Medicaid Planning - Trust and Estate Planning Law Office

Understanding the Medicaid Look-Back Period and Penalty Period

If you need help with paying for healthcare costs and have low-income and limited resources, you might qualify for Medicaid. Medicaid is a federal and state program that offers medical and health coverage for people with low incomes and limited assets who otherwise cannot afford paying for health care. In order to be eligible you must meet strict financial eligibility requirements both during the application process and after you have qualified.

Financial Eligibility Requirements for Long-Term Care Medicaid

Many low-income seniors find that their countable assets and/or income exceed the Medicaid restrictions in their state. They must carefully reduce or "spend down" extra funds on things like medical expenditures, house improvements, a prepaid funeral plan, and so on in order to meet the financial requirements. Gifting—giving away money or assets for less than market value—is not permitted as part of a Medicaid spend-down strategy.

The Centers for Medicare and Medicaid Services (CMS) devised a system for analyzing all applicants' financial histories to prevent seniors from simply giving away all of their assets to family and friends and then depending on Medicaid to pay for their long-term care. The following sections review the ins and outs of the Medicaid look-back period, as well as what happens when a senior decides to transfer assets.

The Medicaid Look-Back Period

Medicaid only looks at applicants' previous financial information for a limited period of time. This is known as the Medicaid Look-Back Period. Each state's Medicaid program has slightly different eligibility standards, but most states look at all of a person's financial transactions five years back (60 months) from the date of their qualifying application for long-term care Medicaid benefits. (This timeframe is only 30 months in California.)

There is no difference between the number of gifts an applicant made and to whom the gifts were given during the Medicaid Look-Back Period—barring a few exceptions, which will be discussed later on. If a senior's money or assets changed hands for less than FMV in the five years leading up to their application date, they will incur a penalty period during which they are ineligible for Medicaid.

The Medicaid Penalty Period

If a senior files for Medicaid and is found to be otherwise eligible, but has gifted assets within the five-year look-back period, they will be prohibited from receiving benefits for a specified amount of months. This is known as the Medicaid Penalty Period and there is no limit to how long a penalty period can be.

For example, if you write a check to a family member for $14,000 and apply for Medicaid long-term care within five years of the date on the check, then Medicaid will delay covering the cost of your care because you could have used that money to pay for it yourself. The penalty period begins running on the date a senior applies for Medicaid coverage, not the date on which they gifted the money.

The length of the penalty period is determined by the total amount of assets gifted by the applicant and their state's specific "penalty divisor," which is the average monthly cost of a long-term care facility in that state. (The divisors may be the averaged daily expenses in some jurisdictions, and several states even employ divisors that are particular to nursing home costs in individual counties.) These figures are published annually by each state’s Medicaid program.

Who Pays During Medicaid Penalty Periods?

When a senior requires care but has spent down all of their assets (inadvertently) and is no longer covered, one might wonder who pays for their care. If a senior has gifted countable assets during the look-back period and needs nursing home care, they will have to pay for it out of pocket until the look-back period is over and the senior can apply for Medicaid without difficulty, or until the penalty period expires and they are eligible for coverage.

Exemptions and Exceptions to Medicaid Gifting Rules

Medicaid penalties do not apply to all gifts.

One exemption you may receive is a “child caregiver exemption” for transferring assets to a child who has taken care of you for at least two full years. For example, if your daughter's care allowed you to put off moving into a nursing home, then transferring your home into her name for less than fair market value would not be penalized. Even if a senior applies for Medicaid within five years after the transfer, the "child caregiver exemption" still applies.

Another exception to the rule is a gift (or the creation and funding of a trust) for a kid who is blind or disabled under the Social Security Administration's standards. No penalty will be imposed on such a gift, regardless of its size.

Finally, gifts between spouses are never subject to any penalties. There is no need to impose a penalty on such transactions because both spouses' entire assets are counted when one spouse applies for long-term care Medicaid.

Successfully applying for Medicaid is a complicated and difficult process, and is rarely something you do on your own. Mistakes can have long-term financial consequences for a family. If you or someone you know plans to apply for long-term care Medicaid, please contact the best elder lawyer who can guide you through the application process at the Law Office of Inna Fershteyn at (718) 333-2395.

How Will a Personal Injury Settlement Impact My Social Security and Medicaid Benefits?

Dealing with an injury that hinders your ability to work is hard enough. Many seek Social Security benefits to help ease the difficulty in times where they are injured but the process is intricate and can come with many hardships in order to receive these benefits. If you were injured in an accident, you are now also able to file a personal injury lawsuit against the party responsible for the accident. This can hinder your benefits that were already difficult to receive and though a settlement may seem nice in a situation like this, you depend on your social security benefits more. Situations like these may seem troublesome but you can seek out the help of a personal injury attorney as well as an elder law attorney as this overlap of your benefits and injury can be complicated. The personal injury attorney can help with a lawsuit for the accident but an elder law attorney has in-depth knowledge of the Social Security benefits and what will affect these benefits so you are not put at risk of losing them.

How much liquid assets can you have for Medicaid and for SSI?

