New York Elder Law Attorney Blog

Many residents remain completely unfamiliar with most aspects of New York elder care until the need for skilled long-term treatment is thrust upon them by a loved one's sudden health decline. For one thing, the high costs of the service catch most community members completely off-guard. Coming up with over $10,000 a month (or more) for this care is simply impossible for most areas families that have not planned ahead of time. On top of that, our New York elder law attorneys know that many are also surprised by the challenge of simply finding a suitable facility in the first place, regardless of the costs.

One peculiar aspect of the process, for example, is that men have a harder time finding a bed in nursing homes than women do. The situation was discussed last week in a post at the New York Times' "The New Old Age" blog.

It was explained that the problem has to do with nursing home demographics. A 2010 CMS Report noted what most intuitively suspect: two-thirds of all nursing home residents are female. In some specific areas, the rate of female use of these facilities is much higher. As our New York Medicaid lawyers often explain to clients, Medicaid--which pays for most nursing home care--only covers "semiprivate" rooms. These rooms usually house at least two residents with privacy provided, as in a hospital, by a curtain. Only residents of the same gender can live in each room.

That is where the demographic problem comes in.

Men who are seeking to enter these facilities cannot be put into a room where a woman already resides--even if there are open beds. Therefore, the man is forced to wait until there is a bed available in a room with another man. Considering the skewed demographics, there are a lot fewer male rooms, and the wait can last longer than many expect.

The financial demands on these skilled long term care facilities also play a role. For example, when residents leave a facility, there are often ways to make bed changes so that a room opens up to serve as a male room. However, many facilities are reluctant to do that, because the chance of a bed going unused in a male room is higher than in a female room. If the facility accepts a man and then three woman immediately call and want to move-in, they may have to turn those three down because they used an open room for the man instead of making it another female room. Most long-term care facilities are understandably loathe to not lose money on unused space, and so decisions about room assignments are often affected by the financial motives.

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Confusion often reigns when one learns that a family member will likely need long-term skilled care. Finances are always an issue. With the average stay in a local nursing home running $11,000 per month, our New York elder law attorneys are acutely familiar with the financial challenges facing local families at these times. Few can afford to pay those costs out of pocket. Without long-term care insurance (expensive in its own right), most families instead turn to Medicare and Medicaid for support.

Many seniors on Medicare get understandably confused when trying to determine what long-term care is provided by the program. The short answer is: very little. The Centers for Medicare and Medicaid Services have produced a handbook entitled Medicare Coverage of Skilled Nursing Facility Care which is a good starting point for those hoping to learn more. In general, the takeaway is that Medicare will only pay for certain skilled nursing stays and never for those staying longer than 100 days. The first 20 days of qualifying care are covered completely, while anything more (up to 100 days) often requires some sort of copayment. To even qualify for that care a resident must have a qualifying hospital stay, need the care immediately after the hospital stay, and meet a few other requirements.

Conversely, Medicaid is the joint state and federal program that provides the most support for extended nursing home stays. That is why on the elder law side of our practice our New York Medicaid attorneys work closely with local seniors to help them apply for the program and save their assets from being consumed in the qualification process. Unlike Medicare, Medicaid is an income-based program, meaning that local seniors will have to show specific financial need before receiving the help. The application process which takes all of this into account has complex asset and transfer rules. Because it is a joint state and federal program, the qualification process is different in each state.

There are actually two forms of Medicaid: Community and Chronic Care. As the name implies, Community Medicaid is much different in that it provides certain resources for individuals who wish to remain at home in their community. When that is no longer an option and close nursing home care is needed, then Chronic Care Medicaid comes into play. It is this form of Medicaid that has a "five year look back" period for assets and transfers. That means that if assets--a home, stocks, savings accounts--were handed over to another within that period, the value of those transfers may take the form of a penalty period where Medicaid services will not be provided. However, there are various strategies that can be employed to protect against the loss of all of one's assets while qualifying for Medicaid. This is true even if one is on the nursing home doorstep. Professionals in the area will be able to explain those strategies and decide on the right course in your case.

