Medicare Decision – 6 Years Later
I wrote about this decision here six and a half years ago. (Blog posts 3-25-13 and 4-1-13) The case is Jimmo vs. Sebelius and it corrected the misapplication of Medicare rules concerning coverage for rehabilitation services and therapy. The standard that had been applied for many years was whether the patient was improving as a result of the treatment, called the “Improvement Standard’. If not, then Medicare coverage would be terminated. This termination was often well short of the 100 days of coverage allowed under Medicare. It is certainly easy to understand why this became the standard. With elderly patients suffering from dementia, Alzheimer’s, Parkinson’s and other noncurable illnesses, they often could not show sufficient improvement to avoid Medicare’s cutoff. Medical treatment is focused on curing a condition. The problem, however, was that this was never the standard as written. Instead, what determines whether Medicare Part A coverage for skilled nursing home stays, home health care and outpatient services will continue is whether those services are needed to maintain the patient’s current condition or prevent or slow further deterioration. This is what is termed the “Maintenance Coverage Standard”. That was the issue at hand in the class action suit filed. The outcome
More Numbers for 2020
In my 11/4/19 post, I disclosed some of the important numbers that change year to year with respect to the Medicaid and VA Aid and Attendance programs that we work to obtain for many of our clients. Here are the rest of the important numbers as well as 2020 Medicare and estate and gift tax numbers. In the case of a married couple where one spouse is applying for Medicaid, the healthy spouse is entitled to keep a certain level of assets, referred to as the Community Spouse Resource Allowance (CSRA). The maximum CSRA is $126,420 (if the couple has $252,840 in countable assets or more). The minimum CSRA is $25,284. This means that the healthy spouse can keep at least the first $25,284 of countable assets. The primary residence is an exempt asset for Medicaid purposes no matter the value if the non-Medicaid spouse is living in it. In the case of a single applicant with no spouse, in New Jersey the first $878,000 of equity is exempt and does not have to be spent down. Any equity above this amount is a countable asset and subject to the spend down requirements. Let’s look at some of the relevant Medicare numbers. Under
Alternate Care Facilities (Part 2)
In last week’s post I discussed lesser known facilities that provide some level of long term care. One is a residential health care facility and another is a dementia care facility. They are categorized differently by the State of New Jersey for licensing purposes. But paying for them can also be very different than covering the cost of a nursing home or assisted living facility. One way, however, does remain the same. Private paying – using your own savings – always works as long as you don’t run out of money. If you have a long term care policy it can be a little more tricky. A residential health care facility such as the Society House which I talked about last week probably would not be covered under a long term care insurance policy for one of two reasons. Policies that cover the cost of a nursing home or assisted living facility will define those facilities within the insurance contract. Boarding homes, individual residences and independent living units won’t qualify for coverage. Whether a residential health care facility will be covered will also depend on what services it provides to residences and the frequency. A second reason the insurance may not cover the
Alternative Care Facilities (Part 1)
    I recently made a visit to see a new facility opening in Livingston. The Society House is a single family home built to house 15 seniors in a group home type setting. The owners have applied but not yet received approval for licensing as a residential health care facility.     When considering options for long term care care in a facility setting, most people know about assisted living facilities and nursing homes. There are many such options in our area. There are, however, lesser known categories of facilities licensed by the State of New Jersey. One type is the residential health care facility defined as a homelike setting that provides shelter, food, supervised health care and related services.     There are only a handful of licensed residential health care facilities in New Jersey. Meals are provided in a common dining area similar to an assisted living facility. Staff is present to provide some assistance as needed and in some cases to administer medication. Society House’s price point is $3900 per month so it would appear that they will be focusing on higher functioning residents for whom living alone is no longer safe, although that is
New Medicaid and VA Figures for 2020 (Part 1)
The Social Security Administration announced last month the cost of living adjustment for 2020. This adjustment is also applied to many of the government programs besides Social Security, that affect our clients’ lives. So here it is. Following an increase last year of 2.8%, this year the increase is smaller, only 1.6%. In December, Social Security recipients will receive notices calculating their new monthly benefit amount with the increase. This includes people receiving traditional retirement Social Security, Social Security Disability and needs based Supplemental Security Income benefits. All are administered by the Social Security Administration. The Medicaid income cap, which is tied to Social Security will rise by the same 1.6% to $2349 per month. This number is the limit on income per month needed to qualify for most Medicaid programs. For Medicaid recipients whose income exceeds this limit a Qualified Income Trust (commonly known as a Miller Trust) must be used to achieve and maintain eligibility. Because the VA Aid and Attendance program adjustments is also tied to the same percentage increase, this means that those benefits will increase by the same 1.6%. The maximum benefit for a single veteran will increase to $1912. For a married veteran the maximum monthly benefit
Self-Proving Will (Part 2)
Last week I wrote about the process of probate and how easy it is to admit a will to probate without the need to appear before judge if it is a self-proving one. But what exactly is a self-proving will? New Jersey law sets out clear instructions on how to make a will self-proved. The testator (person signing his/her will) must sign the will before a notary public or attorney at law and the witnesses must sign an affidavit before a notary public or attorney at law. The affidavit should state that the testator signed the will willingly, that the witnesses signed in the presence of the testator as witness to the testator signing the will and, to the best of the witness’ knowledge that the testator is 18 years of age or older, of sound mind and not under any undue influence. The statute even includes a form which, if followed, will meet the requirements. Attorneys who practice in the area of wills and trusts understand the requirements. Problems generally occur when the testator decides to save the legal cost by doing it him/herself, which has certainly become easier in the age of the internet. This approach, however, reminds of the