Our own Michael Steinberg was featured in a Huffington Post article earlier this month. He offers information and advice on the two eligibility categories related to Medicaid applications: clinical eligibility and financial eligibility.
Clinical Eligibility
Clinical or medical Medicaid eligibility and reimbursable services are determined by individual state criteria. Michael explains that proof of clinical eligibility is not a complicated process.
Financial Eligibility
On the other hand, proving an individual qualifies for Medicaid services based on their financial standing is a daunting task. Applicants must gather financial documentation for five years – which is known as the five year look back. Every cash-value asset must be reported to show proof of financial eligibility.
The Problem faced by Skilled Nursing Facilities
What does this mean to skilled nursing facilities? If a patient is having trouble obtaining Medicaid approval, the facility is no doubt having trouble getting paid. About 55 percent of nursing home patients are on Medicaid, delays in reimbursements based on eligibility could be a big financial hardship to the nursing home business.
Michael advises that the best way to prepare for what’s ahead is to be well versed in Medicaid rules and guidelines. An even better idea is to leave it to the experts, such as the team at Senior Planning Services.
The Medicaid eligibility application process can be very stressful for applicants and their families. Allow Senior Planning to take on the comprehensive Medicaid eligibility process for you or your loved one. Thousands of Medicaid applicants and their families have relied on the expertise of Senior Planning Services. We’re here to help.
Transcript: To some people it comes as a shock they’ve just been sitting at the breakfast table and on the next day end up in a hospital and have to go to a nursing home. And the families are almost paralyzed over what’s ahead of them and what they’re gonna need to face. We’re really here to help you, it’s not easy getting someone on to Medicaid but that’s really what we’re here for. We’re completely devoted to do a Medicaid application, that’s all that we do every day.
I’m Melissa Grassman, admissions director at Hampton Ridge Healthcare. The Medicaid application is very, very stressful, having to consistently go back and forth to the banks, to pension companies, to the board of social services, so Senior Planning takes a huge burden off the family.
Once somebody retains our services, they are assigned a designated caseworker. You don’t have to worry about, OK did this one get my bank statement, and this one you’re assigned the case manager who is going to hold your hand through the entire process and be your one point of contact and it makes it a really simple and enjoyable process for the seniors, the families and the organizations that are providing the care.
We are a large company but yet we’re still a mom-and-pop operation in a sense that we still provide the highest level of customer service to both our clients and to the facilities. Customer service is really key because when you have family members that are going through a tough time where they’re putting a loved one into a skilled nursing facility or they are already there, they need that extra love, they need that extra communication, they need to know that there’s always going to be somebody there to answer their question.
So once an application is approved it’s extremely exciting and you call the families and you tell them and you can just feel the joy that they have and the relief that this person’s now nursing home bill is going to be paid. It’s, you know, $10,000 or more a month and it’s gonna be taken over by Medicaid and they’re not gonna be responsible for that. You could really feel the relief and the appreciation that the families have for Senior Planning for taking over and really taking the burden off of their shoulders.
About Us:
Senior Planning Services’ Medicaid specialists are well versed in all of Medicaid’s guidelines and will handle the entire Medicaid application process from start to finish. Allow us to take on the stressful burden ofobtaining Medicaid, knowing you or your loved one is in good hands with our knowledgeable staff. The services we offer in Massachusetts, New Jersey, New York, Pennsylvania and Connecticut are all the same; our goal is to simplify the Medicaid application process and alleviate the anxiety associated with it. Call us for a free consultation: 1-855-775-2664.
This year’s Healthcare Summit is bigger than ever. It’s on June 19 – 20 at The Coaches Club at MetLife Stadium. We had a Q&A with Ovadyah Stavsky, Director of Marketing at SPS and LTC, to find out what you need to know to get the most out of the packed agenda.
Q: This is the sixth annual Healthcare Summit. What’s new this year?
We’ve taken the learnings from each of the previous Healthcare Summits and have built them into this year’s event. The Healthcare Summit started outfairly small, but due to overflowing classes and increased success year after year, we’ve scaled the program to a full two-day event. We are offering attendees up to three CEUs per day for a total of six, and all workshops are approved LNHA’s, CALA’s, DON’s and SW’s, and for all states.
The Healthcare Summit is all about appreciation and learning opportunities for our clients and healthcare professionals. I’m sure attendees won’t be disappointed.
Q: Can you tell us about the informative CEU sessions?
On Monday, June 19th, there are two sessions on “Utilization Review Today – Everything You Need to Know…And Then Some!” The UR process controls costs and quality of care, which protects both patients and facilities. Each session earns 1.5 CEUs, for a total of 3 CEUs for the full course.
Tuesday’s two-part program is on a topic that doesn’t receive enough attention: “From High School to Old School: Elders Who Bully and Strategies to Intervene.” Some seniors in facilities undergo the same unfair treatment as high school students. Again, each session earns 1.5 CEUs.
Attendees do not have to go to all sessions to get credits. New Jersey social workers should be aware that they must attend part one and two of a course for three credits. They can’t receive 1.5 for half of a course.
