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MEDICAID AND MEDICARE 2017 COLA NUMBERS

Posted by: Begley Law Group

by Thomas D. Begley, Jr., Esquire, CELA CMS has released the Medicare and Medicaid numbers for 2017. They are as follows: Medicaid Income Cap[1] $2,205 Maximum Community Spouse Resource Allowance (CSRA)[2] $120,900 Minimum CSRA[3] $24,180 Maximum Minimum Monthly Maintenance Needs Allowance (MMMNA)[4] $3,022.50 MMMNA (July 1, 2016 until June 30, 2017)[5] $2,002.50 MMMNA (July 1, 2017 until June 30, 2018)[6] $2,030.00 Excess Shelter Allowance (July 1, 2016 until June 30, 2017)[7] $600.75 Excess Shelter Allowance (July 1, 2017 until June 30, 2018)[8] $609.00 Maximum Resource Limit (Individual)[9] $2,000 Minimum and Maximum Cap on Equity in the Home[10] $560,000 –$840,000 Medicare […]

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Filed under Blog, Estate Planning, Life Care Planning, Medicaid Applications, Medicaid Planning, Medicaid Planning, Special Needs Planning, Special Needs Trusts.
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10 THINGS YOU NEED TO KNOW ABOUT ABLE ACCOUNTS

Posted by: Begley Law Group

by Thomas D. Begley, Jr., Esquire, CELA On December 16, 2014, Congress enacted and sent to the President for signature an Act known as Achieving a Better Life Experience (ABLE) Act of 2014.[1] This Act is to provide a tax-favored account, similar to a 529 Plan, for individuals with disabilities to pay for qualified expenses. The effective date of this legislation was December 31, 2014. Highlights of this Act are as follows: State Established or Contracted. Each state is authorized to establish and operate an ABLE program. This must be done by each state before these accounts can be opened […]

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Filed under Blog Special Needs Planning, Estate Planning, Life Care Planning, Medicaid Planning, Medicaid Planning.
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ADVANTAGES AND DISADVANTAGES OF ABLE ACCOUNTS

Posted by: Begley Law Group

by Thomas D. Begley, Jr., Esquire, CELA Congress enacted and the President has signed legislation known as the Achieving a Better Life Experience (ABLE) Act of 2014.387 The Act is modeled on 529 Plans and will provide tax-favored accounts for individuals with disabilities to pay for qualified expenses. Before these accounts can be implemented, two things must happen: (1) the federal government must adopt regulations governing the accounts, and (2) state must either create their own ABLE accounts or contract with other states to do so. It is likely that these accounts will operate in a manner similar to existing […]

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Filed under Blog, Blog Special Needs Planning, Estate Planning, Estate Planning, Long Term Care, Medicaid Applications, Medicaid Planning, Special Needs Planning.
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Medicaid Planning with Disability Annuity

Posted by: Begley Law Group

By Thomas D. Begley, Jr., CELA The Concept A sole benefit of trust is a creature of HCFA Transmittal 64.’ These trusts have traditionally been used in crisis planning. They can be established for the benefit of disabled persons—a Disability Annuity Trust (“DAT”).2 The idea is that assets would be transferred to an irrevocable trust for the sole benefit of the disabled individual. The assets in the trust were then paid out to the beneficiary on an actuarially sound basis using the actuarial tables contained in HCFA Transmittal 64.;i However, some states, including New Jersey, maintain that despite the clear language in HCFA Transmittal 64, the language in the statute “sole benefit […]

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Filed under Life Care Planning, Medicaid Planning, Medicaid Planning, Medicare, Special Needs Planning, Special Needs Trusts.

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ESTABLISHING A DISABILITY ANNUITY TRUST FOR A BENEFICIARY RECEIVING SSDI OR SSI

Posted by: Begley Law Group

by Thomas D. Begley, Jr., CELA A Disability Annuity Trust (“DAT”) can be established for a disabled child or any disabled individual.[1] However, in considering the use of a DAT for a disabled person, care must be taken to examine the other government benefits currently being received, or which may be received in the future by the person with disabilities. If the person with disabilities is receiving Supplemental Security Disability Income (“SSDI”), this is usually accompanied by Medicare. SSDI and Medicare are insurance-based programs, rather than means-based programs. Receipt of income from the DAT would not cause a loss of […]

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Filed under Life Care Planning, Medicaid Planning, Medicaid Planning, Medicare, Special Needs Planning, Special Needs Trusts.
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FUNDING AND TAX CONSIDERATIONS INVOLVING CHILDREN’S TRUSTS IN MEDICAID PLANNING

