As discussed in a prior blog post, a major overhaul of Medicaid will be introduced in New Jersey in the coming months. The new Medicaid program is called Managed Long Term Services and Supports (MLTSS). The MLTSS implementation date has been repeatedly adjourned, and the next date scheduled to put the new program into effect.. read more →

An appeal of a claim for Medicaid benefits that was filed late may be considered when the applicant shows that the filing deadline should be extended due to “extraordinary and extenuating circumstances.” Reuter v. Division of Medical Assistance and Health Services, Docket No. A-0514-13T2 (App. Div., October 17, 2014) Plaintiff, Greta Reuter, a nursing home.. read more →

Gifts made during the Medicaid look-back period result in a penalty, or period of ineligibility, unless the applicant can prove that the gifts were made exclusively for some purpose other than to qualify for Medicaid. S.L. v. Division of Medical Assistance and Health Services, Docket No. A-3520-11T4 (App. Div., September 2, 2014) In December 2009,.. read more →

The Medicaid programs in New Jersey which help residents pay long-term care costs are about to get a major overhaul. Currently, there are three (3) Medicaid programs in New Jersey that pay for long-term care costs. The Medicaid-Only Medicaid program pays the costs of caring for nursing home residents. A companion program, Global Options for.. read more →

A nursing home resident’s adult child who signs an admission agreement as the “Responsible Party” can be sued in his/her individual capacity for services rendered to the resident, if the adult child fails to use the resident’s financial resources to pay for care provided by the facility. Manahawkin Convalescent v. O’Neill, 217 N.J. 99 (2014)… read more →

In the May 30, 2014 Kongtcheu v. Secaucus Healthcare Center decision, the United States District Court for the District of New Jersey denied the defendant nursing home’s motion to dismiss a claim against it brought by nursing home resident Philbert F. Kongtcheu. In Kongtcheu, the pro se nursing home resident brought a variety of claims.. read more →

On June 23, 2014, the Government Accountability Office (GAO) released its report, Financial Characteristics of Approved Applicants and Methods Used to Reduce Assets to Qualify for Medicaid, which Sens. Tom Coburn (R-OK) and Richard Burr (R-NC) and Reps. Darrell Issa (R-CA) and Trey Gowdy (R-SC) requested. The GAO report confirmed that about 95% of approved.. read more →

A federal district court in New Jersey ruled that a Medicaid applicant was not entitled to a preliminary injunction to prevent the State from counting her annuity as an available resource. Matrangolo v. Velez (U.S. Dist. Ct., D. N.J., No. 13-6289 (MAS) (LHG), May 30, 2014). Plaintiff Marie Matrangolo, an 88-year-old woman who has been a.. read more →

A United States District Court recently ruled that a nursing home resident does not have a private right to assert a lawsuit against a nursing home for involuntary discharge under the Nursing Home Reform Act. Schwerdtfeger v. Alden Long Grove Rehabilitation and Health Care Center (U.S. Dist. Ct., N.D. Ill., No. 13 C 8316, May.. read more →

The Affordable Care Act (ACA) is an historic effort by the government to extend medical insurance coverage to all Americans, increase the quality of care, increase accountability, and reduce cost. It’s been said that the ACA changes the relationship between government, health care providers and all who receive health care in the U.S. However, at.. read more →

The Centers for Medicare and Medicaid Services (CMS) has released a letter (CMS Letter SMD-14-001) to States with guidance on how to apply Medicaid’s estate recovery and transfer of asset rules to individuals newly eligible for Medicaid under the Affordable Care Act (ACA). In general, most of the long-term care rules that apply to traditional.. read more →

For the first time, the Division of Medical Assistance and Health Services (DMAHS), New Jersey’s  Medicaid agency, held that an applicant for nursing home Medicaid was eligible for benefits despite the fact that she made a substantial gift within the look-back period and owned an $80,000 annuity. M.W. v. Division of Medical Assistance and Health.. read more →