Q: Who are the platinum sponsors?
We are very excited about our platinum sponsors! They are:
Mobilex USA, America’s leading provider of mobile imaging services. Mobilex brings x-ray and sonogram technology to your facility. For over 35 years, they have been serving patients in over 7000 facilities throughout most of the United States.
Brian Patten and Associates specializes in assisting organizations in the explanation in enrollment of core and ancillary employee benefits. Their management team has over 54 years of benefit and rolling and consulting experience, and the service over 1.5 million employees throughout all 50 states.
APS Marketing Group is a full-service marketing agency. They help companies make a good first impression and work with brands on reputation control.
Tech-Keys is your one-stop destination for everything IT. From IT Consulting through system design, implementation and ongoing maintenance, Tech-Keys provides all the technological support your facility or organization needs to stay relevant in today’s digital world.
We encourage Summit attendees to visit with our platinum sponsors during the event.
Q: Bo Dietl is your guest speaker this year. What can attendees expect from his address?
With Bo, one thing I’m sure we can expect is the unexpected. Bo is a force of nature and is always memorable. He is one of the most highly decorated NYPD detectives in the history of the NYPD and he runs one of the most successful private investigation firms in the country. He’s quintessentially New York, and he’s currently running for mayor of New York.
Q: Who should attend the Healthcare Summit?
The daytime courses are designed for healthcare professionals, such as administrators of nursing homes and assisted living facilities, social workers, and directors of nursing. Others in the industry, such as BOM’s etc., will enjoy and benefit from the networking events. We look forward to seeing you there!
Pre-planning for a patient or family member’s move from a hospital into a skilled nursing facility (nursing home) will make the transition easier for everyone involved.
Helping the patient with worrisome financial arrangements will ease the family’s mind and placate the patient.
You may need to learn or get assistance with Medicare guidelines. For example, a patient must be admitted to a hospital and treated as an inpatient for at least three days before being transferred to a nursing home. Otherwise their initial nursing facility care will not be covered under Medicare.
Medicaid qualifications may vary state to state, but there are general guidelines to know. Eligibility for Medicaid is based on the financial income and assets of the patient. But, people who are not qualified based on their finances may be eligible for Medicaid assistance if they have high medical expenses that “spend down” their income levels. Also, if the patient has a spouse, it’s important to understand spousal protection rules.
With finances secure, you can help a patient have a safe and healthy move by providing all necessary information to the nursing home. It’s unfortunate, but depending upon the facilities involved, you may need to assist with communications between the hospital and nursing home. The most critical information to verify is that the hospital provides accurate and complete medical history and treatment records. If the proper prescriptions are not included with the patient’s transfer, they may not have immediate access to important medications. The continuity of care also includes any ongoing medical treatments that are essential to the patient’s health and comfort, such as dialysis, physical therapy, and pain management.
There is information other than medical records that is vital for a smooth transition. Confirm that the nursing home is aware of cultural needs that will affect the patient’s well-being. Medical transfer records may not include essentials such as language(s) spoken, diet restrictions, and religious practices.
Finally, decorate the patient’s new room with items from home. Family pictures, knick-knacks, and a quilt or linens will make the new surroundings comfortable and familiar.
Many agree that there is a great deal of room for improvement in the patient transition process. It certainly can be overwhelming for family caregivers to handle. If you feel unsure about the process, ask a professional. ‘
Find out more about how Senior Planning Services can help. We provide the assistance needed for a well-planned and stress-free transition for both the patient and their family.
Sundowning is the term for daily symptomatic personality changes that dementia patients experience. Sundowning occurs around the same time every day; usually at dusk. You may notice your patient or loved one experiencing some or all of these symptoms in the evening.
Since our clocks shifted ahead an hour and the days are getting longer, your family member or patient may experience sundowning symptoms a bit later in the day, which could require a change to their caregiver’s schedule or adjustments to the patient’s evening routine.
The most important thing is that you understand that Sundowning is real, and you should treat it as you do other dementia symptoms. It’s helpful to know that there are things you can do to help minimize the patient’s symptoms.
Some theories state that mental and physical fatigue brings on sundowning symptoms. However, if a fatigued patient is treated with a familiar evening routine in peaceful and calm surroundings, they will wind down with minimum stress and be prepared for a good night sleep. To reduce sleep disturbances, encourage daytime activity and exercise, and discourage excessive daytime napping.
The right eating habits can also help reduce sundowning symptoms. Be sure to limit late day caffeine and sugar.You may even shift your patient’s eating habits by serving a larger meal earlier in the day, and prepare a lighter fare for dinner. This will make them more feel more comfortable and will help provide a more restful sleep.
As the day comes to an end, the darkness itself can cause problems for dementia patients. Increased shadows can make them unsure of what they see. This could cause agitation and fear. Be sure to turn on indoor lights as soon as daylight begins to fade. Keep a nightlight on when your patient goes to bed. If they awake during the night, they will not feel as frightened or confused if there is light in the room.
