Government Long-Term Care Benefits for NJ Residents 908-232-7400
Vanarelli & Li, LLC provides comprehensive Government Long-Term Care Benefits Legal Services throughout the State of New Jersey. See: https://vanarellilaw.com/medicaid-public-benefits-planning/
Elder Law topics covered in the video include Eligibility for Medicaid, Income and Resource Limits and Caps, Medicare Coverage, Home Health Aides, Home Health Care, Nursing Home Care, Assisted Living Facilities, Long-Term Care Insurance, Nursing Home Costs, Resource Rules, Lookback Period Calculations, Eligibility for Veterans Pension Benefits, Net Worth Test, and more.
Noted NJ Attorney Donald D. Vanarelli presents Government Long-Term Care Benefits — the final video in a 4-part series that discusses crucial Elder Law topics. Call 908-232-7400 or visit https://VanarelliLaw.com/ for additional information.
The YouTube Channel for Vanarelli & Li, LLC is located at: https://www.youtube.com/channel/UClCWs2FIrzO7BUY7ooVe_Lw
Government Long-Term Care Benefits for New Jersey Residents
By Donald D. Vanarelli, Esq.
Overview of Government Sources for the Payment of Long Term Care Costs
Government Sources of Payment
- Medicare
- Medicaid
- Veterans Administration
Overview of Long Term Care Costs Covered by Medicare
- Home Health Aides
- Nursing Home Care
Medicare – Home Health Aides
- Covers up to 100 home visits per “spell of illness”.
- Preconditions to payment: prior hospital stay of at least 3 days and home health care initiated within 14 days of discharge.
- Beneficiary must be homebound and need skilled nursing care, physical or speech therapy, NOT custodial care.
Medicare Payment of Nursing Home Care
- Immediate prior hospital stay of 3 days
- Admitted to NH within 30 days of hospital discharge
- Covers skilled nursing care or rehabilitation only, NOT custodial care.
How Much Does Nursing Home Medicare Pay?
- Maximum Coverage – 100 days
- Day 1-20 – Medicare pays 100% of covered charges
- Day 21-100 – Medicare pays all covered charges, except coinsurance amount. Year 2016 coinsurance payment = $157.50/day, or about $4,800/month
- Day 101 – on your own
Overview of Medicaid Payment of Long Term Care Costs
MEDICAID
- Pays the majority of long-term care costs in New Jersey and elsewhere
- Joint Federal and State Program
- Provides medical assistance for financially eligible persons who are aged, blind or disabled
Income Limits
- Income – all income is counted in determining eligibility
- Income cap – All Medicaid programs have an income cap. In 2016, the cap is $2,199/month. Income above the cap must be transferred to a Qualified Income Trust each month.
Resource Limits
- Countable resources – all assets in the sole name of applicant, in the sole name of spouse, or in joint names, either with the spouse or another person. Includes pension and retirement assets of BOTH the applicant and spouse.
- Resource Limits – $2,000 for an individual and $3,000 for a couple.
- Excess resources – must be spent down.
Transfer of Resources Rules
- “Look-back period” – Period which Medicaid examines upon the submission of a Medicaid application to determine an applicant’s countable assets, and the disposition of an applicant’s assets.
- Look-back Period Under the Medicaid Law- 5 years, or 60 months
- “Penalty period” – Period of Medicaid ineligibility imposed as a result of a transfer of assets for less than fair market value (i. e., a gift) made during the 60-month look-back period.
- To prevent gifting of assets, Medicaid imposes a “penalty period”, or period of ineligibility for Medicaid, for all gifts made within the “lookback period”.
Comparing Medicare and Medicaid Coverage for Long-Term Care Costs
Medicare: covers costs of home health aides and nursing homes for those who need skilled nursing care or therapy, but for a limited time only. No financial limits. Medicaid: covers home health aides, assisted living facilities and nursing homes, but only for the aged, blind and disabled who need custodial care and who meet strict financial limits.
Overview of Major VA Benefit Programs
1.Service-Connected Compensation
Disability compensation is a monetary benefit for veterans who are disabled by an injury or disease that was incurred or aggravated during active service.
2. Needs-Based Pension
Pension is a monetary benefit for veterans who (1) are disabled (not service-connected) (2) have low income and resources, and (3) served during a period of wartime.
Basic Eligibility Criteria for VA Pension Program
All of the following criteria must be met before a veteran or widow(er) of a veteran can receive Improved Pension benefits:
1.The veteran must have served at least 90 days of active duty service, one day of which must have been during a wartime period. In general, wartime is:
- World War I
- World War II – Dec. 7, 1941 – Dec. 31, 1946
- Korean War – June 27, 1950 – Jan. 31, 1955
- Vietnam War – Aug. 5, 1964 – May 7, 1975
- Gulf War – August 2, 1990 through date to be set by law by Presidential Proclamation
2. The veteran must have received a discharge other than dishonorable;
3. The claimant must have limited income and assets; and,
4. The claimant must be permanently and totally disabled, or be over age 65.
VA Improved Pension Program: Three Tiers of Benefits
- Low Income Pension
- Housebound Benefits
- Aid and Attendance Benefits
Housebound benefits and Aid and Attendance benefits are supplements paid in addition to the basic Low Income Pension to certain veterans to cover the additional costs of care for their added disabilities.
Net Worth: Standard
The VA considers the net worth of the individual seeking benefits, excluding the value of the person’s home, furnishings, and car. The standard as to whether a person will be eligible for benefits is whether the person has “sufficient means” to pay for his or her care.
Assets that are counted toward the “sufficient means” analysis include bank accounts, certificates of deposit, money market accounts, investment accounts, annuities, retirement accounts, life insurance cash surrender values, etc.
Net Worth Test
- STANDARD: Sufficient Means to Self-Pay
- Sufficient Means: A commonly used measure is $80,000 or less for a married couple, $50,000 or less for a single veteran.
- Age Analysis: Age vs. Asset test
VA Transfer of Resources Rules
No look-back period
Compare Medicaid with VA Pension rules regarding transfers of resources. But, note difference in VA Nursing Home Rules.
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