Category: Medicaid New Jersey

Is There A Difference Between Medicare And Medicaid?

Post author By sps
Post date March 18, 2015

The answer is a resounding Yes.

Medicare is health insurance that pays for doctor’s visits, hospitalizations, certain medical equipment and short term rehab. Medicare is available to individuals who are over the age of 65, and younger people who are disabled. Medicare also requires that the individual be a resident of the United States for a minimum of at least 5 years. Medicare is not dependent on one’s income. There are some scenarios in which an individual may not be eligible if the applicant or their spouse never worked or paid taxes.

Medicaid is a need based program in that eligibility is dependent on one’s income and assets and sometimes their Medical condition. Medicaid is available to cover ones long term care services either in a care facility setting or for services in one’s home. There is an extensive application process in which applicants may be required to submit documentation about their medical and financial circumstances. Once the necessary information has been gathered and submitted to Medicaid, a county caseworker will review and determine whether or not the individual meets Medicaid’s eligibility guidelines.

To illustrate the differences between Medicare and Medicaid coverage, I’ll share with you a story about Ann. Ann was an active elderly woman who had all her wits about her. She walked to the grocery down the block weekly to purchase her produce and hopped on the city bus to do her monthly shopping at Shop Rite. This past winter, after a really big snow storm, Ann walked out of her apartment building, slipped on ice and broke her hip. She was admitted to a hospital for a week all while Medicare was being billed for the services provided there. She was then discharged to a nursing home for rehab. She was receiving rehab for about 20 days while Medicare was covering the full cost with no co-pays or insurance. A Medicare nurse evaluated Ann and informed her that she was eligible for more rehab, another 80 days but now it wasn’t free of charge and Ann was required to pay a copy of $157.50 a day until the 100 days were up. Ann had thought once she would reach her 100 days she will be well enough to return home. The diagnosis wasn’t looking positive and Ann would need to stay at the facility long term. Medicare will not cover Ann’s stay after 100 days. Medicare views more than a 100 days as long term services and therefore Ann would either be required to pay the nursing home the private monthly rate or apply for Medicaid. Ann was in no position to cover the private monthly rate of $10,000.00. Luckily, the skilled nursing facility informed Ann about Senior Planning Services who helped Ann secure the Medicaid coverage she so desperately needed. Medicaid then covered the nursing home bill in full.

Medicaid New Jersey

Obtaining Medicaid Coverage For A Homeless Individual

Post author By sps
Post date February 27, 2015

Naomi, a Senior Planning Services caseworker, related her experience in trying to obtain Medicaid coverage for an individual who had no family support and was homeless for a period of time. Additionally, he had poor memory and gathering necessary information changed a simple caseworker into an investigative detective. Ultimately, Naomi achieves the impossible: a Medicaid approval.

In mid April, Senior Planning Services retained a case from a nursing home for Gregory Slate who needed Medicaid coverage dating back to January. According to Medicaid guidelines, one may be able to obtain retroactive coverage three months back so long as at the time of the coverage request date the individual had met all the Medicaid guidelines. Being that Greg was homeless for a short time, we were under the assumption that he would meet the financial criteria . After speaking with the skilled nursing facility where Greg resided at, it was confirmed that Greg had also been clinically evaluated and that medically he had met the Medicaid requirements. Naomi understood that for Greg to remain eligible for retroactive coverage the application needed to be submitted before the end of April. This implied that Naomi had about two weeks to open the case with Medicaid and submit necessary information. There was just one problem: Greg could not recall where he banked and had no documents to establish identity or citizenship.

Naomi quickly filled out an application with the limited information and submitted it to Medicaid to open the file. Simultaneously, she sent out request letters to all the established banks in the area with the hopes that one of the banks was the one where Greg’s accounts were held. Sure enough, Naomi received a response and was able to obtain the five years of bank statements for Greg’s application. She also had to obtain a birth certificate for Greg to establish identity and citizenship, but once again, Greg’s memory fell short and he was unable to recall the name of his mother. With extensive research into the previous facilities that Greg had been at, Naomi was able to track down a distant family member who had the information necessary to request a birth certificate from vital statistics. There was much back and forth with the Department of Vital Statistics but eventually the birth certificate was received and a copy was sent to Medicaid.

