Medicaid Stakeholders Attend the Big MAAC

New Jersey FamilyCare’s Medicaid program has many components that serve different population groups of people who are aged, disabled or poor. Did you know that there is a Medical Assistance Advisory Committee (MACC) which meets regularly and is required to hold quarterly public forums? On February 5th, along with other members of New Jersey NAELA, I attended the first MAAC (Medical Assistance Advisory Committee) meeting of the year.  MAAC meets quarterly outside of Trenton to discuss issues related to Medicaid and to take stakeholder input. It was quite a lively meeting.

In the audience there were attorneys, non-profit advocates, members of County Boards of Social Services, representatives of the Medicaid Managed Care Organizations and several Medicaid enrollees.  Here are some of the issues discussed  at the meeting:

— implementation of S499 and how that relates to denials of Medicaid applications for failure to provide certain information;

— Transitioning Medicaid/ MLTSS  recipients from a nursing home to a home in the community and how to assure continuity of care when the person switches from one program to the other;

— reductions in Private Duty Nursing and Personal Care Assistant (home health aide) hours for certain enrollees;

— how enrollees transition from one way of having Medicaid eligibility to another.

— an update on the Coronavirus, and many other topics.

I asked questions and expressed concern about how the State was implementing S499’s provision about giving extensions to applicants to obtain documentation.  I also commented on the importance of planning ahead for Medicare eligibility when a Medicaid recipient is eligible under the ACA.

Stakeholders at the meeting have a chance to ask questions of the state officials who are responsible for the Medicaid program, and they also have a chance to make recommendations for future MAAC meeting presentations.  If you have a concern about the Medicaid program in New Jersey, consider attending these meetings, or bringing them to the attention of your elder law attorney or another organization who can bring the concern to the MAAC.

Call us for advice on medicaid eligibility planning, applications and appeals ……… 732-382-6070

FRE-L Attorneys have been busy teaching Continuing Legal Education

This has been a busy year for the elder law attorneys at our Firm in the realm of community education. We’ve been teaching at programs run by the NJ Institute for Continuing Legal Education almost every month. Among the topics of Linda and Lauren’s lectures were Representing Clients in Medicaid Fair Hearings at the Office of Administrative Law; Getting the Most out of Medicaid/MLTSS Home Care Benefits; Medicare’s Individualized Care Plan Requirements for persons residing in nursing homes; Limited Guardianship and its applications to individuals with intellectual disabilities; preparing and filing Medicaid/MLTSS applications; Ethics in SSI practice before the SSA, and Medicaid from A to Z;     We also spoke at the annual NJ Elder Law Retreat in April. At the November Symposium of the National Academy of Elder Law Attorneys in Washington, DC., Gene Rosner spoke on elder law issues in divorce and Lauren Marinaro spoke about developments in Federal Policy. Our public speaking engagements included Jewish Family Services of Central New Jersey; the Senior Monthly gathering in Cranford; and our frequent seminars at the Clark Holiday Inn.

We enjoy doing in-service training for health care staffs, financial firms and family services organizations. We can develop a talk on whatever elder law subject is of importance to the group.

Call to arrange a speaking engagement or in-service training ……. 732-382-6070

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