Posted by: Begley Law Group

by Thomas D. Begley, Jr., CELA Funding Many clients who use Children’s Trusts as part of their Medicaid planning are non-crisis planning clients. They either have an early diagnosis or are elderly but in good health. They are doing advance planning and want a sense of independence. They do not want all of their assets in a trust. Good practice dictates that the lawyer have a discussion with the client and determine how much the client feels should be kept out of the trust to give the client a feeling of comfort. The client should understand that the funds retained […]

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CHILDREN’S TRUSTS AND MEDICAID PLANNING

Posted by: Begley Law Group

by Thomas D. Begley, Jr., CELA (Originally published in the June issue of “The Straight Word”) Under a Children’s Trust typically a parent transfers assets to an irrevocable trust for the benefit of her children and reserves no right to access to either income or principal. One or more children usually serve as trustee. The trust document authorizes the trustee to distribute income and principal to children, subject to the approval of a trust advisor who is not a trust beneficiary. The trust advisor may be a spouse of a trust beneficiary or even an attorney or law firm. A […]

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Filed under Medicaid Planning, Medicaid Planning.
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MEDICAID MANAGED LONG-TERM SERVICES AND SUPPORTS

Posted by: Begley Law Group

by Melanie S. Kaplan, Esquire As of July 1, 2014, what was formerly known as Global Options for Long Term Care (GO) is now known as Managed Long Term Services and Supports. (MLTSS). Individuals previously receiving benefits under AIDS Community Care Alternatives Program (ACCAP), Community Resources for People with Disabilities (CRPD) and Traumatic Brain Injury (TBI) were automatically enrolled in the MLTSS program. The MLTSS program was designed to permit individuals to live in the community for as long as possible with services and support. The change from GO to the MLTSS program has reduced the number of programs and […]

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Filed under Medicaid Applications, Medicaid Planning, Medicaid Planning, Uncategorized.
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THE PROBLEM WITH INCOME ONLY TRUSTS IN MEDICAID PLANNING

Posted by: Begley Law Group

by Thomas D. Begley, Jr., CELA   Purpose Income Only Trusts are a means by which seniors transfer assets to a trust rather than to their children. Seniors tend to view transfers to trusts as protection, while they tend to view transfers to children as gifts. Trusts provide them with a sense of dignity and security. Requirements Income only trusts are permitted by OBRA-93.[1] They must be irrevocable. The trust instrument provides that the grantor or the grantor’s spouse receive all of the income from the trust, but has no access to principal. Design of the Trust In order to […]

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Filed under Estate Planning, Medicaid Planning, Medicaid Planning.
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TRUSTS/MEDICAID CONSIDERATIONS

Posted by: Begley Law Group

by Thomas D. Begley, Jr., CELA There are seven Trust that should be addressed in considering Medicaid. These are: Revocable Trusts, Income Only Trusts, Children’s Trusts, Disability Annuity Trusts, Disability Annuity Special Needs Trusts, Self-Settled Special Needs Trusts, and Third Party Special Needs Trusts. There are seven considerations in drafting trusts. These are: availability of trust assets, applicability of a Medicaid or SSI transfer penalty, Medicaid payback provisions, good and bad assets for funding trusts, tax considerations (including income, gift and estate), estate recovery, and elective share issues. This chart is designed to address each of those issues with each […]

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Filed under Medicaid Planning, Medicaid Planning, Special Needs Trusts, Special Needs Trusts.
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OVERVIEW OF MEDICAID TRUSTS

Posted by: Begley Law Group

by Thomas D. Begley, Jr., CELA Types of Trusts. Trusts established and funded after August 10, 1993, are governed by OBRA-93. The Medicaid-qualifying trust rules were repealed by OBRA-93, and new rules for revocable and irrevocable trusts created after August 10, 1993, were established. OBRA-93 also created special disability trusts, each of which has rules. These trusts include Self-Settled Special Needs Trusts and Pooled Trusts. OBRA-93 also established a Miller Trust, to be used when a potential Medicaid recipient has income in excess of the income cap. The fourth trust authorized under OBRA-93 is a sole benefit of trust. The […]

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Filed under Medicaid Applications, Medicaid Planning, Medicaid Planning.
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MEDICAID LIENS IN PERSONAL INJURY CASES

