Pooled Trusts Eligibility

Pooled Trusts are a type of trust applicable to those individuals who are seeking public assistance benefits, such as Medicaid, to become eligible financially by setting aside funds in a trust for additional needs. The trust allows its beneficiaries to preserve a specified amount of money in a trust to pay for supplemental care not covered by public assistance programs. For the elderly, many need public benefits assistance as they continue to age but do not qualify based on higher income. In these situations, a pooled income trust will benefit an elderly person by allowing them to continue their lifestyle, which is usually seeking to stay in the home, while also obtaining homecare services and paying for what their budget requires.

New York Medicaid Rules

There are many factors that go into maintaining a budget in a family while also trying to save for the future. For Americans, the cost of maintaining a household has gotten continuously more expensive; the average cost of raising a child born in 2013 now costs roughly $245,000 for a middle income family in the United States, with housing for the child accounting for about 30% of those costs. This is compared to a study done in 1960 by the United States Department of Agriculture that stated middle income families could expect the average cost of raising a child to be a little more than $25,000 until age 18. Interestingly in both studies, housing accounted for the largest expense for the families surveyed. The children once focused on in these 1960s studies have now become the focus of our article, and one thing remains the same, housing is still the biggest expense they must account for.

As the aging population refocuses their priorities for housing, they must consider factors such as accessibility to stores, services, transportation, medical care if they experience chronic conditions, as well as access to social settings and connections. The worry of many aging people is that they will be forced to leave their home and instead reside in an assisted living or nursing home in order to retain government assistance with healthcare. There will also need to be a refocus on the ability to provide for a more diverse population of elderly people; with the thousands of individuals turning 65 years old daily over the next two decades will come a much more diverse population that has had drastically different housing situations.

Possible Solutions

Planning how your assets are going to be distributed and for your health care needs is an important tool all adults, not just elders should utilize. However, over 60% of Americans have not made a basic will. There are many misconceptions about estate planning and the reasons for it, which has led many Americans to shy away from the process.

Common Mistakes & Misconceptions

  1. Estate planning is for the elderly or the wealthy. Determining how you want your property distributed or what you would like to happen to you in the event you can no longer speak for yourself are tasks everyone needs to think about. Even the most simple finances can become complicated when there are multiple parties involved.

Making a will can be a time consuming process that involves the interest of a potentially large amount of people. One of these interests is that of the testator’s spouse. A surviving spouse is generally presumed to be the first heir to which asset distribution goes to in the event property or assets are not accounted for in the will. However, not all marriages work out and when this happens, the terms of distribution in your will can be greatly affected, depending on the state you live in.

New York Law For Wills

There are three scenarios for will distribution to a former spouse in the event of divorce: the divorce automatically revokes the entire will, it only revokes the testamentary provisions making gifts to your former spouse, or it does not affect your will at all. In New York, upon the final divorce decree, all provisions or bequests to your former spouse are revoked, if the will is still valid. If you are still legally married but your spouse has abandoned you up until the time of your passing, the court will also view this the same way as divorce, and disinherit the spouse.

In the largest single criminal healthcare fraud laundering scheme that dates back to 2009, three Floridians have been charged with defrauding Medicare and Medicaid of over $1 billion dollars. The owner of more than 30 nursing homes and assisted living facilities in Miami and a few in Illinois worked with a hospital administrator and physician assistant to put thousands of people through their care systems that did not in fact qualify or to use them to bill unneeded services and medication. Using these laundered funds, the head mastermind behind the scandal took private jets, bought half a million dollar watches, hired private escort services and pay off a reported nearly $9 million dollars in credit card bills.

Once in the criminal’s facilities, the conspirators further kept the individuals in the nursing homes by heavily medicating them with narcotics to keep receiving Medicare and Medicaid. Additionally, the individuals in the homes received medically unnecessary services just to bill to insurance. This is the not first health care fraud scheme to affect the South Florida area; South Florida has been ridden with fraudulent scandals targeting government aid systems and has had government attention called to it several times. While this issue has been brought to the attention of officials in the Miami, leading them to create ‘strike forces’ in hopes of catching these criminals, it is evident that the problem is difficult to regulate.

Fraudulent schemes extended beyond the healthcare system to law enforcement, who were paid kickbacks in cash or disguised as charitable donations payments for services, and payment for lease services. There were many players associated with the scandal, not only law enforcement officers, but doctors and pharmacists were taking part in the billing scheme in order to receive more kickbacks from the nearly 14,000 elderly patients that went through the defendant’s care facilities. It is no surprise that the defendant withdrew almost $4 million dollars over the past few years, since many of these payouts were in cash. This charge is not the defendant’s first regarding healthcare fraud; in 2006, defendant settled a civil claim in which he was ordered to pay out $15.4 million dollars for conducting Medicare fraud. These current charges will show that the defendant failed to learn from his illegal conduct and continued to defraud these programs of funds for over half a decade.

