Useful Info During COVID (v. 5)

August 15, 2020

Hello Friends!

I hope you have been enjoying / avoiding / surviving this heat, depending on your predisposition to such weather.  We live in a proper New England house with not enough storage and no A/C (just window units), so I have definitely been missing the luxurious central air conditioning in my office lately!  But we have been getting to the beach a bit, especially in the evening (the best time of day).  I hope you have too.  Don’t you just love living on the South Shore?

Let’s start at the top:

#1 If you have a loved one in a nursing home, then you know there are a lot of changes going on lately when it comes to procedures and protocols.   Here are a few places where you can go to keep up: Consumer Voice, MANR, Center for Medicare Advocacy, and mass.gov.  If you have an issue with a nursing home and you don’t feel like you are making headway, call your Ombudsman.  These are volunteers who genuinely love the role and usually want to help develop a solution that is win-win.

#2 Great news on qualifying for MassHealth home care!  As you may know, MassHealth has some programs that will pay to send home health aides into you home.  To qualify, you must (1) medically need a certain level of care, (2) be below an asset limit, and (3) be below an income limit of $2349/month.

Ironically, this last piece, the income requirement, has put home care out of reach for many over the years, needlessly forcing people into the nursing home, which MassHealth will pay for with no income cutoff.  For far too long, if an elder meets the other requirements for home care, but is $1 over the income limit, she must spend down, every single month, on medical care, every dollar over $542.  That means that she could use the excess over $542 to pay for health insurance, private aides, and the like, but then she is somehow supposed to pay for groceries, heat, home repairs, sundries, and all the rest on just $542 per month!  Impossible to do.  Most elders in that situation have no choice but to move to a nursing home (which can cost the state much more than a home care package!!).

But – great news.  On a temporary basis, during the state of emergency, MassHealth is CHANGING the rules for anyone over-income for home care.  Instead of spending down to $542, an elder can simply spend down to the actual home care income limit of $2349.  It will be very interesting to see the data as the months go by, to see how many more seniors were able to stay at home with this simple change.  But what about after the state of emergency, you may ask?  Well, there is a health care bill currently in conference at the state legislature.  Please call your state representative and your state senator, and ask them both to talk to their caucus representatives about making this change permanent.

#3 Last week I had my first telehealth appointment!  What a pleasure to not have to drive, navigate through a building, and then sit in a waiting room forever.  An added bonus was getting a glimpse into the doctor’s life and personality, as he was sitting in his studio at home, surrounded by musical instruments.  That added a new dimension to the relationship.  Congress is talking about making telehealth a more prominent part of our medical landscape post-pandemic – yes, please.

#4 This is your periodic reminder to keep your health care proxy and emergency contact information with you at all times!  If you are out and about, that could mean keeping copies in the glove compartment of your car or making up a card to keep in your wallet.  We enroll all of our clients in DocuBank, and they send you a wallet card that connects emergency responders to your key health information.  I keep my DocuBank card in my wallet, and if I am going off adventuring without my bag, I put the card in my pocket.  Like when I go rowing with the fabulous crew out of the Hull Lifesaving Museum.

#5 Along the same lines… your health care agent can do a better job for you if you have shared your care wishes.  There are some great tools out there to help you think through your priorities and wishes for yourself, and then share them with your health care agent.  One free option online is the Conversation Project.  We give our clients the Your Way Workbook.  If we gave you one and you have not completed it – go pull out your black folder with all of your estate planning documents, find the Your Way workbook in there, and fill it out!

As always, reach out with any questions related to elder law, veterans benefits, long-term care, estate planning, and special needs planning.  Get outside, and wash those hands!

– Alexis

Useful Info During COVID v.4

May 12, 2020

Dear Friends,

This is our fourth newsletter during these interesting COVID times.  It’s funny – my writing bug tends to come in waves and then go away for a while.  Apparently it’s been sticking around lately.  I’m sure you can relate when it comes to your writing, art, or hobbies.  This week I want to focus on what our office can do for you, right now.  You can revisit our prior newsletters here.

