Medicaid nursing homes houston texas,real estate salt lake city mls wiki,nc home foreclosure process florida - How to DIY

18.08.2016
In this ongoing new feature, RIJ will ask and answer questions that pertain to retirement advisors and their clients.
Retirement Income Journal would like to thank the following organizations for their support and encouragement. Retirement Income Journal is an online magazine dedicated to writing for and about the industry that has coalesced around the challenge of helping Americans turn their savings into secure lifetime incomes. You can qualify for financial help to pay the high cost of Texas Medicaid approved nursing homes. To get all the Medicaid nursing home benefits your family member is entitled you need to follow these critical 8 steps.
Double check that the patient is within the income and asset limits for Medicaid nursing home eligibility.
After you send in your paperwork, it’s normal to start worrying. Many people lie awake at night, afraid that they have made a mistake. That’s why so many families turn to us for help preparing and submitting their Medicaid for nursing home applications. We feel so fortunate to have hired Michael Holland and his staff to deal with Medicaid and all the stress of the application. As I stated earlier in this letter I was full of doubts, stress and uncertain about the future. I want to thank Michael Holland, Martin and Kathy for their kindness and help no matter when we called for assistance. I am one of those people that requires a reference before using an individual or service and I give a strong recommendation to the entire Holland Law Firm.
I was a bit skeptical at first, but your confidence convinced me I was in good hands for mom’s needs.
Your staff was so professional, helpful, and candid with me when I called, I knew I had the right place to help with the challenge.  Thank you to you and your staff!!! There can be no doubt but that the statutes and provisions in question, involving the financing of Medicare and Medicaid, are among the most completely impenetrable texts within human experience.
Paying for the costs of nursing home care is perhaps one of the biggest concerns for many families of the “greatest generation” and, for that matter, the aging boomers.
As a practical matter, the people privately paying will do so until their savings and assets are exhausted before moving on to Medicaid. For most individuals, the object of long-term care planning is to protect savings (by avoiding paying them to a nursing home) while simultaneously qualifying for nursing home Medicaid benefits. The second section reviews the transfer penalties that may apply if an individual or couple transfers assets within five years of applying for Medicaid.
The third section outlines the income rules applicable to the Medicaid nursing home benefit. If the applicant is married, the spouse is called the Community Spouse, and there are rules concerning how many countable assets the Community Spouse may keep. Keep in mind, the rules discussed in this part relate to qualifying for Medicaid and have nothing to do with transferring those assets or whether those assets might be subject to estate recovery upon the death of the applicant. A home with equity of less than $543,000 will not be considered a countable asset and, therefore, will not be counted against the asset limits for Medicaid eligibility purposes as long as the nursing home resident intends to return home or his or her spouse or other dependent relatives live there. Further, the $543,000 equity limit does not apply if the home is occupied by a spouse or other dependent relative of the applicant. Do keep in mind, that while the Home does not count for Medicaid qualification purposes, it may likely be subject to estate recovery later after the death of the Medicaid applicant and his or her spouse.
Tenancy-in-common property is NOT countable property for purposes of Medicaid qualification. The Life Tenant has a current ownership interest that brings with it the exclusive right to occupy and use the premises for the rest of her life. Once the life tenant has died, the property passes automatically to the Remainder Interests and free of liens the Life Tenant may have added to the property after the life tenancy was created. Historically there had been much confusion with respect to whether the joint tenancy interests had to be equal.
Household furnishings, clothing, jewelry and other personal effects used by an applicant and spouse as such are non-countable. Instead say Maude owns a $7,000 face value policy with a cash value of $6,000 and a $2,500 policy with a cash value of $2,000. If an annuity purchased on or after November 1, 2007, is either revocable or assignable it is a countable resource. If the annuity is not a countable resource (because it is irrevocable and nonassignable), then the annuity must be analyzed to determine whether a transfer penalty will apply. General Rule: If an applicant is the beneficiary of a trust funded with his assets or the assets his spouse, the trust will be countable to the applicant.