Senior Planning Services was featured on WABC “Mind Your business with Yitzchok Saftlas”.
We’re going to open with Michael Steinberg, the Director of Business Development at Senior Planning Services. Michael, thank you for joining me here on Mind Your Business.
Michael: Thank you for having me.
Q: Yes, okay. Let’s talk about Medicaid – the world of Medicaid. We’ll talk about what’s going on with the health care system and the fact that a couple of days ago, Trump didn’t get his way and Obamacare is still in effect, let’s move that to the side for a second. What’s the first step for someone who is seeking to apply for Medicaid.
MS: The first step and the most important step when somebody is seeking to get Medicaid for their loved one is to get educated. The Medicaid rules and guidelines are forever changing and the smallest mistake can really cost you tens of thousands of dollars.
Q: That much?
MS: Yes, absolutely. I mean the cost of care, whether you’re in the community or in a skilled nursing facility, especially in a skilled nursing facility, you’re running about anywhere between $10,000 and $15,000 a month, so the smallest mistake can really cost you a lot of money and I encourage everybody that the first step you should do is get that education.
Q: Wow! Now, what’s some of the documentation that a person would need?
MS: So the basic documentation that somebody would need is, first and foremost, they need to provide documentation showing that they are a US citizen, so whether that’s a birth certificate or a passport, some type of photo identification, Medicare card, Social Security card and, of course, the financial statements from the past five years.
Q: Okay. Now, what are some of the basic requirements for Medicaid eligibility?
MS: As far as whether somebody needs to be clinically eligible and financially eligible – on the clinical side, they need to be 65 years or older and/or permanently disabled or permanently blind and then, obviously, there is the whole financial piece of it, but, ultimately, initially they need to be 65 or above or permanently disabled.
Q: Now, you touched on this a moment ago, what are some of the common pitfalls that applicants face? You touched on the 5-year look-back. Maybe you could discuss that. What is that all about?
MS: Okay, so I’ll answer both of your questions, the common pitfalls and the 5-year look-back. Some of the common pitfalls, first and foremost, is trying to gather the documentation which is needed, which we’ll get into in a moment, which is the 5-year look-back, but just getting out there, doing the legwork, gathering all the documentation, whether you’re dealing with vital statistics or the financial institutions, gathering all the statements that are needed. Number one: It’s extremely time-consuming, it’s extremely frustrating when you have to wait on hold with these financial institutions, you try to do it on your lunch break and then you have to wait on hold for a half hour…..
Q: And they are on their lunch break!
MS: Correct, so that gets extremely frustrating and that is a pitfall where you cannot gather all the documentation that you need. As far as the 5-year look-back, in order for somebody to be financially eligible for Medicaid, and let’s just use a single individual because that’s really the simplest way to go for now, but the threshold for a single individual to be eligible for nursing home Medicaid is $14,850.
Q: Okay.
MS: Once somebody hits that magic number, they are financially eligible for Medicaid; however, it’s not as simple as just going to the Medicaid office and say, “Hey, look. I have $14,850, now give me Medicaid.” Medicaid says it’s very nice that you have that today but how did you get there. And we want to see, and they do a full financial audit on every individual for five years going back. So that means you need to gather every statement from every checking account, savings account, money market, stocks, bonds, annuities, IRAs, life insurance policies, anything that has any kind of cash value, they want to see a full 5-year financial look-back on that. And once they do that, then they will determine your eligibility to see if those funds were properly spent down, which means, when they’re going through the 5-year look-back, those funds can only be spent on the applicant or the applicant’s spouse. So that’s another tremendous pitfall that individuals face because if you fail to provide the proper verifications to Medicaid and showing where your money went to and how it was spent with the proper verifications, they’re going to either impose a penalty or even a denial. That’s a tremendous pitfall that people do get into.
Q: Now, what is the concept of Medicaid allowable expenses?
MS: Okay, so Medicaid allowable expenses, which means, again, we’re going back to that 5-year look-back, they’re reviewing everything, to put it in a nutshell, anything that’s for the benefit of the applicant or the applicant’s spouse is a Medicaid allowable expense, so just to give you a couple of examples: For a single individual, they can set up what’s called a prepaid funeral, where they pay for their funeral in advance, so long as it’s irrevocable; they can pay for their care or loved one in skilled nursing facilities; they can hire a company like Senior Planning Services to assist them with the Medicaid application. In the case of spousals, there’s a whole lot more that you can do and that’s why I get back to that first point, the most important piece here is to make sure that you’re educated on the do’s and don’ts of Medicaid.
Q: Now, what is this issue of a Medicaid spend-down?
