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 →
A U.S. district court denied a preliminary injunction to a Medicaid applicant who sued New Jersey to prevent the state from denying benefits based on her dead husband’s assets. Flade v. Connolly (U.S. Dist. Ct, D. N.J., No. 16-4407, Sept. 23, 2016). Plaintiff, Eileen Flade, was a nursing home resident. On April 12, 2016, plaintiff applied for.. read more →
In general, Medicaid rules impose periods of Medicaid ineligibility (“penalty periods”) when a Medicaid applicant makes gifts of assets in an attempt to qualify for Medicaid. If a Medicaid applicant gifts assets within the 60-month “look-back” period, the applicant may be subject to a Medicaid penalty period, based on the value of the gift. Notably,.. 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 →
The Superior Court of New Jersey, Appellate Division, affirmed a decision of the Director of New Jersey Medicaid reversing a ruling of an Administrative Law Judge (ALJ) who reduced C.W.’s Medicaid ineligibility penalty previously assessed for transferring assets for less than fair market value. C.W. v. Divison of Medical Assistance and Health Services, Docket No. A-2352-13T2.. read more →
Federal court rules that federal law does not require a State to disregard a transfer of a life estates by a Medicaid applicant to a disabled veteran. Pike ex rel. Estate of Pike v. Sebelius (D. R.I., No. CA 13-392 S, July 16, 2015). The late mother of plaintiff F. Norris Pike transferred of two life.. read more →
E.A. began residing in a home owned by her adult daughter, B.C., in September 2004. From September 2004 to June 2005, B.C. received no compensation for any caregiver services or lodging provided to her mother. From June 2005 to September 2006, B.C. received E.A.’s Social Security benefits of approximately $1500 per month to offset the.. read more →
In the C.C. v. Division of Medical Assistance and Health Services case, plaintiff filed an application for nursing home Medicaid benefits which was denied by the Ocean County Board of Social Services. The agency imposed a penalty, or a period of ineligibility, on her application. That is, the agency found that plaintiff sold her residence during.. 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 →
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 →
71st Semi-Annual Tax and Estate Planning Forum Our country is experiencing a growing number of households in which a parent and an adult child reside together. Census data reveals that the number of Americans living in multi-generational family households is the highest it has been since the 1950s, with a significant increase in recent years… 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 →
In an Initial Decision of the New Jersey Office of Administrative Law, Administrative Law Judge Laura Sanders held that transfers by a Medicaid applicant to her adult disabled children were exempt transfers that did not subject the Medicaid applicant to a penalty period. M.K. v. Division of Medical Assistance and Health Services and Somerset County Board.. 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 →
Aid and Attendance is a benefit that is available through the Department of Veterans Affairs (VA) to a qualifying veteran whose net worth is not “excessive” and who: is bedridden, or requires the aid of another person to perform activities of daily living, or is a nursing home resident, as a result of mental or.. read more →
Very often, family members provide assistance in caring for an aged or disabled loved one. The assistance is often provided at great personal and financial sacrifice by the family member involved in care-giving. One way to alleviate the financial sacrifice experienced by the care-giver to some extent is by utilizing a Personal Services Contract (“PSC”)… read more →
A New Jersey appeals court upheld the imposition of a penalty period on a nursing home resident’s receipt of Medicaid benefits, holding that the resident failed to rebut the presumption that a court-ordered payment made to the resident’s adult children for previously uncompensated services provided under a power of attorney was not a valid payment.. read more →
Here are my selections for the top ten (10) twelve (12) New Jersey elder law / public benefits / Medicaid cases decided in 2010: (1) R.C. v. Division of Medical Assistance and Health Services and Hudson County Board of Social Services, OAK DKT. NO. HMA 08047 – 10 (Hudson County, October 22, 2010): Judge Awards.. read more →
As many readers know, Medicaid applicants are subject to the imposition of a penalty, or a period of ineligibility for Medicaid, when gifts, called “transfers for less than fair market value” in the regulations, are made at any time during the five year period prior to the date on which the Medicaid application is filed,.. read more →
Soon after the passage of the Deficit Reduction Act of 2005 (DRA), New Jersey’s Division of Medical Assistance and Health Services, the State Medicaid agency, took the position that the penalty period, or period of ineligibility for Medicaid, resulting from transfers made during the look-back period by applicants for home or community – based services.. 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 →
A New York trial court allows a guardian to conduct Medicaid planning on behalf of his ward, his great aunt, but requires that gifted money be put into a trust for the aunt’s personal needs. in-matter-of-ml (N.Y. Sup. Ct., No. 924XX/08, June 2, 2009). Matthew S. was appointed guardian of his great aunt, M.L., who.. read more →
In the May 27, 2009 Initial Decision of Estate of M.M. v. DMAHS, a New Jersey administrative law judge (“ALJ”) made noteworthy decisions regarding two Medicaid topics: (1) increasing the Community Spouse Resource Allowance (“CSRA”); and (2) rebutting the presumption that a transfer of assets was made to establish Medicaid eligibility. In the Estate of.. read more →
A New Jersey appeals court held earlier this month that a Medicaid applicant’s transfer of assets occurred when the checks she wrote were cashed, not when they were written, so the Deficit Reduction Act of 2005 (DRA) applies to the transfer and the penalty period begins when the applicant would have been otherwise eligible for.. 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 →
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