July 20, 2017May 4, 2022

Medicaid Proposals

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Even though a vote over the Senate’s bill to repeal Obamacare (Affordable Care Act) has been delayed, it is important to know whether or not it affects elders who rely on Medicaid for nursing home care.

At least for the moment, the legislation to cap Medicaid will not proceed. Nor will the full repeal of the Affordable Care Act. There were several proposals that could have had an impact.

In March, the House legislation included limits to home equity as a countable resource and repeal of three-month retroactive coverage. By lowering the limits on home equity, recipients could have been forced to chose between home ownership and Medicaid assistance. Ultimately, the first was removed from the Senate bill and the second was modified to not apply to persons with disabilities and those over 65.

NAELA is also concerned about the misuse of 1115 waivers to limit Medicaid eligibility. Maine has already proposed an 1115 waiver to put limits on annuities and end retroactive coverage. An elder law attorney can help you learn if you or a loved one qualifies for Medicaid and how to do Medicaid planning.

July 19, 2017

Medicaid Facts

Repeal of the Affordable Care Act has been one the biggest news items in recent weeks. Changes to Medicaid in Republican proposals have received a lot of attention, but many people do not know exactly what Medicaid does.

You probably know that Medicaid is the federal government program that provides health care coverage to poor Americans. However, in the debate about the repeal of Obamacare (Affordable Care Act) and possible reductions to Medicaid in various appeal proposals, what often gets lost is exactly what that federal government program for the poor does.

Facts about the program get lost in the media noise.

It is important to know the facts, because only then can you really decide if you are for or against any changes.

NPR recently published a list of some lesser known facts about Medicaid in "From Birth To Death, Medicaid Affects The Lives of Millions," including:

It is very expensive. Medicaid currently takes up approximately 10% of the federal budget. State governments contribute even more on top of that to the costs of the program.
Half of all births in the U.S. are covered by Medicaid. The program has been expanded multiple times to include more and more pregnant women.
Some 62% of nursing home residents have their care through Medicaid.
Disabled people and the people who take care of them are often eligible to receive their care through Medicaid.
Medicaid is a major source of funding for the fight against opioid addiction.

Reference: NPR (June 27, 2017) "From Birth To Death, Medicaid Affects The Lives of Millions."

July 17, 2017October 2, 2024

Fiduciary Rule Confusion

The new fiduciary rule for financial advisers has caused a lot of confusion about what is and is not allowed with retirement accounts.

On June 9, a controversial new Department of Labor rule went into effect. The rule seems simple enough. Financial advisors who give investment advice to consumers about their retirement accounts, must act as fiduciaries of those consumers.

At least for attorneys, that is a very simple idea to understand.

Nevertheless, for consumers and their advisors the new rule has caused a lot of confusion, as the Washington Post details in “A new conflict-of-interest rule for retirement savers is causing a lot of confusion.”

The easiest way to understand what the new rule means, is that advisors have to act in the best interests of the people they are advising. Investment advice must be based on the best thing for the saver, not the advisor.

Therefore, if an advisor would earn a higher fee from suggesting one investment rather than another, he, or she cannot advise the saver on that basis. If the investment that pays the least to the advisor is better for the consumer, then that is the investment that must be recommended.

Many advisors are taking advantage of the new rule to make changes to how they manage retirement accounts.

The confusion surrounding the rule has given them the opportunity to make changes customers may not like and place the blame for them on the new rule.

If you are not sure if a change your advisor is making is really required by the new rule or if you should look for a different advisor, ask an estate planning attorney.

Reference: Washington Post (June 19, 2017) “A new conflict-of-interest rule for retirement savers is causing a lot of confusion.”

June 29, 2017

Medicare Penalty Waived for Some

People who are eligible for Medicare and who do not sign up on time can face stiff penalties. Some of them have been granted a small window to have those penalties waived.

The federal government has always been particular about Medicare. Eligible people either sign up at the right time or they face stiff penalties, if they attempt to sign up later.

Elder law advocates have always thought that this was a harsh way to penalize many people who simply made honest mistakes and were not aware of those penalties.

Advocates' complaints have typically fallen on deaf ears, since the government was more concerned about cost controls. However, an important victory has been won for some who would otherwise face penalties for not signing up for Medicare on time.

NPR reports on this latest development in "Feds to Waive Penalties for Some Who Signed up Late for Medicare."

People who purchased their health insurance through the Affordable Care Act's marketplaces were not made aware that they needed to sign up for Medicare, when they became eligible.

When looking at the marketplace website, it appeared they were doing everything properly as long as they continued to purchase insurance on the marketplace. They have been granted a waiver of the penalties.

People affected will need to apply for the waiver. They only have until Sept. 30, 2017 to do so.

This waiver is only being granted to those who continued to purchase insurance through the Affordable Care Act, but it is an important step for many elderly people.

Reference: NPR (June 6, 2017) "Feds to Waive Penalties for Some Who Signed up Late for Medicare."