MS: The issue is, again, unfortunately, some people are not well versed and not well educated. Many people are giving their children Christmas presents or birthday presents or just giving money to their loved ones, and, they’re not doing anything illegal but when it comes time for Medicaid, they didn’t know that they weren’t allowed to do that and that’s a cause of a tremendous issue. Spend-down really again varies for a single individual or a spousal, like I mentioned before, a single individual has to get down to that $14,850. If you have a spousal, the spouse in the community gets to keep a minimum of approximately $74,000 and a maximum of $120,000. So there are a lot of different options once you get into the spousal scenario, but I definitely encourage everybody to get that education and we at Senior Planning do offer a 100% free Medicaid education and consultation to anybody, regardless of their situation, whether they would like to retain our services or not, it doesn’t matter. They can give us a ring at 516-500-7364. We will answer all your questions, go through your scenario, getting a good understanding of what’s going on today, what has been going on over the past 5 years, and then give you a clear understanding of what you need to do to make sure that your loved one gets Medicaid quickly and efficiently and you get the right results that you are looking for.
Q: You know, what I love about the feedback that I get on the show is the variety of guests and topics and this is such a critical topic for everyone, for really everyone out there. I mean, is there a particular time that you find that people wake up and then they like, “Oh, if I only knew, I would have done this right.”
MS: Absolutely, I mean we meet with hundreds of families a month and it’s time and time again where it’s unfortunate where people are just waking up too late and if only they would have known a couple of years back or even a little sooner, there’s so much more money that they were able to preserve, so many different options that they were able to do. And, yes, it’s sad because we hear it all the time, you know, Mom or Dad has worked so hard their whole life and now they have to spend everything down to the nursing home. So when you’re being proactive and you get started early on, you’ll see those better results and everybody will be happier at the end of the day.
Meir Kaplan – Marketing Manager at Senior Planning Services
Q: Let’s talk about, if I may, someone putting their loved one in a facility. Obviously, that’s fraught with so many complications and is such a difficult decision, but what are some of the common challenges that people face when they take that step?
MK: One of the biggest challenges that families face that we hear on a daily basis is choosing the right facility for their Mom or Dad, for their loved one, picking the right facility that will suit their needs. You know, there’s not that much time when picking a facility, picking a nursing home. Nobody plans to ever go into a nursing home. Somebody ends up in a hospital, you know the hospital keeps them for 24 or 48 hours and then the discharge planner says, “Well, guess what? Now you got to go ahead and pick a facility.” You try to pick somewhere where they live, or where the hospital is or just the closest distance that they’re able to go ahead and visit, so on and so forth. But, again, all this process comes into a shock. You know, they went into a hospital, they thought they were coming home and now they end up having to go into a long-term skilled facility – what is the next step? Where do I go? Who can I turn to?
Q: So how does Senior Planning Services handle and help people with that?
MK: At Senior Planning Services, we have a division, a placement division, that gets involved, that we help the families navigate the process. When somebody does end up in a hospital and then they end up having to go to a nursing home, they don’t know where to go, they don’t know what to choose from, the different costs that go into a facility as well, that the families were not ready to go ahead and just jump into. Senior Planning Services – what we do is we come in and pretty much handle the entire burden for that family, from A to Z.
Q: I’m overwhelmed – it’s such a complicated process!
MK: This is a very, very complicated process. Two or three weeks ago, I was dealing with my own grandfather that was in an adult home and, all of a sudden, just had an issue breathing, ended up in a hospital, ended up having to go to a nursing home and my aunt, who was very involved, didn’t even know where to turn, didn’t know how to choose what to do. She knew that I was dealing with Medicaid. She knew that I helped families get on to the Medicaid application process, she did know that I was familiar with all the facilities and knowing which one would suit my grandfather best. But it ended up all working out, thank G-d.
Q: Well, certainly, because she had a nephew who knew the industry! Wow! Before I get into more questions, how could someone reach you or reach the firm in order to access your great depth of knowledge in this area?
MK: Senior Planning Services – there’s a telephone number – 516-500-seniors. They can go onto our website which is www.senior-planning.com. They can call us, again, at any one of these telephone numbers.
Q: Now, you’re also on social media? Let’s say someone wants to follow…
MK: Sure, we’re on Facebook, Linked-In, Instagram, you name it, we are all over the Internet, very, very accessible to anybody.
Q: Now, let’s talk about gifting. Can you explain what is the concept of gifting?
MK: So the concept of gifting is a very, very scary process when it comes to Medicaid in general. The Medicaid philosophy is that your funds are to be spent on your care. What’s right or wrong is irrelevant to Medicaid. Medicaid is not interested in hearing, “Well, I felt the holiday came around, I wanted to go ahead and gift out funds.” It’s irrelevant. Your funds are to be spent on your care. But like I said before, nobody ever stops and says, “Wait, hold on one second, I’m about to give a gift, let me plan for Medicaid, let me not give that gift.”
Q: Right, it doesn’t even enter the mind.
MK: Correct. Now on the flip side of giving the gift, nobody, I mean I don’t, I can’t say anybody else does, ever holds onto a gift in order to go ahead and give that gift back. So when it comes to gifting…..
Q: Like most people.
