One big takeaway from our Medicaid webinar with elder and estate law attorney, Allison Busch was to plan ahead. So, even if you or your loved ones are not in need of medicaid or long term care now, watch this recording to learn how to prepare…
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Okay. Hi everyone. I’m Susie Adamson and I have my partner, Bonnie Ramsey. We are Adamson Ramsey Homes with Keller Williams and we have tonight, Allison Busch, sometimes known as Allison Busch Vogel, who is an elder law attorney and estate attorney. And I’ll let her introduce herself, but just to explain why as realtors, we would be hosting a Medicaid seminar or webinar. Bonnie and I are really committed to providing resources for our community that are valuable across the spectrum of topics. And years ago, when my parents started to age and into the Medicaid group I had a lot of questions and it’s incredibly confusing. So I reached out to a friend, Bethany Joseph, who is an elder care specialist or consultant. And she connected us with Allison who has been an incredible resource, not just for Medicaid, but for any kind of elder law topics.
Speaker 1 (01:17):
And also the big work she helped me with my to update our will and last will and testament which was long overdue. So if anyone has any questions about that, Allison is incredible and was really, really helpful in that process. So I’ll let Allison go ahead and take over and introduce herself, and then she will go through her presentation. And then as Bonnie mentioned, we will have a time for Q & A, but as you think of questions throughout, please feel free to type them into the Q & A box on your zoom. And we’ll try to read them throughout the course of the presentation if applicable, and Alison will explain the types of questions that we will be able to cover.
Well, thank you very much, Susie and Bonnie for posting for having me, but actually for doing these, these webinars just on a range of topics it really is nice for the community to have this as an option. So thank you. So some of you may know me, I recognize some of the names. So you may find some of what I’m going to talk about to be familiar. I practice elder law and trust in the states, both in New York and New Jersey. And my law firm is Hartmann Doherty. It’s a firm I’ve been at just about 10 years prior to working at this firm. I practice at a family law firm and I had my own practice for about seven years. And before that I was at a private law firm in New York. And before that I was at Legal Aid.
So I’ve been doing and the entire time, the only areas of law that I practice is estate planning or trust estates and elder law. So I have been doing this for a while and have seen a lot of the changes that have happened in Medicaid and estate planning over the last two and a half decades. So and I still find it confusing. I still have trouble sleeping at night trying to figure out what it is that I have to do on a specific issue. And I’m someone who has done this for 25 years and almost nothing else. So if you have questions and if you don’t understand the family member you’re helping or for your own planning, I mean, of course not because if they make it so hard. So this is just really going to be a primer to give you some of the information.
It is absolutely not going to be you know, telling you everything you need to know so that you can just be on your way. It’s just going to give you some information. So just to start off with, you know, who pays for long-term care, what is long-term care. Long-Term care is when the care needs that you have are no longer considered skilled needs. So when you have, I think of it a little bit of a, of a roulette wheel, if your care needs land on things like heart issues or cancer or hip replacement or, or some kind of medical need that you have, that’s usually covered by Medicare. So Medicare will cover that, but when your needs go past that, and now you need someone to help you with all the activities of daily living, you need to be reminded to take pills.
You need help with toileting, bathing, dressing, eating, walking, all of those things. That’s a long-term care. And that’s what Medicare cuts out. Medicare may visit you a couple of times after some surgery, but there’s no Medicare long-term care element, which is too bad. And most health insurance companies don’t cover any sort of long-term care. So the next possibility of who pays for it is you can pay privately for it. Of course, money usually works in, in any kind of setting and long-term care is, is no exception. And the costs are very high. So if you need 24/7 full-time care at home, you’re probably looking at something like $8,000 a month. It could be less if you have somebody from the community, who’s not affiliated with an agency, or if you don’t need a lot of nighttime works. You can have somebody live in, it could be less, but it could be as much as 8,000 or more assisted living facilities in our area, start at something like five or $6,000 a month and go up for memory care units to something like 10 or $11,000 a month.
If you go into New York, all these prices are higher and nursing home care is going to be somewhere between $11,000 to $15,000 a month. So that’s big bucks. At some point people run out of money very often, and a lot of people, aren’t sure they want to use all their money to pay for that level of care. A really good option when that is an option as long-term care insurance. So by the time people come to me that often is not an option either. There are health issues that prevent somebody from getting long-term care insurance. They can’t afford long-term care insurance. It’s expensive. Also something, it could be anywhere from three to $10,000 a year in premiums. But when you do have long-term care insurance, it is a very nice way to offset the private pay costs of all of those things.
