CMS Issues Guidance on Same-Sex Partners as Patient Representatives – RegBlog

CMS Issues Guidance on Same-Sex Partners as Patient Representatives – RegBlog.

Resource: Chart of Benefits by Income Level – October 2011

New, updated Chart of Benefits. Here’s a breakdown of the updates:

• Income levels for LIHEAP increased September 1, 2011. Clients have 2 options- Percentage of Income Payment Program (PIPP) or Direct Vendor Payment (DVP)
• Income levels for the Weatherization program increased effective September 1, 2011
• Income levels for SNAP will increase effective October 1, 2011
• Income levels for Illinois Cares Rx decreased effective September 1, 2011
• Illinois Cares Rx-Basic is for those who are under 65 and do not have Medicare or for those who are 65 years of age or older and are not a U.S. citizen or qualified non-citizen
• Illinois Cares Rx- Plus is for those with Medicare or those without Medicare who are 65 years of age or older and  a U.S. citizen or qualified non-citizen
• Seniors who want the Free Ride program must qualify by income effective September 1, 2011

 

To download the Chart of Benefits, please click on the path below to access the document on AgeOption’s website:

http://www.ageoptions.org/newsandviews/documents/ChartofBenefits-October2011.pdf

Update: Illinois Medicaid

On September 13, 2011, the Joint Commission on Administrative Rules (JCAR) again considered the comprehensive new Medicaid regulations proposed by the Department of Healthcare and Family Services (DHS) which in part implement the requirements of the federal Deficit Reduction Act provisions affecting Medicaid eligibility.  DHS released revisions of its proposed rules to the public on Friday, September 9, 2011, giving advocates little time to consider the revisions.  JCAR had the option of lifting its prohibition or continuing it.  Due to the remaining concerns of the elder law bar and others, JCAR announced that it was continuing the prohibition and directed DHS to sit down and negotiate with the interested parties.  On September 28, 2011 JCAR staff, Julie Hamos, Director of DHS and her staff members met with various members of the elder law bar to negotiate some of the controversial provisions.  As of now, it is not certain whether DHS will adopt all or some of the proposed revisions suggested by the elder law bar.  If JCAR does not lift its prohibition in its October meeting on October 11,   2011, the proposed regulations will expire and DHS will need to start over in the future.  Director Hamos has suggested that if this occurs, that she will take the matter (implementation of the Deficit Reduction Act) to the Illinois General Assembly for passage in the form of a statute.  Stayed tuned next month – Illinois may or may not have new Medicaid regulations in place.

Medicaid Spousal Impoverishment Protections for Same – Sex Civil Union Partners

When one partner in a long-term relationship needs expensive long term care, often the only way for the couple to pay for it is to look to Medicaid. Historically, there have been no spousal impoverishment protections afforded to partners in same-sex relationships when one partner needs long term care and applies for Medicaid. However, the combination of the new Illinois Civil Union Act and a policy change recently announced by the U.S. Department of Health and Human Services ensure that Medicaid spousal impoverishment protections are afforded to Illinois same-sex civil union partners.
On April 1, 2011, U.S. Department of Health and Human Services Secretary Kathleen Sebelius announced that, effective immediately “[t]he Centers for Medicare & Medicaid Services will notify states of their ability to provide same-sex domestic partners of long-term care Medicaid beneficiaries the same treatment as opposite-sex spouses in the contexts of estate recovery, imposition of liens, and transfer of assets. This includes not seizing or imposing a lien on the home of a deceased beneficiary if the same-sex domestic partner still resides in the home. It also includes allowing Medicaid beneficiaries needing long-term care to transfer the title of a home to a same-sex domestic partner, allowing the partner to remain in the home.” In additional to these protections, the partner in the community is allowed to receive assets, in addition to the home, from the nursing home partner in an amount sufficient to bring the community partner’s assets to the Community Spouse Asset Allowance standard – presently $109,560. The community partner may also be eligible to receive income from the nursing home partner when Medicaid is paying for that partner’s long term care.
The new Civil Union law which became effective on June 1, 2011 provides that a “party to a civil union” is to be included in any definition used in state law where the term “spouse,” “family,” “immediate family,” “dependent,” “next of kin” and other terms that denote “spousal relationship” are stated. The Civil Union Act stops short of granting same-sex couples the right to “marry”; however, it does guarantee “[a] party to a civil union … the same legal obligations, responsibilities, protections, and benefits as are afforded or recognized by the law of Illinois to spouses.
The Civil Union Act in Illinois mandates that the Illinois State Medicaid agency, the Department of Healthcare and Family Services, treat partners in civil unions the same as married partners. The federal Medicaid agency, the Department of Health and Human Services, is allowing states to treat same-sex partners as opposite sex spouses for purposes of Medicaid. Therefore, same-sex partners in Illinois Civil Unions should be afforded Medicaid spousal impoverishment protections if Medicaid coverage of long term care becomes necessary for one of the partners. Dutton & Casey, P.C. is available to represent civil union partners needing long term care in accessing Medicaid and Medicaid spousal impoverishment protections. Please note, federal Medicaid spousal impoverishment protections apply to the Medicaid programs covering nursing homes and assisted living (supportive living) facilities, as well as to the home based services program, the Community Care Program, administered by the Illinois Department on Aging.