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Yesterday our New York elder law attorney Bonnie Kraham Esq., had another article published in the Times Herald-Record. In the piece Attorney Kraham explains how it is common sense for middle class families to work to protect their assets from long-term care costs. The basic idea behind asset protection for seniors is simple: take advantage of legal tools so that assets can be passed down to children instead of lost to pay for long-term care. The wealthiest families have been using these strategies for decades, but more and more middle class families are coming to appreciate the benefits of protecting assets that have often taken a lifetime to accumulate.

As Attorney Kraham explains in the story, long-term care costs are high everywhere, but they are particularly significant in New York--roughly averaging about $11,000 per month. At the end of the day there are only three ways to pay for those costs: (1) out of one's own assets; (2) via expensive long-term care insurance; (3) through Medicaid. Few community members can afford long-term care insurance and most only have personal assets to pay for these costs for a limited time. That is why our New York elder law attorneys work with families by using available tools under the law to protect assets in these situations. The goal is to help families receive Medicaid assistance without losing their personal assets in the process.

To accomplish this goal Medicaid Asset Protection Trusts (MAPTs) are often created. Assets are then moved into the trust. Those assets can be protected from being taken to pay for long-term care costs. Government officials specifically designed the system to allow for such planning. For example, there is a five year "look back period" during which the government will evaluate to see if certain asset transfers were made. Those transfers will trigger a penalty period whereby Medicaid payments will be withheld. However, if planning is done beyond that five year window, then all assets can be protected without any such penalty.

A few have questioned the morality of asset protection. It is important to keep these New York elder law asset protection strategies in context. Asset protection measures have been used in various capacities for centuries. Estate taxes are routinely guarded against, and corporations shield personal assets from private ones. It is not be surprising or unfair for middle-class families to use the same strategies to pass on the fruit of their labor to the next generation.

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The New York Times published a blog post last week on a new effort called the "Conversation Project" seeking to make long-term care planning a kitchen-table issue. The project, spearheaded by former journalist and Pulitzer Prize winner Ellen Goodman, is the first step in a comprehensive effort to ensure that long-term caregiving is considered when all local, state, and federal policy and financial decisions are made. Ms. Goodman became involved in the project while helping her 92-year old mother in her later years. Being 70 years old herself, the journalist became incredibly frustrated with the confusing nature of the senior caregiving process and the lack of advocacy for those involved. Ms. Goodman was actually on Medicaid for a few years at the same time as her mother, a situation that our New York Medicaid lawyers know is becoming more and more common.

Many details of the Conversation Project are still being developed. At this point Ms. Goodman is leading a webcast in late January, has an online forum, and has an article being published in the upcoming Harvard Business Review's "12 Audacious Ideas" issue. The Institute for Healthcare Improvement in Cambridge is also acting as an unofficial sponsor of the project in its early stages.

In discussing the project, Ms. Goodman explains that the beginning of the advocacy effort involves massive communication. She noted, "Everyone has a story. We need to share stories of the good deaths and bad deaths of people we loved." She explained that more community members must demand access and information to help them ensure their story is not one of pain and unhappiness. Of course, every New York elder law attorney at our firm is familiar with how prior preparation plays a huge role in the quality of life experienced by seniors in their later years.

The Conversation Project is hoping to combine with other efforts which are pursuing similar goals. For example, a former head of the AARP has launched the Coalition to Transform Advanced Care (C-TAC). C-TAC states its mission as one to empower long-term care consumers and deliver policy changes for the benefits of an aging population.

Many of the activists involved in these efforts are surprised that there has not been more community outrage based on the often inadequate care provided to many seniors. They argue that Medicare and Medicaid have not kept up with the changing dynamics of the elderly population. One advocate noted that these days seniors "live too long and die too slowly, at enormous financial and emotional cost to themselves and their families."

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For decades those involved in elder care research have known that the vast majority of seniors would prefer to age in place at their own home instead of moving into a long-term care facility. Yet, our New York elder law attorneys know that for most of that time little was done to actually help seniors leave a nursing home or not enter it in the first place. Historically, only those who had conducted elder care planning well ahead of time (or were independently wealthy) had choices when they reached a point when they needed day-to-day living care.

Fortunately, times have changes. As an online article in last week's New York Times discussed, Medicaid rule changes now require senior and disabled care givers to be more proactive in helping these residents leave the facility if they are willing and able. In the past, most caregivers would ask residents if they wanted to move back to the community, but the law did not demand that they actually do anything to help the senior move. Now, if a resident mentions that they would like to move back home, the senior caregiver is obligated to connect the senior to an outside agency that will look into the feasibility of their moving back home.