Posted by: Begley Law Group

by Thomas D. Begley, Jr., CELA Assignment to State of Rights against Third Parties As a condition of Medicaid eligibility, a Medicaid applicant is required to assign to the state any rights to payment of medical care from any third party.[1] This is essentially a statutory right of subrogation. Federal law further requires that each state Medicaid program have procedures for determining the legal liability of third parties to pay for medical assistance provided by the state’s Medicaid plan, and for reimbursement of the cost of medical assistance provided, whenever recovery is feasible.[2] In New Jersey, the Attorney General is […]

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Filed under Medicaid Planning, Personal Injury Consulting, PI Special Reports.
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MEDICARE SET-ASIDE ARRANGEMENTS IN SPECIAL NEEDS TRUSTS

Posted by: Begley Law Group

by Thomas D. Begley, Jr., CELA   Countable Asset for SSI and Medicaid A question arises as to whether assets held in an MSA are countable for SSI and Medicaid purposes. This has been addressed by CMS in the WC context, but the same line of reasoning should apply to third party liability cases. CMS has stated that:[1] Medicare Set-Aside Arrangements are not subject to any special treatment under Medicaid resource rules. These funds should be evaluated to determine whether they meet the legal definition of a resource for Supplement Security Income (SSI) and, therefore, Medicaid purposes, i.e., ‘cash or […]

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Filed under Medicaid Planning, Medicare, Special Needs Planning, Special Needs Trusts.
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WHEN SHOULD A MEDICARE SET-ASIDE ARRANGEMENT BE CONSIDERED?

Posted by: Begley Law Group

by Thomas D. Begley, Jr., CELA In settling of a personal injury case, commonly called a third party liability case (TPL), a Medicare Set-Aside Arrangement (MSA) should frequently be considered. Many Lawyers and Structured Settlement Brokers believe that if the client is not currently receiving Medicare, an MSA need not be considered. However, the Regulations require consideration of an MSA even if there is a “reasonable expectation” of receiving Medicare within thirty months. Individuals receiving SSDI or RRD are eligible for Medicare within twenty-four months of their Determination of Disability. Therefore, an MSA should be considered if: Plaintiff is receiving […]

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Filed under Medicaid Planning, Personal Injury Consulting.
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PROTECTING THE HOME FROM THE COST OF LONG-TERM CARE

Posted by: Begley Law Group

By: Thomas D. Begley, Jr., CELA INTRODUCTION The most important asset for most Americans is their home. They have worked hard, paid off a mortgage, and enjoyed many happy times in their home. They do not want to lose it. Seventy percent of Americans will require some form of long-term care be it nursing home, assisted living or home care. The cost of this care can range from $20 per hour or more for home care to $10,000 – $12,000 per month for nursing home care. Before becoming eligible for Medicaid in a nursing home or assisted living facility, an […]

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Filed under Estate Planning, Long Term Care, Medicaid Planning, Medicaid Planning, Special Reports.
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PROTECTING THE HOME FROM THE COST OF LONG-TERM CARE

Posted by: Begley Law Group

by Thomas D. Begley, Jr., CELA Seventy percent of Americans will require some form of long-term care be it nursing home, assisted living or home care. The cost of this care can range from $20 per hour or more for home care to $10,000 – $12,000 per month for nursing home care. Before becoming eligible for Medicaid in a nursing home or assisted living facility, an individual must list their home for sale and if it does not sell during the individual’s lifetime, Medicaid will place a lien on the home on death. If the individual is receiving home care […]

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Filed under Estate Planning, Life Care Planning, Long Term Care, Medicaid Applications, Medicaid Planning.

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BABY BOOMERS AND RETIREMENT

Posted by: Begley Law Group

by Thomas D. Begley, Jr., CELA Nothing is likely to have greater impact on public policy and programs for the elderly than the aging of the Baby Boomers (“Boomers”). Boomers represent 76 million persons in the United States born between 1946 and 1964 – 31% of the total population. Boomers are divided into two waves. The first wave was born between 1946 and 1954 and is currently between 61 and 69 years of age. The second wave was born between 1955 and 1964 and is currently between 51 and 60 years of age. By the year 2030, all surviving members […]

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Filed under Estate Planning, Estate Planning, Long Term Care, Medicaid Planning.
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SPECIAL PROBLEMS AFFECTING THE ELDERLY – PART 2

