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How Joint Accounts and Gifting Affect Medicaid Eligibility

As individuals begin to age, long-term care services and how to finance them become major concerns. Many turn to Medicaid to pay for their long-term care needs. Medicaid is a joint Federal and State funded program that provides medical insurance and long-term care payments on behalf of middle- to low-income individuals, including those who are elderly and disabled. However, since Medicaid eligibility is determined by the combined value of income and assets, gifting money and joint accounts may impede a person’s ability to secure Medicaid benefits.

 

Whether a penalty period results from the transfer or gifting of money to another person depends upon whether the individual is applying for Chronic Care Medicaid or Community Medicaid. For Chronic Care Medicaid, which provides coverage for long-term care services in a nursing home facility, there is a five-year look-back period. This means that, if an individual transfers or gifts money within five years of applying for Chronic Care Medicaid, he or she will face a penalty period. For Community Medicaid, which provides support for long-term care in the home, there is no look-back period when applying for coverage and the applicant will not face a penalty period for transferring or gifting money.

 

Joint accounts may also hinder an individual’s ability to secure Medicaid benefits. When an individual applies for Medicaid coverage for long-term care services, the state will assess the person’s income and assets to see if they qualify for public benefits. Even though the bank account has two names on it, the state presumes that the content of the joint account belongs to the Medicaid applicant, regardless of who contributed money into the account. The state will presume that the account belongs to the Medicaid applicant unless it is proven that the individual did not contribute money into the account. If the Medicaid applicant is unable to overcome the presumption, then 100 percent of the account’s contents are considered to belong to the Medicaid applicant.

 

Whether the state presumes that all contents of a joint account belong to the Medicaid applicant depends upon what type of joint account it is. If the account is a convenience account, the entire account will be presumed to belong to the applicant. However, if the funds are placed in a joint stock or brokerage account, then there is no presumption that the account belongs solely to the Medicaid applicant. In this instance, each individual is presumed to own half of the joint stock or brokerage account.

 

Individuals who are applying for Community Medicaid may be able to eliminate income over the state income limit by placing the excess income into a Pooled Income Trust.  When applying for Community Medicaid, an applicant’s resources may be “spend down” by placing them into a trust or by making transfers. Under current Medicaid regulations, there are certain asset transfers into trusts that may be identified as exempt income when determining Medicaid eligibility.  Transferring assets should never be done without first consulting a qualified Elder Law attorney familiar with transfer of assets rules.

 

As you or your loved ones reach retirement age, it is important to determine what long-term services you will need and how you will pay for them. The New York Elder lawyers at Hobson-Williams, P.C. are experienced in assisting elderly and disabled individuals meet Medicaid income eligibility standards and will help establish trusts and assist with exempt transfers to protect their assets. For more information or to schedule a consultation, call our New York elder law and estate planning office at (718) 210-4744 or fill out our contact form.

 

What is Medicaid Fraud?

Today, there are over 5.3 million New York residents enrolled in the Medicaid program, according to the New York State Department of Health. As one of the largest state and federally funded programs, both New York State and the federal government have devoted millions of dollars to investigate, penalize and prosecute individuals and entities engaging in Medicaid fraud.

There are several types of Medicaid fraud, such as those who receive Medicaid fraudulently. Medicaid recipient fraud may include an applicant falsifying information on the application and certification failure to disclose information about income and assets owned, and the failure to disclose income earned by a spouse or other household member. Other activities that can be deemed as Medicaid fraud are loaning another person their Medicaid identification card, changing or creating a falsified order or prescription, using more than one Medicaid identification card, deliberately receiving excess, duplicative or conflicting medical service and/or supplies, and selling Medicaid-provided supplies to others.

However, there are some instances that may trigger an investigation into Medicaid fraud, even if the individual has not acted outside the scope of the law. These instances may include an unusually high frequency of Medicaid claims, an anonymous call to the Medicaid fraud hotline, and a computer-generated analysis of Medicaid claims and billing codes. Medicaid can also perform an investigation if Medicaid benefits were paid incorrectly, even if you are not at fault.

On the federal level, Medicaid fraud is investigated by the Inspector General, the Federal Bureau of Investigation or other federal entities. On the state level, it is investigated by The Medicaid Control Unit of the New York Attorney General’s Office, the Office of Medicaid Inspector General, and local district attorneys. On the local level, it is investigated by the NYC Human Resources Administration or County Department of Social Services. Medicaid fraud can result in a variety of penalties and consequences, from repayment of Medicaid benefits to lengthy prison sentences. Due to the potentially severe consequences an individual can face, it is important that anyone under investigation for Medicaid fraud contact an experienced New York Medicaid fraud lawyer who can advise you of your legal rights and course of action.

