In This Issue

	Medicaid NoNos
	If you answer yes to any of these questions, Hurley Elder Care Law can help
	Life Care Planning Goals
	The Nuts and Bolts Guide to VA Benefits

Medicaid NoNos

	In our elder centered law practice, the goal is to keep clients in the least restrictive custodial care arrangement possible. However, due to either care requirements or ability to pay, some clients do end up residing in skilled nursing facilities. Not only are skilled nursing facilities the most restrictive custodial care alternative available, but they are also generally the most expensive choice. Since the costs are great, we try to help people who move into these facilities qualify for Medicaid at some point in time. Those of you who work in the elder care world know how difficult the Medicaid process can be. Not only is a massive amount of paperwork required, but the documentation is very tedious and technical. We attempt to make the process relatively easy, but often times that is just a dream. Since the implementation of the Deficit Reduction Act of 2005, everything has only become more difficult.
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If you answer yes to any of these questions, Hurley Elder Care Law can help.

		Has the elder been diagnosed with a mentally or physically debilitating disorder such as Alzheimer’s, Parkinson’s, ALS, stroke or a decline in functional capacity?
		Is the elder isolated due to the recent death of a spouse, or have family that either lives too far away or is too busy to provide adequate care?
		Is the elder soon to be discharged into a care facility or currently receiving in-home care?
		Does the elder have a variety of healthcare providers and need coordination and advocacy for quality care?
		Does the elder seem unusually concerned about costs of medication and services, indicating he or she may be having financial troubles?
		Does the elder have assets that fall between $50,000 and $400,000 – enough to finance a short stay in a care facility but not enough for an extended stay?
		Does the elder have a spouse whose financial needs must be considered in light of the elder’s medical condition?

Life Care Planning Goals

1. Meeting the elders’ immediate health care and long-term care needs.
2. Making sure the elder/family is making good health care and long-term care decisions.
3. Helping the elder/family sort through the maze of their long-term care options including residential options.
4. Identifying and accessing public benefits and resources to pay for care should the elder meet the qualifying criteria.
5. Help with asset management, including the burden of home ownership and personal property.
6. Providing the entire family the peace of mind that comes from knowing their loved one is monitored by a team that combines legal and financial expertise with specialized knowledge of the elder’s physical, mental and emotional health.
7. Ensuring the highest level of independence the elder can achieve, while ensuring safety.

Medicaid NoNos

Adult children of clients come to us trying to make sense of their elderly parents’ affairs after the parents’ faculties have deteriorated. The elders, often of the “Depression Era,” hold matters close to the vest and many have never discussed their financial affairs or their wishes with their children. This becomes an emotional issue that typically arrives during a crisis event, such as a stroke, broken bone or advancing dementia. In the end, if someone is going to qualify for Medicaid, they must go through the effort of dotting the I’s and crossing the T’s, while providing full disclosure. The basic income and asset levels for an individual going onto Medicaid in Georgia are: maximum income of $1,911 per month and total “countable” assets of less than $2,000. The Department of Children’s and Family Services, which administers Medicaid in Georgia has access to just about every other federal and state agency that maintains data on financial and property assets, so just leaving something off of an application and hoping to still qualify will not work. If you are an adult child of a parent who is dealing with chronic conditions, try starting a dialogue as soon as possible and make sure that at a minimum, powers-of-attorney are in place. It is important to have the legal authority to act on someone’s behalf in order to deal with banks, companies and other institutions without having to involve the probate court. If you know of someone who may need to qualify for Medicaid within the next five years, the following is a basic list of practices to avoid: Giving away your assets in the prior five years. Medicaid does not allow people to give away their assets so they can qualify for assistance. If assets are transferred during the previous five years, Medicaid will impose a penalty period during which time it will not pay a person's nursing home bill. Those needing Medicaid must spend their money only on legitimate purchases or services for themselves or their spouses until their assets are reduced sufficiently to qualify for assistance. Do not assume that IRS rules and Medicaid rules are the same. Many people are aware that the IRS allows annual individual gifts up to $12,000 without gift tax return or tax due; however, any such gift would be penalized by Medicaid. Medicaid usually does not penalize someone for past tithing to churches and contributions to charities, if there is a “pattern of giving,” but even that must stop when on Medicaid. Relying on friends, neighbors, social workers or nursing home admissions clerks for Medicaid eligibility rules. There is a great deal of misinformation in the community as a whole. I have many people come into my office who have been told things that are completely off base. Elder care lawyers are the best source of information regarding qualification for Medicaid benefits. The Medicaid rules are complicated and unending and everchanging. They are not easily understood by people who do not look at them on a daily basis. Do not sell or trade an asset for less than “fair market value.” If an asset is transferred for less than FMV, then the difference between FMV and the transfer value creates a penalty as described in number 1 above. One must know the fair market value. For a house, you can get that amount from the county tax assessor’s office. For other items that do not have a readily determined value, consider an appraisal. The most important lesson here is to save documentation. Mixing funds with people other than a spouse. As previously stated, in order to qualify for nursing home Medicaid coverage, a recipient may not have more than $2,000 in countable assets. DFCS will assume that any funds held in a joint account belong to the person applying for Medicaid. It is possible to prove otherwise, but you will have to show the source of the money. Children should not a parent on their bank accounts if the money does not belong to the parents as Medicaid will count that money against the person applying for assistance. Paying a caregiver, especially a relative, without a written contract in place. Caregivers who are paid must work and be paid on a documented, regular schedule and should not receive lump-sum payments. Caregiver contracts, especially for family caregivers, are extremely important. They outline the services rendered and the amount to be paid for the services. Be sure that the caregiver also declares the payment as taxable income, or the payment may be considered to be a gift. Once again, keep documentation. Taking ATM withdrawals for large amounts or writing checks for “cash.” A person who wants to spend down money to qualify for Medicaid needs to use assets for his or her expenses and not the expenses of others. This can be extremely difficult to explain when a parent is suffering with dementia and still has access to bank accounts. As paranoia sets in, this type of individual may want to hoard cash just to show that he or she is in control. While the cash may be being spent on the needs of that individual, documentation can again prove to be elusive. Allowing assets to accumulate after reduction to the $2,000 Medicaid limit. Once the $2,000 asset limit has been reached, maintain a balance below that amount by the time that the bank statement is published. Go ahead and prepay a nursing home or other bill even before the statement has been sent. If there are excess funds, make sure that they are spent necessities before the last day of the month. Failure to keep financial records for five years. Medicaid currently looks back into a person’s financial history three years. By February 8, 2011 they will want five years of records. DFCS will want to see checks, bank and brokerage statements to see how a person has spent money. Again, make sure to keep detailed, separate records related to income, property, bank accounts and health insurance. Taking action without getting informed advice. When in doubt, call someone who deals with Medicaid and DFCS for a living. Remember that, especially in Medicaid cases, it does not pay to be penny wise and pound foolish. Correcting a mistake is much harder and more expensive than having gotten the proper guidance in the first place.