So when the first three options, Medicare private pay and long-term care insurance are not on the table for you. The safety net that we all are here to learn about is Medicaid. And Medicaid is a needs-based government program. A needs-based means that you need to qualify in two ways. So you need to qualify both medically and financially and medically. So you can run out of money and it doesn’t mean you get Medicaid. You can be in assisted living facility. And this is, this has happened with clients of mine. Very often, you can go into assisted living facility. They tell you, you only have to pay for two years of private pay and then you’ll get Medicaid. But after those two years, you’re still walking to the bingo class and you’re still having a good time with your friends. You do not qualify medically for Medicaid.
And therefore the payment of that assisted living facility is not going to be covered by Medicaid. And that is a little fact there that I see skipped over at assisted living facilities. When they’re explaining what the eligibility process is, because it’s, it doesn’t serve them well to explain that you also have to be medically eligible to be medically eligible. You need to need at least need assistance with at least three activities of daily living, which is the walking, transferring, bathing, dressing, all of those things. Or if you have a cognitive decline that you need queuing to do those things. So medical eligibility is a clinical evaluation done by Medicaid. If you’re in a nursing home, you likely meet a nursing home level of care. That’s the key word there, a nursing home level of care. But if you’re at home or in an assisted living facility, you might not meet a nursing home level of care, and that is crucial to your eligibility.
But the second part that everyone talks about and that’s the financial eligibility. So the very basics of what you need to know for financial eligibility is the applicant can have no more than $2,000 in or less in his or her name. And that includes everything. Bank accounts, investment accounts, retirement accounts, CDs, stock certificates that you inherited from your mother, that you keep in your safety deposit box cash value on a life insurance policy, a timeshare that you have in Florida, that you can’t even give away because there’s no way to give it away if there’s any value to it, that counts. So that $2,000 or less is a hard number. You have $2,002 on the first of the month when you wanted to get Medicaid, you’re not getting Medicaid. So it’s like a no joke.
You know, I have lots of clients who really feel like I was pretty close and unfortunately that doesn’t work for Medicaid eligibility. There currently is not an income cap. People ask that a lot. There used to be in New Jersey, and I think it’s now been probably eight or nine years since there was an income cap for home care and assisted living. So there are things you have to do with your income. If you’re over a certain amount, I won’t get into that, but you don’t have to worry saying, I don’t think my mother is ever going to qualify for Medicaid. She has a $3,000 a month pension for home care for any of the programs. It isn’t going to be a problem. There’s just some things you have to do with the income. And if you’re married your spouse and I’ll stop one sec, the spouse can have up to $130,000 in his or her name just under that. I think Bonnie, you did you have a question? Oh, I can’t hear you.
So just to quickly clarify, the $2,000 is that that does not include an income that’s coming in. So separate from that?
Right? So the way Medicaid looks at things is that there are two categories, there’s income and resources. So income is the amount of money that comes into your account on any given month. And they will, and Medicaid will determine how much of that income has to be turned around and given to the nursing home or assisted living facility or paid towards the cost of your care. Any time income comes into your account and doesn’t leave your account by the end of the month, it becomes a resource.
Okay. So the balance can’t be more than $2,000 at the end of the end of the month. Right? Okay. And then you can’t have a savings account or anything else anywhere else? No. Okay. No,
Sorry. That, that does get confusing. So and every month your income has to go back out and as part of what it’s called a cost share, it goes towards the cost. So one thing to keep in mind is, and I’m going to use nursing homes. As the example, if you go to a nursing home, it may be something like $12 or $13,000 a month, but if you’re on Medicaid, Medicaid only pays that nursing home. Let’s say something like $7,500 a month. That’s the Medicaid capped rate for that nursing home. And if you have a $3,000 income, that income goes towards the cost of what Medicaid is paying. And then Medicaid is paying about $4,500 a month to the nursing home. So there’s a formula that happens in there. So, but that’s, so that’s the general financial eligibility. Go ahead, Susie.
We have a great, great question here. What if one spouse in assisted living qualifies medically, but the other one does not.
So that means if one spouse qualifies medically, you also have to look at whether or not they also qualify financially. If they do that, spouse can go on Medicaid, but the other spouse, who’s not medically eligible, has to pay for her care out of private pay or some other funds. If she’s out of funds. If she’s out of funds, then either she will lose her ability to stay in the assisted living facility or someone else will have to pay for her ongoing care costs there. Yeah, that, that’s hard. So one thing people often ask about, and this is like the big ticket item when we do Medicaid is the house. The house is an exempt asset, so that’s great news.
And the amount that is exempt is up to $900,000, $906,000. So that’s that’s a big exemption. The problem is, is if you are a single person living in a house that’s worth, let’s say $900,000, and then you go into a nursing home. The house is not really exempt because it must be sold within a short period of time. And now suddenly you have $900,000. It’s no longer exempt and you’re off Medicaid. So when there’s a house, the house being exempt works, if you are living in your home and you’re going on to home care Medicaid and it works, if you’re married and you can transfer the house to your spouse and your spouse gets to live there and Medicaid, doesn’t get to, you know, reach in and have any part of the house. So a house is exempt sort of.