Exception 2: If not funded by will, does the trust allow the trustee to distribute anything from any part of the trust under any conceivable circumstance? If a trust set up by someone other than the applicant or her spouse, will the assets be counted?
General Rule: If a trust set up by someone other than the applicant or her spouse requires the trustee to distribute assets under certain circumstances, the assets that are required to be distributed will be countable if those circumstances occur. Common Example: If the trust says my trustee may not distribute to daughter in any manner that would disqualify her for nursing home benefits under Medicaid, but may distribute for other reasons, the trust assets will not be counted. The CSRA is calculated with respect to assets held by a married couple as of the beginning of the first continuous 30 consecutive day period that the applicant spouse has been confined to a hospital or nursing home or some combination of the two.
So, for example, if a couple owns $90,000 in countable assets on the date the applicant enters the hospital and stays in it or a nursing home for 30 days or more, he or she will be eligible for Medicaid once their assets have been reduced to a combined figure of $47,000 – $2,000 for the applicant and $45,000 (one-half of $90,000) for the at-home spouse. Often, it is advantageous for the couple to try to have as much money as possible in their names on the Snapshot Date up to $234,480 (that is, $117,240 x 2) so that the amount the community spouse is allowed to keep will be as high as possible. This concludes the discussion of the classification of assets for Medicaid eligibility purposes. Medicaid restricts asset transfers by imposing a period of ineligibility for nursing home benefits called a Transfer Penalty. DSS reviews any transfer made within 60 months of the Medicaid application to determine if a Transfer Penalty (discussed below) should apply.
If an applicant (or his or her spouse) transferred assets more than 60 months before the date of the Medicaid application, the transfer is irrelevant. If transfers were made within 60 months of the application and they were not exempt transfers (some are .
The actual number of months of ineligibility is determined by dividing the amount transferred by $6,300 (2012-2013). Remember, DSS may only consider transfers made during the 60 months preceding an application for Medicaid, the “look-back” period. A Transfer Sanction will not apply if an applicant can prove “by the greater weight of the evidence” that the earlier transfer was made exclusively for reasons other than to qualify for Medicaid. As mentioned above, a transfer can be cured by the return of the transferred asset in its entirety.
The General Assembly enacted “hardship rules” that would allow qualification of a person for Medicaid and allow a Community Spouse to retain a certain level of assets even if DSS imposes a transfer sanction on an earlier transfer. The adopted Hardship Rule allows a Community Spouse to retain the previously protected income (see “TREATMENT OF INCOME” below), slightly more than $60,000 of Countable Assets, and a homeplace with equity of less than $543,000 . Mason Law maintains that the Hardship Exception to the imposition of Transfer Sanctions should not be viewed as a pre-application planning opportunity. The state has the right to recover whatever benefits it paid for the care of the Medicaid recipient from his or her probate estate.
Property that is jointly owned with rights of survivorship, in a life estate, or in a trust, is not included in the probate estate and thus escapes estate recovery.
Contrary to popular belief, there is no such a thing as a Medicaid or “nursing home” lien in North Carolina. The income eligibility rules are convoluted, but in summary, if the applicant’s income is in excess of the facility’s private pay rate, the applicant will not be eligible for Medicaid. As will be discussed a bit more below, Medicaid considers only the income of the applicant and not that of the community spouse (the spouse not being institutionalized). In all circumstances, the income of the community spouse will continue undisturbed; he or she will not have to use his or her income to support the nursing home spouse receiving Medicaid benefits.
In some cases, the community spouse is also entitled to share in all or a portion of the monthly income of the nursing home spouse. The application process can drag on for several months as the local DSS demands more and more verifications regarding such issues as the amount of assets and dates of transfers. Under federal law, and North Carolina follows this carefully, a Medicaid application decision must be rendered within 45 days of receipt.
In fact, Medicaid will pay benefits retroactively as much as 3 months before the date of the application IF the applicant was financially qualified during that retroactive period.
