State Takes Restrictive Position on Caretaker Agreements
Post 6 and Post 34 have discussed caretaker agreements extensively. Basically, we are talking about an agreement pursuant to which a child agrees, prior to rendering services, to care for a parent in consideration for the parent’s compensation to the child for such care.
The prior posts have indicated that in addition to the agreement, there should be a schedule of activities performed by the child and an independent valuation of services by a geriatric care manager or agency.
Properly structured, the payment by the applicant to the child for such services would not result in Medicaid transfers.
In early March, 2009, Medicaid, at a meeting of supervisors, set forth the following restrictions:
1. The amount that the child should be reimbursed for care is the amount of monies that an aide would receive for the relevant time period and not the amount of monies that the aide’s agency receives. For example, if the agency receives $20.00 per hour and the aide receives $10.00 per hour, the proper reimbursement for the child is $10.00 per hour. As the prior posts indicate, compensation in excess of that considered reasonable by the respective Board of Social Services is deemed a transfer.
2. Child must report any monies received from parent on income tax return.
3. There shall be no payments for future care. That is, some agreements have allowed the parent to make substantial payments “up front” rather than on a recurrent basis. This would not be acceptable to Medicaid.
Comment: Such an approach seems unduly restrictive. I have had clients who have provided virtually round-the-clock care for a parent and rendered services such as daily testing, taking the parent to the doctor, providing and administering medicines, coordinating care of the parent with the various physicians, taking the parent on a short vacation or stay (if possible), etc. The compensation for such services should not be limited to that received by an aide, but should be based upon an appropriate valuation by a geriatric care manager. Another example of additional compensation would be a situation in which the child actually builds a wing on his or her home or hires an architect to make the home accessible to a disabled parent. Restricting the compensation to the child as proposed by Medicaid appears to be unfair. Hopefully, the structure allowed for a caretaker agreement will be loosened.
Disclaimer: This article does not constitute legal advice and each person may have unique facts for which legal consultation may be necessary.
© August 2009, Post 52
Showing posts with label Essex County Elder Law Attorney. Show all posts
Showing posts with label Essex County Elder Law Attorney. Show all posts
Tuesday, August 18, 2009
Wednesday, August 5, 2009
Community Spouse Resource Allowance Changes Annually
Community Spouse Resource Allowance Changes Annually
In Medicaid Communication No. 09-2, the community spouse resource allowance maximum is increased from $104,400 to $109,560. The community spouse resource allowance increases annually on January 1st of each year. The letter ruling indicates that the increased amount applies to “any case which has not yet been determined eligible, regardless of the date of application.”
The following example is set forth in the letter ruling:
Mr. Smith entered a long term facility on October 15, 2008. He and his wife had combined resources of $300,000. The community spouse’s share of the resources would have been established at $104,400.00 at the time of the resource assessment. Because the Smiths’ resources still exceeded $106,400.00 (the community spouse’s share plus the $2,000.00 resource limit), Mr. Smith had not yet attained Medicaid eligibility. Beginning January 1, 2009, the community spouse’s share in this case increased to $109,560.00. Resource eligibility will exist once the Smiths’ countable resources are equal to or less than $111,560.00.
In other words, although the figure used as a community spouse resource allowance is generally determined the first day of the first month of institutionalization, this is subject to change (if a determination of eligibility has not yet been made). Also, note in the example that eligibility is based upon total countable resources of $111,560.00 due to the 90-day rule (see Post 10).
Disclaimer: This article does not constitute legal advice and each person may have unique facts for which legal consultation may be necessary.
© August 2009, Post 50
In Medicaid Communication No. 09-2, the community spouse resource allowance maximum is increased from $104,400 to $109,560. The community spouse resource allowance increases annually on January 1st of each year. The letter ruling indicates that the increased amount applies to “any case which has not yet been determined eligible, regardless of the date of application.”
The following example is set forth in the letter ruling:
Mr. Smith entered a long term facility on October 15, 2008. He and his wife had combined resources of $300,000. The community spouse’s share of the resources would have been established at $104,400.00 at the time of the resource assessment. Because the Smiths’ resources still exceeded $106,400.00 (the community spouse’s share plus the $2,000.00 resource limit), Mr. Smith had not yet attained Medicaid eligibility. Beginning January 1, 2009, the community spouse’s share in this case increased to $109,560.00. Resource eligibility will exist once the Smiths’ countable resources are equal to or less than $111,560.00.
In other words, although the figure used as a community spouse resource allowance is generally determined the first day of the first month of institutionalization, this is subject to change (if a determination of eligibility has not yet been made). Also, note in the example that eligibility is based upon total countable resources of $111,560.00 due to the 90-day rule (see Post 10).
Disclaimer: This article does not constitute legal advice and each person may have unique facts for which legal consultation may be necessary.
© August 2009, Post 50
Monday, June 22, 2009
Transfers for a Purpose Other than to Qualify for Medicaid
Transfers for a Purpose Other than to Qualify for Medicaid
Another exemption from the transfer rules is a transfer exclusively for a purpose other than to qualify for Medicaid.
I recently had a case in which a 78-year old father transferred approximately $40,000 to pay for his child’s wedding. The father was as healthy as an individual his age could possibly be and had no thought of going into a nursing home.
Generally, the position of Medicaid is that it is extremely difficult to show that Medicaid was not one of the reasons for the transfer. However, presented with such a case, points to be stressed are the health of the individual at the time, the uniqueness of the purpose of the transfer (i.e. wedding of child) and additional points that would negate Medicaid ineligibility (such as, the child voluntarily making payments back to the father before Medicaid was even an issue). The gentleman passed away before Medicaid was able to make its determination.
The key point of the above analysis is that a representative should never give up if there are valid arguments in favor of the applicant.
Disclaimer: This article does not constitute legal advice and each person may have unique facts for which legal consultation may be necessary.
© June 2009, Post #43
Another exemption from the transfer rules is a transfer exclusively for a purpose other than to qualify for Medicaid.
I recently had a case in which a 78-year old father transferred approximately $40,000 to pay for his child’s wedding. The father was as healthy as an individual his age could possibly be and had no thought of going into a nursing home.
Generally, the position of Medicaid is that it is extremely difficult to show that Medicaid was not one of the reasons for the transfer. However, presented with such a case, points to be stressed are the health of the individual at the time, the uniqueness of the purpose of the transfer (i.e. wedding of child) and additional points that would negate Medicaid ineligibility (such as, the child voluntarily making payments back to the father before Medicaid was even an issue). The gentleman passed away before Medicaid was able to make its determination.
The key point of the above analysis is that a representative should never give up if there are valid arguments in favor of the applicant.
Disclaimer: This article does not constitute legal advice and each person may have unique facts for which legal consultation may be necessary.
© June 2009, Post #43
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