she couldn’t stop thinking about the space in her future that would be so empty and how she would manage things. She was paralyzed with fright. When she thought about the future, all she could see was jumbled chaos.

The husband brought his wife with him to meet with me. We talked about the survivor’s benefit on his pension and the bump-up in Social Security that she would receive. We looked over the assets and showed her how they would transition to her ownership and would not be lost. We sketched out a plan of steps to be taken “when the time comes,”  and we reviewed and updated their powers of attorney, health care proxies and Wills. We talked about ways she could keep him comfortable at home at the end, and what benefits could help with that. We discussed hospice and when it would make sense to bring in that support. The husband dictated his wishes for his funeral arrangements, which were typed up for his signature. We also mapped out the budget  so that his wife could see that she could comfortably remain in the house “afterwards.”

By focusing on a set of specific decisions and steps in an orderly way, my client’s wife became less afraid for her future. Sad, yes, but less afraid and less worried. She felt more confident that as they began moving through this terrible transition, she would have a framework for decisions and would know how to approach each decision as it became necessary.

Careful planning can prevent a crisis. Call us for advice on elder care and end of life planning….. 732-382-6070