The change reflects new national trends in long-term care. In the context of maximizing the quality of life for area seniors, this is a welcome development. The author notes that in the past "Medicaid, which pays for most long-term care, was spending way too much on care in the places nobody wanted to be--nursing homes--and very little on care in the places almost everyone preferred--their homes." The shift has been steady. In 1999, roughly 75% of Medicaid spending in this area went to institutional care. However, ten years later that spending level was down to 55%, with 45% going to home and community based services. The shift will likely accelerate even more as President Obama's "Money Follows the Person" program continues to take effect. It is helpful to note that this reallocation of resources still requires local residents to conduct New York Medicaid planning to shield assets from the going to pay for the program participation.

Along with the federal government, many more states are devoting Medicaid dollars to at-home care. Yet, New York seems to be lagging behind the pack. Along with Mississippi, New York is the only other state that has not seen any change in nursing home occupancy levels in the past six years. Some are concerned that part of the problem is the nursing home resistance to the proposal, because, as one advocate pointed out, "they make money keeping you in."

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For years the New York Medicaid attorneys at our firm have helped local families navigate the Medicaid program's complexities. We guide families as they sort through the application process, protect property through use of New York Medicaid Asset Protection Trusts, and engage in similar planning strategies. Millions of families throughout our state depend on the program to receive the care that they need to get by each day. However, the popularity of the service has also threatened its long-term stability. That is why many observers have been closely watching lawmakers as they propose various programmatic changes that may affect individuals currently using the program as well as those who will likely apply in the future.

Yet, for all the "doom and gloom" discussion that seems to perpetuate, the state has actually received praise for its ability to save money without drastically altering the services available to residents. The Ithaca Journal commented this week on a Kaiser Family Foundation report which found that the New York Medicaid system was outperforming other states in efforts to keep spending in check. The report found that nationwide Medicaid spending increased 28.4 percent this year. New York, however, actually spent slightly less money on these services. The state has been able to avoid the significant increase in spending, say some experts, because of their increased use of managed care. In addition, New York eliminated a separate prescription drug plan for Medicaid receipts; the plan was folded into the managed care service. Other states may follow our lead. The article explains that the state's "redesigning the program appears to be the leading edge of a national trend."

Not only has the redesign saved state money, it may also have improved the actual services provided to residents. For example, the state's spokesman for the Division of the Budget claims that the restructuring has led to a major expansion in patient-centered medical homes and better care management for those with complex medical needs. The state has also added substance abuse screening procedures, expanded smoking cessation counseling services, and now requires hospitals to provide patient-centered palliative care.

The program expansion coupled with spending cuts is even more impressive considering that program participation has swelled. Since the onset of the recession in late 2007, Medicaid participants have risen by a million, now totaling nearly five million. This increase was expected as economic troubles nationwide typically lead to an increased reliance on Medicaid services.

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Syracuse News reported this week on public concern over changes that are about to take effect within the New York Medicaid system. Per the planned alterations, many local residents with developmental disabilities will lose their caseworkers as that task is soon to be outsourced to non-profit agencies in the state. Currently, many of these residents receive assistance from a group of public employees known as Medicaid service coordinators. However, these residents have been instructed that by the end of this week they must select a non-profit to take over this function.

Many community members are concerned about the effect the changes will have on their vulnerable family members with disabilities who have grown familiar with their personal caseworkers over many years. The service coordinators function as advocates for program participants, developing relationships with the clients and helping their family find the services that they need. Many coordinators have helped families find appropriate educational opportunities, arrange for respite care, and have linked participants with employment programs. Our New York Medicaid attorneys are aware of the complications that are intrinsic in working through the Medicaid system, as we also devote our time helping local residents work within the system to protect their assets while receiving the resources that they need to get by each day.