Once the five years of bank statements had been received, Naomi carefully reviewed them. Greg was over the Medicaid asset limit due to his Social Security money accruing. Naomi reached out to the Medicaid case worker to explain the situation and ask for retroactive coverage despite the fact that he was over the resource limit. There are guidelines that the caseworkers can sometimes fall back on if an exception is needed. After much negotiation with the case worker at the Board of Social Services, Greg was approved for Medicaid with the retroactive coverage he needed to cover the nursing home bill.

Names have been changed to protect the privacy of those involved.

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Understanding Life Insurance Policies And How They Relate To Medicaid

Post author By sps
Post date December 3, 2014

Understanding Life Insurance Policies And How They Relate To Medicaid

When an individual is applying for Medicaid and has assets that exceed Medicaid’s resource limit, a Medicaid spend-down is necessary. Assets in excess of the allowable amount must be spent down in order to achieve financial eligibility. Some kinds of life insurance policies are included in the spend-down with a few exceptions. Below is a breakdown of what needs to be liquidated in order to be eligible for Medicaid.

There are two popular types of life insurance policies that have different effects on the Medicaid application process.

Term Life Insurance Policies:

Term Life Insurance Policies have premiums that increase as the individual’s age increases. These policies only carry a death benefit. They are also referred to as protection policies; their purpose is to assist the beneficiaries in the event of the policy holder’s sudden death. Since there is no current cash value in term policies they are not considered an asset according to NJ Medicaid guidelines. These policies may remain active and will not impede one’s Medicaid eligibility. Once an individual is on Medicaid he/she will have minimal assets and may not have the money to cover the monthly premiums. Some beneficiaries choose to cover the monthly premiums so that they can ultimately benefit from the death benefit once the Medicaid recipient passes.

Whole Life Insurance Policies:

Whole Life insurance policies generally have fixed premiums, death benefit and cash value reserves. These policies may be liquidated at any time. Being that they carry a current cash value, they are not exempt from the Medicaid spend-down and must be liquidated in order to meet Medicaid’s financial eligibility requirements. There is one exception to the rule! If the Whole Life Policy has a face value of less than $1,500.00, regardless of the cash surrender value, it is exempt from the Medicaid spend down and may remain open and active. “Face Value” is the original death benefit amount on the day the policy was purchased, prior to the policy holder making monthly premiums. While the policy is active it will accumulate cash value from the premiums as well as dividends from reinvestment money. The cash value may exceed the original death benefit (or Face Value). Once the policyholder passes, the beneficiaries will then be able to claim the total death benefit from the policy.

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Utilizing A Special Needs Trust With The Excess “Spend-Down” Money

Post author By sps
Post date November 24, 2014

In order for an individual to be eligible for Medicaid, there are financial standards that need to be met. Many Medicaid applicants will have to spend some of their assets in order to meet Medicaid’s financial threshold. There are a few excludable resources that are exempt from the Medicaid spend down. These assets can be retained by the Medicaid applicant and will not impede Medicaid eligibility. An individuals personal possessions, a prepaid irrevocable funeral trust, and a special needs trust for a disable child are just a few excludable resources when applying for Medicaid.

Today we will discuss utilizing a special needs trust with the excess “spend-down” money. When a Medicaid applicant has a disabled child, a special needs trust allows the transference of assets from a parent to the child without jeopardizing the child’s government benefits.

Special needs trusts are also referred to as “supplemental care trust”. These trusts supplement the disabled child’s Supplemental Security Insurance (SSI) and Medicaid benefits. The money in a special need trust may only be used for specific items or services. The trust is meant to supplement and not pay for basics such as food and shelter. Some things that may be purchased through a special needs trust include:

• Home modifications to assist the disabled
• Medical treatments and equipment not already covered by government assistance programs.
• Education and recreation equipment
• Computers
• Musical instruments
• Sports equipment
• Travel expenses
• Prepaid funeral

When a parent creates a special needs trust for a disabled child, he/ she chooses a trustee. A trustee is an individual or institution who manages the assets in the trust. The trustee’s responsibility is to follow the terms and guidelines outlined in the trust as well as transferring the funds from the trust to the beneficiary or disabled child. A trustee can be a family member, attorney, bank or anyone that one chooses to assign as a trustee.