MK: Like most people. So when it comes to Medicaid, Medicaid gifting is one of the scariest things to go into and the reason for that is, and I believe Michael touched on this before, is that Medicaid gifting can cause a penalty on a Medicaid application for somebody going long-term in a facility. And if a facility ends up seeing a Medicaid application coming along with a penalty, it can possibly jeopardize the admission when trying to place a loved one in a facility.
Q: Which is why, it really brings to mind, I just have to bring this up, this is kind of the elephant in the room – how important it is for someone to reach out to a firm like Senior Planning Services, as opposed to trying to wing this on their own.
MK: We try to stress it to the families, we speak in different community centers, we speak in the community, we do family nights, we do seminars in different counties, in different areas, to express to the families that are planning for the future – get an education, get an understanding of what’s coming down the line, what’s coming down the pipeline. I can tell you that every single day that a family comes to us and says, “How come I didn’t know about you guys a few months ago. If I would have known, if I would have, should have….” These type of things can be prevented by getting an education, getting an understanding of this Medicaid process and what you’re about to face.
Q: I have to add, how special does it feel to be in a business that aids people in such a meaningful way, it’s really special.
MK: There is no better feeling, when we finish a Medicaid application, whether it’s somebody that’s going long-term in a nursing home or somebody that’s going short-term in the community, getting set up with home care and all of a sudden you see a testimonial come in from the family ranting and raving and praising all the different parties that were involved in assisting that family getting onto the Medicaid application process. There’s no better sense of accomplishment, by receiving that testimonial to help that family.
Q: Now, Medicaid has strict policies regarding asset limits. This was touched on but is there any way that someone can retain their assets for the family? Could they protect their home?
MK: So, yes. Without getting into too many details, and again, if somebody would like more information on protecting their home or protecting assets and the few different types of trusts, again, we could be reached at the 516-500-seniors or on our website, we can be reached at any time to go ahead…..
MK: 516-500-seniors. One of the ways, like I said before, is the gifting. You’re not allowed to go ahead and gift in the 5-year look-back period. Any amount that was gifted for somebody in the 5-year look-back period when going into a nursing home can be a penalty. It’s not a percentage. It’s a dollar-for-dollar amount. Whatever amount was gifted is the amount that has to go ahead and be paid back in order to prevent the penalty. In our situation usually which comes to us is that there’s no funds left to go ahead and repay a gift. So what happens is, there is a legal way today, which is called a promissory note. You could look it up online. It’s either called a __________ rule or a split rule, however you want to go ahead and call it, which Medicaid in New York allows somebody to split half of their assets. Half of the assets the family gets to go ahead and keep. The remaining part of the assets which covers the penalty period, gets paid back, but not to the family, gets paid back to the long-term care facility which covers the penalty period. Once that penalty period is up, then Medicaid will go ahead and then pick up in full. So you can look at the status of the resident as a Medicaid penalty period or you could it look at it as private pay, but that period of time is the penalty period from the gift that was given.
Q: I’m just going to, again, repeat the obvious. For some people that want to try to do this on their own, it just, they’re navigating something that’s near impossible, not impossible.
MK: I don’t want to say that a person might end up needing a nursing home themselves after dealing with this process. You know what I mean?
Q: So what does Senior Planning Services do to prevent spousal impoverishment?
MK: Spousal impoverishment which does come up on a daily basis. You know we have a lovely couple living in the community and, all of a sudden, let’s just say the husband, in our case, slipped on the ice and ended up having to go to a nursing home and now, all of a sudden, this sweet, little woman, living in the community doesn’t know how to start to pay bills and how to deal with all the finances as well as she was living off her husband prior to him going into the facility, how can she protect her home, how can she live, what’s the process?
Q: Right.
MK: So the way Medicaid allows her to do is something called a spousal refusal which enables the community spouse to, pretty much, the way I like to explain it, to financially separate herself from her loved one going into a nursing home. Medicaid looks at it now as almost like a single case. So if it’s a single case, the community spouse gets to keep most of the assets. As a single case, he would be Medicaid eligible as of today. Medicaid would then go ahead and pick up his bill entirely and the community spouse would not be affected too much. Now, there are little, minute details that do end up coming in along the line with doing a spousal refusal. I don’t want to scare anybody. We’re going to leave those off. So when going ahead and doing a spousal refusal, you do have to be a little bit cautious. Like I said before, Medicaid and the philosophy of Medicaid is that it’s irrelevant what the situation is at home prior to needing Medicaid, is your funds are to be spent on your care. So the fact now that Medicaid is allowing you to do a spousal refusal to protect the community spouse with the assets and the income that she needs to go ahead and live, Medicaid still comes after and says, “Well, we’d like our piece. We’re paying x amount of dollars out for your loved one’s care in the facility, that’s fine. You’re getting to keep, let’s say $2-300,000 of the assets. We would like to take a certain part of those assets, at least to cover the outstanding bill that we went ahead and paid for your husband to go into the facility.”
Q: My guest now is none other than Ben Mandelbaum. He is the COO of Senior Planning Services. Ben, thank you for joining me here on Mind Your Business.
B: Thank you for having me.