In addition, after Medicaid eligibility is achieved, it must be redetermined every six months. If you manage this site and have a question about why the site is not available, please contact us directly.
In the last five months, each of these four nursing homes has gone out of business, unable to make ends meet with the money they get from Medicaid because reimbursement rates have not increased in nearly a decade, according to the Massachusetts Senior Care Association, the industry trade group. The recent closures, which required hundreds of elderly residents to be relocated, are the latest wave in a decades-long squeeze that has closed more than 50 nursing homes in Massachusetts in the past 10 years.
Nursing home operators say that reimbursements from Medicaid, on which many of their residents depend, are not keeping up with rising costs.


Nationally, the cost of care exceeded Medicaid reimbursements by nearly $8 billion, according to a recent study by the American Health Care Association, a Washington nonprofit that represents nursing homes and other providers.
This data from the state Department of Medical Assistance Services shows that seniors and the disabled receive a large portion of Virginia's Medicaid expenditures. The GOP-led General Assembly blocked the expansion last month, saying Washington can’t be trusted to pay its promised shares.
But Craig Markva, a spokesman for the Department of Medical Assistance Services, which runs the state’s Medicaid program, gave us a different explanation.
Markva sent us Medicaid statistics for the budget year that ended June 30, 2013 -- the latest numbers available. Out of a $6.7 billion Medicaid budget that fiscal year, the state spent $648 million to care for seniors in nursing homes. Sickles said that 70 percent of the state’s Medicaid spending goes to seniors in nursing homes. Emails from Craig Markva, spokesman for Department of Medical Assistance Services, June 26 and July 9, 2014. A Senate health committee issued a disturbing report nearly three years ago: In sharp contravention to the Americans with Disabilities Act and a landmark 1999 Supreme Court ruling, many states were warehousing patients with serious but manageable illnesses such as diabetes, blindness and mental illness in nursing homes. Instead of spending available federal and state Medicaid funds on community-based or home care to handle these patents, a majority of states were using the more expedient and less costly option of sending them to nursing homes, many of which had empty beds and were eager for the business. The Senate Health, Education, Labor and Pensions Committee revealed in the July 2013 report that roughly 250,000 working-age people were needlessly placed in often isolated nursing homes. The Supreme Court held in the 1999 Olmstead case that the ability to live in the community is a protected civil right under the 1990 Americans with Disabilities Act. On Monday the Department of Justice issued a scathing analysis of South Dakota’s health care system. But the Justice Department says that South Dakota officials have fallen well short of what they could do to ameliorate a problem they have known about for years. To its credit, the Obama administration has opened more than 50 civil rights investigations into cases of patients being forced into nursing homes and so far has reached settlements with eight states. The Times analysis offered several poignant glimpses into the plight of disabled Americans who were forced to move to nursing homes.
And a 73-year-old man in a wheel chair told investigators that he was in a nursing home against his will.
Our first Q&A concerns Medicaid annuities, which middle-class Baby Boomer couples who face nursing home costs should know about. The typical clients are in their 70s or 80s, with $200,000 to $300,000 in savings, according to Michael Denton, COO and president of Clarke Financial Group, an Irvine, Calif.-based insurance marketing organization. As a rule, the Medicaid annuity must be a period-certain contract with the healthy spouse as the owner and annuitant, and the term equal to the healthy spouse's life expectancy. This industry includes members of the insurance, asset management, banking, pension, structured products, reverse mortgage, information technology, financial planning and academic communities and the professional organizations that serve them.
The government says if you want Medicaid to help pay nursing home care, you must meet four basic tests.
Texas Medicaid case workers have a “document or deny” attitude toward Medicaid applications.
Those costs are your responsibility until the State approves the Medicaid nursing home benefits. Their job is to decide whether the information you’ve provided meets the agency’s financial and health criteria. They have taken my hand and led me through the mound of paper work to qualify my husband for Medicaid. The members of the team treated me like family and I am very proud to recommend them to others. What is really important to me is how you listened when I had questions and worried (which I did a lot!) and then put my mind at ease. You took charge of the process, saw it to a successful completion and followed up and remained available. As I am sure you know from the many cases this is a difficult time and Martin and Kathy have helped me relax and feel like we are able to manage the best for Eric & my Aunt.