Event: Elder Law Update

In this session, Attorney Janna Dutton will update you on two important subjects…New Power of Attorney Act and DRA. Bring your questions!

Date: September 15, 2011 – 830-10am

Location: Terrace Gardens Assisted Living, 8415 North Waukegan Road, Morton Grove, Illinois   60053

Registration: There is no cost to attend this program. However, advanced registration is required. Call 847-470-4550 or email tbischoff@bethanymethodist.org by September 12, 2011. Seating is limited.

Continuing Education: 1.5 hours of credit will be awarded to LPC, LCPC, LSW, LCSW, and RN. Credits provided by Silver Connections.

Janna Dutton Authors Article on Possible Risks for Veterans Who are Thinking About Purchasing Annuities

Duton & Casey partner Janna Dutton has authored an article on the surprising facts that veterans should know before they think about purchasing an annuity.  Here is an excerpt from the article:

It is becoming commonplace for assisted living facilities to refer veterans and their families to financial advisors for help with applying for Veteran’s Aid and Attendance Benefits.  In most instances, the financial advisors are insurance brokers who sell insurance products, most notably annuities, which just so happen to pay out high sales commissions for these “advisors.” The financial advisor does not charge for help with the application, however, the advisor recommends that the veteran purchase an immediate annuity (paying out monthly income) to qualify him or her for VA benefits. While this may be an appropriate technique for qualifying for Veteran’s Benefits in some instances, it may not be necessary and may actually pose a huge stumbling block to qualifying for Medicaid if the veteran requires nursing home care in the future.

Click here to read the full article.

To discuss asset protection planning with an experienced elder law attorney, contact the law firm of Dutton & Casey, P.C. at (312)899-0950 or check us out at our website www.duttonelderlaw.com.  We are compassionate advocates for elders, persons with disabilities, and their families.

Changes in Medicaid: Special Needs Pooled Trusts Still Available for Seniors

Since we published last month’s Proposed Chages in Medicaid article, outlining a few ways in which Illinois is attempting to change its rules on Medicaid eligibility, you may wonder what hasn’t changed about qualifying for Medicaid benefits in Illinois.  One method of Medicaid eligibility that Illinois has contemplated eliminating entirely, but still currently allows, is the special needs pooled trust for disabled people over the age of 65.

Ordinarily and generally speaking, to qualify for Medicaid, a person cannot own more than $2,000.00 in assets, a home, a car and a prepaid funeral.  Medicaid is intended to provide healthcare coverage for the indigent blind, disabled and aged.  However, one shortfall of this policy is that the indigent disabled usually have special needs and those needs are not met through Medicaid coverage.  To correct for this shortfall in policy, the federal government allows disabled people to qualify for Medicaid even though they have more than $2,000.00 in assets as long as they place those excess assets into a special needs trust.  That special needs trust can then be used to pay for the disabled person’s special needs which are not covered by Medicaid.  Special needs can include special medical and dental equipment, therapies, treatments, pharmaceuticals, custodial and companion care, clothing, personal products and transportation.  For a disabled person living in either the community or a long term care facility, a special needs pooled trust can increase quality of life enormously.  

