Lauren S. Marinaro

About Lauren S. Marinaro

Lauren S. Marinaro has been with Fink Rosner Ershow-Levenberg since 2006, and a partner of the firm starting in 2016. She holds a JD and LLM in Elder Law from the University of Kansas. Lauren has been a SuperLawyers Rising Star from 2010-present and is a past Chair of the Elder Law Section of the State Bar Association.

Estate Recovery Bill Limits Medicaid Services That Can Be Recovered

New Jersey expanded Medicaid under the Affordable Care Act, (ACA, also called Obamacare) causing terrific health coverage gains for its residents.  One unfortunate byproduct of Medicaid expansion is Estate Recovery, which can be assessed against any Medicaid recipient over the age of 55.  The purpose of estate recovery is to reimburse the State for Medicaid benefits provided, and typically the recovery is against assets that were excluded from consideration during the beneficiary’s lifetime (such as a residence)

For MLTSS recipients, the recovery is limited to nursing home or home and community-based services (HCBS) and ancillary services, but for ACA Medicaid recipients, all services, including hospital and doctor coverage, could be recoverable. The lien is placed against the assets in the estate of the deceased Medicaid recipient. The Executor of the Estate would need to pay back the lien from estate assets before distributing the remainder to the heirs of the deceased person. This can create an encumbrance against real property, for example.

Sen. Cryan has proposed a bill to conform ACA Medicaid Estate Recovery to MLTSS Estate Recovery.  This is a welcome revision.  People age 55 or older looking for coverage won’t have to think twice about being Medicaid eligible and using Medicaid for their basic healthcare needs.  The New Jersey Chapter of the National Academy of Elder Law a Attorneys (NAELA) wrote in support of this bill and we look forward to its passage.

If this legislation is of interest to you, contact your legislators.

For legal advice concerning estate administration and problems with Medicaid liens, call us at 732-382-6070

Spousal Impoverishment Protections in Medicaid Home Care Program Help All Ages

NAELA has been at the forefront of keeping the Spousal Impoverishment Protections in the Medicaid Home Care Program (HCBS) that were included in the Affordable Care Act.  So far, with great effort, it’s working.

It’s important for disabled people who are under 65 and who meet the nursing facility level of care to recognize that these protections are out there. The “level of care” standard is generally thought of as needing assistance with three of six of the basic ADL’s, called activities of daily living. The disability community worries a lot about the “marriage penalty” in SSI, and this is a real and legitimate concern.  But in New Jersey, if it’s homecare that’s preeminent, marrying your significant other should not necessarily prevent you from keeping your Medicaid/MLTSS benefits.  Spouses are allowed to keep certain exempt assets, and all of their income from working and other sources, without affecting the Medicaid applicant’s eligibility.

Sometimes when a disabled person is used to being on one kind of Medicaid eligibility, they accept what their caseworker says about what they can and can’t do.  Never take what a Medicaid worker says at face value!  Speak with an elder law attorney and get that critical second opinion.  You may not even realize what creative planning options are out there!

Call for advice on Medicaid applications, asset protection and appeals ………. 732-382-6070

Eliminating the Medical Expense Deduction Will Harm People Who Are Chronically Ill

House and Senate Republicans have approved their plans to reform the tax code and are currently in a conference committee. The House legislation calls for ending the medical expense deduction (MED). This proposed change will cause major disruption to individuals and families trying to privately pay for the catastrophic costs of long-term services and supports (LTSS).

The MED has been in the tax code in one form or another since 1942, at  26 U.S. Code § 213  .  

Elder law attorneys are intimately familiar with it because they have a front-row seat to their elderly clients’ chronic illnesses and long-term care expenditures as well as the special medical and remedial care expenses of individuals with disabilities. In my work as an elder law attorney, I deal with this tax deduction every single day, usually to reassure my clients that they will probably be able to offset the taxable income from, say, their IRAs or 401Ks,  with their substantial deductible nursing home expenses and minimize the tax consequences of paying for long-term care (LTC) themselves.

Right now, the MED is used for a variety of expenditures and situations. Taxpayers can deduct medical expenses in excess of 10 percent of their Adjusted Gross Income for the 2017 tax year. The Senate tax bill actually lowers this threshold back to 7.5%.  The MED can be used when people are:

  • Trying to afford their health insurance premiums, co-pays, and deductibles
  • Paying for the cost of childbirth and post-natal care
  • Paying for their own LTC or the LTC of a dependent child, parent, or other relative
  • Paying for assisted living
  • Paying a Medicaid cost share to a facility
  • Using pre-tax accounts for catastrophic medical expenses when they have no insurance or insufficient insurance coverage
  • Paying for home accessibility for disabling conditions
  • Paying for dental work, which is critical to long-term health
  • Paying for toxic lead or mold remediation
  • Paying for drug abuse rehabilitation for their dependent relative
  • Paying for additional ABA for a child on the autism spectrum

Our current long-term care system is driven by Medicaid, a means-tested program, and it sometimes acts as a disincentive for the middle and working class to save. Perversely, many middle- and working-class individuals who develop a chronic illness would have been better off had they not saved at all, thereby allowing them to qualify immediately for Medicaid. Clients express this frustration to us all the time. The MED acts as a key counterweight to that disincentive by substantially expanding the length of time someone could pay privately before needing government assistance.

The House Republican Tax Reform plan takes this important tax incentive away without any appropriate justification. Elder and special needs law attorneys are leading the way in educating and persuading stakeholders and the larger public  to fight back against removing the MED.

Read more about the Medical Expense Deduction for the Chronically Ill.

This post first appeared on the mailing list of the National Association of Elder Law Attorneys (NAELA): View the original online here.

Call us for advice about long-term care planning, nursing home care and elder law . 732-382-6070