Indeed, one approaches them at the level of specificity herein demanded with dread, for not only are they dense reading of the most tortuous kind, but Congress also revisits the area frequently, generously cutting and pruning in the process and making any solid grasp of the matters addressed merely a passing phase.
Medicare is an entitlement program (meaning you paid for it over all those work years with payroll withholding). The first section discusses the Medicaid asset rules; namely, the type and amount of assets that an individual or couple may own and qualify for nursing home benefits. In other words, when someone applies for Medicaid a very careful inventory of all that person’s (or couple’s) assets is taken.
As a result, for all practical purposes, nursing home residents do not have to sell their homes in order to qualify for Medicaid. However, it is available for estate recovery and may raise transfer issues if later transferred. In this type of ownership, one owner is referred to as the Life Tenant, the other as the Remainder Interest.
Life Tenants are legally obligated to maintain the premises, pay the taxes and keep it insured.
They also have the added feature of not being available for estate recovery upon the death of the Life Tenant. As long as the joint tenancy exists, if a joint tenant dies, the surviving joint tenant or tenants take the deceased tenant’s interests automatically (in this way, a joint tenancy is similar to a life estate). For example, clothing and furniture regularly used by an applicant or spouse will not count; clothing and furniture in a storage area (perhaps from a discontinued business) will count.
The DMA manual instructs the caseworker to assume that is the case unless there is evidence to the contrary. One whole life policy has a face value of $7,000 and a cash value of $500; the other has a face value of $4,000 and a cash value of $2,500. Because the face values total less than $10,000, the $8,000 total cash values will not count.
The fact that accessing them may cause unpleasant tax consequences or surrender charges is irrelevant. For purposes of this brief discussion, however, an annuity purchased (or a preexisting annuity that has any changes made) on or after November 1, 2007, will not be subject to a transfer of assets sanction if the State is named as remainder beneficiary to the extent of Medicaid benefits paid (the State may take second place behind a spouse and a minor child) and the annuity is expected to pay out in level payments over the actuarial life expectancy of the annuitant. If so, and if the trust was properly designed as a discretionary trust (meaning the trustee is not legally obligated to distribute anything at all to the beneficiary), the assets in the trust will not be countable. See a further explanation of special needs trusts on the Mason Law website by clicking HERE. Under the general rule, the spouse of a married applicant is permitted to keep one-half of the couple’s combined countable assets up to $117,240 (2015). For the sake of administrative convenience, DMA will actually measure the assets as of the close of the last business day of the preceding month. If the couple owned $250,000 in assets, the spouse in need of care would not become eligible until their savings were reduced to $119,240 ($2,000 for the nursing home spouse and the maximum $117,240 for the community spouse). Sadly, many couples believe they understand the rules and spend half of their assets before a Snapshot Date only to later discover they must reduce their assets by half again!
We now turn our attention to the much misunderstood (but very harsh) Medicaid transfer penalties. Medicaid has always imposed some sort of restriction on transferring assets before entering a Medicaid application – were it not for such restrictions, anyone could qualify for Medicaid simply by giving assets away at the time nursing home entry became necessary. The idea is that the transferred assets could have been used to pay for nursing home care rather than having been gifted to others.
If the applicant applies for Medicaid 59 months after the transfer (within 60 months) he will be ineligible for Medicaid for 63.49 months commencing on the date of application.
Effectively, then, there is a 60 month cap on periods of ineligibility as long as no application is made within the 60 months.
In the example above, if the transfer was made to trust or perhaps a child more than 60 months before the application, there will be no Transfer Penalty. Planning is tricky and should be undertaken only with expert guidance (there are available strategies). Note that the burden will be on the applicant, who may or may not be in any position to go through a hearing process and may well need to engage an attorney for assistance. Transferring assets to certain recipients will not trigger a period of Medicaid ineligibility.