Cost-cutting is the state's motivation for changing the way the services are provided. The state spokesman for the Office for People with Developmental Disabilities reported that non-profit agencies already handle roughly eighty percent of Medicaid service coordination in the state. Nonprofit agencies explain that they are prepared to handle their expanded role. However, they also report that it may be difficult to complete the transition in a month--which is the goal of the administration. Even if the changes go through, there is a chance that families may be able to remain with the same service coordinator if that coordinator is hired by a nonprofit after leaving the state payroll. The program shift will allow the state to cut 300 service coordinators who had previously served about 10,000 local residents. Current service coordinators may try to approve an amended contract and submit it to the state in an effort to halt the layoffs. However, there is no guarantee that the privatization effort will be halted.

These latest New York Medicaid changes are part of a wide range of alterations that will likely take place over the coming years in an effort to help the state absorb the program's growing costs. Other proposed changes may affect the way that seniors and other program participants use the service to receive the extra care they need. Our New York Medicaid lawyers urge all local residents to visit with professionals to plan ahead for all long-terms health and financial concerns.

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Last week state legislators proposed New York Medicaid changes which would eliminate the financial involvement of local county governments--a state take-over of the program. However, this change would do nothing to curb the overall costs of the program. Lawmakers explain that reigning in Medicaid costs remains a top priority, and so additional alterations to the program are likely. Many observers are calling for tighter enforcement rules to root out fraud. Stricter enforcement of the program will likely target medical care providers who seek to collect money, but these changes may also affect individual residents who are working through the New York Medicaid application process.

An editorial in last Friday's Albany Times Union called upon the legislature not to go "soft" on Medicaid users. Recent problems of fraud in institutions serving those with developmental disabilities were used to highlight the current problem with the program. Some observers believe that homes for those who are unable to live independently because of age or disability are the site of the clearest patterns of excessive Medicaid utilization. Several years ago the New York Commission on Quality of Care and Advocacy for the Mentally Disabled noted that Medicaid billing for these services were "costly, fragmented, sometimes unnecessary, and often appeared to be revenue-driven, rather than based on medical necessity."

Senior care advocates believe that many disabled seniors find themselves in need of dental care, hearing aids, and similar basic services only to be shuffled to alternative medical appointments not of their choosing or tailored to their need. These advocates claim that Medicaid changes are necessary to correct the disconnect between needed services and the ones actually provided. On top of the programmatic problems, the state's Long Term Care Coalition noted that the Health Department lacks the resources to oversee these adult homes properly. The state body struggles to ensure that nursing homes and senior living facilities are abiding by state rules and regulations. The quality of elder care suffers as a result.

Together these issues suggest that far too many local seniors fail to receive the care that they need. To ensure that one's quality of life remains high in the golden years, local residents should take steps as early as possible to prepare for the help they might need. Our New York elder law attorneys work with community members on these issues, helping them apply for Medicaid, shield assets with a Medicaid Asset Protection Trust, chose appropriate long-term care insurance, and otherwise take steps to protect themselves if they need extra assistance.

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The New York Medicaid application process can be a confusing and time-consuming experience. A large number of local residents can expect to go through it at some point in their lives. The latest figures suggest that one in four New Yorkers get some form of Medicaid, and nearly one million residents have been added to the program in the last ten years alone. Professional assistance with the application process is always advisable to ensure mistakes are avoided, the procedure is expedited, and asset-saving strategies are employed. Our New York elder law attorneys have worked with residents on these matters for decades.

Applying for Medicaid and planning for potential long-term care is made even more complicated by the fact that lawmakers threaten to make changes to the program on a seemingly endless basis. Yesterday the Albany Times Union reported that even though the state legislature is not in session until January, many officials floated the idea this week of a state take-over of the Medicaid program from local counties. As it currently stands, the federal government pays for fifty percent of Medicaid costs, the state pays for twenty five percent, and local counties pay for the remaining twenty five percent. New York is unique in its current structure in requiring county governments to pay for part of the costs. Only a handful of states across the country require local governmental bodies to contribute.

However, a new two percent property tax cap will make it considerably harder for counties to pay their share of Medicaid expenses without cutting other services like police patrols, veterans' program, and road maintenance. As one state lawmaker explained, the property tax cap combined with rising Medicaid costs places localities in an untenable position with an unsustainable program. Governor Andrew Cuomo has also made a push for statewide Medicaid savings. The Governor created a Medicaid Redesign Team which is working on strategies to streamline state and local Medicaid responsibilities. However, some advocates worry that shifting the burden entirely onto the state does nothing to solve the underlying problem of rising costs. They worry that cuts to the program will still need to be made, including changes to qualification requirements.