So it’s of some use and it’s helpful, but it’s not as good as sort of what we think about it being. So the other, the next, the most important part of applying for Medicaid really once you’ve hit these basic numbers, which people can do pretty easily on their own is that five-year look back and the five-year look back. This picture, when I saw it, it just really describes the feeling of what happens. So when you apply for Medicaid, you must bring in, or it used to be bring in. Now it’s send inevery bank statement of every financial transaction of every account that has been in either person’s name. So if you’re married, both spouses count it’s, they’re like one unit, but it’s not just that, oh, we all had our own accounts and now I just have to give them my husband’s and my bank statements, everything of the whole couple gets provided to Medicaid and not just every bank statement.
And lots of people say, well, you know, I don’t, I didn’t keep them all. And that’s not enough. You have to go to the bank, you have to get those statements. And a new court case came out today, actually that said a bank not being responsive and giving you that information is not an excuse for Medicaid denying you. So if you say, well, I tried, I went to Chase three times. They wouldn’t give it to me. Medicaid denies you, you don’t have an appealable, right. Just because there has, you have to get that information. There’s no way around it. And not just that, if you, if, and I’m not sure if we’re saying, if it was your mom, if your parents wrote checks over the last five years, or which most people have, you need to show documentation of what every one of those checks was for that’s greater than a thousand dollars.
And so if they wrote a check for to apple and they got a new iPhone and all those things, that’s okay. But if they wrote a check to your name, to your grandchild, so the grandchild’s name, Medicaid’s going to want to know what that’s for. And the assumption will be that that’s a gift. So the five-year look back. The whole reason. There’s a five-year look back is for Medicaid to determine if any gifts had been made in the prior five yearsthat would make you ineligible for Medicaid. So that’s the, the big ticket item is that at some point you may have had money in your name. They want to know where it went. Why is it that you only have $2,000? Now, if you spent all your money in the nursing home, if you went on a lot of vacations, if you just bought a new vehicle, all of that is okay, it’s not that you can’t spend money over the last five years, but if you gave $30,000 to your daughter to help her deal with the divorce, if you paid for your grandson’s law school, if you gave a thousand dollars to your granddaughter for her wedding, all of those are gifts, even though you weren’t thinking about Medicaid at the time, and those are aggregated together.
So what Medicaid does on the day that you are the period of time when you submit the Medicaid application, and you show that you’re under $2,000, Medicaid looks at all the documents, it’s called an audit, and they say, okay, you would be eligible for Medicaid because you’re medically eligible less than $2,000 in your name. But for the fact you gave $80,000 worth of gifts in the last five years. And because of that, we’re not going to give you coverage for a period of time. And the period of time called the penalty period is basically for every $11,000 that you gave away. You’re not eligible for Medicaid for one month. So for $80,000, it’s about seven months that you’re not eligible for Medicaid. The problem is you have to pay for your care another way. And the real problem is you have only $2,000 in your name. So the worst thing, the worst possible scenario is to have given gifts in the prior five years and not kept enough money in your name to pay for what you ever your needs are going to be till you clear that five-year hurdle. So I’m going to stop there for a second and see if you have any questions. That’s a lot,
Sounds like there would be a gap between somebody getting rid of all their money and then getting approved for Medicaid. Like, it seems like it’d be very hard to reach that $2,000.
So that’s an excellent question. So if you are healthy and not need a Medicaid, or just on the horizon of me thinking, I think I’m going to need care at some point, but I’m good. Now that’s the point where, and I’m going to get to that in a minute, but where you look at these numbers and you say, well, I can give away X amount, but I must keep at least this amount of money in my name to make sure that I can meet all of my care needs over the period of time where I can apply for Medicaid. It’s never a perfect science. So you, after the five years, you still may have $300,000 in your name and either you spend it down or we, there’s another way to shorten the period, but worse than having too much money is turning out that you didn’t save enough and whatever money you gifted is long gone.
And you know, now as part of your daughter’s mortgage, and now, you know, there’s no money, there’s no cash that is actually, you know, worse, terrible. Yeah. It’s really terrible. So why is Medicaid so hard to get, and it does feel punitive. I’m working with Medicaid on a case right now, and I’m super, super frustrated because they’re dinging my client on so many things. It’s not a client that has taken any money. There’s nothing funny going on. It’s somebody hardworking, who’s doing his best to try to gather all the information and it’s hard and it feels punitive. And that often is it is hard to take. Hi Bethany. So and the reason is, is that this is a welfare program. Sometimes people come to me and they feel entitled to get Medicaid, and they may have a couple of million dollars in their name.