In other words, do not plan on transferring assets in excess of the Hardship levels outlined in the preceding paragraph and plan to argue “hardship”.
Given the rules for Medicaid eligibility, the only property of substantial value that a Medicaid recipient is likely to own at death is his or her home. Congress has given the states the right to seek estate recovery against such nonprobate property; so far, North Carolina has not acted on this provision. Upon the death of a Medicaid recipient, and providing no exception to to estate recovery applies (see below), DMA is a fifth class creditor against the probate estate of the deceased recipient – DMA “gets in line” with other creditors of equal rank. In other cases DMA will completely forego estate recovery if the deceased is survived by a spouse or a minor or disabled child. When a nursing home resident becomes eligible for Medicaid, all of his or her income, less certain deductions, must be paid to the nursing home. DMA determines an income floor for the community spouse, known as the minimum monthly maintenance needs allowance, or MMMNA.


In other words, a Community Spouse with high shelter costs could retain as much as $2,980.50 monthly income.
If the applicant does not comply with these requests and deadlines on a timely basis, DSS will deny the application.
As the 45 day deadline nears, the applicant had best promptly comply with information requests to avoid a denial. This is usually a fairly simple mail-in form for providing an opportunity to report any changed circumstances. Nevertheless, many worthwhile planning opportunities exist that this rather “bare boned” summary cannot explore. Mason, JD, CELA, CAP, is owner of Mason Law, PC, of Asheboro, North Carolina, a law firm devoted exclusively to legal issues involving the elderly and the disabled. But their calls for an increase are countered by some state officials who say there is no need to boost the payments — because fewer people are using nursing homes these days. Mark Sickles, D-Fairfax, says increased demand for nursing home care is a major reason why the Virginia’s Medicaid costs have soared.
The statement comes amid a partisan battle over whether expand Medicaid to up to 400,000 additional low-income Virginians. He said 70 percent of the money is spent on the medical expenses of all elderly and disabled patients, who comprise 32 percent of Virginia’s Medicaid recipients. They show that of the slightly more than 1 million Medicaid enrollees in Virginia, only 22,513 -- or 2.2 percent -- were seniors in nursing facilities. Between 2000 and 2007, nursing home use actually increased among adults age 31 to 65 in 48 states, according to the report. Tom Harkin (D-IA), the chief author of the 1990 Americans with Disabilities Act, said in releasing the report. The government found that thousands of patients were being held unnecessarily in group homes and nursing facilities.
The state’s budget provides some insight into officials’ priorities in treating the physically and mentally disabled: In 2013, South Dakota spent $133 million on nursing homes but only $27 million on in-home or community-based care, according to state figures cited in the Times. The Justice Department says those efforts have led to more than 53,000 disabled people either leaving nursing homes or avoiding them altogether. One 45-year-old South Dakotan with diabetes told a Justice Department investigator that he badly wanted to be home with his wife and daughter, but was confined to a nursing home because he needed assistance getting around his house with one leg. Bureau Chief Eric Pianin is a veteran journalist who has covered the federal government, congressional budget and tax issues, and national politics.
The healthy spouse can buy a payout annuity with assets that would otherwise have to be spent before the patient could qualify for Medicaid nursing home coverage. The healthy spouse is the sole payee and state Medicaid department is the primary beneficiary. When there are any problems, it’s usually when an advisor sells an ordinary immediate annuity to the couple and not a restricted one. You can also get it from a local office of the Texas Health and Human Services Commission or online .
They will deny the application if you fail to provide accurate and complete verification documents on time. I know this approval for Medicaid could not have happened without the Holland firm’s team of experts. However, in order to qualify for federal reimbursement, the state program must comply with applicable federal statutes and regulations.
The Remainder Interest holder has a current ownership interest, too, in as much as he may transfer that interest at anytime.