You may be worried about how much liquid assets you can have to be eligible for Medicaid and SSI which include cash, stocks, bonds, and CDs. In New York, In order to be eligible for Medicaid and SSI benefits, you can have up to $2,000 in liquid assets. If you have more, you won’t meet the requirements to receive these benefits, and if you are already receiving benefits, they may be compromised.This is something to keep in mind if you have Medicaid or SSI benefits and want to file for a personal injury lawsuit. Social Security doesn’t depend on work credits and is need-based so it depends on assets. If you receive a settlement for an accident, it can potentially put you over the asset threshold hindering your eligibility for your SSI benefits. It may seem unfair that your benefits may be suspended for receiving a no-fault settlement for your injury, but this is how the system works. These are a few things you should be aware of when deciding between a personal injury settlement or the benefits you need to meet ends meet.

2 Ways To Protect Your Settlement:

A “spend down”: This option is when you spend a good amount of the settlement on resources that are exempt and needed for the benefit of the disabled recipient to ensure you are not over that asset threshold. This is a good option for those who want a simple way of using the settlement money but also helps them while ensuring they are still eligible for the benefits. Some exempt resources include household goods, personal effects, paying off your home mortgage, and paying off any existing debts. These are just a few items that are exempt from being counted as assets and your settlement fund can be used towards them to keep you under the asset threshold.
Set up a Special Needs Trust (SNT): This option is for those who don’t want to go through the trouble of spending the settlement fund but rather just set up a special needs trust. A special needs trust is a trust that is created for you to put your settlement money in and can be used for transportation, certain therapies, and nursing care without hindering your SSI or Medicaid benefits. This is good for those who want to use the funds to help recover from the accident without having to worry about their SSI benefits and Medicaid benefits being suspended, compromised or revoked. This trust can be set up with the help of an Elder Care attorney and will help make the process of protecting your settlement trouble-free.

Both these options are great for those who are considering filing for a personal injury lawsuit, but do not want to risk losing their SSI and Medicaid benefits. You should make sure you proceed with either option that best fits your situation after obtaining a settlement for an accident when you are receiving these benefits. This will help reduce the risk of your benefits being suspended and protect your settlement.

Speak with an Elder Law Attorney

An Elder Law attorney is informed of all current updates to the laws on Medicaid eligibility and SSI benefits eligibility. Unfortunately, Medicaid and SSI requirements can differ from state to state so it makes the process of applying and keeping your benefits even harder. An Elder Law attorney in your area will help simplify this process for you and advise you of all updates to the law and eligibility requirements creating fewer problems on this journey of Medicaid planning and other aspects surrounding Elder Law. Hiring an Elder Law attorney will also ensure that you're still eligible for your SSI and Medicaid benefits even if you plan on filing a personal injury lawsuit. Protecting your settlement will be a priority and an attorney will help you choose the right option to ensure you can still receive your settlement fund without hindering your benefit eligibility.

For further information on how a personal injury settlement may affect your Medicaid and SSI benefits please contact the Law Office of Inna Fershteyn at 718-333-2395 to obtain aid in options to protect your settlement fund and help with any of your Elder law needs.

How Can An Elder Law Attorney Help Me Get Approved for Medicaid?

There are many ways an elder care attorney can help you get approved for Medicaid. Medicaid is a joint federal and state program that covers medical payments, such as hospital care, physician services, and long-term care in nursing homes for individuals with financial need. Individuals of low socio-economic class are unable to cover the costs of medical care out of pocket and therefore rely on Medicaid for aid. Applying for Medicaid is a very difficult and lengthy process, as the questions being asked within the application have great depth and implications for your future. The foundation system responsible for asking the questions that define your eligibility for Medicaid purposely selects specific diction and word choice which may make it challenging for elderly individuals to effectively answer the questions. Answering these questions incorrectly or inaccurately could place your potential coverage in jeopardy, meaning you may not qualify for the aid you need to cover your medical costs. Considering that these questions are the main defining factor when it comes to obtaining Medicaid coverage, family members should seek guidance from an experienced Elder Law Attorney to guide them through this imperative process. The attorney is highly experienced and familiar with New York state’s rules when it comes to long-term care planning and receiving government benefits.The Elder Care Attorney will use her experience in the field to devise the most effective plan in assisting the family by selecting strategies that align with the family’s personal and financial circumstances.

Differences Between Medicaid and Medicare:

Medicaid and Medicare are often confused, as both provide medical coverage to individual applicants. However, there is a grand difference between both programs based on the qualifications and the services provided. Medicaid is directly managed by the state and federal government, which correlates with an individual's income to calculate their estimated extent of need. Medicaid covers low-income individual’s medical care regardless of their age. Medicare, on the contrary, typically applies to individuals over the age of 65, and in some cases covers the costs of medical bills for individuals with disabilities at any age. Medicare patients pay part of the costs through deductibles for hospital coverage and small monthly premiums for non-hospital coverage. Expenses that are not covered by Medicare will have to be paid out of pocket or with the help of a private long-term care insurance policy.

Benefits of Medicaid Coverage:

New York Medicaid benefits pertain to regular examinations, immunizations, and doctor visits. Coverage also extends to medical supplies and equipment, lab exams, X-rays, dental, and vision. Medicaid is beneficial in regards to covering nursing home service payments, hospital stays, emergencies, and prescriptions. Medicaid coverage is extremely helpful for individuals who cannot afford to pay the costs of their medical healthcare independently. This is a great stress reliever and minimizes the pressure on loved ones who worry about paying for their own care or their family members’ care. New York state Medicaid covers essential dental services that are medically necessary, such as extractions to prevent disease. Medicaid will provide a reimbursement for eye examinations every two years and glasses when medically necessary. Medicaid may also cover the cost of contact lenses with prior authorization. Medicaid guarantees that medical professionals will select the most cost effective options when prescribing a patient’s medication, which in most cases is simply the generic brand. Medicaid may also provide reimbursements for over the counter products. New York Medicaid also provides emergency and non-emergency transportation services to beneficiaries.