The experienced New York Medicaid fraud defense attorneys at the Law Offices of Tanya Hobson-Williams have successfully defended clients who were accused of Medicaid fraud. Our lawyers are knowledgeable in the laws of Medicaid eligibility and usage and will vigorously defend your rights. To schedule a consultation, call 1-866-825-1LAW.

Elderly Misuse of Antipsychotics: A Disturbing National Trend

A recent National Public Radio (NPR) investigation revealed that nearly 20 percent of senior nursing home residents receive some form of antipsychotic medications.

Similar reports, drawing from the NPR investigation, found significantly higher rates of antipsychotic drug usage concentrated in the Western New York area.  In the Rochester region, data revealed that antipsychotic drug usage rates reached up to 30 percent.*

These statistics are concerning as recent news has suggested that many seniors in nursing care facilities are often given antipsychotics meant to treat conditions that they do not actually have. For example, a 2011 government study found that 88 percent of Medicare claims for antipsychotics prescribed in nursing homes were for treating symptoms of dementia, even though the drugs were not approved for that. The consequences of such overmedication can lead to unfortunate complications, including an increase in the risk of accident, injury, and even heart failure.

In response to this trend, the federally-operated Center for Medicare and Medicaid Services instituted a national campaign to reduce the misuse of antipsychotics. Despite its efforts, however, investigations reveal that the government has been slow to penalize caregivers that run afoul of the program’s mission.

Federal law prohibits the use of antipsychotics drugs for the convenience of the caregiving staff.  Thus, it is important that loved ones be cognizant of the signs of over-medication. If you suspect that you or your elderly loved one is being subjected to over-medication in his or her Senior Care facility, contact an experienced New York Elder Law attorney at the Law Office of Tanya Hobson-Williams at (718) 210-4744.

*While the numbers are alarming, Medical professionals in the Rochester region maintain that the comparatively higher usage rates reflect the elderly patient’s higher need for the medications. Statistics suggest that the Rochester region leads the nation in care for elderly patients with substantial and complex needs, providing support for the medical professionals’ contentions that such medications are necessary to treat their elderly patients.

Nursing Homes Attempt to Lure in More Medicare Patients to Increase Profit

A recent exposé by the New York Times revealed that as nursing homes revamp their facilities to include luxury living quarters, the disparity between the lavish amenities of short term accommodations, and the quality of care can be drastic.  Although nursing homes are attempting to lure in patients whose short stays will be funded by Medicare dollars, in lieu of Medicaid, many patients are being discharged from the facilities before they have been rehabilitated.  Or worse yet- they leave with more medical issues than they had upon admittance.

Nursing homes are reaping 84% more in profits from short-term patients on the Social Security age based Medicare program than they do from lower income patients whose long-term stays are funded by need based Medicaid program.  Medicare does not provide for long term care funding, so many facilities are creating “luxurious” accommodations that may even include putting greens, restaurants, and private rooms with the hopes of luring in patients and increasing revenue.  Some nursing homes have decided to sustain themselves on Medicare funding alone because it is so profitable, thus excluding Medicaid patients.

Due to the time limits for nursing home stays for Medicare patients, many patients will be forced to leave the nursing home before they are fully rehabilitated or before they have adjusted to their medications.  More facilities are catering to short term care in order to receive the substantially higher Medicare payments.  The quality of care is being compromised by ushering patients out the door with quick (and often ineffective or negligent) treatment with less staff.

One family has decided to sue the nursing facility where their mother was rehabilitating after a fall.  While at the facility, she lost twenty pounds and developed a bed sore that exposed her bone.  As a result of the nursing home’s negligence, the patient’s health had deteriorated so badly that she was brought to a hospital where such succumbed to her condition a month later.

In another case, an 87 year old retired neonatologist who checked herself into a top rated facility to recover from an injured foot also developed bedsores so severe that she had to be brought to the emergency room.  She also claims that the staff did not take precautions to prevent bedsores by turning her over periodically; nor did the staff respond to her diaper change requests promptly or give her a full bath.  The patient is suing the facility for negligent care.

Those in the industry are optimistic that the playing field will even out and the quality of care will stand on equal footing with the quality of accommodations in the not too distant future.  While hospitals are required to pay penalties if too many patients are readmitted, they will likely cease sending patients to nursing homes that perform poorly.  In addition, new payment models are being implemented that reward low costs without sacrificing quality.

To read the full article:  http://www.nytimes.com/2015/04/15/business/as-nursing-homes-chase-lucrative-patients-quality-of-care-is-said-to-lag.html?partner=rss&emc=rss&_r=0

Medicare Prescription Drug Abuse on the Rise

Tanya Hobson-WilliamsA recent examination of federal data conducted by USA Today has recently revealed that the number of U.S. senior citizens receiving narcotic painkillers and anti-anxiety medications under Medicare’s prescription drug program is sharply rising. Recreational drug use can still be classified under medication-related problems (MRPs).  Caregivers can play a key role in identifying and managing substance abuse issues, however, they may also be held liable if they fail to notice the signs of substance abuse.

