When I first started filing Medicaid applications for my clients back in 1995, a person who needed long-term care services in the home or assisted living but had run out of money could not even apply for Medicaid if their gross monthly income was higher than the “income cap.” Of course, the income cap was well below the amount that was needed to pay for care, which meant that a lot of people couldn’t receive necessary services. Basically it meant that many people who would have done well in a community environment with a home health aide and other support ended up moving into a nursing home, because that was the only setting where Medicaid would pay for them. Or they had to do without care or cobble together a plan in which family members took care of them.
Finally, in 2014 when the State’s Comprehensive Medicaid Waiver went into effect, the income cap was eliminated as a bar to receipt of community & assisted living services. There is a special procedure that the applicant has to use, because the income has to be funneled through a structure called a Qualified Income Trust (QIT), but at least the person can now apply for Medicaid benefits. You can read more about QIT’s in our earlier blogs.
We continue to meet people who haven’t heard this good news. If your family is struggling with how to arrange and pay for long term care, call us for legal advice regarding Medicaid eligibility that fits your specific situation.
For personalized advice about a Medicaid plan call … 732-382-6070
What can you do if your loved one can’t feed himself but the nursing home staff just keep leaving the tray on his table? The Nursing Home Reform Act Residents’ Rights 42 CFR Ä 483 requires that provision of adequate nutrition be part of the services provided to all nursing home residents. The facility must provide adequate services to “attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident, as determined by resident assessments and individual plans of care.” Dietary Services must be included in the Medicaid or medicare daily rate and cannot be billed to the patient separately, and this includes feeding. The facility must provide special equipment if that is what a resident needs to be able to feed him or herself, and in lieu of other certified staff dietary aides, a nursing home may employ a paid trained Feeding Assistants to take care of feeding certain patients who have non-complex feeding needs: ” (i) A facility must ensure that a feeding assistant provides dining assistance only for residents who have no complicated feeding problems.(ii) Complicated feeding problems include, but are not limited to, difficulty swallowing, recurrent lung aspirations, and tube or parenteral/IV feedings.”
I was responsible as legal Guardian for the care of a fellow who was confined to his bed in a nursing home for the last few months of his life due to various illnesses and weaknesses. When I would visit him, I often saw that his meal tray was on his table, the containers were opened, and spoonfuls of food were on the floor or on his bed or on himself. It was apparent that he could no longer hold his spoon. He was rapidly losing weight. The patient insisted that he could feed himself and didn’t need help, but clearly he wasn’t getting the nutrition he needed. Or he’d say he wasn’t hungry – clearly not true, as he ate eagerly when I fed him. I had a discussion with the case manager and they began assigning someone to sit with him and feed him and encourage him to eat.
The family of a nursing home resident is not responsible to feed their frail loved one. This is the facility’s legal duty. Call for a care planning meeting and address this with them if you are told that there “aren’t enough staff” or “not enough time” or “the family needs to do it” or “the patient keeps refusing.”
Call for legal advice about the rights of residents of nursing homes … 732-382-6070
An application for Medicaid benefits cannot be approved before the applicant (and spouse, if any) has completed the spend-down, because benefits are not payable unless the applicant is financially eligible. It is not uncommon for someone to initiate an application for Medicaid without having any idea whether they are eligible or not. The nursing home may start the process; a nonattorney representative may start the process; a hospital social worker may suggest that they apply. They may leave the intake interview with a List of Required Documents, but not be told that they have to spend down to “X” level before the application can be processed. Sometimes, months go by and the hapless applicant is running up nursing home bills without actually being Medicaid eligible because they didn’t “spend down.”
Despite the fact that the regulations of the State Medicaid Manual at N.J.A.C. 10:71-2.2(c) specifically obligate the County Welfare Board to assist the applicant in this process, all government agencies are reticent to provide advisory opinions on what measures will comply with a program’s rules. There may be substantial opportunities to shelter assets for the family, but the CWA cannot be counted on to provide that sort of advice. Also, given the huge volume of cases, there may be many procedural tangles that prevent the applicant from receiving necessary advice through the CWA. Unfortunately, if the applicant sits back and waits for guidance, they may discover that they and their spouse are incurring tremendous financial obligations that they have no good way to pay.
The spend-down may be a combination of expenditures, exempt transfers and replacement of existing assets. The math is precise and until the spend-down is completed, there can be no eligibility. By getting individual legal advice early in the process, an applicant can take advantage of the opportunities that the rules provide to protect his family and achieve eligibility at the soonest possible time.
Call for representation regarding Medicaid eligibility spend down planning …. 732-382-6070
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