Posted by: Begley Law Group

by Thomas D. Begley, Jr., CELA This article continues the discussion of special problems for the elderly.  (Here is a link to Part 1.) Long-Term Care. About 70% of Americans will require some form of long-term care be it home care at $22 to $25 per hour, assisted living at $4,500 to $8,500 per month, or nursing homes at $10,000 to $12,000 per month. Only about 6% to 8% of Americans have long-term care insurance. Expenses of long-term care will wipe out most families very quickly. The Affordable Care Act has already covered between 10 and 13 million additional individuals. […]

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Filed under Estate Planning, Estate Planning, Life Care Planning, Long Term Care, Medicaid Planning.
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20 THINGS YOU NEED TO KNOW ABOUT ABLE ACCOUNTS

Posted by: Begley Law Group

by Thomas D. Begley, Jr., Esquire, CELA On December 16, 2014, Congress enacted and the President has signed an Act known as Achieving a Better Life Experience (ABLE) Act of 2014.[1] This Act is to provide a tax-favored account, similar to a 529 Plan, for individuals with disabilities to pay for qualified expenses. Highlights of this Act are as follows: State Established or Contracted. Each state is authorized to establish and operate an ABLE program. This must be done by each state before these accounts can be opened in that state. States may contract with other states to operate these […]

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Filed under Life Care Planning, Medicaid Applications, Medicaid Planning, Medicaid Planning, Special Needs Planning.
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MILLER TRUSTS

Posted by: Begley Law Group

by Thomas D. Begley, Jr., CELA New Jersey is an income cap state for purposes of nursing home level of long-term care services. Nursing home level of services includes nursing homes, assisted living and most home care. The income cap is 300% of the Federal Benefit Rate (FBR). For 2015, 300% of the FBR is $2,199. This figure is indexed for inflation. This means that if an individual’s income exceeds $2,199 in 2015, they would not be eligible for Medicaid long-term care services. Historically, individuals with income in excess of the income cap were eligible for Medicaid in a nursing […]

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Filed under Estate Planning, Medicaid Planning, Medicaid Planning, Special Needs Planning, Special Needs Planning.

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PROTECTING THE HOME: USING TRUSTS TO PROTECT YOUR HOME FROM THE COSTS OF LONG-TERM CARE

Posted by: Begley Law Group

by Thomas D. Begley, Jr., Esquire, CELA Studies show that 70% of Americans will require some form of long-term care be it nursing home, assisted living or home care. The cost of this care can range from $20 per hour or more for home care to $12,000 per month for nursing home care. If a single person applies for Medicaid to pay for this care, the Medicaid agency will require that the home be sold and that the proceeds of sale be used to finance the care. If a Medicaid applicant is married and owns a home as tenants by […]

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Filed under Blog, Estate Planning, Life Care Planning, Long Term Care, Medicaid Planning, Medicaid Planning.
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MILLER TRUSTS

Posted by: Begley Law Group

by Thomas D. Begley, Jr., Esquire, CELA For purposes of Medicaid long-term care services, New Jersey has always been an income cap state. That means that an individual’s income must not exceed 300% of the Federal Benefit Rate (FBR). Beginning January 1, 2015 that means that an individual’s monthly income cannot exceed $2,199. Historically, individuals in nursing homes were able to qualify for a “Medically Needy” program to spend their income down and qualify for Medicaid. Individuals requiring care in assisted living or at home were not eligible for the Medically Needy program and could not become eligible for Medicaid, […]

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Filed under Medicaid Applications, Medicaid Planning, Medicaid Planning.
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THE IMPORTANCE OF PUBLIC BENEFITS IN SETTLING PERSONAL INJURY CASES

Posted by: Begley Law Group

Article by Thomas D. Begley Jr. Public benefits must always be considered in the settlement of a personal injury case.  They are important for two reasons:  (1) whether there is a lien to repay the public benefits, and (2) whether the plaintiff’s continued eligibility for public benefits depends on the establishment of a self-settled special needs trust.  Common public benefits include the following: Supplemental Security Income (SSI)  SSI is a monthly payment from the Social Security Administration to the SSI recipient.  The maximum payment for an individual for 2014 is $721 per month.[1]  For many people this is a significant […]

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Filed under Medicaid Planning, Medicaid Planning, Personal Injury Consulting, PI Special Reports.

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IS THE BIPARTISAN BUDGET ACT OF 2013 THE DEATH OF AHLBORN?