It remains unclear if any of these Medicaid changes will become law, and, if so, what that will mean for residents. In any event, it is increasingly important for local residents thinking about their long-term care to meet with a New York elder law estate planning attorney to learn what options are available. With smart planning, residents can often avoid the need for Medicaid assistance at all, or at least ensure that their assets are protected from the requirement that they be spent down to qualify for Medicaid.

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This weekend the Times Herald-Record published a story written by one of our New York elder law estate planning attorneys, Bonnie Kraham, Esq. The article sheds light on the process of applying for Medicaid--the joint federal and state program that can pay for long-term care costs. It explains how there are actually two forms of Medicaid: Community Medicaid and Chronic Care Medicaid. Community Medicaid is targeted at those who require care at home. To apply for this form of care various documents must be provided such as three months of financial material, proof of income, past tax returns, and various other "common documents." A successful applicant can then keep a set monthly income with the remainder going to contribute to the care. Also, a single applicant can usually only keep about $14,000 in assets while a couple may keep $20,000. Local residents can consider visiting a New York elder law attorney to look at the possibility of using a "pooled" trust or Supplemental Needs Trust to keep more monthly income.

The second form of Medicaid is commonly known as Nursing Home Medicaid. It requires a more extensive application process. For one thing, financial statements for the past five years must be provided--this is known as the "five year look back period." Department of Social Services (DSS) investigators will examine financial transactions from that period to determine if any gifts were made which could have been used to pay for this care. If they are found then a penalty period may be imposed during which time the applicant will not be eligible for Medicaid. In addition, DSS investigators will examine IRS reports from the past five years, DMV reports, and financial institution documentation. This is all in an effort to ensure that the applicant is not attempting to hide any assets. Fraud charges may be brought if the DSS investigators believe that an applicant has engaged in deceptive practices.

Unlike with Community Medicaid, a single individual on Medicaid in a nursing home is essentially required to pay all of their income to the facility. If the individual has a spouse living at home then the spouse is allowed to keep about $3,000 a month in income. There are also limits on the amount of assets that the applicant is allowed to keep. However, legal strategies can be used to substantially increase the amount of assets that a family can save while still qualifying. The Medicaid Asset Protection Trust is one of the most useful ways to protect assets from Medicaid costs.

Many Medicaid applicants have problems with the process when they attempt to go it alone without the assistance of an elder law attorney. The complex documentation requirements and intensive investigation rules often result in an official hearing being called to resolve the matter. This is a stressful and time-consuming process that can be avoided by having professional help.

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Medicaid is a financial needs program available to elderly and disabled community members. The regulations applicable to Medicaid vary between states, because the program is a joint state and federal government effort. As anyone who has had to navigate the system for themselves or a loved one can attest, the program application and rules can be quite complex. In fact, an advice column published by New Jersey News this month on the topic began with one clear refrain: everyone should get help from an elder law attorney.

The Medicaid rules are detailed and confusing, and the challenge is made even more difficult by the fact that process is dependent on each individual situation. In other words, there is no simple answer that applies to everyone. Most area residents seek help understanding what they have to do to receive Medicaid benefits and what they can do to protect the family's assets.

An individual may apply for either Community Medicaid or Chronic Care Medicaid. In both cases, proper completion of the New York Medicaid application is accomplished when one has a full, confidential survey of their assets and recent asset transfers. This is useful to understand what property an applicant may be able to keep and what information must be submitted with the specific application.

Both Community and Chronic Care applications will require the reporting of various documents regarding the applicant's economic situation. Community based Medicaid applications must include at least 3 months of financial documents, proof of income, "common documents," and income tax filings. Chronic Care applications require even more information, as the Medicaid administrators will want to know details about the past five years. A thorough examination of an applicant's financial situation will be conducted by Medicaid investigators, and therefore proper assistance in these applications is often invaluable.

In general, because the program is primarily based on financial need, the government will expect many of an individual's own assets to be used to pay for the necessary long-term care before the public funds will be provided. However, certain planning strategies exist to protect some assets in these situations. In most cases the earlier than an individual plans for their long-term care needs, the more options will be available to them to receive the necessary aid while preserving assets built over a lifetime.