And they may want very much to save that money for their children and grandchildren, which I completely understand, and I don’t judge, but they need to realize that Medicaid is a welfare program. And so in order to qualify for a welfare program there’s going to be some strict rules because it’s intended to support the poorest people in the country. It was created in 1965 as part of the welfare act. And it’s not meant for middle class and upper middle class people accessing it, but because long-term care is such an expensive area because we live a lot longer. And because there is a concern that our kids and grandchildren are not going to have enough money. People want to make gifts down to lower generations. It’s not just that they’re trying to stand the system, they’re concerned about their families, but the reason why it’s so hard is that over the years, there’s been so many concerns of millionaires being on Medicaid of which, by the way, in 25 years of doing this, I’ve never had any medic millionaires on Medicaid.
Even though I do planning for for millionaires, they never end up on Medicaid because there’s enough money there that don’t need Medicaid. So it’s not something that I’ve seen as being a huge problem. But Medicaid being difficult to get is a problem. It should. I mean, I feel very strongly that this should not be something that you need a lawyer and to spend this much money on it’s become a very frustrating area of law for me. So I’m going to take a minute there, cause the next thought my next slides are really ahead of what planning opportunities you have. I didn’t know Bethany, if you wanted to say hello and just take a break from me for a minute.
I never want to take a break from you. You’re the best. Hi, I’m Bethany, Joseph. I have my own elder care consulting business. I’m here to be a helpful resource for folks that are trying to do the planning. That’s not the legal planning. So the social aspects and talking through all of the, the little bits and pieces and the guilt and the worries. So I’m here to help.
Okay. Well, feel free to chime in the next two are the legal parts. And then I’m going to, you know, we can take, do question and answer. So just going back, what, what can you do to plan and planning, being a planner? I could get rid of that little there. I am a planner. I mean, it’s my personality. It’s also my career. I probably am a little bit actually annoying about being a planner at this point. But the most important thing that any one of us can do is to speak to an attorney way ahead of meeting an attorney and that you really need a specialist. One of the things I, I like the least is when I get a case where someone said, well, my attorney said I could set up a trust this way, or I could do this this way.
And it’s, you know, it’s very it’s just so frustrating because it’s done incorrectly, but the client didn’t know and relied on the fact that, you know, they thought they had all the plans done and they weren’t and elder law. I mean, if you had kidney failure, you would go to a kidney doctor. I mean, it’s a very specialized area. And again, as I said, I stay up at night worrying about these things. And not that I wish that on anybody, but you really want an attorney who worries about these things, helping you with Medicaid and also a care manager also. But in terms of the legal aspects of the trusts, you set up of the power of attorney of all those things. You really want somebody who does this at least 50% of their practice. A key thing don’t take advice from family and friends.
They may have spoken to people in Florida or at the, you know, the bingo or the gym or whatever. A hundred percent of the time don’t answer them ever. Other than when they say I know someone really good for you to speak to. The most important thing that you can do is get a power of attorney and a healthcare proxy in place, even more important than understanding Medicaid, because at least if you get your parents or yourselves, the power of attorney and healthcare proxy, there are at least as somebody out there who can do the planning that’s needed for you. So those are my top three pieces of advice. If you want to know planning strategies and this is really getting into the weeds, but if you have time and when I say time, years, when you have time and you have a decent amount of money there are ways that you can do Medicaid planning.
You can make gifts moving assets out of your name to children to trusts, and you can create an irrevocable trust, but you have to keep in mind that when you make a gift, either to kids outright or to a trust, it is an irrevocable act. It is a completed act. You’ve said goodbye to that money. You can’t put money into a trust and then use it, that money is gone. And that may be just what you want for your children and grandchildren, or just what you want your parents to do for help you. But it can’t also be cake and have it too, or eat it too, and have money from the trust that comes back out of the trust. And it goes back to helping mom and dad will take the trust entirely and make it a complete waste of time as there’s to be no principal going from the trust back to mom and dad.
So there are planning strategies when you have time and money and they may be worth doing and worth looking into for sure. And then when you’re saying, you know, great, I don’t have time. I don’t have that much money. Is there anything we can do? And there usually is some crisis planning. If you’re married, there’s some options with using spousal annuities. Which is pretty in the weeds of legal options when you’re not married. There’s not only some gift annuity planning that you can do, but there’s some exceptions to the gift penalties having to do, if you have a disabled child, if you have a caretaker child living with you. So there are some options and those are the options that are, make it really worth speaking to an attorney. So I’m going to leave it there because that’s a lot of information. And I’m happy to answer questions and I’m happy for Bethany to speak. And, okay.
I have a quick question, which is to your point about how important it is to have somebody who’s really focused in this area of work and understands the ins and outs, how often do does Medicaid, how often does it change? You know, how much do you have to keep on top of?