According to the data collected between, 2007-2012, the number of senior patients receiving Medicare prescriptions for opioid-based pain medications has increased by more than 30 percent to upward of 8.5 million beneficiaries.

Specifically, the use of the most commonly abused painkillers, like hydrocodone and oxycodone, rose by more than 50 percent. The data also showed a significant increase of the personal supply of each narcotic provided to the average recipient rose about 15 percent over approximately three months. Continue reading “Medicare Prescription Drug Abuse on the Rise”

Special Needs Trust Can Provide Effective Financial Relief for the Disabled Elderly.

Tanya Hobson-WilliamsFederal and State law provide a number of programs to help a person with disabilities.  Such programs include. Security Income and Medicaid. Supplemental Security Income, or SSI, is a federal program that provides monthly cash payments to people in need. SSI is for individuals who are 65 or older, as well as for blind or disabled people of any age, including children.

However, to qualify for SSI and Medicaid an applicant must own less than $2,000 in assets. The value of your home does not count if you live in it. Usually, the value of your car does not count and the value of certain other resources, such as personal items or a burial plot, may not count either. Continue reading “Special Needs Trust Can Provide Effective Financial Relief for the Disabled Elderly.”

Elder Law Changes in 2014

While many things remain the same, the laws in the United States are constantly subject to change and revision. Elder law is no different. It is crucial to stay informed and understand the latest regulations that concern you or your loved ones. Below are a few changes made in 2014 regarding elder law (or laws that are particularly relevant for seniors and their families who are attempting to plan for the future):

Medicaid Spousal Impoverishment Amounts

If you and your spouse are contemplating applying for Medicaid because of the need to place one of you in a nursing home, keep in mind that there are income and asset limits, which will prevent eligibility. If your assets exceed $23,448 (excluding your house, one automobile and household possessions), you will be eliminated from Medicaid eligibility without correct planning. There are ways to shelter assets above that amount. Consult an experienced elder law attorney for more detailed advice. Continue reading “Elder Law Changes in 2014”

Medicaid Myths

Tanya Hobson-WilliamsWe all expect and hope to have long and healthy lives. However, the truth is, no one lives forever and all too often health issues and accidents occur, leaving many individuals unprepared and in trouble. But there is something you can do to ensure you are never put in this position: PLAN! By planning ahead, you are able to answer the tough questions and make arrangements while you are in good health and mind.

The harsh truth is that 7 out of 10 people over the age of 65 will require expensive long-term care at some point. Would you be able to foot the bill for an extended stay at a nursing home, assisted living facility or at-home care for you or your spouse? Even if you could, would you prefer to pass your savings and other assets to your loved ones rather than have those assets depleted by costly long term care expenses? To protect your lifestyle and assets, Medicaid Planning is necessary.

Continue reading “Medicaid Myths”

NYS Breaks Record in Medicaid Fraud Recoveries

Tanya Hobson-WilliamsThe New York Office of the Medicaid Inspector General (OMIG), reports that in 2013, it recovered what seems to be the highest ever recovery amount regarding Medicaid fraud in the history of the agency. Gov. Andrew Cuomo made the announcement early this February, reporting a sense of pride in New York and explaining the figures as an illustration of how New York State is “truly leading the nation in fighting fraud and protecting taxpayer dollars.” The exact figures calculated reached $1.7 billion over the past three years, and a record of $851 million in 2013 alone.

Continue reading “NYS Breaks Record in Medicaid Fraud Recoveries”

Medicare Wants the Power to Ban Certain Doctors

Tanya Hobson-WilliamsWhile the main focus of Medicare has historically been to provide affordable and accessible medications to seniors, its focus has recently changed. Early this January, The U.S. Centers for Medicare and Medicaid Services (CMS) announced a proposed rule that would bring significant changes to the federal agencies.

The most notable change offered by the proposal is the agency’s new authority to kick out physicians and other providers who engage in abusive prescribing. It could also take such action if providers’ licenses have been suspended or revoked by state regulators or if they were restricted from prescribing painkillers and other controlled substances.

Additionally, the agency will tighten a loophole that has allowed doctors to prescribe to patients in the drug program (known as Part D) even when they were not officially enrolled with Medicare. Under the new rules, doctors and other providers must formally enroll if they want to write prescriptions to the 36 million people in Part D. This requires them to verify their credentials and disclose professional discipline and criminal history. Continue reading “Medicare Wants the Power to Ban Certain Doctors”