Continue reading "The Importance of Getting Help with Medicaid Applications" »

Many New Yorkers will one day be called to help care for their elderly parents. The majority of those caregivers report that the complexities and challenges of the process cannot be fully grasped until one experiences them firsthand. There is often no easy way to handle the emotional and financial toll incurred while helping an elderly loved one when they need it most. Our New York elder law lawyers know well the challenges so that many local families face as they work through this experience.

A new book released last week by New York Times reporter Jane Gross offers a first-hand look at how her own New York family struggled through the process of helping their elderly mother. In "A Bittersweet Season" the writer shares the tumultuous way in which she tried to navigate the eldercare system. She reports on her family's confusion with Medicare and Medicaid programs and other problematic parts of the American health-care system as it relates to the elderly. The book also shares the impact that the time had on her mother's finances. An itemized ledger is revealed which imparts the true monetary cost incurred by her loved one throughout this time in her life.

In the new volume the author explains how her family was unprepared for the experience. In some aspects the main take-away from book is summarized by Ms. Gross when she writes that "being clueless--utterly clueless--is the central and unavoidable part of this experience." As difficult as the process is on many families, there are resources available to ease that uncertainty. In fact, a main lesson from the book is the need for families to do what they can to prepare for the process ahead of time.

Continue reading "New York Writer Releases New Book Explaining Complexity of Elder Care System" »

Medicaid Supervisor for Ettinger Law Firm, Elizabeth Schalk, has been reviewing Medicaid applications for over fifteen years. Having worked in this capacity for a nursing home and an elder law estate planning law firm, Schalk has gained valuable insight and experience from counseling New York State residents in various counties about receiving Medicaid assistance.

"The most frequent thing I see is when someone's mom or dad is sick and s/he knows it will be a short time before his/her parent will have to go into a nursing home. All of a sudden, money gets transferred out of the sick parent's resources. The thinking behind this is that that this will make his or her parent eligible for Medicaid to pay for nursing home costs. Nothing can be further from the truth. In fact, these kinds of "gifts" can cause a delay in Medicaid benefits."

When a person transfers assets and then receives or applies for Medicaid-covered nursing home services, the local New York Department of Social Services ''looks back'' at financial transactions made within 60 months or five years from the first date on which the person was subsequently institutionalized and applied for Medicaid coverage.

A person in a nursing home or receiving equivalent services in a hospital is made ineligible for Medicaid coverage for a period of time after a gift or transfer of resources by the person or his or her spouse.

The person is ineligible for a period equal to the value of the resource divided by the average cost of nursing facility services to a private patient in the community.

The penalty period is based on the total amount of transfers and/or gifts divided by the New York State Regional rate set for each county by the NYS Department of Health in January of each year. The length of the ineligibility period is calculated by dividing the total, cumulative, uncompensated value of the transferred assets by the average monthly cost to a private pay patient of nursing home care in the applicant's geographic area as of the date of the application for Medicaid.

In New York City the average cost for nursing facility services for 2011 is presumed to be $10,579.00 per month. In Dutchess, Orange, Putnam, Rockland and Westchester counties it is $10,105.00. In Albany and surrounding counties it is $8,323.00.

If gifts are made into a special needs trust, an applicant may be exempt from the five year look back period penalty. Or, if gifts are a normal gifting pattern such as the same gifts each year for Christmas and written verification can be provided prior to the look-back period, these kinds of gifts often cannot be counted as a transfer for Medicaid purposes.

Before gifting or transferring money out of an estate, and especially if a nursing home is imminent, consulting an experienced New York elder law attorney with an on-staff Medicaid supervisor may assist in avoiding unnecessary delays in receiving state assistance.

written by A.K. Lehmann, ABA Paralegal

Each county in New York State demands a unique set of paperwork when applying for Medicaid assistance to pay for nursing home care. While this is subject to change in April when the New York State Department of Health will institute statewide uniformity application rules, right now the rigid documentation requirements by individual county can often slow down the process - even when a family member may need immediate transfer into a residential health care facility. In order to prevent any delay, it is absolutely necessary to gather all relevant documentation before the application is actually submitted. (See below document list.)