Medicaid Eligibility Requirements:

Medicaid eligibility depends on your household size and your earned income. An individual with assets and income that exceed the designated Medicaid requirements will not be eligible for coverage. This means that individuals entering nursing homes will be considered private pay residents and must continue to spend down until they become eligible for Medicaid coverage. There is a five year lookback period involved regarding any gift given to heirs,which may result in a Medicaid penalty or completely prevent you from meeting the qualifications of Medicaid coverage. This is established to prevent Medicaid applicants from transferring their large assets to their children and then claiming they have a financial need for coverage. The lookback period is exactly 60 months, which is five years from your application date. The applicant’s home is not considered as assets, but the estate pay be billed for services provided after the individual passes away. Vehicles, household contents, prepaid burial funds, and an IRA or 401(k) plan are all excluded from the asset calculation process that determines if you are eligible for Medicaid coverage. If the applicant is married, then both spouses’ income will be considered in the effort to grant coverage, even if only one spouse is in need of Medicaid. A spouse that will continue to reside in the home when the other spouse enters nursing home care will be able to keep half of the assets with some additional income for support services, as long as this amount meets the maximum quota.

Elder Law Attorney Assistance in Applying for Medicaid:

An experienced and esteemed Elder Law Attorney can assist you in the process of applying for Medicaid coverage in a variety of methods. One such method is guaranteed avoidance of potential penalties that you may have been unaware of had you decided to file for Medicaid without the help of a lawyer. There are numerous questions that seek to identify if the applicant has made any disqualifying transfers that would result in a penalty. The most common question that correlates to the Medicaid penalty prospect is the prompt asking if the applicant has made any gifts or transfers for less than fair market value within the last 5 years. If you hire an Elder Care Attorney, the lawyer will ensure that you do not have any penalties that would prevent you from obtaining the Medicaid benefits you deserve. The attorney will be well aware of any of the exceptions that will prevent you from earning a penalty and will therefore assist you in the process of qualifying for Medicaid. Hiring an Elder Care Attorney enhances the probability that your application is approved, therefore increasing your chances of obtaining Medicaid coverage. Additionally, another benefit to hiring an Elder Care Attorney to assist in filing for Medicaid coverage is the establishment of effective spend down plans. In order to qualify for Medicaid many married couples must participate in the Spend-Down process, which pertains to the prospects of saving assets when only one spouse needs Medicaid. The purpose of this process is to ensure that the individual in need of long-term care receives the aid they need, while also guaranteeing that their spouse has the financial means of remaining in their home and covering the cost of all their living expenses. An Elder Care Attorney may assist in creating a personal care agreement that enables the senior to provide monetary compensation towards their family caregiver, while also participating in the Spend-Down process. Additionally, the attorney can aid in renaming bank accounts and real estate titles in the effort to enhance the applicant’s eligibility for Medicaid. The attorney will use her experience in the field to answer any inquiries you may have regarding the application process and determining whether you and your loved ones qualify for coverage.

For further Medicaid eligibility information please contact the Law Office of Inna Fershteyn at 718-333-2395 to effectively complete the Medicaid Application.

6 Medicaid Planning Mistakes People Make

Medicaid is one of the largest medical insurance programs in the nation. This program is intended to assist low-income individuals who require financial needs in paying the costs of their healthcare. Medicaid is beneficial for seniors, disabled individuals, and those who are unable to simply cover medical care costs out of pocket. There are a variety of benefits to receiving Medicaid coverage, especially at a time when a loved one begins to age and needs additional help with their daily activities. A common fear among many elderly individuals is that they will not be able to afford long-term care and will have nobody to look after them in their time of need. Those familiar with nursing homes are aware of the massive price tag of $90,000 a year for care. Medicare will not cover these costs, thus it is important that individuals apply for Medicaid coverage prior to the need for long-term care arising. The same financial issue is present when elderly individuals attempt to pay for the costs of in-home care out of pocket. In most cases, it is unlikely that a family will be able to afford more than a year of care without Medicaid if they are in the low or middle class. Applying for Medicaid will minimize the pressure of having to pay the entire cost of care, thus it is recommended that you and your loved ones reach out to an Elder Law Attorney to begin your Medicaid Planning journey in advance. The attorney will guarantee that you are aware of the common mistakes and traps associated with independently Medicaid Planning without the guidance of an experienced attorney.

Applying for Medicaid can be a challenging and complex process as previously mentioned, and without the knowledge of a professional, many mistakes can be made that could compromise your eligibility.

