Florida Veterans Benefits Lawyer

We may be able to help you or your loved one qualify for Aid and Attendance Pension Benefits from the Veterans Administration if you reside in a Florida Assisted Living Facility. http://floridaveteransbenefitslawyer.com/

The Aid and Attendance (A&A) program can provide money for assisted living health care expenses for qualified Florida veterans or their surviving spouses.

This VA program has provided monthly payments to veterans and their spouses who have high out-of-pocket medical costs, and who are disabled or homebound, to help them offset health care expenses.  A veteran or eligible spouse receiving pension in assisted living or at home, who is also receiving Medicaid, can still receive the pension benefit in addition to Medicaid Benefits.

Can A Family Agree to Pay A Nursing Home or Assisted Living Residence for A Private Room When Their Loved One is Receiving Medicaid?

By Fredrick P. Niemann, Esq. of Hanlon Niemann Wright, a Freehold, NJ Medicaid Attorney

It’s a question I’m asked often.  It’s also one that causes a lot of confusion within the nursing home community.  Some nursing homes think that any form of private payment violates Medicaid laws.  That is incorrect, it’s perfectly legal.

Here’s the general fact pattern – Mom qualifies for Medicaid, which pays for a semiprivate room, that is, a room with a roommate.  If the family wants a private room for Mom, they can pay the additional charge, provided of course that the home has a single room available.

What is the going rate for a private room? Generally it ranges from $25 to $30 per day. While Medicaid is picking up the semiprivate room rate its reimbursement rate is much lower than the private pay rate. You see, Medicaid pays long term care facilities at a rate approximately 40-50% less than the rate that you and I must pay.  But, while you and I must pay the much higher rate, the good news is that the difference between a semiprivate and a private room is small, once Medicaid eligibility is established.

If your loved one is in an assisted living facility it works the same way.  Medicaid will pay for a shared room but not a single, private room.  Provided the facility has a single room available, the family can pay the difference between the single vs double room rate at the private non-Medicaid rate.  Medicaid will cover the double rate.

Keep in mind that with both nursing home and assisted living Medicaid Mom will continue to contribute almost all of her income to the cost of the facility and Medicaid will pay the rest up to its reimbursement rate.

To discuss your NJ Medicaid matter, please contact Fredrick P. Niemann, Esq. toll-free at (855) 376-5291 or email him at fniemann@hnlawfirm.com.  Please ask us about our video conferencing consultations if you are unable to come to our office.

Medicaid’s “Caregiver Child Exception”- Does My Parent Qualify to Transfer Their Home If I Take Care of Them?- Part 1

By Fredrick P. Niemann, Esq. of Hanlon Niemann Wright, a Freehold, NJ Medicaid Attorney

As a faithful son or daughter of a parent who is of ill health, you want to be able to be there for your parent when they need you the most, as they were once there for you.  It’s your way of giving back to your family that made you into the person you are.  If you are someone who lives with your parents and takes care of them as they decline in health, you may be in luck to help your loved one become possibly eligible for Medicaid quicker if there is a need in the future to send your parents to a nursing home.

As mentioned in my earlier blogs, normally, under Medicaid’s regulations, a transfer of assets is a gift when made below the fair market value of the asset. A gift results in a Medicaid application being assessed a penalty period of non-eligibility.  To have Medicaid pay for your parent’s stay at a nursing home, the parent’s total assets must be less than $2,000.  Often times, a parent has a house in his or her name, and it needs to be taken out of their name to qualify for Medicaid.  Or if the house is sold, or transferred out of their name into another’s with very little money given for the transfer, it is penalized if that is done within 5 years of the application for Medicaid.

But there is an exception that allows the house to be transferred below fair market value without it being considered an improper gift or transfer.  Under the applicable regulation, N.J.A.C. 10:71-4.10(d)(4), a parent’s interest in their home may go to a child of the parent needing Medicaid, if the child resided in the home for at least 2 years before the parent was placed in a nursing home facility AND he/she had provided care that permitted the individual to reside at home rather than at a nursing home.

What kind of care needs to be provided?  It must be beyond supportive activities and include taking care of everything essential to the health and safety of the parent.  So, for example, shopping for your parent and occasionally taking them for their doctor’s appointments will not be enough.  Examples that the regulation gives of activities that would need to be done includes supervising your parent’s medication, monitoring your parent’s nutrition, and insuring your parent’s safety.  I would also argue that to qualify, you need to take care of your parent’s basic needs, including bathing them, dressing them, feeding them, toileting them, and transporting them to their necessary doctor’s appointments.

There is a lot that needs to be proven here, and in our next blog, I will discuss a case where a daughter provided this care, but the court still found it not to be enough under the exception.

