Although it is common practice to add the name of a family member to a bank account as a convenience, the existence of a “convenience” account can have negative results when that family member applies for Medicaid benefits. In F.J. v. Division of Medical Assistance and Health Services, the applicant’s daughter testified that she opened.. read more →

A New Jersey appeals court upheld the denial of Medicaid benefits to an applicant who failed to provide necessary verifications, rejecting the claim that the Medicaid agency’s failure to assist with the application prejudiced the applicant. P.B. v. Division of Medical Assistance and Health Services (N.J. Super. Ct., App. Div., No. A-5405-15T2, Dec. 8, 2017). P.B.’s daughter.. read more →

Before Mr. Trotman was admitted to a nursing home, he resided in a home that he owned. He had difficulty maintaining the home and paying the bills, so his daughter began paying his bills in 2007. In December 2011, Mr. Trotman asked his daughter to assume full responsibility for the property, which then was also.. read more →

Ohio’s highest court suspended an attorney who advised his client to transfer assets in order to qualify for Medicaid and then lied to the state Medicaid agency about whether the client transferred assets. Stark County Bar Association v. Buttacavoli (Ohio, No. 2017-Ohio-8857, Dec. 7, 2017). Attorney Glen Buttacavoli’s law practice consisted of providing financial-planning advice.. read more →

Payments for Pre-eligibility Medical Expenses (PEME) are available to individuals eligible for Medicaid who reside in a nursing home (NH) or an assisted living facility (ALF). This blog post attempts to clarify the procedure for processing requests for payments of PEME made by or on behalf of residents of NHs and ALFs. Residents of NHs.. read more →

The Centers for Medicare and Medicaid Services (CMS) has released its Spousal Impoverishment Standards for 2018. The official spousal impoverishment allowances for 2018 are as follows: Community Spouse Resource Allowance The “community spouse resource allowance” is a protection provided under Medicaid law for the healthy spouse of an applicant for benefits (called the “community spouse”) to.. read more →

After being sued by Medicaid applicant in federal court, the Director of New Jersey Medicaid, who had previously denied benefits because the applicant transferred assets to a trust more than 5 years before, instead stated the application was denied because, under the terms of the trust, the trustee was permitted to pay the applicant’s rent… read more →

E.H. submitted a Medicaid application to the Hudson County Division of Welfare (HCDW) and designated Future Care Consultants (FCC) as her designated authorized representative (DAR). Shortly thereafter, the HCDW denied the application because E.H. failed to provide her husband’s bank records for the five-year look-back period. FCC appealed the denial, submitting a request for a.. read more →

Contrary to the recent decision in the G.V. v. Division of Medical Assistance and Health Services case which held that assets transferred to an Income Only Trust more than 5 years before a Medicaid application was filed were still available, rendering  the applicant ineligible for benefits, the M.K. v. Morris County Board of Social Services.. read more →

A Superior Court judge in Ocean County dismissed a lawsuit filed by a nursing home for unpaid bills against a power of attorney appointed by a former resident, and ordered the nursing home to pay legal fees incurred by the power of attorney, ruling that the law prohibited the nursing home from requiring the power.. read more →

After being denied Medicaid because of a $70,000 joint bank account she maintained with her son, the Medicaid applicant, S.M., appealed the case to An administrative hearing. S.M. argued that Medicaid had failed to consider that her son was the sole source of $60,000 of those bank funds. After the ALJ affirmed Medicaid’s denial, and.. read more →

A New Jersey appeals court held that a Medicaid application was properly denied when the applicant did not submit all the financial information and documents requested by the Medicaid agency. P.N. v. Division of Medical Assistance and Health Services (N.J. Super. Ct., App. Div., No. A-2025-15T2, July 28, 2017). P.N. resided in an assisted-living facility. Based.. read more →

On August 10, 2017, I presented at the 2017 Sophisticated Elder Law Program on Medicaid litigation strategies. I provided an overview of various strategies and tactics which have been used successfully in litigation involving Medicaid and other needs-based public benefits in state and federal courts and in administrative agencies. I prepared a paper and PowerPoint slides.. read more →