Top 6 Medicaid Planning Mistakes:

Applying for Medicaid too Early: The consequences of applying for Medicaid coverage too early includes a longer ineligibility period and spending much more money than if you applied at the appropriate time. You should wait to apply until you are certain that you meet all of the criteria and requirements. For example: If you made a generous gift to a loved one four years ago, you should wait for the five year lookback period to finish prior to applying for coverage. If you do not wait the designated amount of time, you risk being rejected for Medicaid coverage and having to pay the costs out of pocket for a longer period of time. Consult with an Elder Care attorney to discover the most appropriate time to apply for medicaid to ensure that you are granted coverage.
Applying for Medicaid too Late: It is common for individuals to procrastinate on applying for coverage and only apply when medical care is an absolute necessity. If you apply too late you are missing out on months of eligibility. This means that you are most likely using assets you have saved for your spouse or children on medical costs. Applying at an earlier period in time could make all the difference when it comes down to spending your entire life savings on medical costs. For example: If you needed Medicaid to cover your nursing home costs in July, but only filed your application in December, you will not receive full coverage to cover the costs of care. This would result in a massive financial burden on you and your family when it comes to covering the costs of the months that Medicaid will not cover because the application was filed too late.
Giving Away Assets too Early: Make sure that you consider all of the consequences of giving away your assets too early before giving your children the assets. Poorly planned gifts are the easiest way to jeopardize your Medicaid coverage. Medicaid will not apply for nursing home care for a certain number of months after giving a gift to your children because you will not meet the Medicaid eligibility qualifications. For example: If you give a gift to your children on Friday and then apply for Medicaid the following Monday, you will be rejected due to the Medicaid transfer penalty. Now you will need to get the money you gave your children back so that you can afford your medical costs. However, there is no guarantee that the money is readily available, as your children could have already spent it. Consult with an attorney to understand the five year lookback period prior to making a gift you may regret.
Thinking it is too Late to Plan: It is never too late to plan for your or your loved ones future. Even if your loved one is already enrolled in nursing home care, you may still apply for Medicaid in the effort to obtain coverage for at least some of the costs of care. Scheduling an appointment for a consultation with an experienced Elder Care Attorney is the first step to beginning your planning journey. The attorney will take the time to walk you through the process and answer any questions you may have during the process. It is never too late to start thinking about your Medicaid planning process.
Ignoring Safe Harbors Created by Congress: There are specific transfers of assets that you may partake in without risking the loss or rejection of Medicaid coverage. These transfers include, but are not limited to transfers to disabled children, caregiver children, and certain siblings. Additionally, you are able to transfer assets into a regular trust in the case that you are disabled and under the age of 65. This would be considered a pay back trust and would not jeopardize potential Medicaid coverage. In the case that you have a disability and are over the age of 65, you can still place your assets in a trust, but this trust is called a pooled-disability trust. An Elder Care Attorney can provide you with more information on transferring your assets and different types of trust in relation to obtaining Medicaid coverage.
Not Consulting an Attorney: There is no greater mistake than choosing not to consult an attorney, as an attorney is trained and experienced in the field and can update you on any rules or regulations you are not familiar with. Hiring an attorney will reduce the stress of having to file for Medicaid independently, for the process is very difficult and time consuming. In most cases, the questions are very difficult to understand and there is a specific way of responding to the questions in the application. Without an attorney, you are much more likely to make mistakes in your application which could jeopardize your ability to receive coverage. Some mistakes cannot be fixed, so it is important to ask any questions you may have and inquire about the best way to fill out the application to demonstrate your financial need.

For further Medicaid eligibility information please contact the Law Office of Inna Fershteyn at 718-333-2395 to effectively protect your assets from Medicaid.

Top 5 Strategies for Protecting Your Assets From Medicaid

Medicaid is a means-tested program that conditionally accepts applicants based on their income and current assets. According to Medicaid regulations, individuals must have less than $2,000 to qualify for coverage. Applying for Medicaid is quite a complex process, as the questions being asked within the application have great depth and implications for your future. The foundational system responsible for asking the questions that define your eligibility for Medicaid purposely selects specific diction and word choice which may make it challenging for elderly individuals to effectively answer the questions. Considering that these questions are the main defining factor when it comes to obtaining Medicaid coverage, family members should seek guidance from an experienced Elder Law Attorney to guide them through this imperative process. The attorney is quite familiar with your state’s rules when it comes to long-term care planning and receiving government benefits. An Elder Care Attorney will use her experience in the field to devise the most effective plan in assisting the family by selecting strategies that align with the family’s personal and financial circumstances. Below are the top 5 strategies suggested by an Elder Law Attorney regarding ways of protecting your assets from Medicaid.

1. Income Trusts

Income Trusts serve the purpose of protecting your assets and keeping your monetary income safe. This trust aids in maintaining the income limit set for all Medicaid applicants. Income Trusts are beneficial towards those applicants that exceed the qualifying amount. These trusts give the applicant an opportunity to designate a sub quantity of their income to a specific trust in order to refrain from exceeding the standard acceptable quantity. The Qualified Income Trusts are irrevocable meaning they cannot be changed or revoked. They serve as holding areas for the applicant’s excess income and protect this income from being taken by Medicaid. In states that allow applicants to spend down their excess income, these trusts are less effective, yet can still be utilized based on the applicant’s preference. In order to qualify for Medicaid many married couples must participate in the Spend-Down process, which pertains to the prospects of saving assets when only one spouse needs Medicaid. The purpose of this process is to ensure that the individual in need of long-term care receives the aid they need, while also guaranteeing that their spouse has the financial means of remaining in their home and covering the cost of all their living expenses. An Elder Care Attorney can assist you in establishing an Income Trust and answering any of your questions regarding the trust.