So that’s, that’s a good question. So I practice in both New York and New Jersey, and right now there are a new, numerous changes happening in New York. New York used to be the go-to place is still a go-to place for Medicaid. It’s a much easier set of rules than New Jersey. It’s in the process of getting stricter to be sort of more in line with New Jersey, not entirely. But so as it’s changing there, you don’t always get a written sheet of like what the new law is both in New York, in New Jersey. And New Jersey, you don’t always know that one county handles things differently than another county, unless you’re actually working in those counties. And then you get this letter that says, you know, we’re only looking at transactions above $2,000. You no longer have to show $1,000. So some of it is laws changing and some of it’s just pattern of practice of being on the list, serves, hearing what everybody’s finding.
And a lot of it in New Jersey is you may have a caseworker who’s just gone rogue and, you know, they may not be right, but they’re going to make your case really hard. And therefore, when I hear that I’m going to sort of follow it, it works to sort of be a silencer in some other areas. So I mean, I do all my CLEs on elder law and estate planning. I don’t do any other CLEs. So, and because I’m doing two states, I’d probably do double what I actually need to do. And I constantly feel like I’m catching up. So I, you know, I don’t know the answer to how many CLEs it takes, but somebody who, who does not consider them an elder law attorney themselves, an elder law attorney, can’t possibly know what elder law attorneys know. So
I don’t see any questions in the chat box or the Q & A. Does anyone have any questions that they want to pose?
I have a question about a hypothetical, hypothetically, we’re getting ready to do Medicaid. And dad has a car he hasn’t driven in years. Do we sell the car for a dollar because we’ve seen people do that, right? Sell the car for a dollar and change the title, or do we have to sell it for like blue book value, reasonable value.
If you sell it for a dollar, then Medicaid will say that it was gifted and that will be a penalty that will cause you to lose eligibility. Now, if your car, if your crappy old car was worth $3,000 and you sold it for a dollar, you made a gift of $2,999. And if you do the math that comes out to being something like five days of being an eligible for Medicaid, I don’t think I did that right. Seven days of being ineligible for Medicaid, and maybe that’s not a big deal. And it was a nice gift to give to your grandson. So that might be a good idea, but if it’s an expensive car, then that would be a bigger problem and you should take the $3,000 and there are ways that you can spend it. When you have small amounts of money, you can buy a funeral package for yourself, for your spouse, a prepaid irrevocable funeral package.
That’s a good way to spend money on a fun way to spend money, but it’s a good way to spend money. So all of that is sort of organized when, when needed. You can buy yourself things that you need if you’re in an assisted living or home, or, you know, you can pay mortgages off on your house. There’s different ways to do a spend down, which I didn’t really cover. Cause it was just got a little dense. But so I know somebody just so I know I’m reading. So David…
Do you want to read it out loud? Alison, if that’s, even if you want to reframe it.
Sure. It just says if my parents are about to buy into a place like Winchester gardens and can’t cover the first year plus and can just cover the first year plus another seven years or so, what does that mean plus another? So they need to worry about qualifying for Medicaid. So you’ll pay, so there’s two answers to that one. You can have your parents pay for their care at Winchester gardens until they’ve spent it down and then they will begin the Medicaid process. And it will be a pretty easy Medicaid application because you’re just basically going to show the drain of, of money that went to Winchester gardens over the prior five years. So you can do that if there is a desire to move some of that money, depending on what the amount is, depending on what the care needs costs are. Then there can be some movement of, let’s say 200, if there’s $700,000 in their name and they only need $500,000 to get through the next five years, they can move $200,000 to their children or to a trust and keep that 500,000 and apply for Medicaid at the end of that five years.
But with a couple, and if they’re in a, let’s say assisted living level of care, you don’t always know what their costs needs are going to be. I get very nervous about cutting things too close, because very often your care needs are at $7,000 a month when you’re 80 and at the beginning of dementia. And by the time you’re 83, your cost needs are $11,000 a month. So I don’t like cutting it too close. Oh, you’re not sure that Medicaid takes when Medicaid, Winchester takes Medicaid at all. I actually thought their nursing home did.
I think the nursing home does, but so my only, my only comment for David’s question would be when you’re at a facility and you’re going to move from private pay to Medicaid, the facility doesn’t have to offer a bed. They’re not obligated to keep everybody because they could end up with a facility full of Medicaid beds and they would go out of business so they can move you to another facility. You’re not, you’re not guaranteed that you’re going to get to stay where you are. If your parents are in the independent living portion of Winchester gardens and they run out of money, I don’t think Medicaid is going to cover that.
Definitely. Well, no Medicaid won’t cover the cost of living in an independent living. They might cover the cost if you’ve got home care in that space. So you might be able to offset care needs um… I have kids downstairs who are wrestling and I have to yell at them. So I just want them to be quiet. I don’t know, I don’t know, ready to kill them. Assisted living facilities are a particular added level of stress to the whole Medicaid issue that is sort of absent when there’s a nursing home involved. So an assisted living facility will tell you, you must pay privately for two years or three years before you’re eligible for Medicaid. And the number seems to keep getting longer and longer. And they’ll say, and if you can’t pay privately up to that amount, well, you, somebody else is going to have to pay privately because we’re not giving them that negative Medicaid slot, which is what Bethany was saying.