No matter what New York State county you or your family member lives in, Medicaid requires documentation from five years ago. Be prepared to gather, research and request paperwork dating back to 2006. There are absolutely no exceptions. An application will be denied without all of the requested paperwork. Often applicants request that a Medicaid application be incompletely submitted, hoping that the documents that they provided will be enough.

"There is no 'let's make a deal' with a county's Department of Social Services. Even if clients have submitted two or three years' worth of paperwork, but omit one year, I still have to explain them that without all of the necessary documentation, their Medicaid application will be denied," says Elizabeth Schalk, Ettinger Law Firm's experienced Medicaid supervisor.

As New York elder law attorneys with offices in over eleven counties, Ettinger Law Firm is familiar with many application requirements of statewide Department of Social Services offices. Schalk is well-apprised of how county application processes differ and what is required in order to improve the likelihood of a speedy process of individual Medicaid applications.

Please see this general list of documentation that may be required for your New York State County's Department of Social Services when applying for Medicaid for nursing home care:

1.Original birth certificate, passport or Social Security confirmation.
2.A copy of naturalization papers if applicant was not born a U.S. Citizen.
3.A Social Security Card.
4.A copy of Medicare and secondary health insurance cards.
5.Verification of all life insurance policies and their face and cash values.
6.If a spouse is deceased, a copy of his/her death certificate.
7.If the applicant is married, a copy of the marriage license.
8.If the applicant is divorced, a copy of the divorce decree.
9.A copy of all burial plans and prepaid funeral arrangements.
10.Verification of Social Security benefits received
11.If the applicant still owns a home, a copy of the deed.
12.If the home has been sold on or after January 1, 2006, verification that the home
as sold at fair market value, with a statement from a real estate agent.
13.Financial statements for all investment accounts in the applicant's name from January 2006 until the present, including all those closed or transferred.
14.All pages from bank statements from January 2006 until the present, along with a verification of Origin of Deposit (where the money came from) for any transaction of $1,000 or more and any withdrawals for any transaction of $1,000 or more. Verification of the gross amount of a pension received (such as a current award notice or check or statement from the source or a payor)
15.Federal income tax returns for the year 2006 through the present, including copies of all schedules and attachments. If a return hasn't been filed for any of those years, a NO FILE letter must be provided from the IRS.

When applying for Medicaid benefits, the help of an experienced New York elder law attorney is invaluable.

This post was written by A.K. Lehmann of Lehmann & Lehmann Legal Communications

by A.K. Lehmann, Paralegal.

More and more Americans are caring for an older friend or relative. According to the National Alliance for Caregiving and AARP, 43.5 million serve as caregivers to their elders, a 28% increase from 2004. Because of the tough economic climate of recent years - including the high unemployment rate - an increasing percentage of those are receiving compensation for providing care to a relative or friend.

This trend is predicted to rise due to the 2006 change in Medicaid law that makes it harder for people who qualify to give away assets. (A New York State Medicaid attorney familiar with the changing laws can assist in creating trusts that may make it possible to give away assets and still qualify for benefits.)

When caregivers make financial sacrifices it is often appropriate that they receive compensation.

There are various ways to pay relatives or friends with an:
• Hourly wage,
• Annual gifts or lump sum payments, or
• Larger inheritance.

Families must consider estate planning implications, Medicaid eligibility rules, and tax consequences.

Under federal law, when an annual compensation exceeds $1,700., an employer and employee each owes federal payroll taxes of 6.2% for Social Security and 1.45% for Medicare. There are also state taxes. (For more information see IRS Publication 926 "Household Employer's Tax Guide.)

Because of these reasons, elder law attorneys advocate the drafting of a written agreement called "a personal care contract" - before services are rendered.

A written agreement is especially prudent if the care recipient may eventually need to rely on Medicaid. Without an employment contract, Medicaid would consider payments to the caregiver as an attempt to hide assets - a real "no-no" for Medicaid administrators who carefully review applications.

Caregivers and recipients are urged to disclose any compensated caregiving arrangements to family members. New York elder law attorneys see family conflicts and even estate litigation as a result of hidden arrangements.

Source: Wall Street Journal, 12/10/10. "Should You Pay a Relative to Take Care of Mom?" Anne Tergesen