Tag: #elderlaw

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Climate Change Bill Brings a Bright Spot of Good News for Americans

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We welcome any good news in a dismal news cycle, but the healthcare provisions built into the “Inflation Reduction Act” are worth a special mention.

The New York Times calls it “the most substantial changes to health policy since the passage of Obamacare in 2010.”

Passed by the U.S. Senate on August 8 and expected to pass in the House of Representatives on August 12, President Biden says he is looking forward to signing the bill into law. Here’s what we are looking forward to:

What seniors have needed for decades: giving Medicare the power to negotiate directly with pharmaceutical companies to reduce the astronomical costs charged for many drugs seniors need to stay alive and healthy.

The bill, beginning in 2025, sets a cap of $2,000 yearly for how much seniors pay for drugs. After reaching the cap, funds will come from the federal government, private insurers, and drug companies.

Federal subsidies for people who buy private health insurance through the Obama exchanges will be extended for three additional years, as they were during the coronavirus pandemic. For example, someone who pays about $80 in premiums will continue to pay that amount. These costs would double in 2023 without the bill.

Adult vaccines will be free starting in 2023 for seniors and people on Medicaid.

The bill uses federal subsidies to reduce the cost of health insurance and prescription drugs, insidious economic difficulties suffered by middle class and senior Americans.

Many benefits of this bill may not be evident to the people they help, as they are not visible directly. For instance, people won’t see large medical bills and may not be fully aware of free vaccines. But for the millions of Americans, particularly seniors, who struggle to pay for their prescription medications, the bill will be life-changing.

By design, the legislation will pay for itself and reduce the federal deficit over time while cutting prescription drug costs for the elderly and tightening enforcement on taxes for corporations and the wealthy.

It sounds like good news to us.

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SCOTUS Rules State Medicaid Programs Can Recoup a Larger Share of Personal Injury Settlements

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Suppose you were injured due to another person’s negligence and your medical expenses were paid in whole or part by Medicaid. In that case, the state has a legal right to recover the funds it spends on your care from a personal injury settlement or award. In a case involving a Florida teen catastrophically injured more than a decade ago, the United States Supreme Court has ruled that state Medicaid programs can recover the amounts paid from settlement funds reserved for future medical expenses.

In 2008, a truck struck 13-year-old Gianinna Gallardo, leaving her in a persistent vegetative state. The state’s Medicaid agency provided $862,688.77 in medical payments on Gallardo’s behalf. Her parents sued the parties responsible, and the case eventually settled for $800,000, of which about $35,000 represented payment for past medical expenses. The settlement also included funds for Gallardo’s future medical expenses, lost wages, and other damages.

The state Medicaid agency claimed it was entitled to more than $300,000 in medical payments from this settlement, including money specifically allocated for Gianinna’s future medical expenses.

Gianinna’s parents then sued the agency in federal court, arguing that Florida should be able to recover monies only from that portion of the settlement allocated for past medical expenses in accord with a prior Supreme Court ruling.

A U.S. District Court ruled for Gianinna, and the Medicaid agency appealed. The Court of Appeals reversed the lower court’s decision. Ultimately, the Supreme Court agreed to hear the case

In a 7-2 decision, the Supreme Court agreed that Florida could recover from the proceeds allocated to Gianinna’s past and future medical care. Justice Clarence Thomas, who wrote the majority opinion, noted that Medicaid law “distinguishes only between medical and non-medical care, not between past (paid) medical care payments and future (un-paid) medical care payments.”

Justices Sonia Sotomayor and Stephen Breyer dissented. They argued that accepting Medicaid shouldn’t leave a beneficiary indebted to the state for future care that may or may not be necessary.

If you or a family member are receiving care through Medicaid and expect a settlement, it would be wise to contact our office and learn if Medicaid will zero in on you or your estate for past, present, and future medical expenses.

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May is National Elder Law Month – What Does That Mean?

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It began in 1963, when President John F. Kennedy met with the National Council of Senior Citizens and designated May as “Senior Citizens Month” to honor Americans age 65 and older with a Presidential Proclamation. Since then, May has also been designated Elder Law Month by the National Academy of Elder Law Attorneys (NAELA), a national organization dedicated to improving the quality of legal services for older Americans and individuals with special needs.

In most years, Elder Law Month is recognized by Elder Lawyers who offer educational programs and work with local community groups to support the legal needs of seniors. The goal is to help seniors and their families better understand their legal options regarding Medicaid eligibility, long term and health care planning, special needs planning, elder abuse, and other issues germane to senior Americans.

Two historical events have merged in the last year and a half to make this a timely and important issue. The COVID-19 pandemic caused many Americans to confront their mortality. Millions of families across the country learned first-hand how not having a plan for serious illness and death created more problems, complications, and costs for the survivors.

