Lack of Verification – Worse than a Medicaid Penalty? Part 1
Whenever we are preparing to file a Medicaid application on behalf of a client we closely examine the 5 years of records that we will need to provide to the State together with the 16 page application. Those records include every statement for every asset the client owned in the 5 years directly preceding the month we want Medicaid benefits to begin. As I explain to my clients, we are looking at what the Medicaid caseworker will be scrutinizing – money going into the client’s accounts and money leaving those accounts. Money leaving the accounts – whether by check, electronic transfer, cash withdrawal etc. – is important because Medicaid wants to determine whether the applicant received something of equal fair market value back in product or service. If he/she did not, then the uncompensated transfer is subject to a Medicaid penalty. When I explain how the penalty works most people understand very quickly how that can negatively impact the applicant and his/her family. The penalty is actually a waiting period for benefits. If I am in a nursing home and spent down to $2000, but I have transferred $50,000 in the past 5
The Biggest Misconception about ALFs and Medicaid (Part 3)
The last two weeks I have been talking about the biggest misconception about assisted living facilities and Medicaid so let’s continue. I explained to Carol the issue with level of care – that her mom must establish the need for nursing home level care even though she is residing in an assisted living facility. There is, however, another potential problem with getting Medicaid. ALFs must make at least 10% of their beds available for Medicaid. Most facilities only make 10% of their beds available for Medicaid. For that reason, the facility cannot guarantee that a Medicaid slot will be available at the exact time when Carol’s mom qualifies. It has a limited number of slots and they could be filled when Carol’s mom is approved. It is impossible to know years - or even months - in advance whether a slot will be open at precisely the “right time” for Carol. It is a game of “musical chairs” of sorts. When the music stops, -ie. Medicaid is approved – will there be a “chair” available? Impossible for anyone to say. (We have in some cases been able to get that guarantee for our
The Biggest Misconception about Assisted Living Facilities and Medicaid (Part 2)
Last week we were discussing Carol, her mom and a very common disconnect we see when families speak with assisted living facilities. The facility explained its requirement that residents must private pay for a certain period before being considered for one of its Medicaid slots. Carol, however, heard something entirely different. She heard what was said to mean that as long as she meets the private pay requirement, Mom will get New Jersey Medicaid. It’s easy to see why this happens. First of all, the Medicaid rules are quite complicated. The average person is unfamiliar with the rules and regulations of Medicaid and very often the assisted living representative isn’t much more knowledgeable either. There are strict income and asset requirements. Assets must be spent down to less than $2000. Income is viewed by another set of rules. Medicaid has a strict income cap of $2250 of gross income. For applicants who exceed that cap a Qualified Income Trust must be used but the rules are very technical and it is easy to be tripped up and lose Medicaid eligibility for failing to follow those rules. That, however, isn’t the biggest misconception about assisted living Medicaid. We have to
The Biggest Misconception about ALFs and Medicaid – Part 1
I wrote about this 5 years ago, but it still is one of the most common misconceptions families have about the ability to qualify for Medicaid in an assisted living facility. Let’s look at the following very common scenario. Mom can no longer live at home alone. Her daughter, Carol, is exploring assisted living as an option. She tours an assisted living facility and has a conversation with the Admissions Director. Carol asks the following question, “Do you take Medicaid?” The director tells Carol that they are a New Jersey Medicaid approved facility and then explains that residents are required to private pay for 2 years before becoming eligible for one of their Medicaid “slots”. That time period for most facilities typically falls within the range of 2 to 3 years. Each facility sets its own policy and requirements. But what Carol is likely to hear is something very different. She tells me “the facility said if I pay for 2 years Mom will get Medicaid”. Now, although I wasn’t in the room when that conversation took place, if I was a betting man, I would say odds are that the director didn’t
New Medicare ID Cards
In an effort to prevent fraud, the Centers for Medicare and Medicaid Services (CMS) has redesigned Medicare cards. The cards are still red, white and blue but they will no longer contain a Social Security number, gender, signature and other personal information, all of which could compromise the Medicare beneficiary’s identity. The new cards have an 11 character, randomly assigned number that is not in any way connected to the beneficiary’s other personal data. All current beneficiaries are scheduled to get their new cards no later than December, 2019. In our area, Pennsylvania residents are scheduled to receive their cards between April and June, 2018. New Jersey and New York residents will receive their new cards beginning after June, 2018. Before the mailings start, beneficiaries should insure that the Social Security Administration has their correct address. Any address changes should be made by contacting the Social Security Administration at ssa.gov/myaccount or by calling 800-772-1213. Medicare beneficiaries should also be aware of scammers who are trying to take advantage of unsuspecting beneficiaries by contacting them directly about their replacement cards. CMS employees never call and ask for personal or private information about Medicare recipients. There also is no fee or
Unexpected Inheritance – Too Good to Be True? Part 2
In last week’s post I shared with you a letter my client, John Smith, received about an unexpected inheritance. There are several red flags that tell us it’s a scam. The letter contained the bank’s recognizable logo. It appeared to be “off”, although I was looking at a copy of the letter. It may have been even more apparent if John had given me the original. The account manager’s instruction to email him at his personal email was also a clear sign this was a scam. In fact, the letter only had listed his personal email address. Let’s take a look at the content of the letter. Donald Smith died in a car accident without a will. It is curious to me how the account manager would know this. Banks don’t have any reason to inquire or know whether their clients do or do not have wills. But let’s assume that Donald didn’t have a will. What happens in that case? Well, one thing that doesn’t happen is the bank taking it upon itself to go looking for heirs. Banks don’t check for heirs when their clients die. The account sits