2. Asset Protection Trust

An Asset Protection Trust is a great way to preserve your assets when applying for Medicaid, as it allows you to maintain your wealth while still receiving coverage. This is helpful because a Medicaid applicant is only eligible for convergence if they meet the specified quantity of assets held within their account. Many individuals fall into the assumption that the best way to remove the additional assets that prevent them from getting Medicaid coverage is to transfer the assets to family members. This approach, however, is extremely flawed and risky because it often results in a Medicaid penalty. Incurring a penalty prevents you from receiving coverage for a specified period of time. A trust allows you to disperse these assets to the family members you had in mind at the time of creating a trust. The beneficiaries will not be subject to the payment of capital gains tax based on the increase in quantitative value your assets have accrued over time. It is important to note that transfers to a trust are still subject to the Medicaid Lookback period,which tends to include the last five years of your assets. This strategy is extremely effective when it comes to protecting your assets fromMedicaid, while still receiving the coverage you are in need of. An Elder Care Attorney can guide you through the process of creating an Asset Protection Trust based on your personalized extent of assets.

3. Caregiver Agreement

A caregiver agreement is beneficial to individuals who require additional services that will not be included within the typical Medicaid coverage. This option is great for individuals who would prefer to be cared for by a family member or a trusted close friend. You would not only be cared for by an individual you already know and have a close relationship with, but you would also be benefitting the caregiver for their service. The caregiver will be paid for their duty in caring for you and you will receive the best care possible. In most cases the caregiver would be paid for their services in advance under a contract that defines the services provided and the hours being worked. In the case that the patient passes away all of the unearned funds must be paid to Medicaid in correlation to the amount that Medicaid paid for the patient’s care. A Caregiver Agreement can be the best option for numerous individuals who do not wish to leave home and go into the care of a nursing home, as they would still be able to maintain their full Medicaid coverage. An Elder Care Attorney can help you make the decision in selecting a caregiver you trust to take care of you.

4. Medicaid Compliant Annuities and Promissory Notes

In many cases, individuals require urgent long-term care services, however they have recently conducted a transfer of assets or are still in possession of the assets that limit the income cap they require to qualify for Medicaid coverage. As of now, there is no possible method of removing these assets in time to qualify for coverage because any movement of the assets will result in a Medicaid penalty. The only options left to qualify for coverage under such short notice and with exceeding assets present would be to write an annuity or promissory note. This would serve as an insurance product that would payout the income. First, you would make an investment into the annuity. Then, the insurance provider would return your income by using a constant stream of income approach. The annuity has specific qualifications to ensure that Medicaid will approve of the strategy. The annuity must be fixed with all monthly payments being the same, while also being irrevocable. The annuity is unassignable meaning it cannot be transferred or sold to another individual. The payments on the annuity must be immediate in order to qualify for coverage. An Elder Care Attorney can further explain this strategy in describing the best course of action in selecting an annuity with qualifications that would make it possible for you to still qualify for Medicaid.

5. Spousal Transfers and Spousal Refusal

According to current Medicaid laws, transfers may occur between spouses without being subject to the five year look-back period. The assets who are under the name of the spouse in need of care should be transferred to the name of the spouse who doesn't require care. The spouse who is not in need of care is typically referred to as the community spouse. With the presence of spousal refusal, the community spouse may refuse to provide necessary support to the spouse in need of care. If this is the case, then the spouse who is in need of care will immediately be provided Medicaid services to ensure that they are provided with all the care necessary. Medicaid may then require the community spouse to make contributions even though that spouse initially refused to provide the necessary support. The community spouse will still receive a benefit because the reimbursements to Medicaid will be at specified discounted rates. Spousal refusal is present in New York, however it may not be present in other states. Seeking legal advice from an Elder Care Attorney puts you and your loved ones in a good position to protect your assets from Medicaid.

Reasoning Behind Asset Protection:

Asset protection from Medicaid is extremely important in the long run in regards to receiving long term coverage. Without taking the proper steps now to protect your assets, you may be unable to receive long term coverage, such as nursing home care. Long term care insurance provides coverage for nursing home care and at home coverage for individuals ages 65 and older with chronic conditions. There is nothing worse than running out of money when you need it most, so by taking the necessary steps to protect your assets today, you will avoid this problem when it becomes time to consider long term care. An Elder Care Attorney will guide you through the process of following all of the strategies above to save and protect your assets from Medicaid.

For further Medicaid eligibility information please contact the Law Office of Inna Fershteyn at 718-333-2395 to effectively protect your assets from Medicaid.

Will an inheritance compromise my Medicaid Eligibility in NY?

Medicaid eligibility in NY is quite a serious concern, as it is very difficult to qualify for coverage given the laws and eligibility requirements. Many individuals find it difficult to fully understand the qualification laws and appeal to an elder care attorney for guidance. There is a capped limitation regarding the extent of liquid assets an individual may hold in order to remain eligible for Medicaid coverage in NY. A common inquiry pertains to the preservation of benefits even after receiving an inheritance, as there are several ways to do so. It is highly recommended that you schedule a conference with a well experienced elder care lawyer prior to accepting the inheritance, as this may jeopardize your Medicaid coverage and leave you without any healthcare.

As most of you already know, the maximum value in assets an individual may hold is $2,000 in order to still qualify for full Medicaid coverage. This demonstrates financial need in paying for services, thus individuals within this income cap will qualify for much needed coverage. However, receiving an inheritance may compromise your ability to maintain your Medicaid eligibility because your assets will exceed the $2,000 limit. As a rule, all inheritance recipients must report their change in financial status to the Social Security Administration within 10 days of receiving the inheritance. Additionally, they must inform the Department of Children and Families of this inheritance. Individuals must explain how it is that they will utilize this inheritance and what the assets would be used for.