As the older population continues aging, we are constantly trying to find new tools to help this population manage their lifestyle with more ease. Assistive technology is any service or tool that aids the aging population in performing their otherwise increasingly difficult or impossible daily activities. This technology ranges from a smartphone, to a walker to GPS tracker, many of which allow the individual to continue living independently or without care, while also allowing their loved ones to check on them.

Paying for Technology

As with any other medical assistance, insurance coverage is always a concern. Although there is no universal plan covering assistive technology for the aging population, some plans do cover a portion of the costs. Medicare Part B will cover up to 80% of the cost of technology that can be considered medical equipment. Also if you are eligible with the Department of Veteran’s Affairs for assistance, they will pay for a portion of the cost and will also help train those who are using the device.

MOLST Forms, What Are They?

Easily identifiable by its bright pink color, another advance directive has been approved for use in New York medical treatment and healthcare administration. Medical Orders for Life Sustaining Treatment are medical forms similar to a DNR Order, being that they both provide for life of end care preferences. However, Medical Orders for Life Sustaining Treatment (MOLST) not only allows a patient to refuse resuscitation in the event it is needed, but it also allows for a patient to state when they would allow or request it. Once the form was approved in 2008, EMT agencies now may use the MOLST form without needing a non-hospital DNR order, however, they must honor the DNR bracelet if worn by the patient or a non-hospital DNR form if it is on file.

How it Differs from DNR Orders

Advance Directives

When determining the type of health care you wish to receive in the event that you are no longer able to make medical decisions, advance directives give you the ability to determine when you will continue or cease to receive medical care, the kinds of care or treatment that are acceptable, as well as who has the power to make health care decisions on your behalf as your health care power of attorney/health care proxy. There are a few different types of advance directives, we have previously discussed the health care proxy roles in medical decisionmaking as well as the importance of living wills. Although the names and regulations vary by state law, there are also Medical Orders for Life Sustaining Treatment forms, as well as Do Not Resuscitate Orders that patients can fill out in order to refuse or request medical care.

DNR Orders

New York Statute

In February 2011, New York amended the Palliative Care Information Act, requiring doctors and nurse practitioners to inform terminally-ill patients about end of life options and counseling regarding palliative care. To receive palliative care information under the New York statute, the patient must reasonably be expected to be within the last six months of his or her life, a standard that is commonly associated with hospice care. The information provided to the terminally ill patients includes their diagnosis and the likely course of the disease, the options that would be available to treat the disease, risks and benefits of those options, and their legal rights to pain and symptom management during their final months. If the patient lacks decision making capacity, their appointed proxy or representative must be provided with the information.

Hospice versus Palliative Care

In a previous post titled Health Care Proxy: What is Their Role in My Health Care Decisionmaking?, we discussed the role of health care proxies in your end of life planning and what capabilities they have regarding your medical treatment in the event you are not able to make your own decisions due to incapacity. In New York, naming a health care proxy is commonly done along with the formation of a living will. A living will is another type of advanced directive, it is a written statement that outlines what the patient seeks to have done regarding his or her medical treatment, in the event of incapacity or unconscious. A health care proxy will carry out the terms of a living will when there is one on record, instead of making the medical decisions for the patient which is their traditional role. A living will puts the patient’s loved ones on notice of what the patient’s wishes are and ensures they are carried out.

Interestingly, in New York, legislation has not given guidance as to the right of an incapacitated individual to have their last rights respected. However, courts in New York will, through clear and convincing evidence, attempt to respect those wishes if there is a way for them to be known, i.e. through a written document such as a living will. In the living will, you can state which treatments you wish to refuse in the event that they are being considered for treating your condition. Many forum living wills state that in the event of irreversible physical or mental condition, either due to terminal illness, permanent unconscious condition, or minimal consciousness but inability to make decisions, the patient can decide whether they wish for treatment to be withheld. You can also indicate in which scenarios, such as cardiac resuscitation, artificial feeding, mechanical respiration or refusal of antibiotics, you wish for treatment to be administered or withheld.

When it comes to terminal illness, majority of doctors are quick to respect the wishes of a patient who has completed a living will. Terminal illness is generally the most common and uncontroversial example of a situation where a patient’s living will being recognized by the court. However, situations such as permanent disability have been more difficult to apply living wills to. While some people view disability as an intolerable condition in which they would rather cease living than to have a lesser quality of life, doctors have a difficult time because many people will show signs of improvement over time in situations such as a traumatic accident or episode in which they are left in a lesser state than before.

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