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.

NJ 2017-18 Budget Adds Funding for Medicaid Long-Term Care

After the Governor and the Assembly leader resolved their Fourth of July Weekend Budget Kerfuffle, some positivity came out of it for Medicaid long-term care providers and beneficiaries.

Nursing home reimbursements would be increased by $10.5 million, shifting funds from Managed Long-Term Services and Supports (MLTSS). This would be $5.25 million of state funds with an identical federal match. The funds would be distributed by a per diem adjustment based on the increase. Assisted living per diems would also see a moderate increase from $73.13 for assisted living facilities, $63.13 for comprehensive personal care homes and $53.13 for assisted living programs, to $75, $65 and $55 respectively.

The legislature’s budget would also increase the minimum monthly personal needs allowance (PNA) to $50, effective July 1st, 2017. It had been $35 for a very long time.  The PNA is the amount a resident can keep from his or her income to use for monthly personal needs.  This applies to persons residing in nursing homes, state or county psychiatric hospitals, and State Developmental Centers who are eligible for Medicaid or SSI benefits.  We are awaiting a MedComm (Medicaid policy memorandum issued by the NJ Division of Medical Assistance and Health Services) to provide guidance on implementation of this increase.

Trying to pay for nursing home care? Call us to find out the real options with Medicaid eligibility … 732-382-6070

Memory Cafe and Support Group are Great Resources in Union County

Many of our clients are caregivers of elders with Dementia.  They feel shut in taking care of their loved ones, never sure if they can go out together without incident.  Well, here is one option:  Jewish Family Services of Central New Jersey presents the Memory Cafe, on February 9th, March 23 and April 27th from 12 pm to 2pm at 655 Westfield Ave., Elizabeth, where individuals with dementia and their caregivers can enjoy a social outing together with support.  And it’s free!  To go, RSVP at 908-352-8375 Ex. 236.

Jewish Family Services also has an Alzheimer’s Support Group that meets on Fridays at 1 pm, at the same address.  The dates are February 3rd, March 3rd, April 7th, May 5th, and June 2nd.  Check it out!

Care planning for seniors includes care planning for the caregivers.

Call for advice on all facets of elder care planning …. 732-382-6070

 

Block Grants Could Throw Elder Care into Chaos

Since the election, there have been serious plans put out there to radically alter the Medicaid program .  Right now, while it can be hard to get Medicaid without guidance and assistance,  if you meet the eligibility criteria you are entitled to receive certain statutory benefits under federal law.  The benefits provided to every person on Medicaid are paid for through a combination of  state dollars and federal dollars, and each state has a formula for this.

Block grants change this.  Instead of the federal government contributing a certain amount per person, each State would receive a yearly amount (block of funds), and the State would decide how to allocate the funds.  Right now, this is how the Temporary Assistance for Needy Families (TANF) program works. While block grants may provide enough money to help people in good economic times (when enrollment is lower), when times aren’t so great the money won’t go as far, and eligible people might not get the services they would have gotten before.  This could mean waiting lists for nursing home Medicaid residents (creating financial hardship for the nursing home providers), and waiting lists for receipt of home health care services by aged or physically disabled people residing in the community, as well as waiting lists for residential services for people with intellectual disabilities, and less health care for low-income adults and children. Here is the  KAISER FAMILY FUND Block grant analysis

What can we do about this?  I can think of a couple of things.  First, speak out–let your Congressperson know that you don’t like the idea of block grants and you don’t want services for seniors cut.  Second, really think about whether a loved one has put off seeking present or future public benefits that he or she could benefit from. Seniors need to plan for their care and it’s important to seek enrollment before the rules substantively change for the foreseeable future.  If you’re not sure, we’re here to help.

We can prepare and file your Medicaid application. Call us for legal advice about your eligibility … 732-382-6070

County Medicaid Agency Backs Off – Small Business Saved

Recently, a senior client who had a very small business that he ran by himself came to see me in a panic.  He was just making ends meet. His spouse had been on Medicaid in a nursing home for several years, but the county board of social services was now questioning the nature of the business and whether it was a countable resource that should have been spent down.  They were going to  terminate the wife’s eligibility.  “How can I appeal this?” was one of his worries.

The client was distraught, but we helped him to keep a level head.  Our first step was to file for a Medicaid Fair Hearing and make sure that benefits were continued while that administrative appeal was going on. Next was getting more information about this business–did it have any other employees other than the spouse?  What equipment or real estate was owned by the business?  How were taxes handled–could we see the returns?  Did the applicant spouse have an ownership interest in the business?

Once we had this information, it looked like these business activities and the equipment associated with them would fall firmly in the category of excluded resources under the New Jersey Medicaid regulations (N.J.A.C. 10:71-4.4):

“Excludable resources (b) The following resources shall be classified as excludable:  5. Nonhome property that is used in a business or nonbusiness self-support activity that is essential to the means of self-support of an individual and/or spouse, is excluded from resources.   i. Tools, equipment or other items that are used for trade or business and required for employment, including, but not limited to, the machinery and livestock of a farmer, are assumed to be of a reasonable value and producing a reasonable rate of return and are, therefore, excluded from resources.”

Further, under the Social Security Administration interpretive publication (called the POMS), there is no value limit to property that is essential to a trade or business.  It would all be excludable as long as it is in current use. The income the business generates to a community spouse is exempt, regardless of how much.  This is true of all income of a community spouse.

Once we fully disclosed the nature of the business and how it was essential to the spouse’s self-support, the county backed off and reinstated benefits. We could then withdraw the fair hearing.  The client was relieved and thrilled.  He could get back to caring for his wife without this cloud hanging over his head!

The Medicaid regulations are a thorny thicket, but sometimes protection is available if you can just find where it is hidden in there.

If you or a spouse needs Medicaid, but you are unsure about how an active business affects this, give us a call…. 732-382-6070

 

Unsure about VA Burial? Now You Can Inquire in Advance.

Setting up meaningful funeral and burial arrangements is an important component of estate planning and end of life planning.  Many veterans are unsure about whether they or their family members are entitled to burial in a VA Cemetery.  Family members may not realize that  VA burial is a possibility and may miss an opportunity despite the fact that service in the military was very important to the identity of the decedent.  Now, the VA is taking steps to let everyone figure out what burial services are available to veterans and their families well before death.

Eligible individuals are entitled to all of the following: burial in any open VA national cemetery, opening/closing of the grave, a grave liner, perpetual care of the gravesite, and a government-furnished headstone or marker or niche cover, all at no cost to the family. Veterans are also eligible for a burial flag and may be eligible for a Presidential Memorial Certificate.  It’s important to know if your loved one is eligible for this before making alternate arrangements for a private funeral that may otherwise not be needed.

It certainly can be emotionally difficult to tackle the task of making pre-arrangements. However,  pre-planning and pre-funding a funeral will be helpful to the surviving family members who will be struggling with their grief.  In fact, if a person requires nursing home care and will be applying for Medicaid, they can fully pre-fund an irrevocable funeral trust, and the value of that trust will be an exempt asset that won’t preclude eligibility. So whether one seeks to have a VA burial, or one privately paid, these arrangements should be fully explored and planned in advance whenever possible.

Call us about estate planning for veterans and non-veterans alike … 732-382-6070