While the federal government allows disabled people to hold their excess assets in a special needs trust and to use those assets to pay for their special needs, the government does impose some limitations.  For instance, the funds in the special needs trust can only be used for the benefit of the disabled person and any funds remaining in the trust at the end of the disabled person’s lifetime must be used to pay back the bill Medicaid has incurred providing benefits for the disabled person.  Those limitations are minor considering the benefit a disabled person receives from being able to preserve and use their own funds during their lifetime while still qualifying for Medicaid coverage.  The special needs trust is an exceptional tool to prevent the complete impoverishment of the disabled and it is very fortunate that Illinois has not yet attempted to eliminate this important option for disabled people over the age of 65.

For more information on how to prepare a special needs pooled trust, or for other questions you may have in the face of the proposed changes to Medicaid eligibility, contact the experienced elder law attorneys at Dutton & Casey, P.C. at www.duttoncaseylaw.com or (312)899-0950.

IMPORTANT: Proposed Changes to Medicaid Eligibility

Dutton & Casey, P.C. attorney Janna Dutton reviewed the Illinois Department of Health and Family Serivces’ (IDFHS) proposed regulations regarding the future (and past) of Medicaid eligibility.  Reading the proposed regulations could probably take days if you went through them in their entirety, so below Janna has summarized what these proposed changes could mean to you.  I highly recommend taking a look at the summary to see how you or your loved ones could be affected, because the ramifications could be significant, or as my mom put it, “we’re screwed.”

The Illinois Department of Health and Family Services has released a series of proposed regulations which it will be publishing in the Illinois Register on August 13, 2010.  These regulations, in part, implement the federal Deficit Reduction Act provisions passed in February of 2006.  For those in the Chicagoland area that are interested, there will be a 45-day public comment period as well as public hearings scheduled for September 13, 2010 at 9:00 a.m. at the Michael A. Bilandic Building, 160 North LaSalle Street, Chicago, Room 500.

            The proposed regulations contain numerous and significant changes to eligibility for Medicaid coverage of long term care services.  To say they are lengthy would be quite an understatement, so below are some of the most notable changes:

1.  Five Year Look-Back

As of the date of implementation of the proposed regulations, applicants for Medicaid coverage of long term care (skilled nursing, supportive living, and the community care and in-home services programs) will be required to account for and document all financial transactions occurring during the five years prior to the date of application, or February 6, 2006, whichever is later.

 2.  Retroactive Application of More Punitive Transfer Penalty Rules

The Department is proposing to apply new punitive penalty rules to transfers of assets which have occurred since February 8, 2006.  As of the date of the implementation of the new rules, transfers of assets for less than fair market value, meaning gifts, will result in the applicant being ineligible for Medicaid coverage for a certain time period.  This time period does not begin until the month the person is eligible for Medicaid, meaning in need of long term care services and having an approved Medicaid application (but for the imposed penalty period).  The penalty period is calculated by dividing the total uncompensated value of assets transferred by the average monthly cost of long term care services at the private rate in the community in which the person’s nursing home is located at the time of application.  The result is the transfer penalty period of ineligibility in number of months, days, and portion of a day.  For example, if a person makes gifts to grandchildren of a total of $65,000 in June of 2006, and then applies for Medicaid on or before May of 2011, assuming an average private rate of $4000, they will be deemed to be ineligible for Medicaid for a period of approximately 16 months and 7.5 days beginning with the month that their Medicaid application for nursing home care is approved.

 In addition, the Department will no longer allow a penalty period to be reduced by a partial return of the funds gifted.  In order to reduce a penalty period, the entire amount transferred during the five year look-back period will need to be returned.

 3.  Spouses Must Disclose Separate Assets

 Historically, the State has allowed spouses of nursing home residents applying for Medicaid to refuse to disclose their separate assets without affecting the Medicaid eligibility of nursing home residents.  The proposed regulations will no longer allow spouses to refuse to disclose their separate assets. If they do, the only way the nursing home Medicaid applicant (or community spouse) will be allowed to receive Medicaid benefits is if they assign their support rights to the State of Illinois to allow the State to take legal action against the non-disclosing spouse, or, if they can prove that it is an undue hardship. 

 4.  Exempt Homestead Property Limited to $500,000 of Equity

 Under the proposed rules, a person is not eligible for long term care coverage of the person’s equity in homestead property exceeds $500,000.  The federal law allows equity of up to $750,000.