June 28, 2017

Food Stamp Reductions Possible

It might not intuitively seem like an elder law issue, but President Trump's plan to cut federal food stamp assistance is definitely something that elder law advocates should monitor closely.

When the Trump administration recently released a proposed budget, one thing took many people by surprise. The budget proposed drastic cuts to the Supplemental Nutrition Assistance Program (SNAP), more commonly referred to as food stamps.

Much of the media coverage on the proposal has focused on new additional work requirements that are being proposed on the program, how it might affect children, or in CNBC's case, how it will impact retailers in "Trump's plan to slash food stamp assistance would be a major setback for these retailers."

However, there is another group of Americans that could be adversely affected, if the proposal becomes law: the elderly.

Millions of American seniors rely on receiving food stamps to make ends meet every month. Since many of them are unable to go back to work, they do not have an obvious way to make up the difference, should they lose their assistance.

To be fair, the Trump administration is expecting the states to make up the difference from federal cuts. That might happen, but it will be a state by state battle to see that it does.

Elder law advocates need to pay attention to this issue to make sure seniors do not lose the assistance that many of them desperately need.

Reference: CNBC (June 2, 2017) "Trump's plan to slash food stamp assistance would be a major setback for these retailers."

June 6, 2017

Massive Medicare Fraud Alleged

A former insurance company executive has made public allegations that insurers have systematically overcharged Medicare and cost the government billions of dollars.

Every few years it seems the federal government needs to do something to fix Medicare or risk running out of available funds for the program. One attempt to fix Medicare was undertaken in the early 2000s. It is now known as Medicare Advantage.

The program privatized parts of Medicare by turning things over to insurance companies. The idea was that insurers would do a better job of controlling costs in the program than the government.

Instead of doing that, however, a whistle-blower alleges that insurers have used the program to make billions of dollars from Medicare they are not entitled to, as The New York Times reports in "A Whistle-Blower Tells of Health Insurers Bilking Medicare."

The alleged fraud is a relatively simple one.

Insurers are said to have used the medical coding system to make patients look sicker than they really are. As a result, the insurers easily collect more money from the government than they actually should.

The government has already announced plans to sue one insurer based on these allegations and more lawsuits against other companies are expected.

It is important for the government to stop this fraud, if true, and any other Medicare fraud.

The Medicare system is yet again close to running out of funds and in need of a fix. The government cannot afford to lose billions to fraud.

Reference: New York Times (May 15, 2017) "A Whistle-Blower Tells of Health Insurers Bilking Medicare."

June 5, 2017May 12, 2022

Handling Death in the U.S.

Studies continue to show that the how and when Americans would prefer to pass away, is not how they actually pass away. That needs to change.

Most of the time, the medical profession treats its patients in keeping with what the patients want. If someone has a broken leg, for example, then doctors set the leg, put a cast on it and let it heal.

That is what people want.

When we get sick, doctors give us the best known treatment for whatever disease we have and everyone is satisfied. However, this does not necessarily hold true when people are at the end of their lives.

What medical professionals do at the end of their patients’ lives, is not what studies suggest patients necessarily want, as The New York Times reports in “We’re Bad at Death. Can We Talk?”

The disconnect at the end of life between doctors and patients, stems from the fact that doctors are trained to do everything they can to sustain life. On the other hand, most patients would prefer to be let go with the least amount of pain and discomfort.

This leads to terminally ill patients being placed in intensive care units on artificial life support, when they would prefer to be placed in palliative care or return home so that they can pass away in peace.

This is something that needs to be addressed by the medical community.

There is something you can do about it for yourself. You can get advanced medical directives to let doctors know what you want, when you are terminally ill. At Profit Law Firm, we prepare Advanced Medical Directives as part of basic estate planning.

Reference: New York Times (May 10, 2017) “We’re Bad at Death. Can We Talk?”

June 2, 2017

Just Living Together After 50

More and more elder Americans are choosing not to get married to their partners. Instead, they are just living together.

The trend over the last few decades has been for people to get remarried late in life. This has created many issues for estate planning and the families of the people who do get remarried.

That trend is starting to reverse, but that does not mean people are not finding companionship in their retirement years.

Today, rather than getting married, many elderly people are just moving in together and foregoing a marriage certificate, according to The New York Times in "More Older Couples Are 'Shacking Up'."

While this might solve some problems, such as getting around the laws of intestate and spousal election to make sure that any assets go to the children and remain in the family, it does not solve all of the problems. Instead, it creates a different set of problems that need to be worked through in an estate plan.

If two elderly people are living together, it becomes important to create estate plans that do not leave one of them in a bad position when the other passes away.

You do not want to create a situation where a partner is unable to afford the rent after you pass away or gets kicked out of the property you own by your heirs.

These do not need to be major problems with proper estate planning, but they can be without that planning.

Reference: New York Times (May 8, 2017) "More Older Couples Are 'Shacking Up'."

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