FinanciallyEligible but Still No Medicaid (Part 2)
In my post last week, I told you that, while our focus in achieving Medicaid eligibility tends to be on the financial part, there are some non financial requirements we must also pay attention to. One is medical eligibility. Another is residency. Medicaid is a combination federal and state program. Federal funds are provided but the programs are applied for and administered on the state level. This means that if I apply for Medicaid in New Jersey I must reside in New Jersey. There is, however, no “waiting period” to establish residency. In other words, if I move to New Jersey today and can prove I intend to remain here as a resident, I can apply for Medicaid today in New Jersey. When an applicant is in a long term care facility - whether a nursing home or an assisted living facility- establishing residency is easy. If applying for home care, one must prove residency by home ownership, a lease or other proof that New Jersey is now their legal residency. Changing a driver’s license, voter registration, utility bills addressed to the applicant at their New Jersey residence all can be proof. There is, however, another aspect to the residency requirement. That is legal residency. An applicant must be living in this country
Financially Eligible but Still No Medicaid (Part 1)
Many of my blog posts on Medicaid focus on the financial part of eligibility - meeting both the income and asset requirements. There are instances, however, in which meeting those requirements still won’t get someone Medicaid. That’s because there are other hurdles to get over. One is the medical requirement, establishing the need for assistance with at least 3 of the activities of daily living (ADLs). The ADLs are transferring (ambulating), dressing, bathing, toileting, feeding (different than preparing meals which is not an ADL), and incontinence. A Medicaid nurse must conduct an evaluation of the applicant to make the medical determination. Despite common misconceptions, having someone administer medications is not an ADL and by itself, is not enough to meet Medicaid’s medical test. The need for medication monitoring, however, does often indicate or lead to the need for assistance with the ADLs. As I always explain to families, even if we meet all the financial requirements, spend down the assets and establish a qualified income trust when income exceeds Medicaid’s monthly income cap or limit, if you are “too healthy” you still won’t get Medicaid. That’s because you can’t meet the medical test. But, the medical requirement is not the only non financial requirement. Next week I’ll tell you about another
The Perils of GoFundMe – Part 3
In my blog post last week, I discussed crowd funding sites like GoFundMe. We see families dealing with a sudden catastrophic illness or injury attempt to use these sites to raise money to pay for medical and other bills. It rarely is a solution if only because of the amount of money needed and length of time of recovery - if full recovery is even possible. For most people Medicaid becomes a necessary financial solution. As I explained last week, Medicaid is a needs based program. Certain asset and income limitations must be met and the State scrutinizes an applicant’s finances over a five year look back period. Raising money thru GoFundMe and sites like it create two common problems when trying to achieve Medicaid eligibility. The first is that in order to meet Medicaid’s asset limit one must spend down. GoFundMe money coming in results in account balances going in the “wrong direction”, increasing rather than declining. Granted, that money will be spent on medical and other bills as part of the spend down process but strict asset limits must be met and that is difficult when money keeps coming into accounts in differing amounts and at different times. Secondly, these transfers in must be documented for Medicaid
The Perils of GoFundMe – Part 2
In my post last week, I wrote about a particular solution - really attempted solution - to the financial burdens caused by a catastrophic illness or injury. In the age of the internet, crowd funding websites have made it easier to raise money from a large group of people. The GoFundMe site is maybe the most commonly known one. Efforts to raise the money needed to pay medical bills and the cost of long term care are rarely successful simply because the target amount is so undefined in terms of dollars and length of time. The road to recovery is a long one and for those without long term care insurance the Medicaid program will be the only alternative, which is where the fundraising efforts can create a problem. As regular readers of this blog know, Medicaid is a needs based program with an asset test and an income test. A Medicaid applicant must have less than $2000 in assets to qualify for Medicaid. In the case of married couples, the non-Medicaid spouse also has an asset limit. When an application is filed, 5 years of account statements must be provided for every account the applicant and spouse had in that time frame. All transfers into and out of
The Perils of GoFundMe (Part 1)
In this week’s blog post, I write about a particular solution - or really attempted solution - to the financial burden caused by a catastrophic illness or accident. A family member calls concerning a loved one who has suffered a serious illness or accident, one that will result in needing extensive custodial care. As readers of this blog know, custodial care is quite expensive, whether in a facility or at home. On average the cost is $13,000 to $15,000 per month and in some cases much more than that. This type of cost is tough for a majority of Americans to cover for any extended period of time but that’s what usually is needed. Recovery to the point of being able to live independently is not achievable in most of these instances. As I have discussed many times, the problem is particularly acute for younger individuals. That’s because they have not accumulated as much savings that can be applied towards care and are less likely to have even considered - let alone purchased - long term care insurance. They also tend to have been working to support spouses and young children. A major source of income may be gone. Medicaid becomes the obvious solution. When I explain how Medicaid works and how
Dispute Over a Retirement Account – Part 2
In my blog post last week I told you about a recent Wall Street Journal article that caught my eye. Jeffrey’s siblings sued to recover their brother’s retirement account. In 1987 Jeffrey designated his girlfriend at the time as the beneficiary of the account. He broke up with her in 1989 but never changed the beneficiary so when he died the account custodian said they had to pay her. That’s because the retirement account is considered contract property. A will or when there is none state intestacy laws, do not control contract property if there is a beneficiary designation on file with the account custodian. Jeffrey’s siblings sued and lost but according to the WSJ article they intend to appeal. Based on my experience I would say they are very unlikely to succeed. It reminds me of a case years ago I was referred by another attorney who had tried and failed to do what Jeffrey’s siblings tried - to get a court to override the beneficiary designation. The siblings sued Proctor and Gamble, the company that Jeffrey worked for, alleging it violated a fiduciary obligation to inform him of his beneficiary designation. It isn’t clear from the article why they should have reminded him. P&G said that when it changed service