Income of both spouses is counted for Medicaid health coverage and medical payments I recently had a client who filed a fair hearing appeal because of the termination of NJ Family Care Medicaid health insurance. He was in the process of a divorce but living in the same household as his spouse. Both federal regulation 42 CFR §435.119 (b) (5) and state regulation N.J.A.C. §10:78-4.3 assert that countable income for purposes of determining eligibility “shall include the income of all members of the household unit.” The federal regulations define two different tests to determine a household’s income. The first, the modified adjusted gross income test, which the State used to calculate your income, defines a household “[i]n the case of …
New Jersey Medicaid Not Repaid From Third Party Trust
Recently, I met with new clients who are grandparents to many grandchildren, one of which is special needs. I was asked if Medicaid will be able to take whatever funds are left over in the grandchild’s trust if he receives public benefits. They want to create a special needs trust for their grandchild since he is not expected to live beyond 30 and is seriously disabled. They are hoping any money left over at that time can be distributed to their other grandchildren and not taken by the government. Let me be clear with my answer. There will be no Medicaid payback required if you create, fund and establish a special needs trust. In other words, you can fund this …
Medicaid Gifting Rules and the Annual Federal Gift Tax Exclusion Are Unrelated: Don’t Be Confused!
I’ve written numerous posts about Medicaid gifting and the misconceptions surrounding the annual gift tax exclusion rules. Generally, I’m asked the question whether New Jersey Medicaid looks at the gifts a person gives to his/her kids if the gift is valued under $15,000 each year. It’s the person’s understanding these gifts won’t have an impact on their qualifying for Medicaid benefits if they ever need a nursing home. Beware! These folks are incorrect. They are confusing the Medicaid gifting rules and the annual exclusion for federal gift tax purposes. Let me explain. The $15,000 referred to above is the annual federal estate tax/gift tax exclusion. That’s the amount that you may give away each year, to as many individuals as …
Oh No, I’m Getting Money; Now What Do I Do?
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 …