However it doesn’t mean you’re guaranteed that Medicaid slot at the end of that three years with that assisted living facility will say, you know what? We already have, our 10% of our beds are Medicaid beds. You have to wait until one of them opens. They don’t have to say that that’s not a law. That’s just the practice of this assisted living facility to make their, their numbers were. And that is very stressful. There can be a gap when there’s Medicaid eligibility, but there’s not a Medicaid slot. That isn’t something that happens though. Typically I’ve never seen it happen in a nursing home because nursing homes will take Medicaid almost, I would say 99% of the time. So that problem of paying and running out of money, isn’t really an assisted living issue. And I guess also for independent living, but at that point you would be moving along and going to a higher level of care. You agree with all that Bethany
A hundred percent? Absolutely. And we’ve had, I’ve had, I’ve never seen anybody get thrown out of a nursing home and were getting moved to another one. Totally agreed. But the assisted living I’ve had clients that have had problems and have had to agree to move to another facility within that company’s portfolio. Right. And it could be a facility that’s, you know, an hour and a half, two hours away,
Right? Yes. I actually have a client who just did that, who had to move to a farther one. And they were just grateful to have been getting Medicaid, Medicaid slot at the assisted living. But as we all know, being near a family who are in a facility increases the level of their care improves the level of their care, just having them visit and nearby and COVID times of the different issue. So I’m just looking to see
There’s a question in the Q & A. Can you read that Alison?
Sure. For private pay period, we would want my father’s ALF, assisted living facility, to evaluate him as needing less care. So care level costs would be less, but for Medicaid who run his assessment to make him medically eligible, needing more care, how should we balance these things? So we don’t care if he’s not medically eligible during the private pay period.
Speaker 2 (37:27):
So if they’re willing to go down in costs, that certainly is to your benefit. Of course, you don’t want them to go down so low that your father’s care needs are not being met. It’s only relevant that what his medical eligibility is at the time that he needs to get Medicaid. So a Medicaid nurse comes out and post COVID a Medicaid nurse typically does this on the phone or on zoom. So they will look at some paperwork. So it is sort of a little bit questionable. You don’t want been like, you know, dad went to the gym today. I mean, that’s not going to help you with a Medicaid and medical eligibility. On the other hand, if you’re two years out and you want to sort of keep costs a little low, so you can extend the period of private pay. I don’t think two years out is going to be a problem. I just think that in the six main people decline older people decline all the, you know, that’s, that’s the nature of aging. So it’s not unusual that in the final six months that the care needs have, but you will get checked on it. If there’s a huge gap. I mean, the Medicaid person is not going to grant medical eligibility if it’s not there,
Right? So there are seven activities of daily living and each patient needs to qualify in at least three of them. So bathing, dressing, feeding, walking, transferring, bed mobility, and I’m missing one
Did I say toileting.
I dunno. I talked about some ADL’s earlier, before you got on. So
Toileting, we’ll go with toileting, but you have to need somebody to actually lay hands on you at the limited assistance or higher level. So three out of seven gets you what you need.
Do we have any other questions? I don’t see any more in the Q & A or chat box.
I have a quick question about the timing. How long does the application process generally take and how early should someone start the paperwork? And that’s the process.
So it’s a good idea you know, if you, if your parents are spending down, it’s a good idea to touch base with an attorney probably six to eight months, nine months ahead of time, because it can take that long to gather the five years of bank statements. And the, you know, cause it’s not just banks, that’s not bank accounts that are currently open it’s, anything that’s been opened the last five years. So sometimes going, you have to go through tax returns and figure out where did they get income sources? And do we have all of that? And the scramble to get it all together is, is stressful. So you want to allow enough time to gather all that. You can’t actually, I mean, people often say that you have to apply early. You can’t actually apply for Medicaid until you’re eligible. So if you have $60,000 left and you put in an application and they review it, they’re going to say you’re not eligible because you’re not below 2000. So it’s a… Facilities sell my clients that all the time you got to put your application, I’m like, you’re not eligible for another six months. What are you talking about? But maybe Bethany has another answer to that. Are you about to say something else?
No. I was just, I was agreeing with you. Oh, I don’t know. Facilities get very, very antsy about it. And I’m like, yeah, you have $60,000. You’re not eligible for a while.
So, and then once you put it, so the, the month you’re eligible, you actually have 90 days to get the application in. I try to get it in, in the month that the person’s eligible just to be organized and get it in. My turnaround time right now has actually been pretty fast. It was really terribly slow in the last year and a half. And even before that, it used to be a really long time. Now I’m hearing back with questions, with requests, for verifications within a couple of weeks. You don’t usually get eligibility established or are starting to go for a cup… It can be anywhere from one month to five months or something. Little less. It’s been, it’s been faster than it used to be. I don’t know if that’s your experience Bethany.
