Medicaid is a safety net for millions of senior citizens across the country, providing funding to pay for home care, adult day care, or prescription drugs. However, the program is designed for low income individuals and can leave many on the fence financially over whether to choose to spend down assets or pay for these necessary services themselves.
Currently, the threshold to receive Medicaid services is only a few hundred dollars for individuals and just over $1,000 for married couples, which leaves these individuals with little income to pay rent, utilities, or buy groceries. Even financially secure seniors can find themselves needing vital Medicaid services like in-home or nursing home care in the event of a catastrophic health event, making planning for the future and keeping options open all the more vital.
One option that may be viable for certain individuals is joining a Pooled Supplemental Needs Trusts, also known as a Pooled Income Trust. Pooled income trusts work by the individual sending his or her income from Social Security, pensions, or annuities to non-profit organizations to pay bills and other expenses to stay below the Medicaid threshold. Any income left over after the individual passes away goes to the non-profit.
As people age, many count on Social Security and Medicare to help them live happy, healthy, and comfortably in their golden years. However, some older Americans are unable to fully provide for themselves and must seek assistance before they become eligible for the landmark elder social services we have become accustomed to. Hard economic times, disability, and other unforeseen events are just some of the reasons elders may be eligible for Medicare.
One of the most important parts of the Medicare program is the nursing home care services members are eligible to receive, particularly seniors. However, not everyone may qualify for Medicare after applying, leaving many families to wonder how they will take care of their beloved elders. Fortunately, denied applicants are eligible to receive a Fair Hearing at their local Medicare office.
What is a Fair Hearing?
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
THOROUGH PLANNING NEEDED IN ADVANCE
This blog has discussed the necessity of proper and thorough planning to ensure a smooth transition into a continuing care retirement community. This requires, among other things, that a person properly and legally transfer all of their assets, or a substantial portion of their assets that is, to people or entities that would enable them to be eligible for Medicaid. As many people know, there is a look back period where the state examines all transfers of assets or money over a certain period of time for purposes of Medicaid eligibility purposes.
If during that time a person transferred any aset for less than full market value or did not transfer the assets to a proper investment vehicle that is otherwise exempt from Medicaid assets, the Medicaid applicant will likely be denied for financial reasons. In other words Medicaid will claim that the applicant has too many assets or their income is too high to qualify. Some examples of a Medicaid exempt transfer is the purchase of a graveyard plot, prepayment for funeral services or the purchase of a short term Medicaid annuity. An interesting case from November, 2015 out of Broome County, entitled Good Shepherd Village at Endwell v. Peter Yezzi shows the many problems that can result when people start their Medicaid planning after admission to a continuing care retirement community.
SOME LIMITED RELIEF
Patients who rely on Medicare sometimes experience sticker shock after being released from the hospital only to find out that because some hospital administrator classified their stay as “observational” that they must pay a large portion of the final bill. Many times a doctor will seek to have a patient admitted for any number of reasons, only to have a bureaucrat reclassify the patient’s time at the hospital as observational. Such a designation will mean that Medicare will not pay for this time in the hospital. For Medicare to pay for a hospital stay, the patient has to be an admitted patient for at least three days (three midnights in the hospital).
Observational status does not equate to an admitted patient in Medicare’s own set of self defined definitions. That may be quite different to the patient who went to the hospital and received a number of drugs and tests during their time their and was consistent with the majority of their non-surgical stays in a hospital in life. In an effort to address these obvious problems that will only grow with time, President Obama signed a bill that required hospitals to warn patients that their stay will be considered observational in nature and that they are not being admitted under Medicare’s rules, which may result in a bill from the hospital that they will have to pay. The Notice of Observation Treatment and Implications for Care Eligibility Act would have to inform the patient that they are going to receive outpatient services under Medicare’s rules which requires cost sharing from the patient and that the observational status does not count towards the necessary three day inpatient in order to transition to a skilled nursing care facility.
Medicaid is a joint federal and state program that provides needed health care coverage for many americans, including those requiring long term care. Since Medicaid is a means-based program, individuals often need to spend down their assets in order to qualify for Medicaid. One way to accomplish this is through the purchase of short term annuities to reduce available assets for purposes of Medicaid. In Zahner v. Secretary, Pennsylvania Department of Human Services, the United States Court of Appeals (3rd Circuit) heard appeals from two individuals that applied for Medicaid, but were denied the advantage of using annuities to reduce their countable assets for purposes of eligibility. While the case arises out of Pennsylvania, it is instructive for those seeking Medicaid coverage in the State of New York, as well as other states.
Facts of the Case
In Zahner, two Medicaid applicants each made substantial gifts to family members leading up to their application and need for Medicaid institutional care, which lead to a period of ineligibility. To help cover the cost of their nursing facilities during the period of ineligibility the appellants purchased a short-term annuity. One applicant paid approximately $84,000 to receive approximately $6,000 over a 14 month period, and the other paid approximately $53,000 to receive approximately $4,500 over a 12 month period. Each annuitant paid $1,000 to set up the annuity. When including fees, the cost of the annuity exceed the return on both annuities. The state’s department of human services determined that the transactions were not annuities and counted the transaction as a resource for purposes of their application, thereby re-calculating the period of ineligibility for Medicaid institutional care.The Medicaid applicants sued, and the district court found that the annuities were sham transactions set up to shield assets for purposes of Medicaid eligibility. On appeal the 3rd Circuit considered whether the purchase of the annuities qualified for the safe harbor by which certain annuities are excluded as an available resource for purposes of Medicaid eligibility.
Forbes loves to tell us who the happiest workers are, or what the healthiest careers are. But no one seems to talk about post-job satisfaction. While these types of articles are generally highly subjective, we can certainly look at professions that tend to produce happier retirees. Whether these can actually be ranked is another thing altogether.
The following list focuses on just 3 areas of health and satisfaction: smoking rates, self-reported job satisfaction, and obesity rates. Obviously, there are plenty of other areas that play a role in health and happiness, but these are generally good indicators as well.
Medicaid is one of the most utilized government programs for elderly American citizens that are in need of medical assistance that they cannot afford. In order to qualify for the Medicaid program, an applicant must meet a number of criteria and an application can either be filled out online or in paper form. However, many applicants to the Medicaid program have run into issues of red tape and other problems when attempting to apply for benefits.
Online Medicaid Application
The online application for Medicaid can be found on the federal Medicaid program website. For seniors that are tech savvy, the online application can be filled out in about 45 minutes. The website contains all kinds of information like eligibility, benefits, and required documentation needed to be considered for the program. After an online application is submitted, there may be follow-up phone calls by the program to make sure that everything regarding their application is in order, but usually an accepted applicant can receive their benefits card within 45 days of submitting the online application.
The Florida House of Representatives rejected an expansion of the state’s current Medicaid system that leaves hundreds of thousands of people caught in the state’s coverage gap. This gap applies to people living in the state who make too much money to apply for coverage but too little to cover the costs of their medical care. It has the possibility of having a serious effect on elderly people who live down in Florida full-time or have made it their primary residence for Medicaid eligibility purposes.
Florida Medicaid Program
Florida currently has 1.3 million people enrolled in the federal exchange for healthcare insurance, more than any other state in the country. Most of these people qualify for subsidies, but if these subsidies were invalidated then they would lose their access to coverage. This is of particular concern now as the U.S. Supreme Court is currently ruling on the case of King v. Burwell, which will determine whether federal tax subsidies that allow for low and middle income people to purchase insurance through the marketplace will be unconstitutional.