The trust restricts the beneficiary (or disabled child) and parent access to the assets in the trust. Only the trustee would have accessibility to the funds and therefore it’s considered an unattainable asset for both the parent and disabled child. To summarize, the Medicaid Applicant who transfers assets to a special needs trust for a child will not incur a Medicaid penalty. Additionally, the recipient will not jeopardize the government benefits which they receive.

Gifting Medicaid New Jersey

When a Medicaid applicant owns a home – could it be successfully transferred to a child?

Post author By sps
Post date November 5, 2014

Senior Planning Services is the premiere Medicaid application company in the states of NY, NJ, PA and CT. We have been privileged to successfully process thousands of Medicaid applications on behalf of our clients. Our unique vantage point allows us to identify trends that have been occurring in regard to Medicaid’s enforcement of rules and policies. The following is a recent trend that we have identified.

When a Medicaid applicant owns a home, there are circumstances in which the asset is exempt and may be transferred without jeopardizing Medicaid eligibility. In the past, the applicant’s home could successfully be transferred to a child if the following two criteria were met:

1. The son or daughter has lived in the home of the applicant for a minimum of two years prior to institutionalization

2. There is a signed doctor’s note stating that the applicant was kept at home (as opposed to a facility) due to the care of the child who lived with the applicant.

Senior Planning Services has noted that the above referenced criteria have become less liberal. Medicaid may now disallow the transfer on the basis of any of the following:

1. If the child had a job that would impede their ability to fully care for the applicant, the Board of Social Services may request documentation in order to determine whether or not
the care was supplemented

2. If the applicant’s medical records do not reflect a need for care, a doctors note may not suffice as proof that there was a need for care.

Although we have seen numerous cases approved without the additional scrutiny, we have also seen cases where the additional requirements were enforced. If the Medicaid applicant meets the criteria of the more stringent interpretation of the policy, educating them to provide this information when applying may help facilitate faster Medicaid approvals.

Senior Planning Services is the most comprehensive and efficient Medicaid application company in the industry. The fact is that many long term care facilities absorb financial losses caused by preventable errors. Slow Medicaid approvals preceded by long pending periods, Medicaid penalties and worst of all Medicaid denials rob facilities of untold sums of revenues. Very often, the root cause of the aforementioned issues are based on actions or inactions attributable to the Medicaid applicant.
For a free Medicaid consultation contact Senior Planning Services at 1855.S.Planning (775-2664).

Medicaid New Jersey

Can the Community spouse keep the home when the second spouse is getting onto Medicaid?

Post author By sps
Post date September 17, 2014

I recently received a call from Samantha who posed a question to me. What would happen to her home should her husband, Nicholas be approved for the Medicaid benefit?

Samantha and Nicholas have been married for fifty-three years. Nicholas was a former general contractor and Samantha was a teacher. They were hardworking individuals who extended themselves to provide for their two children. After years of putting away money, the couple purchased a home and diligently paid their mortgage every month until it was finally paid off. Unfortunately, Nicholas was recently diagnosed with Parkinson’s disease and is in need of a higher level of care. When Samantha heard that she will need to spend down some of their assets for Nicholas to be eligible for Nursing Home Medicaid, she became concerned about what would happen to their home. Would she have to move? It was Samantha’s dream to be able to leave her home to her children. She was afraid that applying for Medicaid for Nicholas would inhibit her ability to do so.

I was delighted to be the bearer of good news, and informed Samantha that according to NJ Medicaid guidelines, a community spouse may keep the home. However, Nicholas, the spouse in need of Medicaid, would have to have his name removed from the deed. The full ownership would now be under Samantha and the home will no longer affect Nicholas’s eligibility. Samantha was relieved, thanked me for my time and will be working with Senior Planning services to get Nicholas approved for Medicaid.

In our next blog we will discuss other situations relating to a home in connection to Medicaid.

*Please note that there are other asset preservation concerns that one should take should the community spouse pass away.