Yeah, I think a positive outcome from COVID was that technology got updated at some of these offices that had terribly outdated systems because all of these workers were working from home. So they all needed new laptops and they had to have really good connections. And I think some of them are still working sort of hybrid some days at home. Some days in that I agree with you. I mean, things have been moving much more quickly
The Allison, and you may have said this, but if someone can’t apply until they’re eligible and then it takes a month or so to establish eligibility, who’s paying for anything during that time or do nursing homes just know to wait. I don’t know how that works.
Yeah. Nursing homes know to wait. And so if you apply, if you’re eligible October 1st, the application goes in October 10th. You find out that you are, you know, you’re in, you’re approved November 30th. So there are two months unpaid Medicaid will go back and pay from that October 1st that isn’t necessarily guaranteed with an assisted living facility application. There’s no retroactive Medicaid. It makes no sense to me since I started practicing in New York where there’s always retroactive Medicaid. When you kind of, when I came to New Jersey and found out that you don’t get retroactive for assisted living, of course you have no money. Cause that’s why you’re eligible for Medicaid. I never understood what happens in there. Either the assisted living facility eats it and accepts that as being the fact that, you know, mom has already spent $400,000 at that facility the last four years, and they’re just going to eat it or there’s somebody else who’s paid it forward.
That sometimes is a reason that when mom doesn’t have a lot of money, but we still have a couple of years and a couple of hundred thousand dollars to do a gift of something like $50,000 to set aside which you need to be able to do. You can’t just do this and then get on Medicaid, but you need to have enough time to do a runway to do this. And then the, you know, the family can hold that 50,000 just in case there’s this weird gap situation. But most people don’t plan for Medicaid. I mean, it’s not really some, most of my clients who were on Medicaid are not people who’ve done planning for Medicaid. I have lots of people who do Medicaid planning, but those don’t tend to be the same people who end up getting on it.
And nursing homes have a billing code. That’s Medicaid pending. That’s an actual status to be in. So they’re running the \bill, you’re running a tab with Medicaid then because you know, the facilities will actually look at the Medicaid application as well to really make sure that you’re eligible before they let you come into that status. So,
And they probably are a little easier about extending that status when there’s an attorney involved or another professional involved.
Oh, absolutely. You’re a hundred percent, right. Especially if there’s an elder law attorney. Oh my God. Yeah.
So the nursing homes like elder law attorneys, Medicaid actually, doesn’t like elder law attorneys. When I practice in New York, Medicaid is thrilled to have an attorney involved and it’s a, it’s a positive. And I have found that an elder law attorney involved in New Jersey Medicaid, quite honestly, I mean, this isn’t a great business model for myself, but it’s not a great, they’re kinder to individuals who are doing it rather than elder law attorneys. I think the assumption is that we’re trying to, we’re going to screw them in some way, but lately I’ve been in better shape than I was in the past. But it’s been my experience. There’s a lot of, you know, there are a lot of suspicion about the elder law attorneys for Medicaid.
Yes. You’re very suspicious looking
So that leads me to another question, which is if this system is primarily set up and initially set up for welfare, the welfare program, right. For people who are right. I mean, how would they afford an elder law attorney?
Yeah, no, I get, I mean, when I started working at my law firm, they’re like, okay, you’re an elder law attorney. Who’s paying you. So people come to me and when mom and dad still have a couple, you know, millions of dollars and they want to do planning, so that’s easy, we know how they’re going to pay us. Then people come to me and say, mom and dad have $600,000 and their house. So there’s money there. So the paying of my payment happens early. That’s the planning side. And most of the time when people come to me and say, I’m going to have to get mom ready on Medicaid. There’s some money left. And it’s either going to go to pay for legal fees to help them get on Medicaid or it’s going to go to the facility. So that’s how we I mean, when somebody has no money left whatsoever, it’s kind of too late for an elder law attorney. People think that elder law attorneys charge a lot. I mean, the numbers seem like a lot. I mean, there’s no flat fee that hasn’t killed me. Like it’s very time intensive process to help somebody get on Medicaid. So, and that’s the part that makes me crazy is that it shouldn’t be that hard for people to get on a government needs based welfare program. There shouldn’t, it shouldn’t be this bar to entry like that. So..