If Inheritance is Large and Medicaid Coverage is No Longer Necessary:

In the case that your inheritance is a grand quantitative sum, you might realize that you do not require Medicaid anymore because you can use your inheritance towards your medical bills and expenses. You are encouraged to inform Medicaid services that you would like to disenroll from the program, as you no longer have such a prominent financial need. Once this step is done, the Medicaid coverage will cease and you will be responsible for paying for the expenses independently. Additionally, Medicaid may ask you to pay back the exact amount of money they provided for you during the period in which you were no longer eligible for the coverage. If you inform Medicaid in advance prior to receiving the inheritance, then you will be able to avoid paying the bill that Medicaid will send you as reparations for the financial services they provided after you received your large inheritance.

If Inheritance is Small and you Still Need Medicaid:

Given that the inheritance is not enough to cover all of your medical expenses, you may want to maintain your Medicaid coverage. In this instance, the calendar month is what will determine if you are able to maintain both your inheritance and your coverage. The rules dictate that an individual must not have more than $2,000 in their bank account by the end of the month. This implies that if an individual receives an inheritance of multiple thousands or hundred thousands in the beginning of the calendar month, they may still have enough time to spend it or to arrange a meeting with an elder care attorney. However, if the individual receives this inheritance at the end of the month, such as March 25th, they will not have much time to allocate the funding and still qualify for Medicaid. An elder care attorney can guide you and advise you on the best actions to take in maintaining both your inheritance and Medicaid, while still following the rule regarding not exceeding $2,000 in assets monthly.

Methods of Preserving Medicaid Benefits even after receiving Inheritance:

Spend Down: A common method of maintaining your Medicaid coverage even after receiving an inheritance pertains to the spend down method. Medicaid recipients must spend down their recently obtained inheritance in order to requalify for Medicaid coverage. For individuals who have a large inheritance, it would be nearly impossible to spend all that money in such a short period of time, thus these individuals should consult with an elder care attorney for some Medicaid planning techniques. Purchasing Exempt Assets pertain to items that are specifically exempt by Medicaid. Therefore, these items and expenses will not hold the Medicaid recipient or applicant accountable, as they do not play a role in Medicaid eligibility qualifications.
Asset Protection Trusts: An Asset Protection Trust is a great way to preserve your assets when applying for Medicaid, as it allows you to maintain your wealth while still receiving coverage. Many individuals fall into the assumption that the best way to remove the additional assets that prevent them from getting Medicaid coverage is to transfer the assets to family members. This approach, however, is extremely flawed and risky because it often results in a Medicaid penalty. Incurring a penalty prevents you from receiving coverage for a specified period of time. A trust allows you to disperse these assets to the family members you had in mind at the time of creating a trust. The beneficiaries will not be subject to the payment of capital gains tax based on the increase in quantitative value your assets have accrued over time. It is important to note that transfers to a trust are still subject to the Medicaid Lookback period,which tends to include the last five years of your assets. This strategy is extremely effective when it comes to maintaining your inheritance funds, while still receiving the Medicaid coverage you are in need of.
Caregiver Agreement: A caregiver agreement is beneficial to individuals who transfer money to a caregiver for their services without deeming this asset as a gift. This option is great for individuals who would prefer to be cared for by a family member or a trusted close friend. You would not only be cared for by an individual you already know and have a close relationship with, but you would also be benefitting the caregiver for their service. The caregiver will be paid for their duty in caring for you and you will receive the best care possible. In most cases the caregiver would be paid for their services in advance under a contract that defines the services provided and the hours being worked. In the case that the patient passes away all of the unearned funds must be paid to Medicaid in correlation to the amount that Medicaid paid for the patient’s care. A Caregiver Agreement can be the best option for numerous individuals who do not wish to leave home and go into the care of a nursing home. However, there will be an income-tax consequence for the caregiver and there might be a loss of control of the money.
Special Needs Trust: A d4A special needs trust is used for individuals under the age of 65 who wish to keep their inheritance while also maintaining Medicaid coverage. Those over the age of 65 will need a d4C special needs trust, also commonly referred to as the pooled special needs trust. A trustee will be responsible for managing the money and can only apply the money to the services and necessities not covered by Medicaid. Some of these expenses may include but are not limited to entertainment, travel, paying off debt, home improvements, and some other common acceptable expenses.

An elder care attorney can assist you in selecting the best option for your personal circumstances. It is imperative that you are able to maintain your Medicaid coverage despite obtaining a recent inheritance. With a proper plan in place, your future will be set and established according to your preferences, Your best interests will be prioritized when selecting an option that would effectively correlate to your situation. If you have any further questions or interests regarding your Medicaid eligibility the Law Office of Inna Fershteyn is here to provide you with all of the answers and help you make all of the important decisions.

For further Medicaid eligibility information please contact the Law Office of Inna Fershteyn at 718-333-2395 to maintain your inheritance and receive Medicaid coverage.

Can You Transfer Your Medicare and Medicaid Plans When You Move to Another State?

Life is a mystery filled with the unknown, you may have lived in a certain state for almost the entirety of your life and now decided to move to a new state. Regardless of the reasoning behind your residence movement, whether it be required by your job, to be closer to your family members, or just to try out a new location, you should consider the necessary steps of transferring your healthcare plans to your new residence. Depending on which medical insurance plan you have, there are different actions that can be taken to ensure that you have access and coverage to insurance when you relocate.Your ability to take your insurance with you depends on the type of insurance you have, whether it is Medicaid, Medicare, or Medicare Advantage. An esteemed attorney can assist you in discovering if you can bring your insurance with you by providing guidance on the best plan of action to take in relation to your specific situation.