At the same time, the aging of the Baby Boomer generation and the transfer of boomer wealth has been underway for the past few years. As of this writing, Boomers are 56 to 74, and they are aging. Over the next two or three decades, Boomers will need to plan for increased medical and long-term health care services.

To clarify – Elder Law and Special Needs Law are different from Trusts and Estate law. Elder Law and Special Needs attorneys are more focused on representing seniors and disabled individuals and their families with legal issues while they are living.

Trusts and Estates law is more focused on post-mortem planning, including creating wills, succession planning and tax planning.

Elder law attorneys help clients with estate planning also, but their practices are skilled with issues like:

  • Long Term Care Needs and Medicaid
  • Eligibility for Medicare and Social Security
  • Guardianship and Incapacity
  • Elder abuse recognition and prevention
  • Assisting with placing individuals in long term care facilities and advocating for patients living in these facilities.

New challenges to seniors and their families continue to emerge, as we recover from the worst of the pandemic and prepare for the coming years. An experienced, well-credentialed Elder Lawyer is an invaluable resource for individuals and families in preparing for the future. We celebrate Elder Law month in May, we practice Elder Law every day all year round as we work with clients to protect them and their families.

If you have any questions about Elder Law or estate planning issues, we invite you to call the office at 516-307-1236, visit our website or follow us on Facebook, LinkedIn or Twitter.

 

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ELDER LAW UPDATE: Medicaid Community Based Care Look Back Period Extended to April 2021

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 As a result of the continued pandemic, the Secretary of Health and Human Services has continued to renew the declaration that a public health emergency exists. The most recent renewal extends the PHE through until late April, 2021. Due to the requirement for states to maintain Medicaid benefits through the Public Health Emergency, no changes to Medicaid benefits can go into effect until July 1, 2021.

For New York State residents and families contemplating a Medicaid application for community home care, this is welcome news. The lookback requirements were to have changed to require applicants to submit to a 30 month financial lookback to ensure eligibility for Medicaid community home care.

As a result of this additional renewal of the PHE, there is additional time for seniors and family members to conduct Medicaid planning for community home care. It is now possible to make gifts, transfer assets and utilize other planning techniques, but only if your Medicaid Application is filed before July 1, 2021.

This is a unique opportunity and one that should be taken advantage of if at all possible.

For decades, Medicaid community home care applicants did not have to worry about any kind of lookback period. This changed in 2020, but the Covid-19 pandemic has created a window of opportunity.

We encourage you to contact our office at 516-307-1236 if you or a loved one anticipates filing for community Medicaid or Medicaid home care.

 

 

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Medicare Doesn't Cover Everything

What’s Not Covered by Medicare?

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Medicare provides health insurance for retirees, but it doesn’t cover everything. In fact, there’s a lot that Medicare does not cover, and many of these are health care costs that can consume a nest egg. Here are the top five healthcare costs that should be part of your retirement preparations:

Medicare and Long Term Care Costs

Long Term Care is one of the biggest budget busters for retirees. Long term care can easily cost tens of thousands of dollars a month. Medicare does offer some skilled nursing care coverage, but it’s very limited. If you are eligible, in terms of age, health and finances, buy a long-term care insurance. Sometimes a long-term health insurance policy is folded into a life insurance policy. Talk to your insurance broker—this is something you need, as much as an estate plan.

Alternative or Chiropractic Care

If your healthcare includes alternative or chiropractic care, Medicare is not yet fully evolved to pay for these services. The monthly massage that you know keeps headaches or crippling joint pain at bay is not covered, regardless of how effective it is for your well-being. There are some Medigap or Medicare Advantage plans that do cover specific kinds of alternative therapies, so do your research.

Dental and Oral Health

Medicare does not connect your healthy smile with your overall health. Despite studies that clearly demonstrate the connections between good oral health and overall health, especially cardiovascular health, Medicare is not paying for your dental treatment, unless they are “medically necessary” for you before your physician will allow you to undergo covered procedures.

But in most cases, you have to pay for your own dental care. And if you’ve ever needed a crown or root canal work, you know these procedures can cost several thousand dollars. Best to set aside some assets for dental work.

Glasses and Vision Care

The same goes for vision care. The cost of an eye exam, glasses and contact lenses must be paid by you. There are more options today than there were ten years ago (i.e., online, or big box prescription glasses and contact lenses) but it’s still an expense that you need to cover yourself.

Hearing Aids

Hearing aids are the bane of many retiree’s financial life. They are extremely expensive, and Medicare doesn’t cover the audiology exam that is needed before you can be fitted for them or the devices themselves, some of which can cost as much as $10,000. A federal law was passed in 2017 that directed the U.S. Food and Drug Administration to ease the financial barriers to purchasing a hearing aid, but the self-fitted, less expensive devices don’t work for everyone.