Q: Thank you. Again, we’re having some incredible conversation so far with your team. Senior Planning Services is an incredible company which provides many critical services. Perhaps you could describe in a nutshell the scope of services.
B: Okay, well there are many but we do work with healthcare providers as well as the individuals who ultimately need coverage to have the healthcare services that they medically need or whatever their current life circumstance may be. But, basically, we help individuals understand what Medicaid and the various Medicaid programs provide so that they can set themselves up for the appropriate care whether it be at home or in a nursing home, assisted living facility and so on.
Q: Does Senior Planning Services work primarily with individuals or companies? Now, this might seem like a stupid question but for someone who has not gone through it, they may not get it. That is, why should someone use Senior Planning Services rather than attempt to navigate the system on their own?
B: That’s not a stupid question at all. That’s actually a good question. Clearly, you’re a pretty smart guy. Our company is set up in a way that we offer an initial consultation to whoever it may be wherever they may be and specifically for that reason because many people don’t understand why should I utilize this service, why should I pay somebody a couple of thousand dollars to go ahead and help me get my benefits in place, and the reason we start with an initial consultation is because once we get to talk to them they could understand that there are various Medicaid programs, that Medicaid is a government program, government insurance, long-term care insurance, but you have to be eligible. There are criteria, there’s a process to apply and, ultimately, the government offices are extremely overwhelmed with an unbelievable amount of applicants that come their way and, naturally, they don’t get to everything timely and it can be difficult. If you apply wrong you can get denied. If you present the wrong information or not enough information, again, you can get hit with a denial. If you’re not clear with certain information, you can get hit with a penalty that they won’t cover certain dates of service for you. There are so many factors that can ultimately inhibit your coverage and getting what you need out of this program that the government is ready to offer you if you don’t go through the process in the right way. So, ultimately, the free consultation really helps us get good information about the potential applicant and helps us guide them. Now, many of the people that have a very straightforward case, we would actually just give them the free information and tell the families that it’s really straightforward and they could do it on their own. So, that’s why we offer the free consult, because not every person is a good candidate for us to actually help through the process. But at least we could guide them from the onset how to do it.
Q: Ben, thank you so much for joining me here on Mind Your Business.
B: Thank you so much for having me and I look forward, any time.
My final guest of the evening is none other than Isaac Itzkowitz, the executive director of SCS Pooled Trust. Now, again, it’s part of the LTC suite of services. Senior Planning Services, as we discussed earlier on with the various guests that we’ve had and one thing is very clear – don’t try doing this on your own. You could forfeit so much, so much at stake, so much is there that people are going to need to rely on and they need a company like Senior Planning Services in order to navigate this very complicated process.
Isaac, first of all, thank you for joining me here on Mind Your Business.
I: Thank you for having me.
Q: Maybe you can explain to our audience, what is SCS Pooled Trust. What is that all about?
I: Okay, so I’m going to defer that question for about 10 seconds and I’m going to explain a little bit and then we’ll go back into that.
Q: Sure.
I: So, SCS Pooled Trust is actually, like we mentioned, a sister company to Senior Planning Services. I know that some of the other guests touched on the nursing home regulations, how to navigate the nursing home process, coming out of a hospital or if you’re in the community. Now, there’s another kind of Medicaid which, I believe, one of the other guests touched on, which is home care Medicaid. Home care Medicaid has a very different set of rules for the look-back periods and it allows people who may not qualify for the nursing home application or the nursing home coverage, to get care to some level in their house. So, as was stated, the nursing home application has a five-year look-back with a full financial audit of your five-year history. With home care Medicaid, which is referred to as community Medicaid, there is a 30-day look-back period. So it gives people the option, not only who don’t qualify for the nursing home application but for those who want to remain at home to the best that they can, age in place, it gives them an option to stay in the comfort of their home, keep their dignity intact and continue to live, hopefully, for the rest of their life in the home they’ve been in for so many years.
Q: Amazing, because if someone is not dealing with a company like Senior Planning Services, they wouldn’t necessarily know that, they may have gotten rejected on the 5-year look-back and then say, “Okay, all is lost,” without realizing that this option is available for them.
I: Correct. We do a lot of seminars, a lot of education in the community and the first thing out of the mouths of the people attending is, “Well, I don’t qualify because I had assets for the last 5 years,” and I try to explain to them that with home care we don’t have that issue. Then, that opens them up to an entire new world that they were not aware of prior to that session. So, there’s the 30-day look-back period. It gives people the option to transfer. Now, as a company which deals with both sides of the coin, we want to make sure that we’re not setting people up for failure should they ever need a nursing home down the road. So when we tell them how to transfer assets, whether it’s to children, irrevocable trust, whatever it might be, we kind of guide them, “Hey, if you’re going to need the nursing home application in the next five years, you’re still going to run into a lot of these issues. So if you are transferring assets to any method that is available today, don’t spend that money, hold onto it.” Because as one of your guests said, it’s dollar-for-dollar that needs to be paid back. So we try to educate them in both regards. Obviously, as a child, they want their parent to remain at home, they’ll try their options. If it doesn’t work, they’ll go to the second option, but, for the most part, it gives people that whole new world that they haven’t heard about before.
