Applications for Medicaid/MLTSS are still being accepted at the County Boards of Social Services

Increasing numbers of frail elderly are trying to arrange for care in their houses or apartments because admission to nursing facilities is so problematic at this time. About one third of the state’s skilled nursing facilities are considered to be incapable of appropriately isolating COVID-19 patients, and have been  barred from any new admissions. Of course, arranging for home care is increasing difficult due to a serious shortage of trained personnel who are capable and willing — understandably — to go into a home setting, due to the risk of infection. Geriatric care managers (Aging and Life Care Specialists) can be very useful in establishing a home care arrangement, even in these trying times.

The Medicaid/MLTSS program can provide home and community -based services to financially-eligible individuals who are over 65 or are disabled and who require hands-on care and supervision with 3 or more of their activities of daily living. It is necessary to contact the Office of Community Choice Options (OCCO) to order the Pre-Admission Screening (PAS). Here’s the latest list of offices and contact numbers.  MLTSS and OCCO Contact List 3.20.20

Previously, this evaluation took place at the residence of the applicant. Now it is being done by telephone. It’s very important to order the PAS because an applicant must be clinically in need of these long-term care services in order to be approved for Medicaid/MLTSS services. To do so, first the family/caregiver calls the ADRC (Aging Disability Resource Connection) in their county.  The ADRCs are sort of the portal-of-entry to gain access to many different government programs. The ADRC will complete the first telephone screening.  The ADRC will then send their screening to OCCO.  The OCCO nurse will contact the family to review the initial screening and gather additional information.


Office of Community Choice Options:

While awaiting the PAS evaluation, it’s necessary to address the financial eligibility requirements, which are stringent and complex. Legal sandtraps are everywhere in the process. The application is then filed at the local County Board of Social Services once all of those benchmarks have been reached.

Call for advice and assistance with medicaid eligibility, applications and appeals … 732-382-6070

Health Care Proxies and Advance Directives help Doctors in critical care of patients

The New Jersey Department of Health issued a comprehensive statement concerning triage and the care of COVID-19 patients in different kinds of licensed health care facilities. This is one among many directives issued in the past six weeks. Read the directive here: FinalAllocationPolicy4.11.20v2

As the patient is being treated, many decisions need to be made along the way, often in rapid-fire fashion. The patient may not be able to communicate or make decisions. It is very important that patients or potential patients have a signed Advance Directive, or Health Care Power of Attorney (proxy) so that if the patient loses his or her capacity to make medical decisions, they have an authorized person who can communicate with the medical professionals as critical decisions need to be made. Certain treatment will be rendered automatically as a response to the patient’s emergency, but in areas where choices and decisions need to be made, it’s vital that there be a designated person. A well-written advance directive will be explicit and reasonably easy to interpret. Whenever possible, naming several back-ups to the primary Health Care Representative (decision-maker) is preferable because if the primary person cannot be reached or has become ill, having a backup to make a crucial decision is vital. If the patient is incapacitated, it would be their representative who has the discussions with the doctor or nurse pertaining to filling out the POLST formPhysician’s Orders Concerning Life Sustaining treatment — which is now a regular part of hospital practice..

We will continue to monitor developments that affect the delivery of crucial health care to our clients If you have concerns or a problem, call for a telephone consultation with one of our attorneys…. 732-382-6070

Good Reasons to have a Power of Attorney in Place After Age 18

Once a person turns 18, s/he is presumed competent in the eyes of the law and their parents are no longer actually authorized to sign documents for them. This can create a vacuum especially if the parents have generally been managing everything for this young adult.

At the other end of the spectrum, older adults may not have anybody who actually has any legal authority to handle things for them. This creates a vacuum if the older adult cannot conduct this business on their own anymore. What kind of things need to be handled? Bill paying. Sale of property. Taking out home equity Loans. Closing or opening bank accounts.  Setting up a reverse mortgage. Selling or buying stock.  Decisions about medical treatment. Changing an insurance policy. Collecting financial records to submit with benefits applications. Many people have informal arrangements in place in which a person who is aged or disabled has another person who handles their bills and accompanies them to appointments, doctors, etc. to help them get things done. But those arrangements can only go so far.

In a Power of Attorney document, you select a trusted person who will be authorized to act on your behalf if necessary, and you can name additional back-up people also. The document can be tailored to your personal situation.  The powers of attorney you need are designed to ensure that there is somebody with actual legal authority who can step in when necessary, and that there is a successor as well. We have streamlined the document signing process to minimize in-person contact, and we are doing our legal consultations by telephone.


