Medicaid is a federal program, run by individual states, that provides medical care to needy individuals. Many of our elders rely upon this program to access essential medical care for their long-term healthcare needs.
The meaning of access to a financial account has recently been litigated in New Jersey. In a non-binding decision, the Superior Court of New Jersey disregarded the Medicaid applicant’s argument that she was physically and cognitively unable to access a joint account – ultimately leading to the inclusion of the resources against her for eligibility determination purposes.
There are many ways to approach Medicaid eligibility: spending down assets, exempt transfers, the creation of certain trusts, and general proactive planning before the look-back period. Some tactics, however, may not be as effective as they once were.
Medicaid is a useful resource for paying for the great expense of long-term care. Only the truly needy qualify; strict Medicaid rules dictate asset and income thresholds, along with penalties for certain transfers. In addition to the traditional criminal penalties that come with Medicaid fraud, there may be a finding of unjust enrichment in civil court.
Overcoming the presumption of improper transfers within a look-back period may be as simple as a keeping a few receipts.
It is tough enough to make the decision to enter a loved one into long-term care – but then throw in complicated contracts, lack of legal understanding, and a whirlwind of emotional turbulence and you can easily be overwhelmed. What happens when the loved one doesn’t qualify for Medicaid, or cannot pay for services through other means? After the contracts are signed, and the loved one is tucked in to their new abode, who might be on the hook for the proverbial financial hot-potato?
The Secretary of Health and Human Services (HHS) has the authority to alter certain Medicaid requirements for states that submit a section 1115 demonstration waiver that is subsequently approved. The pertinent statute that authorizes these waivers, 42 U.S.C. 1315 §1115, has been around since Medicaid’s beginnings in 1965. However, recently these waivers have been used to add a work requirement as a condition of receiving Medicaid.