Q: Now, let’s come to the other question, what is SCS Pooled Trust?
I: Very good. So in a nursing home setting, which I don’t know if it was touched on, we talked about assets a lot, which is really the big concern. When it comes to somebody’s monthly income, Social Security, pension and IRA distribution or something of that sort, when you’re in a nursing home that income is due to the facility and Medicaid covers the balance of that bill. Again, it could be a significant amount, as I think Michael said, the nursing homes cost between $10,000 and $15,000. So if you have $2,000-$3,000 a month of income and you’re going to be there long-term, the facility has the right to retain that and Medicaid wants you to be impoverished to that degree. But out in the community, people have mortgages, people have utilities, maintenance, rent, phone, food, groceries, all the different kinds of daily expenses, so Medicaid gave an option that if you have income, for example, let’s say a person makes $2,000 a month and Medicaid sets your income limit at $845, so how are you going to qualify and you definitely cannot afford to pay for private care on that kind of income. So Medicaid says, “Well, if you need the care, not a problem. You pay me everything above the $845, you pay me about $1100 and change a month, kind of like a deductible, and we’ll pay the rest.” So you are getting kind of a fair trade but then you’re left with $845 monthly to pay all of your expenses. I don’t know about you but I don’t know anybody that can live on that, and it’s a very big issue that comes up. So about 30 years ago, there was a lawsuit about this and it went to the Federal Supreme Court and they designed something called the Supplemental Special Needs Trust. There are some individuals, you know, if there’s family and there’s a disabled sibling or whatnot, that they can manage it. Some attorneys will do it, but strictly for income, for Medicaid, for SSI and other types of welfare benefits, there was a law that was enacted that these types of trusts, or any funds that go into these trusts are exempt from these programs. So what happened was in New York, where you have one of the largest home care populations across the US, just from the disabled and age standpoint, there’s about 200,000 seniors, it became a very big issue for the state. So the state put that into their Medicaid laws. The way I view it is if the State didn’t do that, you would have that many more people in nursing homes and that would cost the State a lot more money in Medicaid dollars and they would ultimately go bankrupt which is where they kind of were on the verge of that in 2011 when Governor Cuomo signed the new Medicaid regulations into law and cut spending by two billion dollars. So that was an option that Medicaid gave. New York had adopted it to their Medicaid law and it gave people the option of sheltering their excess money every month in this kind of trust. So, the first thing people tell me when I tell them that is, “Okay, so great, I didn’t pay it to Medicaid but I put it into this trust. Now what? What do I do? I lost the money anyway and I’m still living on $845?” So here’s the greatest catch of all time. The greatest catch is that the money that goes into that trust can be utilized to pay for a member of the trust everyday living expenses, rent, utilities, groceries, credit cards, parking, car insurance, life insurance premiums. The trust has very few limitations. The trust cannot pay for items that are covered under other insurances, Medicare, Medicaid, private insurance and the trust cannot pay for alcohol, tobacco, firearms, gambling. You know, the State wants you to keep this so you can stay at home so it will cost them less money but they’re not going to support any bad habits that a person might have. And it comes up. People tell me, “I can’t take that bus to Atlantic City anymore.” I’m like, “Well, you could with your $845.” So it’s definitely a very, very valuable option. We do hundreds of Medicaid applications for home care style patients a month and we see that about 9 out of 10 people who clearly understand it, especially if there’s a family member involved, will go through with the option because the alternative is really not feasible for getting the care.
Q: Now, how could someone get in touch with you or the people at SCS Pooled Trust.
I: So you could utilize the same number as Senior Planning if you wish. It’s 516-500-seniors. The direct number for SCS Pooled Trust is 718-971-2509.
Q: Now, as far as the website, is it the same site?
I: The website for SCS Pooled Trust specifically is www.scspooledtrust.org.
Q: Now, perhaps you can clarify, why is it that so many on Medicaid, you touched on this previously, but this is such a fundamental concept, they just don’t have sufficient funds for living expenses? Again, you explained this, but they have to hear it straight.
I: And it comes up very often and sometimes it takes two or three tries to get them to understand how the process works, because it is a separate process from the Medicaid application. We always have to start off with what the worst off option is which is Medicaid is going to take whatever their balance above their limit is and that’s going to leave you with no money. I come across people today in my daily travels through the trust, and I see people all the time that are paying extremely large amounts to Medicaid every month and they tell me they’ve been doing this for so many years. And now I understand why they are barely paying their rent and they’re on all of the programs to pay to get food and whatnot and the family is struggling to put it on the table for them and that’s where I see a lot of these members don’t have those funds. So, it’s a very big struggle for them and once we introduce the trust, it changes their world. We have countless stories of people that have been doing this for so long and they never knew, they just never knew.
Q: It just ate away at all their life’s savings.