Applying New Jersey’s filial support law, an appeals court in Pennsylvania affirmed a decision denying a Pennsylvania residential facility’s effort to hold the elderly New Jersey parents of an adult resident liable for the unpaid balance of his specialized services. Melmark v. Schutt (Pa. Super., No. 2253 EDA 2016, July 19, 2017). New Jersey resident Alexander (Alex).. read more →

A U.S. district court ruled that a group of Medicaid applicants do not have a private right of action to sue the state for not issuing Medicaid eligibility determinations with 45 days and that the applicants were not denied due process by the delay. Evangelical Lutheran Good Samaritan Society, Inc. v. Randol  (U.S. Dist. Ct., D… read more →

Medicaid is a joint federal and state program created under Title XIX of the Social Security Act of 1965. It provides a source of funding for long-term care to those aged, blind and disabled individuals who qualify financially.  42 U.S.C. §1396 et seq.; N.J.A.C. 10:71-1 et seq. Eligibility for Medicaid is based upon financial need. For.. read more →

In this case, the Division of Medical Assistance and Health Services (DMAHS), New Jersey’s state Medicaid agency, affirmed the denial of a Medicaid application filed by Grace M. Vinci (G.V.) by the Monmouth County Division of Social Services (MCDSS) finding that G.V. had resources in excess of $2,000 available to her, namely, resources contained in.. read more →

The New York Times, June 15, 2017 The Opinion Pages | Editorial Daughters Will Suffer From Medicaid Cuts Nearly one in five adult children at some point provide care for at least one elderly parent, according to a new study by the Center for Retirement Research at Boston College. The burden is particularly demanding for.. read more →

Reversing a lower court, Massachusetts’ highest court ruled that two Medicaid applicants’ trusts were not available assets even though the applicants retained the right to use the houses that were put into the trusts. Daley v. Secretary of the Executive Office of Health and Human Services (Mass., No. SJC-12200, May 30, 2017) and Nadeau v. Director of the Office.. read more →

New Jersey’s Medicaid rules are complicated, and always changing. One such change in the rules occurring on a regular basis is the State Medicaid agency’s amendment to the Medicaid program’s “penalty divisor.”  On May 12, 2017, a Medicaid Communication, or notice from the agency, was released by New Jersey’s Division of Medical Assistance and Health.. read more →

The needs-based pension program from the Department of Veterans Affairs (VA) is a disability benefits program available to compensate veterans for non-service-connected disabilities. Like the VA compensation program, the pension program is based upon disability. However, unlike the VA compensation program, the pension program is also based on income and need, and the veteran’s disability.. read more →

New Jersey’s ABLE law (the acronym is short for “Achieving a Better Life Experience”) went into effect a few months ago, in October 2016.  Under the new law, New Jersey’s Department of Human Services and the Department of the Treasury are required to establish the ABLE Program pursuant to federal law. Persons who became disabled.. read more →

New Jersey’s Division of Consumer Affairs (DCA) released a Consumer Brief on Medicaid Advisors/Application Assistors. Medicaid Advisors/Application Assistors are non-lawyers who provide limited services without payment or compensation in connection with Medicaid applications. According to the DCA Consumer Brief, the limited services which Medicaid Advisors/Application Assistors may perform include the following: providing information on insurance.. read more →

In Simonsen v Bremby(2d Cir., No. 16-204-cv, Feb. 15, 2017), the daughter/Medicaid applicant filed suit in federal court and sought a preliminary injunction barring Medicaid from imposing a penalty period as a result of trusts established for her benefit by her mother. The two third-party trusts were considered as available resources by Medicaid, and when.. read more →

As 2007 began, Arthur Brown, who was then seventy-eight years old, and his wife, Mary, lived together in a jointly-owned condominium. Several months later, Arthur began living in an assisted living facility. The following year, Arthur was admitted into a nursing home after he was diagnosed with Alzheimer’s disease. Soon thereafter, Arthur applied for nursing.. read more →