COVID Emergency Highlights Importance of POLST

One of the most heartbreaking things about this emergency is the prohibition of in person visitation of loved ones who were already declining in facilities.  Communication with facilities is less than ideal.  Now, more than ever, healthcare workers need to know where legal decision-makers stand on treatments and possible interventions, because one never knows when COVID-19 will take hold.

The Practitioner Order for Life Sustaining Treatment (POLST) is a universal doctor’s order that lays out what treatments and interventions are permitted for a person in the last years of his or her life. It is signed by the individual or his or her legal representative, and the physician, nurse practitioner or physician’s assistant.  It can be filled out and signed over the phone.  It can be updated.  The most recent POLST always controls.  POLST is designed to follow the resident to any subsequent setting, such as a hospital, or hospice.

Of course, the first step of all of this is to determine the resident’s competence to sign a POLST, and subsequently, if the resident is not competent, to determine who the legal medical decision-maker is. The social service department should conduct a telephone conference with the decision-maker to make, reconfirm or update the POLST.

These issues are upsetting and difficult but we’re here to help. Call 732-382-6070 and ask for a “FREL at Home” telephone consult.

 

 

COVID-19 Emergency Means Making Tax and Insurance Decisions

As COVID-19 affects employment nationwide, more New Jerseyans will need to make strategic decisions about health insurance and tax filing this year.  Marketplace insurance and MAGI Medicaid are based on your 2020 Modified Adjusted Gross Income (MAGI).  There is special enrollment for a change in employment status. MAGI will include any unemployment you collect as well as any distributions from retirement plans (but not loans from those plans).  When you apply, you are essentially giving the government an “honest guess” of your income for the year, and if your guess is off, it will be reconciled on your 2020 return in the first quarter of 2021.

How you file your return is also a strategic decision.  If you’re under 26, it might not have mattered that your parent claimed you as a dependent, because you were on their insurance.  Now, there is the possibility of a cash payment under the CARES Act, and the parent may no longer have a health plan that can cover you.  So, filing your own return for 2020 and getting Marketplace or Medicaid insurance needs to be immediately considered.  Additionally, now that the filing deadline has been extended to July, you may want to review your dependent status on any 2019 return as well.

As if things weren’t complicated enough, you might be able to change your MAGI income with a strategic 401k distribution to put you in an income bracket outside of Medicaid eligibility but within income limits for Marketplace insurance subsidies.  This might be best if you’re over 55 because Medicaid would put a lien against assets at death for those amounts they laid out–private insurance doesn’t do this.

In short, it’s a lot to take in; and frankly, it might be time for a family meeting!  We’re here to help!  Call 732-382-6070 and ask for a “FREL at Home” telephone consult!

County Surrogates Modify Hours and Practices in Response to COVID-19

Much of our work in the area of guardianships, probate and estate administration involves our County Surrogates.  As we continue to adjust to working with COVID-19, be aware that each Surrogate Office is adjusting their hours and policies to deal with the pandemic. The overview of changed hours and policies in each county can be found here.  In Union County, the new hours are Mon. & Thurs. 8:30 a.m. – 12:30 p.m. to reach staff by phone and schedule emergent matters.

Court proceedings for uncontested Guardianships are being handled on the papers. The court-appointed counsel files his or her report, the Judgment (Order) is exchanged between the parties and then the Court handles the case on its regularly-scheduled date. In some cases, the Court may hold that hearing by telephone. Our office handled a guardianship case in Essex County last week which involved some unusual issues and the Court decided to conduct a hearing with all the parties present. The Judge was on the bench with his clerk, and six people as well as the Judge called in to the conference from various locations. Witnesses were sworn, oral argument was made, testimony was taken, the Judge issued the ruling. All by telephone and it worked out very well for everyone concerned.

We continue to keep in touch with Union, Middlesex and other Surrogate’s Offices to facilitate mail in and email qualifications for guardians, executors, and administrators, as well as all related necessary filings with this office.  Thank you County Surrogates!

We’re here to help!  Contact 732-382-6070 and mention “FREL at Home” for 25% off the consult fee!

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