Call for advice and to set up your power of attorney.We have streamlined the document signing process to minimize in-person contact, and we are doing our legal consultations by telephone. Mention FRE-L at Home … 732-382-6070

Special Needs Trusts continue to be Vital for People with Disabilities

The term “special needs trust” is used to refer to a trust that’s for benefit of a person with disabilities who depends on means-tested public benefits that have income limits or resource/asset limits. Sometimes these are “first party trusts” — created by the disabled person (over age 18) or his parent, grandparent, or guardian with court permission, or by a court, and funded with assets owned by the disabled person. Other times they are “third party trusts” — created by somebody (such as a parent or grandparent) for benefit of a disabled family member, and funded with the parent or grandparent’s assets. Still other times, these Trusts are written into a Last Will and Testament, so that the share being left to the disabled person will be protected within the “special needs trust.”  Now more than ever, families and individuals should review their estate plans to see if trusts are needed.

When an estate inheritance passes to a person who depends on means-tested benefits like SSI or Medicaid/.MLTSS, the individual might lose their benefits after receiving the inheritance because they will have excess resources. This creates a particularly risky situation for a person who receives Supports services through the NJ Division of Developmental Disabilities, because DDD benefits depend upon the person meeting those means-tested criteria. It can also be risky for an individual who receives skilled nursing benefits through the Medicaid/MLTSS program. There are remedies available, such as filing a court petition, but time and benefits can be lost while the remedies are being pursued. And now in this time of court closings due to COVID-19, everything is more difficult to pursue in court. Supreme Court release 3-27-2020

A special needs trust can be written in your Will and can be named as the beneficiary of your tax-deferred account (IRA, 401K, etc.) or your life insurance. The trust can be designated to receive the share of your probate assets that would otherwise go directly to the person with disabilities (causing the problems described above). Careful planning can prevent a crisis. If one of the potential heirs of your estate or your Will is disabled, you may want to review your plans to see if a special needs trust  would be protective for your heir.

Call us for advice about estate planning with special needs trusts …  732-382-6070

More requirements placed on skilled nursing facilities to address the pandemic, but some waivers as well

The State’s long-term care population are caught behind the proverbial rock and a hard place. Despite all efforts, COVID-19 has spread rampantly in the past 5 weeks through many if not most of the State’s long-term care facilities, as you have read in the newspapers and other media. The rules of the road keep changing and it can be hard to keep up with what’s been ordered by the Governor or the CDC, what’s been merely “suggested” by public health officials, and how much leeway a skilled nursing facility has.

The State’s initial directive was issued and effective on March 14. This is the set of mandatory guidelines issued by the NJ Department of Health that curtailed the access of outside personnel including family members of residents, and also prohibited the presence of volunteers. The presence of CNAs who are hired privately by the family is being worked out on a case-by-case basis it seems, as we hear differing reports from different facilities. In several cases, the aides hired by the family were barred; in another case they were allowed.

On April 1st, an additional set of requirements was issued by New Jersey pertaining to the staff and operations of the facilities. The federal Centers for Medicare and Medicaid Services (CMS)  issued guidance to the operators of nursing facilities  on April 2nd.4.2.20 CMS COVID19 Nursing Home Guidance

Written Orders rolled out from Commissioner of Health Perchilli over the next two weeks. 4-4-20 Infection Prevention Assisted Living Guidance Memo 4-7-2020_Hospital_Temp_Waivers_during_COVID-19_StateofEmergency 4-13-20_EmergencyCurtailmentOfAdmissions (1) Facilities were instructed to segregate COVID-19 positive or symptomatic patients into a separate wing; that all staff had to wear protective masks and other gear at all times; and more.  Now the State is looking to transfer residents and to identify specific facilities who will only house and treat COVID-19 patients (residents) until further notice.

In addition, on April 17th, CMS issued a lengthy set of waivers of many regulations pertaining to care, documentation, licensing and record keeping. Pages 9-12 deal specifically with skilled nursing facility issues, and page 11 has to do with allowable discharges of COVID-19 patients to other long-term care facilities.  Covid19-CMS Blanket-Waivers-508C- 2-final 040320_0 

Call for legal advice on how all of these rules and procedures affect your loved one’s situation… 732-382-6070