Updated Figures for 2009. The Centers for Medicare & Medicaid Services (CMS)  has released the community spouse resource allowance and the maximum monthly maintenance needs allowance for 2009. The new minimum CSRA is $21,912 and the new maximum is $109,560. The new maximum monthly maintenance needs allowance is $2,739. The minimum monthly maintenance needs allowance.. read more →

On September 30, 2008, NJ Administrative Law Judge Stephanie M. Wauters issued a written opinion in a case entitled E.S. vs. Division of Medical Assistance and Health Services and Monmouth County Board of Social Services, OAL Docket No. HMA 14-08, ruling that the payments to a nursing home for care by a Medicaid applicant’s son.. read more →

In a trio of cases which were consolidated because the cases presented a common question of law, NJ Administrative Law Judge Joseph A. Paone recently ruled that a Medicaid applicant’s prepayment for personal care services to be provided in the future by a family member under a Life Care Contract constituted a transfer of assets.. read more →

A New York appeals court held that a community spouse is entitled to an increased minimum monthly maintenance needs allowance (MMMNA) because her basic monthly expenses are almost double her monthly income and therefore qualify as “exceptional circumstances” necessitating access to her husband’s income. Matter of Balzarini v. Suffolk County Dept. of Social Servs. (N.Y… read more →

The Center for Medicare and Medicaid Services (“CMS”) states that the Deficit Reduction Act of 2005 (Pub. L. No. 109-171, 120 Stat. 4, 151) (“DRA”) does not permit a person to receive benefits under a Medicaid waiver program (including assisted living facility Medicaid) if there has been a transfer of assets within sixty months of the.. read more →

The U.S. Department of Health and Human Services has issued a new notice addressing the problems that occur when a Medicaid applicant purchases a long-term care insurance “partnership” policy in one state and then applies for Medicaid in another state. See, 73 Fed. Reg. 51302-51305 (2 Sept 2008), available here. The Deficit Reduction Act of.. read more →

New Jersey’s Office of Administrative Law recently issued a significant ruling that may make it easier to qualify for Medicaid. In K.R. vs. Somerset County Board of Social Services, O.A.L Docket No. HMA 12343-07 (Aug. 25, 2008),  New Jersey’s Office of Administrative Law ruled that an account titled to a Medicaid applicant “or” another person.. read more →

The Deficit Reduction Act of 2005 (“DRA”) authorized the expansion of the Long Term Care Insurance Partnership Program into the various states. New Jersey’s Long Term Care insurance Partnership Program was approved by the Center for Medicare and Medicaid Services (“CMS”) on February 12, 2008 and will become effective on July 1, 2008. Under this.. read more →

I recently received a denial notice from the local Medicaid agency in a case in which the applicant’s Medicaid estate plan involved making a loan to a relative. The borrowing relative signed a promissory note agreeing to repay the note each month at a regular payment amount with included a reasonable interest rate. The note.. read more →

The federal Deficit Reduction Act of 2005 (DRA), which became effective on February 8, 2006, made major changes to the federal Medicaid law. One such major change in the federal law is in the treatment of annuities owned by the spouse of a Medicaid applicant (called the “Community Spouse” in the law) . Under the.. read more →

An administrative law judge has concluded that an individual who is trying to avoid nursing home care by applying for home- or community-based coverage under a Medicaid waiver program, but who has made a transfer during the look-back period, must have the penalty period begin on the date on which the applicant would otherwise be.. read more →

I recently litigated two different cases in the Superior Court, Union County, each involving the financial exploitation of the elderly. In one case, a non-relative “friend” took a frail, elderly widow into her home as a tenant. The elderly widow had no family in NJ. The friend acted as caregiver for the elder, and the.. read more →

In recent presentations to staff at assisted living facilities, I was told that staff members hesitated to recommend to appropriate facility residents that they should apply for Veteran’s Administration (VA) Aid & Attendance benefits, even when the residents had limited income and/or resources and would financially benefit from the additional income that the VA benefit.. read more →

A New Jersey appeals court ruled that $1.7 million in customer contracts held by a disabled man’s family business should be counted as a resource when determining his Medicaid eligibility rather than excluded under Medicaid rules which permit the exclusion of assets otherwise countable that are “used in a business … self-support activity.” G.T. v… read more →