I: Everything they had just gone. It’s a very tough thing for them. And to hear about it later on, it was a nice thing to hear but it was also a tough thing to hear that they spent thousands of dollars…
Q: Hundreds of thousands of dollars burned right through.
I: Correct.
Q: I feel it’s worth repeating because, like you said, people are just not getting it. How, at the end of the day, how does a pooled trust solve this problem?
I: Pooled trust is very simple. It solves the problem by ensuring that your funds that you make on a monthly basis from Social Security or pension, you worked your whole life and this is what you have to retire on, you do need benefits which you’ve paid into the system your whole life as well, you want to ensure that you don’t have to contribute to that system. You should be a recipient of that system 100% in its entirety and you should not have to contribute. And I get a lot of people that tell me, “Well, why should I have to circumvent some of my income to the trust and then you pay some of my bills? Why can’t I just show Medicaid that I’m paying my bills?” And the answer is that Medicaid wants it to be managed. There are certain laws that have to be adhered to as far as what can be paid, what cannot be paid, who it can be paid for. Unfortunately, if someone has a family who is still living with them and they are disabled, the trust can only pay for expenses that are for that disabled beneficiary. So we have to be very careful when we’re paying the bill directly to Verizon or the rent or whoever it’s going to be that it’s for the specific needs of that disabled individual. So we’re solving that problem by making sure that they can retain their money for their expenses and we advise them to use the money in the trust before you go dip into whatever else you have. Clear out the trust on a monthly basis. Everybody has their own account. It’s monitored through a regular banking system and we want you to clear it out because what happens is that Medicaid says, “You can utilize this throughout your life.” Once a person passes away, any money left Medicaid wants to try to recoup some of the funds they’ve laid out which could be, like you said, in the hundreds of thousands. So what happens is, they don’t really know how to use the trust and they start using their funds at home. So we do a lot of that education to say, “No. Use your funds in the trust before you touch any other monthly expenses. Once that’s clear and you’re at a 0 point until the next month’s deposit, then you can dip into your own savings.
Q: So all the people that have reached out to SCS Pooled Trust, is there a customer service number which they could reach with questions they may have on a daily basis?
I. Yes, our main number is 718-971-2509. We have a few different options there for someone who may want to learn about the trust. Once somebody is enrolled in the trust, we have a case management department that specializes where we have one person to talk to about questions you have. We’re not going to throw you around from department to department and that’s kind of what puts us apart and it gives somebody the personal relationship to their case manager and, thankfully, we have that relationship with our members.
Q: Just a final question here. What are some of the benefits of home care versus nursing facilities?
I: That’s kind of like – we’re put in a little bit of a tough position with that. Most people we know want to remain at home. Nobody wants to be in a skilled nursing facility. Unfortunately, there is sometimes a level of care – you just can’t be at home. There are people that should be in a skilled nursing facility and they are at home. They are grandfathered in from the old Medicaid system. They have two 12-hour shifts. They have a 24/7 live-in at their home. They have all sorts of equipment. You know, times have changed and, unfortunately, with all the cuts in 2011 and continuously going on, it’s making it a lot harder for people to remain at home, especially with the family’s involvement because somebody who normally maybe would have gotten full-time help is now only getting 8 or 10 hours, that means somebody has to be there at night, somebody has to be there the rest of the time and it’s a very difficult thing for a child who has their own family and their own job and it makes it very difficult and although it’s the hardest decision to make, in my opinion, it sometimes is the most necessary to maintain a healthy lifestyle for yourself, your family although you hate to see your parent or your loved one go into a facility like that.
Q: What’s so precious here is that it’s such a tense period of time for a family but, at least, to have a company like Senior Planning Services and SCS Pooled Trust to kind of hold their hand along the way, makes it so much easier, if you will, to at least navigate that complicated part of life, I should say.
I: Correct. I mean, you know we get a lot of our referrals to the trust are when somebody is ready to come home from a short-term stay in a rehab or a hospital stay and there are a lot of arrangements going on. You have the ambulette, the home care, and everything going on together, the nursing assessments for this agency, for that agency and it kind of all has to piece together well and it often doesn’t because you’re dealing with multiple different vendors and it’s a very stressful time. So we try to get to their home before everybody else comes in. Let’s get this off the table. Let’s explain how this plays into all the home care which it does in a very big way and let’s resolve this before you have to start with actually getting somebody home.
Q: That was Isaac Itzkowitz, the Executive Director of SCS Pooled Trust. Thank you so much for joining me on Mind Your Business.
Yitzchok Saftlas is the founder and president of Bottom Line Marketing Group, an award-winning marketing agency helping hundreds of corporate, political and non-profit clients since 1992. Yitzchok’s new book: “So, What’s the Bottom Line?” published by Morgan James, contains timeless advice for marketers, seasoned executives and entrepreneurs. He is the host of the weekly business radio show, “Mind Your Business” on 77WABC in the New York / New Jersey metro area as well as on C-Suite TV and C-Suite Radio. Additionally, Yitzchok is a featured columnist in the Yated newspaper and Mishpacha Magazine, both international weekly publications.
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