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In this week’s blog post I return to the topic of Medicaid.  As I often tell people these days, Medicaid application are more challenging than they have ever been.  But even after we get our cases approved, rarely is there an instance in which the approval is a perfect one. There almost always is something about the approval that is wrong or needs to be modified. For example, the cost share calculation may be incorrect.  Remember that the long term care Medicaid programs are designed with a cost share.  The recipient must give part of his or her income towards the cost of care, with the State picking up the rest.  In the case of a single applicant, there are limited amounts that can be kept from income to cover health insurance premiums and personal needs such as the cost of a cell phone or small personal items. In the case of a married couple where only one spouse is receiving Medicaid benefits, there is a calculation to determine the amount of the Medicaid spouse’s income, if any, that the healthy spouse can keep.  This is known as a spousal allowance.  The healthy spouse’s income and certain housing expenses are factored into the calculation.  It is a somewhat convoluted calculation

The subject of my last two posts has been a proposed piece of legislation introduced by 2 New Jersey legislators in response to a couple of cases reported upon in the media in which seniors were moved into long term care facilities and their asset taken from them by individuals with connections to those facilities, using a power of attorney. The new law would prevent such a person from being appointed agent under power of attorney. The proposed legislation, however, goes further to address some other areas of concern regarding facility admissions agreements.  The law would direct the Department of Health to develop a standard resident admissions agreement to be used by all long term care facilities.  Furthermore, the law would prevent facilities from requiring residents to sign anything other than this standard form as a condition of admission. I have written here about clauses in facility agreements requiring a resident to agree to mandatory arbitration in the event of disputes.  The proposed law would prevent such clauses from being included as part of the standard agreement facilities would be required to use.  A facility would not be able to make signing one a condition of admission.   The proposed statute addresses another area of concern - companies

In my post last week, I wrote about a type of financial fraud targeting the elderly that caught the attention of two New Jersey legislators.  In two cases that were reported upon by the media, a man working with a nursing home convinced 2 seniors to sign powers of attorney appointing himself as their agent.  He then allegedly cleaned out their bank accounts and their homes and placed each of them in a nursing home. There are all types of financial fraud and scams targeting the elderly, a problem that will only worsen as the population continues to age. A bill recently introduced in Trenton is an attempt to protect against the type of fraud outlined above. The law would prevent  An owner, administrator, director, officer or employee of a long term care facility or  A person affiliated with an owner, administrator, director, officer or employee of a long term care facility or Anyone who benefits financially from a long term care facility  from managing the affairs of a resident of a long term care facility or an individual who is in the admissions process to enter a facility, except by way of a court order appointing that person as guardian.  That application also must be made on

There was a movie released a couple of years ago with Rosamund Pike called “I Care A Lot”.  The main character finds elderly people without close family who are living alone.  With the assistance of a doctor who examines and certifies that the senior is  incompetent and in need of assistance, she petitions the court to obtain guardianship over the person and property.  Once appointed, she moves the senior to a nursing home or assisted living facility and steals their money. While the plot of the movie was not based on a specific case, this type of fraud happens more than people realize and it will continue to happen as the population ages.  A couple of similar abuses in New Jersey caught the attention of New Jersey legislators. In those cases a man working with a nursing home convinced 2 seniors to appoint him as their agent under power of attorney.  The allegations are that he then cleaned out their homes and bank accounts.  The seniors were placed in the nursing home as long term care residents and were billed higher than normal rates for their care, with the agent under the power of attorney and the nursing home receiving these funds. The cases received some media attention.  This prompted

In last week’s post I distinguished the terms “personal guarantor” and “responsible party” which are found in most long term care facility contracts.   This week I’ll explain why they are so important, in light of the increasing difficulty in obtaining Medicaid benefits under the government programs that cover long term care when an applicant has no funds to pay for it. As I have written about previously in this blog, the State has placed more scrutiny on each application and the 5 years of records for all of an applicant’s assets that is required.  This has resulted in a greater chance that an application will be denied for failure to produce requested documents or approved but with a Medicaid penalty or waiting period for benefits.  As a result, gaps in Medicaid coverage become a problem for nursing homes and assisted living facilities when a resident has run out of funds. If a family member signs a personal guarantee, that means that if the resident has no more funds but Medicaid still won’t cover the cost, then the personal guarantor is obligated to pay out of his or her own funds.  As I wrote last week, New Jersey prohibits a nursing home from making personal guarantees a

In my blog post last week, I was discussing the terms “responsible party” and “personal guarantor” which are found in most nursing home and assisted living facility admissions agreements.  They do not mean the same thing and we must always look to the definitions set out in the specific agreement being analyzed.   In general, however, a responsible party is responsible to make payments to the facility out of the resident’s funds and may include other obligations as may be detailed in the agreement. To be a personal guarantor is to agree to make payments out of the guarantor’s own personal assets if the resident does not have sufficient funds.  New Jersey law prohibits nursing homes from requiring that a family member or friend personally guarantee payment.  That law, however, does not apply to assisted living facilities. If a family member or friend agrees to be a responsible party, one might ask why there is even the need for a personal guarantor, especially if, as is typical in the case of most assisted living facilities, a prospective resident must show proof of funds to cover 2 to 3 years of the cost of care.  Additionally, almost all nursing homes and assisted living facilities now require from applicants