I get quite a few calls from attorneys who have settled cases or obtained judgments in favor of their clients to compensate them for pain and suffering resulting from slip and falls, car accidents, medical malpractice etc. The amount recovered might be small, say $10,000.00. In other cases, it can be substantial, say $1,000,000.00 or more. In each case the attorneys have brought the matter to a successful conclusion, no doubt getting the very best result they can for their client. So, why are they reaching out to me? The reason is that in many cases their clients are receiving “needs based” government benefits; an example, Medicaid. Receipt of settlement money will in each case cause their client to lose …
If the County Medicaid Office Fails to Give You Clear Response Why They Denied Your Medicaid Application, You Can Appeal… And Win
By Fredrick P. Niemann, Esq. of Hanlon Niemann & Wright, a Freehold Township, Monmouth County, New Jersey Medicaid Application and Eligibility Attorney As I’ve often written in my blogs New Jersey’s unofficial Medicaid philosophy is delay, frustrate and deny. Most denial are vague, unclear and wrong but few people know what to do. A recent case outside New Jersey slammed the State and overruled their denial because the stated reasons for the denial were unconstitutional. Let’s take a look at this case. Background of the Case The state medical agency mailed the plaintiffs notice of its determination that the plaintiff had countable assets exceeding the federal and state mandated limits for Medicaid eligibility. This denial notice was representative of the …
Understanding the Differences in the Many New Jersey Medicaid Programs
By Fredrick Niemann, Esq. As an elder law attorney, I regularly work in the State Medicaid programs that provide long term care benefits. I categorize these programs primarily as institutional Medicaid and community waiver Medicaid under the MLTSS Program (Managed Long Term Support Services). Institutional Medicaid covers long term care in a nursing home. New Jersey is a no “maximum income limit state with a medically needy program”. What this means is that we have two (2) institutional Medicaid programs within the main institutional Medicaid program. Confusing isn’t it? The first program is the “Medicaid Only” program which is for residents who have income below the maximum income limit (currently $2,205.00 gross income per month in 2017-2018). For those with …
How Can An Annuity Protect Your Assets From New Jersey Medicaid Laws?
By Fredrick P. Niemann, Esq. a New Jersey Medicaid Attorney Annuities are really confusing. But in today’s medical world, you may hear that annuities can be “Medicaid friendly.” What exactly is a “Medicaid friendly annuity”? Simply stated, they are funds converted into an annuity that Medicaid treats as an exempt resource and only as income which allows for (sometimes) immediate Medicaid approval for nursing home, assisted living and home based care. Under New Jersey law, a traditional commercial annuity does nothing to protect assets from the cost of long term care. In fact, without careful planning, simply investing in an annuity will result in the unnecessary loss of assets and a denial of Medicaid benefits. Understanding why this is requires …
Federal Medicaid Law Prevents a Nursing Home from Billing You Directly
By Fredrick P. Niemann, Esq. of Hanlon Niemann & Wright, a Freehold, Monmouth County, NJ Elder Law & Medicaid Attorney I read an interesting case, which frankly brought up an issue I had not contemplated which is; must a medical service provider (i.e., a doctor, hospital x-Ray technician) bill a Medicare/Medicaid patient directly for services etc. rendered rather than Medicare or Medicaid directly? I pretty much assumed that if you are eligible for Medicare or Medicaid and receiving services, there would be no reason for a nursing home or other medical provider to bill anyone but Medicare/Medicaid, otherwise, the provider would go unpaid. Apparently, in this case, the patient was a plaintiff in a fairly substantial personal injury lawsuit and …
Program of All-inclusive Care for the Elderly (PACE)
By Fredrick P. Niemann, Esq. of Hanlon Niemann, a Freehold, NJ Elder Care Attorney What is PACE? PACE stands for Program of All-inclusive Care for the Elderly. It is an innovative Medicare program that provides individuals age 55 and older comprehensive medical and social services provided by a team of professionals in a community-based center and in their homes, helping program participants delay or avoid long-term nursing home care. The PACE center serves as the hub for medical care, rehabilitation, social activities and dining. Eligibility to participate in PACE To participate, an individual must be 55 years of age or older, require nursing home level of care but be able to live safely in the community at time of enrollment …
When Can Medicare Stop Paying for Skilled Care and Rehabilitation
By Fredrick P. Niemann, Esq. of Hanlon Niemann, a Freehold, NJ Medicaid Attorney Often times families and patients are told by representatives of a nursing home or outpatient Medicare provider that Medicare will not pay for continued rehab, therapy or care because the patient is not improving. But is this policy legal? The short answer is no! The Medicare Policy Manuals have been revised. These changes must be followed in NJ. The revisions have been published by the Centers for Medicare & Medicaid Services (CMS). The changes in policy pertain to care in Inpatient Rehabilitation Facilities (IRF), Skilled Nursing Facilities (SNF), Home Health care (HH), and Outpatient Therapies (OPT). Translated, it means nursing homes and outpatient visitations at home and/or …
This Just In From the State: 2015-2016 Community Spousal Maintenance, Shelter and Utility Allowance Adjustments (MMNA & CSRA Allowance)
Effective July 1, 2015 the new base income allowance for a community spouse will increase from $1,966.25 to $1,991.25. The new standard for determining the excess shelter allowance for the community spouse increases from $589.88 to $597.38. Therefore, in computing the community spouse allowance, the community spouse’s shelter costs in excess of $597.38 shall be added to the base allowance of $1,991.25. If the community spouse is paying directly for their utilities, the utility allowance is also added as a shelter expense. The utility amount has been increased effective October 1, 2014 from $454.00 per month to $491.00 per month. The community spouse’s own gross income is subtracted from the overall allowance to determine the amount that may be deducted …
Big Change to Medicaid
By Fredrick P. Niemann, Esq. of Hanlon Niemann, a Freehold, NJ Medicaid Attorney The Appellate Division of the Superior Court of New Jersey decided an interesting case. The case, Greta Reuter v. the Burlington County Board of Social Services, addresses the contents of any notice the state must give an applicant who is denied Medicaid benefits. If your application for Medicaid benefits is denied, the County Board of Social Services must provide you with a notice of the denial. The denial notice must inform you of the right to appeal this denial through a process called a “fair hearing appeal”. An applicant who is denied benefits has twenty days from the date the notice of denial is issued to file …
Must You Sell Your NJ Business to Qualify for Medicaid
By Fredrick P. Niemann, Esq. of Hanlon Niemann, a Freehold, NJ Medicaid Eligibility Law Firm When the State considers an applicant’s eligibility for Medicaid, it meticulously scrutinizes the applicant’s financial assets to ensure that all resources are valued below the $2,000.00 limit. In order to fully determine whether an applicant is Medicaid eligible, the State considers all assets, including real estate, bank accounts, and liquid resources. Issues exist all too often where families are torn between their need for Medicaid assistance and their ability to support themselves. Fortunately, federal regulations provide help in situations where individuals and their spouses are up against the wall. If your Medicaid application has been denied because of excess “liquid resources” as part of a …