In the case of Medicaid it is important to note that Medicaid has its own eligibility qualifications in each state. That being said, just because you are eligible for Medicaid in NY does not automatically guarantee that you will remain eligible for Medicaid in another state, such as Florida or Texas. Unfortunately, you will not be able to keep your Medicaid plan upon relocating to a new state. This is not devastational and does not bar you from having Medicaid coverage. It simply means that you will have to apply for Medicaid in whichever state you move to. An attorney can assist you in the process of reapplying for Medicaid by first calling the Medicaid office located in the state you are planning on moving to and then filling out all of the appropriate forms and applications. Prior to applying for benefits in the new state, you must first cancel the benefits you are receiving from the previous state you lived in. You are encouraged to complete your Medicaid applications for the new state as soon as possible in order to avoid paying for health insurance out of pocket. Even in the case that you have to pay out of pocket for a short period of time, Medicaid will reimburse you as long as you have a detailed and accurate record or receipts of all health care service costs.

If you have the original Medicare provider, then you have much less to worry about when it comes to relocating to a different state. Plans A and B ensure that you will remain covered regardless of which state you move to. This is due to the fact that Medicare is a federal program that is run by the government. As long as your medical provider accepts your Medicare insurance plan, you are all set for healthcare coverage. The only drastic difference that may impact your coverage would be the cost of your premiums, as they may increase or decrease depending on the state you move from and the new state you are moving to. Additionally, your Medigap plan is expected to cover your healthcare costs even if you move across the country. The only exception to the Medigap coverage would be if you moved to the specific states of Massechusttes, Minnesota, or Wisconsin because these states have their own individual Medigap plans. If you have any questions or concerns regarding transferring your original Medicare Plan A or B to a new state, you should contact an attorney to answer any of your inquiries.

Medicare Advantage and Part D of Medicare are a different story than the original Medicare plan. This is because these plans have a specified service area, which means that there is no guarantee that it will provide coverage for more than one state. You may contact an attorney to help you determine if your new state falls within the specified service location of the Medicare Advantage and Part D plans. Moving into a new specified area may be complex due to the fact that you have a limited enrollment period during which you may change plans outside of the typical annual enrollment period. The annual enrollment date is between October 25th and December 7th. You should make your current plan aware of your intention to move to a new state. This will allow your special enrollment period to begin the month prior to your move and continue for a two month period after you move. However, if you make your plan aware of your relocation after you move, then your opportunity to switch plans begins the month that the plan becomes aware of your relocation. Afterwards, you will have two full months as part of the special enrollment period.

For further healthcare eligibility information please contact the Law Office of Inna Fershteyn at 718-333-2395 to effectively maintain coverage even when you move to a new state.

How to maintain Medicaid Eligibility when your spouse dies in NYC?

The process of aging is a difficult concept, especially for individuals who lack knowledge of their medical coverage system and management of their financial assets. Prior to reaching old age, individuals should consider applying for Medicaid and creating an Elder Care Plan. Applying for Medicaid is quite a complex process, as the questions being asked within the application have great depth and implications for your future. The foundation system responsible for asking the questions that define your eligibility for Medicaid purposely selects specific diction and word choice which may make it challenging for elderly individuals to effectively answer the questions. Considering that these questions are the main defining factor when it comes to obtaining Medicaid coverage, family members should seek guidance from an experienced Elder Law Attorney to guide them through this imperative process. The attorney is quite familiar with your state’s rules when it comes to long-term care planning and receiving government benefits.The Elder Care Attorney will use her experience in the field to devise the most effective plan in assisting the family by selecting strategies that align with the family’s personal and financial circumstances.Additionally, the esteemed attorney will ensure that you maintain your Medicaid Eligibility even when your spouse dies in NYC.

What if the nursing home spouse outlives the community spouse?

In the case that the spouse enrolled in nursing home care passes away prior to the community spouse, then the living spouse is subject to an exception of 50% of the total countable assets of both of the spouses.The total countable assets may only reach the value of $119,220 in order to remain qualified for Medicaid coverage. However, this exemption does not work if the roles are reversed. This means that if the community spouse passes away prior to the spouse in the nursing home, then the nursing home spouse may not use the 50% exemption.This is due to the fact that the individual inhabiting the nursing home will no longer receive Medicaid coverage and therefore will not obtain the care they require. The maximum quantity of assets an individual on Medicaid may hold is $2,000, thus any value above this would result in a Medicaid penalty. In most cases the surviving spouse will receive the remaining assets based upon the content of the will. To avoid dealing with this complex situation you should hire an Elder Care Attorney to begin Medicaid Planning for married couples.

Medicaid Planning for Married Couples

Upon receiving inheritance the surviving spouse should convert this money into a non-countable form. These forms may include Medicaid-qualified annuity, a new car, new household furniture, etc. An Elder Care Attorney will provide guidance on which non-countable form would be most effective for your specific family circumstances in order to avoid incurring a Medicaid penalty. This penalty will result in a disqualification period that may leave you without coverage, which is certainly not worth the risk. Prior to the death of the community spouse, the couple should change their accounts in order to prevent them from being in joint names. Without taking this step, there may be numerous financial consequences that will jeopardize your Medicaid coverage. In the case that the house or the home was under joint names and the community spouse passes away, then the spouse receiving nursing home care will exceed the $2,000 maximum assets allowed. Therefore, the house should be solely in the name of the community spouse instead of under joint names.