For this reason, life estates have been a popular, sometimes abused, method of holding title to real property. Setting up a joint tenancy with one share being 99% and another being 1% would be as valid as setting up two 50% interests. If the applicant and a spouse own more than one automobile, then the most valuable auto does not count, but other autos will be countable. On the other hand, an IRA that is paying a fixed, irrevocable annuity stream may not count as an asset.
Note carefully, if an applicant does not have an irrevocable burial contract, $1,500 in otherwise countable resources may be earmarked for burial purposes and thus avoid classification as available resources. Whether the assets in a trust are countable or not depends on the answers to a series of questions.
In addition, there is a minimum resource allowance for the community spouse of $23,448 (also 2015).
Two concepts are always relevant with respect to a Transfer Penalty: (i) The length of the penalty in months, and (ii) The date the Transfer Penalty commences.
Another way to look at this is that for every $6,300 transferred, an applicant will be ineligible for nursing home Medicaid benefits for one month.
If the transfer was made within 60 months of the application (say 59 months before the application), there will be a 63.49 month Transfer Penalty. Also, if a nursing home stay becomes necessary and there are potential issues with earlier transfers, expert guidance also is essential to repair the situation and devise a strategy. While that tactic may work for a limited time, we believe it flaunts the spirit of the hardship rules (that they be reserved for unintentional cases of hardship) and would incur the wrath of legislators who had made a good faith effort to provide some relief to cases that warranted the relief. Under current law, the state may make a claim against the decedent’s home only if it is in his or her probate estate. The deductions include a $30-a-month personal needs allowance, a deduction for any uncovered medical costs (including medical insurance and Medicare supplemental plan premiums), and, in the case of a married applicant, an allowance he or she must pay to the spouse that continues to live at home. Medicaid will pay benefits retroactively to the date of the application if the applicant remains qualified during the application period. Terry McAuliffe, a Democrat, is exploring whether he can broaden the program without legislators’ consent. If you send us a comment, we'll assume you don't mind us publishing it unless you tell us otherwise. Yet for many others who suffer from chronic illness and disabilities, placement in a nursing home is neither necessary nor appropriate. When one spouse enters a nursing home, the care without insurance might cost $7,000 to $9,000 a month.
If the healthy spouse dies before the annuity term is up, the state would recover its costs from the remaining assets and the balance, if any, would go to secondary beneficiaries. The saddest part is that people accumulate what they consider a lot of money and they watch it disappear when a spouse needs long-term care.
With the new rules [from the Deficit Reduction Act of 2005] you have to name Medicaid as the beneficiary.
Congress created the Medicaid program as a safety net for the elderly and people with disabilities.
The Texas Health and Human Services commission administers financial benefits for nursing home care. To avoid making this costly error, get professional advice on Medicaid nursing home eligibility. Having a second set of copies means that you can easily replace any documentation that gets lost.
Upon sale of the real property, the proceeds are divided according to the percentage ownership interests. The Remainder Interest holder does not have the right to use or occupy the premises, however, until the Life Tenant has died.
The total face value of the whole life policies exceed $10,000, so the total cash value of $3,000 is countable.
When low-income patients seek help in obtaining long-term care, some states push them toward nursing homes.
Instead of paying those bills with savings, “they can put money into a restricted annuity and start an income payout for the healthy spouse.
To receive the booklet form of this article, plus useful tips not appearing below, plus a $250 offer .
Each tenancy-in-common interest can be separately sold, transferred as a gift, and passed on under a Will.
A trust may prohibit distributions of principal under any circumstances but allow or require distributions of income. It is not at all uncommon to have a Snapshot Date that was triggered several years before the date of a Medicaid application. Completing the form the wrong way can delay the approval of Medicaid nursing home benefits.
Of that total, just 12% is paid by Medicare, 9% by long term care insurance and Veterans’ benefits. With Medicaid pending you are still responsible for the full fee. Once Medicaid approves the application, the nursing home sends the bill to the state and eliminate the debt.



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