The Alzheimer’s Association has issued its 2016 Alzheimer’s Disease Facts and Figures report. The report is “a statistical resource for U.S. data related to Alzheimer’s disease, the most common cause of dementia, as well as other dementias.” Aside from providing a definition of Alzheimer’s disease (“Alzheimer’s disease is a degenerative brain disease and the most common cause of.. read more →

Medicaid, unlike Medicare, is a public benefit program based upon financial need. As a result, you are eligible for Medicaid only if you are over age 65, blind or disabled, and have few assets. If an applicant is married, all assets in the sole name of the husband, in the sole name of the wife, and.. read more →

After he was admitted to a nursing home in 2013, petitioner, R.P., accrued unpaid bills of $264,146 for nursing care services. As a result, three successive Medicaid applications were filed on R.P.’s behalf. It was undisputed that R.P. lacked the capacity to assist with any of the Medicaid applications. The first Medicaid application, filed in.. read more →

M.S. is a 73-year old residing in at a long-term care facility. She is a hemiplegic who suffers from obesity, diabetes, arthritis, osteoporosis and COPD. Because she is completely paralyzed on her left side, she had been using a manual one-arm wheelchair. She filed an application to the Division of Medical Assistance and Health Services.. read more →

A court in Connecticut ruled that the administrator of an estate lacked standing to appeal the denial of an application for Medicaid benefits because no appeal of the denial was filed before the decedent died.  Freese v. Department of Social Services (Conn. Super. Ct., No. CV14-6047417S, June 1, 2015). Plaintiff, Kathleen Freese, claimed that the defendant, Department.. read more →

Two years ago, in 2013, a federal judge in New Jersey granted a preliminary injunction to Elizabeth Flamini, a Medicaid applicant who successfully sued for an injunction preventing the State of New Jersey from counting an annuity owned by Mrs. Flamini’s husband Angelo as an available resource in determining Medicaid eligibility. Flamini v. Velez  ,.. 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 →

In A.H. v. Division of Medical Assistance and Health Services, 2014 N.J. Agen. LEXIS 91 (OAL Dkt. No. HMA 00531-13, Jan. 27, 2014), fifteen months elapsed between the assisted living facility resident’s application for Medicaid benefits under the “Global Options” program and the formal denial of the claim. During this time, in which there were.. read more →

In a very unusual ruling, a New York appeals court ruled that, despite transferring significant assets to family members, an applicant still qualified for Medicaid because the transfers were made exclusively for a purpose other than to qualify for benefits. Matter of Safran v. Shah, Docket No. D42144 (App. Div., 2nd Dept., July 2, 2014).. read more →

As a result of the advocacy efforts by several New Jersey elder law attorneys following a class action lawsuit filed against the State of New Jersey, New Jersey Medicaid’s penalty divisor will be increased to $9,535.62 per month, or $313.50 per day, effective April 1, 2014. The newly increased divisor shall be used for all new or pending.. read more →

What Is Medicaid? Medicaid is a government program through which many elderly and disabled people receive care at home or in a nursing home. Medicaid is a statewide program, currently administered In New Jersey through each county’s Board of Social Services. The state agency in New Jersey responsible for administering the Medicaid program is the.. read more →

In this case, the United States District Court for the Southern District of New York granted  summary judgment for plaintiffs in a lawsuit alleging that the State of New York failed to render final decisions following Fair Hearings within the ninety-day period following the filing of Fair Hearing requests as required by federal and state.. read more →

A New York appeals court allowed a case for legal malpractice and breach of fiduciary duty to proceed against an attorney who charged more than $44,000 for Medicaid planning work to protect a net estate valued at about $130,000. Sobel v. Ansanelli, (N.Y. Sup. Ct., App. Div., 2nd Dept., No. 2011-11418, Sept. 19, 2012). In.. 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 →

A.D., a retired physician, began residing at Bergen Regional Medical Center (Bergen Regional), a nursing home, in October 2004. She was 80 years old at the time. She began receiving Medicaid benefits in late 2004. In 2006, the Bergen County Board of Social Services (Board) discovered two Keogh accounts at Citibank in A.D.’s name valued.. read more →

A North Carolina appeals court recently held that assets owned by an incompetent Medicaid recipient which were discovered by her family after she had been receiving Medicaid benefits for several years were countable and that the family must repay the benefits already paid on the Medicaid recipient’s behalf. Ella Mae Cloninger suffered from Alzheimer’s disease.. read more →

In what may be considered a victory of judicial deference over equity, this week our Appellate Division affirmed Medicaid’s denial of eligibility to an incapacitated applicant, based on the applicant’s ownership of assets that she was not aware she owned. In W.B. v. Division of Medical Assistance and Health Services (“DMAHS”), No. A-5658-07T1 (N.J. App… read more →

2009 was an exciting year of litigation in the elder and disability law arena, producing a bumper crop of significant decisions from the administrative forum, as well as state and federal courts. In stark contrast with years past, New Jersey lawyers are now in the forefront of the effort to expand legal protections to greater.. read more →

(The A.N. case, described below, was decided on administrative appeal in 2007 and affirmed the denial of Medicaid benefits. I represented the Medicaid applicant, A.N. You may ask why I would resurrect an administrative decision more than 2 year old which I lost. It’s a legitimate question. The answer is that I believe the case will.. read more →

In order to qualify for Medicaid benefits, applicants cannot possess assets which exceed the financial limits established in the program. In order to prevent applicants from wrongly achieving Medicaid eligibility by transferring their excess resources to others, Congress has established rules which impose a “transfer penalty”, or period of ineligibility for Medicaid benefits, whenever an.. read more →

In June 2009, plaintiff, Daisy Jeanne Prall, applied for nursing home Medicaid benefits with the Ocean County Board of Social Services. To be eligible for Medicaid, plaintiff and her spouse, Christopher Prall, cannot own resources which exceed $111,560; $109,560 is the community spouse resource allowance and $2,000 is the institutionalized spouse resource allowance. Although the.. read more →

It is not uncommon for an elderly or disabled person to entrust his or her finances to a third party. For example, an elder may execute a power of attorney as a simple estate planning tool in order to ensure that his or her affairs are properly handled in the event that the elder is.. read more →

A New Jersey appeals court recently determined that a Medicaid applicant is not entitled to a fair hearing to appeal the state’s assessment of a one-month penalty period because her representative waited more than three months after the decision to request the hearing. Talarico v. Department of Human Services, Division of Medical Assistance and Health.. read more →

A New York trial court held that because the state Medicaid agency failed to reconsider its earlier eligibility determination in a timely manner, its amended decision denying benefits is vacated. dickinson-vs-ny-department-of-health-and-onondaga-county-department-of-social-services, (N.Y. Sup. Ct., No. 08-4831, Dec. 3, 2008). After her application for Medicaid benefits was denied by the Onondaga Department of Social Services (DSS), Viola.. read more →

In E.S. vs. Division of Medical Assistance and Health Services, petitioner, a 91 year old nursing home resident, transferred $42,053 to her son after paying the nursing home privately from her savings for two years. The nursing home payments and the gift combined to leave petitioner with no assets, so she applied for Medicaid. The.. read more →