The passing of a Medicaid recipient’s spouse could harm the current Medicaid recipient by making him ineligible for coverage. If the community spouse dies and leaves the estate to the nursing home Medicaid recipient, then the individual will have too many assets to qualify for coverage. Even in the case that the individual chooses not to claim his share of the estate, Medicaid will still assess the situation, which may result in a Medicaid penalty. In this case, a trust could be an effective option to protect the spouse’s medical coverage. The surviving spouse is typically titled to either half or a third of the assets titled under the name of the deceased spouse. The money must be removed and properly disposed of to ensure that the Medicaid recipient continues to be eligible for coverage.

For further Medicaid eligibility information please contact the Law Office of Inna Fershteyn at 718-333-2395 to effectively maintain Medicaid Eligibility when your spouse passes away.

Medicaid versus Medicare: Who covers nursing home costs?

There comes a point in time when you may begin to consider placing your loved one into a nursing home to ensure that they receive the best care possible. When making such a decision it is important to be well informed and aware of all of the aspects that attribute towards nursing home care. One such attribute pertains to the cost of care and how it will be covered. Usually the cost will either be covered using Medicare or Medicaid. However, there are specific qualifications that outline which coverage plan may be utilized based on your personal situation. Additionally, it is important that you are able to differentiate between the types of care offered, such as skilled care and custodial care. In order to best be informed of all the details concerning enrolling your loved one in the care of a nursing home, you should contact an Elder Care Attorney to guide you in your decision making process. With proper counsel you will be sure to place your loved one in the hands of the best nursing home possible, while still being able to cover all of the costs such care will require.

Qualifications for Medicare Coverage of Nursing Homes

There are specific statements that discuss if an individual qualifies for Medicare coverage when it comes to nursing home care. The first statement pertains to the period of time the individual stayed at the hospital out of medical necessity. In order to qualify for Medicare coverage an individual must have spent at least three consecutive days in inpatient care for a medical necessity. After being discharged from the hospital the individual must then be admitted to a nursing home within the 30 day period that begins the moment the patient is discharged. The individual must be in need of skilled nursing or rehab care on a daily basis for the specific condition they endured while hospitalized in inpatient care. Lastly, in order to receive Medicare coverage for nursing home care, an individual must have a letter from a physician ordering and proving the necessity of this care. If the individual falls within the category that aligns with all of these statements, then they may be eligible for receiving Medicare coverage when it comes to nursing home care.

Skilled Care vs Custodial Care

The greatest difference between skilled care and custodial care pertains to the manner in which the care is provided and who is responsible for providing such care. Skilled care refers to care that is specifically administered by a professional who is responsible for ensuring that the individual does not further deteriorate from the condition they are currently in. This care is administered when direct medical care becomes a necessity as a result of a short-term medical condition that they will recover from. On the contrary, custodial care can be performed within the home setting, meaning the one administering this care does not have to be a medical professional. This type of care provides aid for activities related to daily living. These activities usually pertain to eating, bathing, and similar skills. In most cases, patients that receive custodial care have a chronic condition, meaning they are not expected to improve in the manner that those who receive skilled care are. If custodial care is the only type of care necessary, then it is possible that Medicare will not cover the costs. However, Medicaid will cover the costs of custodial care, so you will be able to provide your loved ones with the care they require to continue thriving.

Medicaid Rules for Skilled Nursing Payments

Receiving Medicaid coverage can be quite complex, as there is a very specific list of qualifications necessary to obtain coverage. Medicaid is based on “needs only” policies, meaning there are strict regulations pertaining to the amounts of assets you are allowed to hold. Medicaid is income based, while Medicare does not depend on your assets or income. An esteemed Elder Care attorney will assist you in qualifying for the type of coverage you need, as the attorney has much experience in the field and knows the specific rules of state pertaining to the amount of money an individual can have while still qualifying for Medicaid coverage. A Medicaid applicant over the age of 65 can possess up to $2,000 in NY in order to qualify for coverage. Asset limits for married couples vary in relation to whether both spouses require Medicaid coverage or only one spouse. One automobile regardless of the quantitative value is referred to as a “non-countable” asset as long as the car is used to transport the Medicaid applicant or other members of the family. The attorney will assist you in preparing for the five year Medicaid lookback period and will provide guidance on the Medicaid spend-down process.

Is Dual-Eligibility a Possibility?

Dual-Eligibility refers to an individual who is qualified to receive both Medicaid and Medicare coverage. In this case, Medicaid will cover all of the costs that Medicare did not cover. Usually, individuals qualify for Medicare based on their age and qualify for Medicaid based on the income bracket they fall into. Additionally, Medicare beneficiaries below the age of 65 who live on Social Security Disability Insurance may be eligible to receive Medicaid benefits. The benefits of being dual-eligible is that you may receive greater medical coverage and lower out-of-pocket costs. For medical issues Medicare is the primary payer, Medicaid will serve as the secondary payer to cover any Medicaid costs leftover. Medicaid assists in covering the cost of the Medicare premiums, deductibles, and copays. An Elder Care Attorney can assist you in becoming dual-eligible and receiving the benefits that result from this eligibility.

For further Medicaid eligibility information please contact the Law Office of Inna Fershteyn at 718-333-2395 to obtain aid in receiving medical coverage to cover the cost of nursing home care.