Posted by: Begley Law Group

Article by Thomas D. Begley Jr. As a condition of Medicaid eligibility, a Medicaid applicant is required to assign to the state any rights to payment of medical care from any third party.[1]  If the individual fails to pursue the claim, the state has the option of pursuing it.  Federal law requires that each state Medicaid program have procedures for determining the legal liability of third parties to pay for medical assistance provided by the state’s Medicaid plan, and for recovery from third parties of the cost of medical assistance provided, whenever recovery is feasible.[2]  In New Jersey, the Attorney […]

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Filed under Medicaid Applications, Medicaid Planning.

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For Medicaid Applications, Having an Attorney Can Be Crucial

Posted by: Dana E. Bookbinder

Given the convoluted and ambiguous set of provisions that are our federal and state Medicaid laws, it is a wonder how any lawmaker could expect individuals, especially seniors with compromised health, to apply for benefits on their own.  Federal regulations require Medicaid caseworkers to be helpful to those who file for benefits, but state and federal budgetary constraints have created a reality that is much more frustrating than the printed law would suggest.   Many individuals file applications unprepared for the minutiae that will delay the processing of their application for several months and cost them tens of thousands of dollars […]

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Filed under Medicaid Applications, Medicaid Planning, Medicaid Planning.

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Resolving Your Nursing Home’s Medicaid Application Challenges – Special Report

Posted by: Begley Admin

Case Study 1: Private funds exhausted – Medicaid denied Bill has been a resident at the Forget-Me-Not Nursing Home for 18 months. After 12 months, Bill’s private pay funds were exhausted and the Medicaid coordinator at the nursing home filed an application on his behalf. Bill’s wife, Linda, was not cooperative in providing the required financial information. Medicaid eventually dismissed the application because it was incomplete. By the time all the necessary information was finally obtained, and the application was re-filed, the nursing home had lost six months of revenue, totaling $60,000, and its cash flow had been interrupted for 12 months.   Case Study […]

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Filed under Medicaid Applications, Medicaid Planning, Medicaid Planning, Special Reports.

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SSI TRANSFERS & TRUSTS

Posted by: Thomas D. Begley, Jr.

If an SSI recipient or spouse of an SSI recipient disposes of resources for less than fair market value during a 36-month look back period,1 the individual is ineligible for benefits for a period of time.  The period is calculated by dividing the uncompensated value of the transfer by the amount of the maximum monthly benefit payable, including any state supplement.2 The penalty is rounded to the nearest whole number with a cap of 36 months.3 The penalty begins the first month in or after which resources were transferred which does not occur during any other period of ineligibility.4   […]

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Filed under Library, Medicaid Planning, Medicaid Planning.
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Protection From Spousal Impoverishment

Posted by: Thomas D. Begley, Jr.

            In 1988, Congress passed the Medicare Catastrophic Coverage Act (MCCA).  Pub. L. No. 100-360 codified at 42 U.S.C. § 1396p(c) as amended by 42 U.S.C. § 1396r-5.  Provisions of this Act were designed to avoid impoverishing the community spouse.  For example, since October 1, 1989, the income of the community spouse is no longer deemed available to the institutionalized spouse at any time for the cost of care.  In addition, the community spouse is entitled to a Minimum Monthly Maintenance Needs Allowance (MMMNA), which may come in whole or in part from the income […]

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Filed under Library, Medicaid Planning, Medicaid Planning.
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What other medical insurance options are available for my client after he has received a personal injury settlement?

Posted by: Begley Admin

The previous blog discussed the importance of ensuring that plaintiffs in personal injury lawsuits obtain the best possible medical coverage. This blog continues the discussion and focuses on other medical insurance that may be available. This includes: • Medicare. A person receiving SSDI for two years will receive Medicare. It is important to obtain a Medicare supplement, if at all possible. There is an open enrollment period for Medicare supplements for six months after the Medicare recipient obtains Medicare Part B. Another option is to enroll in a Medicare Advantage Plan. There is an open enrollment period for Medicare Advantage […]

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Filed under Medicaid Applications, Medicaid Planning, Medicaid Planning.

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TRANSFER OF ASSETS TO DISABLED CHILDREN

Posted by: Begley Admin

The current federal Medicaid statute has been in effect since 1989.[1] Generally, the statute provides that if an individual makes an uncompensated transfer of resources, the value of those resources are divided by the average monthly cost of a nursing home and the resulting quotient is the number of months during which the applicant will be ineligible for Medicaid benefits.[2] The statute further provides that “an individual shall not be ineligible for medical assistance by reason of [the transfer penalty rules] to the extent that…the assets were transferred to, or to a trust…established solely for the benefit of the individual’s […]

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Filed under E-Lerts, Medicaid Planning.

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