Articles Tagged with ny elder law attorney

Medicaid provides valuable health care coverage to millions of low-income adults, children, women carrying children, persons with disabilities, and the elderly. The program is jointly funded by states and the federal government and is administered by the states. For many seniors, Medicaid provides them with the life-saving nursing home and in-home nursing care they need to live comfortable, dignified lives.

However, not all services provided by Medicaid are completely free and recipients sometimes need to pay back the state and federal governments for certain types of services rendered, particularly nursing home or home care aid. In fact, the state may go so far as to try and recover assets from a deceased’s estate if he or she received nursing home or home health care after the age of 55.

Under 18 NYCRR Section 360 -7.11, the state of New York can attempt to recover up to 10-years worth of Medicaid services provided before the deceased’s passing if the individual received nursing home care, had been deemed a “permanently institutionalized individual, and owned a home. However, it is important to know if the deceased left behind a surviving spouse, child under 21-years old, or an adult child deemed permanently blind or disabled then Medicaid cannot place a lien on the home.

As we all know, aging presents a new and unique set of challenges each of us will face as we grow older. Despite that, most of us expect to remain in our homes and continue living with the independence we enjoyed for our adult lives. While it is certainly possible to maintain a high level of independence in our older years at home, there certain considerations we should always take into account to ensure we live in a safe and healthy environment.

First, before considering anything about your home, you should have your estate in order. No matter how young you may be, we all need a last will and testament and instructions in case of an unforeseen event. Once you have taken care of your estate, either through a will or a trust, you are ready to start thinking about ways to ensure your home is accommodating to your changing lifestyle.

If you are one of the many people with mobility issues, you will want to consider installing aids around your home to make getting around the house easier. Even once simple tasks like showering and going up and down stairs can become a challenge in old age. Some home mobility modifications you will want to think about are grab bars, bath chairs, and life chairs.

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?

In New York, there is no set time deadline to contest an estate. Rather, heirs, beneficiaries, and other interested parties will receive notice from the court the executor of the estate intends to enter the last will and testament into probate. However, there are certain deadlines for challenging other aspects of the will, including the accounts of the estate and allegations of theft by the executor.

Before the estate can be divided amongst the beneficiaries, a New York Surrogate Court must accept the last will and testament and enter the estate into probate. After the testator passes away, the surviving spouse and children are informed of the individuals passing, regardless of whether the will mentions these persons.

Next, the executor of the estate will need to ask each of the deceased’s heirs to sign a waiver allowing the estate to enter into probate. Often times, this is not an issue since heirs are often named as beneficiaries to the estate and were hopefully in good standing with the testator before his or her passing.

The law generally gives benefactors great leeway to set conditions for beneficiaries to inherit assets from an estate or trust. This is because the benefactor has every right to disperse his or her assets while beneficiaries have no such right. Often called “dead hand control,” these conditions are often meant to promote a certain type of lifestyle or at the very least prevent beneficiaries from harming themselves with the wealth passed on.

When conditional bequests and devisements are attached to a last will and testament, probate courts rarely concern themselves with whether the conditions are fair to heirs or even wise to try and implement. Rather, probate courts function to ensure proper transfer of assets and that the deceased’s wishes are carried out.

Some situations where benefactors may attempt to impose certain conditions for inheritance can include requiring an alcoholic seeking treatment, children and grandchildren holding down steady jobs, or even finishing school before collecting inheritance. Unfortunately, theses of demands rarely work out beneficiaries sometimes would rather choose to follow their free will than comply with demands of morality or industriousness.

When someone creates a last will and testament, he or she will need to name an executor to the estate to oversee dispersal of the assets and settling of debts. Once the last will and testament is created and the testator passes away, the will cannot be amended and probate laws require this individual to act responsibly and comply with the deceased’s wishes.