 5.  Strict Limitations on Annuities

 At application and upon redetermination, a Medicaid applicant/recipient and community spouse must disclose any interest either or both may have in any annuity or similar financial instrument.  The disclosure must include a statement that the State of Illinois becomes the remainder beneficiary to the extent of Medicaid paid out.  Failure to make this disclosure may result in denial or termination of Medicaid coverage.

The purchase of an annuity which does not name the State as a remainder beneficiary will be considered a penalized transfer of assets.

  Click here for a printable version of the article.

 In addition to these proposed changes, there are many other changes which will have a significant impact on disabled persons seeking Medicaid coverage of long term care. Persons and groups wishing to submit written comments or testify at the September 13, 2010 public hearings are urged to contact Dutton & Casey P.C. at (312)899-0950.  Public response may result in positive changes to the proposed regulations

Help for Veterans: Home Improvement Assistance Program

Aging With Grace, a service dedicated to offering solutions and resources to caregivers, recently posted a blog on the Home Improvement and Structural Alterations (HISA) Program.  Under this program, veterans may receive assistance for home improvements made to accomodate disability in the home.  As the article explains, these grants are typically provided to veterans who are receiving VA health care and who are service-connected disabled, although there are some benefits available for nonservice-connected veterans (see below). 

* Home improvement benefits up to $4,100 may be provided to service-connected veterans.
* Home improvement benefits up to $1,200 may be provided to nonservice-connected veterans.

A clause in the eligibility statutes opens the door for veterans who are on Medicaid or receiving pension with aid and attendance or housebound ratings (commonly referred to as the VA Benefit for Aid & Attendance) to also receive these grants. Also very low income — means tested veterans — may also receive the grant.  Although they are reluctant to provide these grants to veterans who are not in the health-care system, the medical center HISA committee will do so if adequate documentation is provided to justify the grant.
Below are some examples of what the HISA will and will not pay for, but for more information, visit http://www.va.gov.

Examples of what HISA WILL pay for:
* Allowing entrance or exit from veteran’s home
* Improving access for use of essential lavatory and sanitary facilities
* Improving access to kitchen and bathroom counters
* Handrails
* Lowered Electrical outlets and switches
* Improving paths or driveways
*Improving plumbing/electrical work for dialysis patients

Examples of what HISA WILL NOT pay for:
* Walkways to exterior buildings
* Widening of driveways (in excess of a 7ft x 6ft area)
* Spa, hot tub or Jacuzzi
* Exterior decking (in excess of 8ft x 8ft)

Aging With Grace frequently posts new blogs on senior-related topics, click here to visit their blog.

For help with planning your own long term care, contact the elder law attorneys at Janna Dutton & Associates.

$25 Billion in Medicaid Funding

An additional $25 billion in Medicaid funding was included in President Obama’s fiscal 2011 budget. As discussed in the Washington Street Journal article, “Medicaid Could Get Billions,” this inclusion speaks to the government’s adaptation to the sloth-like progress of health legislation in Congress. The article notes that some states “were so confident Congress would pass a health bill that they included the extra Medicaid funds in their state budgets.”

However, the election of Republican Scott Brown over Democrat Martha Oakley in the Massachusetts race for the U.S. Senate seat formerly occupied by the late Ted Kennedy could throw a serious wrench into the President’s health care plan, and it sent governors “scrambling to plug the hole.”

During a conference call on Friday, January 29, Health and Human Services Secretary Kathleen Sebelius assured governors that President Obama’s fiscal 2011 budget would include a six-month extension (which requires congressional approval) of the Medicaid funding increase that was part of last year’s stimulus package. Without an extension, the extra money would expire at the end of the year.

“The move would help ease a strain on state budgets as the recession is sending more Americans into Medicaid, the health-insurance program for the poor that is jointly funded by the federal government and state governments. To cover the shortfall, governors had considered cutting education funding, reducing payments to doctors and hospitals through Medicaid, and taxing soda, candy and chewing gum.”

Click here for the complete article.

Janna Dutton & Associates, P.C. has extensive experience in understanding both federal and state Medicaid regulations, and devising the best approach for each of our clients so that a Medicaid application has the best chance of succeeding in each situation.  For comprehensive legal assistance with your Medicaid concerns, contact the elder law attorneys at Janna Dutton & Associates.