The New Hampshire legislature has enacted a new law that allows nursing homes to sue anyone who received an asset transfer from a nursing home resident, and also makes the resident’s fiduciaries liable for the cost of care under certain circumstances. This new legislation became law on July 2, 2013. The law, enacted under Title.. read more →

In an August 29, 2013 unpublished decision, the Appellate Division considered and affirmed the trial court’s denial of a nursing home’s motion to dismiss a personal injury and wrongful death claim brought by the estate of a former resident. Levonas v. Regency Heritage Nursing and Rehabilitation Center (Docket No. A-4995-11T4, Aug. 29, 2013). In Levonas, the.. read more →

Reversing state agency and appeals court rulings, the highest court of the State of Washington ruled that a guardian cannot be charged with neglect based on the guardian’s good-faith decision to provide care for the ward in her home rather than place her in a nursing home against the ward’s wishes. Raven v. Department of Social and.. read more →

A federal district court judge in New Jersey granted a Medicaid applicant’s motion for a preliminary injunction, thereby enjoining the State from counting an annuity owned by her husband as an available resource in determining her eligibility for Medicaid. Flamini v. Velez, Civil No. 1:12-cv-07304 (D.N.J. July 19, 2013) Elizabeth Flamini entered a skilled nursing.. read more →

A Medicaid applicant who made payments to her daughter for more than four years and claimed those payments were made to cover the cost of monthly payments for her mentally ill daughter’s rent could not prove the payments were made for a purpose other than to qualify for Medicaid because she did not prove that.. read more →

A Rhode Island trial court holds that a niece who signed a nursing home admissions agreement on behalf of her aunt did not sign as a responsible party, and is therefore not personally liable for her aunt’s unpaid nursing home bill. Sunny View Nursing Home, Inc. v. Gorman (R.I. Super. Ct., No. KC 11-0491, Dec. 4,.. read more →

New Jersey’s Medicaid rules are complicated, and seem like they’re always changing. One such change in the rules that occurs on a regular basis is the State Medicaid agency’s amendment to the Medicaid program’s “penalty divisor.”  On December 10, 2012, a Medicaid Communication, or notice, was released by the Division of Medical Assistance and Health.. read more →

An appeals court in New Jersey held that a nursing home resident’s adult child who signed a nursing home admission agreement as the “Responsible Party” can be sued in his/her individual capacity for monies owed to the facility for services rendered to the resident if the adult child fails to use the resident’s financial resources.. read more →

Federal district court in New Jersey denied a Medicaid applicant’s request for an injunction directing the state to disregard his wife’s purchase of a life estate in their daughter’s home when determining his eligibility for nursing home Medicaid benefits.  The Court ruled that issues of fact were in dispute, preventing an injunction from being issued… read more →

The Director of New Jersey Medicaid recently decided that, when a couple is institutionalized, the resources of the couple are not combined when determining Medicaid eligibility. Rather, the resources of each spouse must be considered separately.  Therefore, when only one spouse applies for Medicaid benefits and that spuse’s resources alone do not exceed the resource.. read more →

For most of her life, V.P. resided in her home with her adult son, R.P. V.P. suffered from many significant impairments, including spinal scoliosis and other degenerative diseases of the spine, hypertension, diabetes, gastroesophageal reflux disease, anxiety, and frequent urinary tract infections. As a result of her poor health, V.P. relied upon her son R.P… read more →

A New Jersey appeals court held that a Medicaid applicant who transferred money to her daughter and then a few months later received a life estate in her daughter’s home made a gift to the daughter rather than engage in a bona fide transaction involving the purchase of a life estate, resulting in the imposition.. read more →

Ohio’s First District Court of Appeals has joined other state and federal courts across the country in ruling recently that Ohio improperly imposed a penalty period on a Medicaid applicant whose wife purchased an annuity during the look-back period. The Court held that Ohio’s regulations regarding the purchase of annuities are improperly restrictive, and are.. read more →