However, it is not uncommon for executors to mismanage estates, either through negligence or malice and beneficiaries. Executors owe a fiduciary duty to the estate’s beneficiaries by carrying out several functions including:

  • Obtain a copy of the last will and testament

In continued efforts to protect the rights of elders, The Department of Health and Human Services has passed a rule to further ensure that elders are not taken advantage of and have the right to decide whether they seek a trial or alternative dispute resolution measures when bringing a legal claim. Currently, a majority of nursing home contracts contain arbitration clauses in the event that a residents bring a claim against the nursing home for incidents such as safety, quality of care, sexual harassment, elder abuse,  as well as wrongful death.

Arbitration is a method of alternative dispute resolution that is used as a way to settle a legal claim instead of using litigation. Arbitration involves both parties and a third party neutral arbitrator, who listens to both sides present their case, similar to a judge, and renders a decision after both sides are heard. While arbitration can be a very useful and effective legal tool, the implementation of mandatory arbitration has left room for abuse of the system and injustice for residents and their families who seek legal recourse when bringing their claim. One benefit of arbitration is that it is also a private process; unlike legal proceedings, arbitration proceedings and their rulings will not be made public record, which makes it more difficult to measure rates concerning legal claims brought by elders against nursing homes.

Currently, there are roughly 1.5 million elders in nursing homes who are said to be affected as a result of this rule change, and this number will continue to grow. There may be some confusion regarding the applicability of this new rule however; the rule will only apply to new nursing home contracts that are entered into going forward. Those nursing home contracts already existing that contain a mandatory arbitration clause will be enforceable under the Federal Arbitration Act, according to the Center for Medicare & Medicaid Services. Additionally, a nursing home and potential resident can enter into a contract for arbitration if they wish, but it will not be mandatory in their contract.

LEADING COMPLAINT ABOUT NURSING HOME IS EVICTIONS

On February 25, 2016 National Public Radio (NPR) ran a story about what is looking to become like a national epidemic: nursing home evictions. According to statistics between 8,000 and 9,000 nursing home residents complain each year about nursing home evictions. The problem with this statistic is that it only measures the complaints, not the actual evictions. As if not being able to measure the full extent of the actual problem is not enough, there is a larger, more grievous issue wrapped up in the issue of nursing home evictions. According to the ombudsman to the Federal Department of Health and Human Services, Administration on Aging, it is the number one complaint regarding nursing facilities. In many cases the nursing home wrongfully evicted the resident(s) but will not honor rulings that find that the nursing home wrongfully evicted the resident. The entity that decides if a facility wrongfully evicts a resident is not the same entity to enforce its own decision. Without a sister state agency to enforce its decision (much like one state honoring a sister state’s money judgment on full faith and credit), such legal endeavors by residents are simply an exercise in futility. The rulings are not worth the paper they are printed on. It is a prime example of a bureaucracy run amok; without teeth to enforce its own ruling. One can and should rightfully ask, why do the agencies even bother to engage in a hearing to only allow the offending party to blithely ignore its ruling?

FEDERAL CASE TO FORCE CALIFORNIA TO ACT

COMMON LEGAL WAY TO PROTECT EXCESS INCOME

       
Unfortunately many means based programs, such as Medicaid, are strict in their qualifying criteria.  Depending on the specific facts you may not qualify for Medicaid and even as little as twenty dollars a month can make a difference.  There is no sliding scale of benefits based on your income.  Each state has its own financial thresholds for income qualification, given the drastic difference in cost of living throughout the country.  New York only allows for up to $845 in income, anything above that will disqualify the potential recipient.  So what of the millions of men and women throughout New York that live on modest means and yet still receive more than $845 in monthly income?  For example, a person in Manhattan or even Long Island who earns approximately $2,000 per month does not live luxuriantly, yet he/she may need certain services and does not want or even need to go into a nursing home facility for those services.

Pooled trusts allow for seniors to setup their own trusts so that they can still live a respectable and modest life and not be required to turn over all of their income to the state for Medicaid eligibility.  In the case of the senior above, he/she would $1,155 ($2,000 – $845) to a pooled trust that they joined so that he/she could still qualify for Medicaid and have money left to pay bills and perhaps enjoy their normal lifestyle with family and friends without much financial impact.

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.

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