To discuss your NJ Medicaid Eligibility matter, please contact Fredrick P. Niemann, Esq. toll-free at (855) 376-5291 or email him at fniemann@hnlawfirm.com.  Please ask us about our video conferencing consultations if you are unable to come to our office.

Medicaid’s “Caregiver Child Exception”- Does My Parent Qualify to Transfer Their Home If I Take Care of Them?- Part 2

By Fredrick P. Niemann, Esq. of Hanlon Niemann Wright, a Freehold, NJ Medicaid Attorney

In my last post, I discussed how if you are providing a high-level of care to your parent, you’re eligible to receive your parent’s interest in his/her home. Medicaid will disregard this transfer for purposes of determining eligibility.  One thing I must emphasize is that the transfer rules must be strictly adhered to.  Remember, the State is looking to deny you Medicaid, so if you choose to use this exception, you need to make sure you can meet their strict criteria.  I can think of no better case where this occurred then in M.K. v. Division of Medical Assistance and Health Services.

In this decision, M.K. was severely debilitated and required a high amount of assistance.  Her daughter provided a great amount of care over five years, including shopping for her, dressing and bathing her, cleaning the house, and attending to M.K.’s financial affairs.  The house was transferred from M.K. to the daughter for less than fair market value, and in the application, M.K. argued the caregiver exception applied to make her eligible for Medicaid despite this transfer within 5 years of the date of the application.

This position was rejected by the State and the courts for three reasons.  First, M.K.’s assets went to pay for a home health aide that came in weekdays from 8 AM to noon when the daughter was working.  Second, the daughter was able to leave M.K. home alone five hours a day while working when the home health aide wasn’t there.  Third, during the 2-year period before M.K. was sent to the nursing home, she had lived with her son for five months, with the daughter only providing assistance with M.K.’s medication and transportation to doctor’s appointments.  Because the care was not continuous in the eyes of the court for the 2 years, it concluded the exception did not apply and the penalty assessed was therefore appropriate.

So if you believe the exception applies to you and your parents, you have to really make a showing that not only was your parent debilitated and that you provided a high level of care, your parent was almost never left alone while you went to work, and if she was, you personally paid for home health assistance to stay with her.  In addition, you must also show that you provided the same level of care throughout the 2 year period even if your parent goes to live with another sibling.  In a slumping economy, with the cost of home health care rising, this is a tall task for anyone to perform over the course of 2 years.  The government essentially wants you to become a full-time nurse for your parent, and if you can’t because you need to work, then you must bear the cost for a home health assistant for Medicaid to pay for the subsequent move to the nursing home.  It is an unfortunate decision because it puts a lot of strings on the use of this exception, which was originally meant as a good intention to encourage children to move in and take care of their parents that once cared for them. More than ever you need our experience in Medicaid eligibility law to help you achieve your asset protection goals.

To discuss your NJ Medicaid matter, please contact Fredrick P. Niemann, Esq. toll-free at (855) 376-5291 or email him at fniemann@hnlawfirm.com.  Please ask us about our video conferencing consultations if you are unable to come to our office.

The Consequences of Paying Every Day Expenses with Cash: How One Couple was Penalized Under NJ Medicaid

By Fredrick P. Niemann, Esq. of Hanlon Niemann Wright, a Freehold, NJ Medicaid Attorney

Here’s a disturbing case I recently read about. A 70+ year old couple, consistent with their established pattern, had approximately $42,000 of cash withdrawals during the five year lookback period for which they did not have receipts. The wife needed long term care and applied for nursing home Medicaid. Her county board of social services (the processor of all Medicaid applications in the county of applicant residence) imposed a penalty for the full $42,000.

Of course, the couple has a hard time understanding how paying for their customary living expenses can be considered transferring assets for the purpose of becoming Medicaid Eligible. Are there any effective suggestions on what to do?

One commentator suggested using commonly accepted statistical studies and publications including government reports, for example. There is a United States Department of Agriculture (USDA) chart with food allowances for elderly adults, which has been accepted. Another suggestion was to get letters from vendors, if the customer is well known to them, verifying that “so and so” has been a longstanding customer for many years and frequently shops there. If there are no charges on credit cards for the categories of items purchased, and no checks, by inference, cash was paid. If there is a frequent shopper card (like for a grocery store), you can probably have the store produce receipt copies or a tally of purchases, amounts, and dates.

Unless there are returned checks/debit card line item expenses that indicate otherwise, you may be able to work backwards.

Also, if you have a good relationship with the bank, an affidavit from the bank tellers as to this pattern of practice helps. Better for mom and dad if each went to the bank alone or together and were well known to the employees.

To discuss your NJ Medicaid matter, please contact Fredrick P. Niemann, Esq. toll-free at (855) 376-5291 or email him at fniemann@hnlawfirm.com.  Please ask us about our video conferencing consultations if you are unable to come to our office.