So if genuinely truly cannot afford you or someone like you, maybe Bethany can answer this too. What other resources are available for someone who, who really just couldn’t afford to, you know, in the past or now afford someone to help them and they can’t make heads or tails of how to get on Medicaid? Are there legal services is not really an option for someone. I mean, there are legal aid offices in New Jersey and legal services offices that are completely overwhelmed in so many different ways. They, I don’t, they, they may, there may be a division that helps with Medicaid applications when someone has been poor for a very long time the Medicaid office, you know, they’re not looking for five years of statements, you know, because it’s, it’s less relevant. It’s a problem. I don’t, I don’t know the answer to that. There are, are some attorneys who may do some of this pro bono in really problematic cases. But there’s no, there’s no legal aid that’s sort of focused just on helping people apply for Medicaid. It’s I don’t know the answer actually.
Each of the counties has a board of social services and they will help with that. But that is again, I mean, that’s people that really have been living below the poverty line for a very long time and know how to access. Some of these services are probably already have community Medicaid in place which can be changed to facility medic Medicaid once they’ve been placed in a facility. Unfortunately, a lot of those folks come through the hospital system. You know, they end up in the hospital and can’t go home when it gets really bad. You know, we see that a lot at Trinitas. So it’s unfortunate, you know, the hospitals become the gatekeepers for the truly for the, for the truly destitute. And they end up at nursing homes, Medicaid pending, and then hopefully there’s somebody that can help with a Medicaid application.
I can’t remember if you mentioned this, Allison, but is there an age requirement?
So for long-term care services, which is the Medicaid program that provides coverage for nursing homes, assisted living home care you either have to be over the age of 65 or disabled or blind it’s called ABD aged blind and disabled. But really being 60 to get the services, you have to be medically eligible so that you have to be over 65 and disabled, or you have to be disabled and you can be up to 65. So it actually, the age is not as relevant in that context as being in need of assistance.
Well, I am invigorated to get the word out for people to plan early because there’s a lot of you know, just as a great reminder. And most people don’t think about Medicaid obviously until they need to think about it. And then by then for a lot of people, it’s too late to do the proper planning. So I’m excited to share this information more broadly than on a Facebook group. That’s specific to people who already know that they need to be thinking about this. So we will be sharing this recording more broadly and hopefully everyone found this to be helpful. I know I did. I learned something new every time you speak Alison and Bethany, thank you for joining us.
Yes. Thanks for having me and for what it’s worth. You know, having worked in this field for a while and working, having worked with a lot of different elder law attorneys, Alison really is the best. I’ve never, I’ve never worked with somebody who’s both so skilled at what they do and so compassionate and passionate about what she does. And it’s really, really gratifying to have a colleague like that.
Oh, thank you. Now you’re going to make me cry. I always tell, I tell clients often this is sort of a weird thing, is that after they hear my spiel on Medicaid, I always say, I think it might be cocktail hour now. So because this stuff is, so, it requires a cocktail after hearing it all. So at nine o’clock at night, I usually say this to clients at 11:00 AM, and it’s really inappropriate, but 9 o’clock at at night…Thank you all.
I really appreciate you taking the time to do this for everyone. And we’re excited to share it as far as this, as far as this will go, we will share the news and your resources. We’re really appreciative.
Oh, go ahead. Sorry. Sorry. I just want to put a plug in for Bethany as being an awesome care manager in our community too. So let’s let that go unsaid, sorry, Susie.
A hundred percent. No. And Bethany, and if you want to, just for a second quickly reiterate what it is that you can help our neighbors with, that’d be great.
Well, when is this super simple, not planning ahead. Last minute, let’s get Medicaid. That’s more in my wheelhouse if it’s not rising to the level of meeting an elder law attorney, but I just, I will sit with families and help figure out what the next steps can be, should be and how we’re going to figure out, you know, all the planning for that, how we’re going to pay for mom’s care, dad’s care. And I help people with end of life issues also, so right through hospice and, and saying goodbye. So by offering my services really run the gamut and I am easily found on Facebook, Bethany, Joseph elder care consulting. I got real fancy with the name. We’ll be sharing this recording with everyone who registered for the webinar, but as well as, you know, we will also post it to social media and we will be addingAllison and Bethany’s contact information so that it’s easy for you to access. But I will also put in a plug for Bethany to just say that she is an incredible resource. I think what Bethany can really help with is because we’re also emotional when it comes to caring for our parents or our, for other people that are close to us. And, you know, they can’t hear you the same way. They can hear an expert or an objective person. Even for something as simple as decluttering their home. I know that Bethany can frame things in a way that people can hear that when their children tell them it just comes across in a very different way.
So Bethany can be just a really great resource and she’s been through it so much that she knows how to do it in ways that we just have no idea because for many of us, it’s, you, you don’t go through it until you go through it, and then you have no experience in it, whereas Bethany and Allison have, you know, just so many years of experience doing this. So again, thank you to both of you. You’re both incredible resources. You’re great people having worked with both of you. Thank you. Thank you so much. And thank you all for participating. Those of you who to participate in this late, very dense conversation. All right. Thank you. All. Go have your cocktail.