Get Your House in Order a/k/a Get Your Ducks in a Row

If you have time on your hands right now, maybe it’s a good moment to spend a few hours working out the what / who / how of your estate plan.  I can help you make sure that those who matter most know what matters most to you in terms of your health care.  We can think through and plan for how to make sure that you get the hands-on care you might need over the years.  We can figure out what the best vehicle is for you to create an inheritance process for your heirs.  We can talk through who the best people are to be your health care proxy, power of attorney, executor, and trustee.  We can wrestle with and work through the various components of getting your house in order (or, if you are sick of being at home – we can call it getting your ducks in a row).

Billing & Discharge Issues from the Hospital, Rehab, or Nursing Home

For anyone on Medicare (plus a supplement, or, on a Medicare Advantage Plan), you need to know that Medicare has strict billing requirements.  If the hospital, rehab, or nursing home bills incorrectly to Medicare and the supplemental insurance, the provider will be in trouble.  Not only will they not be paid for the particular service that they incorrectly billed for, but they may even owe a penalty.  If you are having billing problems with a provider, you need to understand this.  And, it gets tougher – during this state of emergency, CMS (the federal agency housing Medicare) has changed MANY of their billing and service requirements.  It is very understandable that some medical billing offices could be confused, receiving conflicting guidance, etc.  If you are having billing problems, first, be patient with the person on the other end of the phone, and second, feel free to call me for help.

MassHealth Applications

If you find out that your loved one needs to stay in a nursing home and you are worried about how to pay for that, please reach out and we can analyze whether it may be appropriate to apply for MassHealth.  If it is, then Doreen and I can handle the application for you.  Or, if the situation is sufficiently straightforward, I can give you some advice and then you can handle the application on your own.

Guardianship & Conservatorship

If your loved one has lost cognitive capacity and does not have an acceptable health care proxy or durable power of attorney, then you might need the probate court to appoint a guardian (to make health care decisions) and/or a conservator (to handle finances and real estate).  If you need this, you have two options: If a hospital or nursing home is telling you that you need a guardianship and/or conservatorship, they may have their attorney handle it, for free.  If that’s the case, just make sure that the attorney is naming someone that the family agrees would be a good choice.  If the free work is not an option for you, then call me and I can handle the guardianship and/or conservatorship for you.  (Pro tip: Don’t ever put your family in this position – instead get your ducks in a row now and sign a health care proxy and power of attorney!)

Stimulus Checks to the Deceased

Some of you have received stimulus checks made out to persons no longer living.  Turns out, you need to send those back.  If you still have the check, you can mail it to the IRS.  If you cashed it or received it by direct deposit, you will need to write out a check to mail to the IRS.  Here are the (very clear) directions from the IRS on how and where to mail it (see Q41).

Pick the Lawyer’s Brain

Go bold or go home.  Oh wait, I’m already working from home.  In any event, I’m trying something new: a Zoom call to ask me anything related to elder law, special needs planning, veterans benefits, or estate planning.  Let’s try this and see how it goes!  Thursday, May 14 from 2:00 – 2:30.  Limited to 15 people.  Reply to this newsletter, or email Doreen (doreen@alexislevitt.com), and we will send you the login information.

Also I am converting a playhouse into a chicken coop, so I am happy to receive any and all chicken coop construction advice!

Be good to yourself and each other, and get outside to enjoy this glorious spring.

– Alexis & Doreen

Repeal & Replace of ObamaCare, a/k/a RyanCare

March 9, 2017

Filed under: Medicaid (MassHealth),Medical Care — rec1 @ 10:16 AM

There are so many articles coming out right now trying to summarize RyanCare.  I’ve gone straight to my favorite source for all things medical financing – the Kaiser Foundation.  Their reports are well researched, and not slanted one way or the other.  Just the facts.

Here’s their summary of RyanCare.  Obviously, being from a think tank rather than a newspaper, a lot of the report requires some background knowledge that most of us don’t have, but it’s still worth reading.

Repeal & Replace of ObamaCare, a/k/a RyanCare

Filed under: Medicaid (MassHealth),Medical Care — Alexis @ 10:14 AM

There are so many articles coming out right now trying to summarize RyanCare.  I’ve gone straight to my favorite source for all things medical financing – the Kaiser Foundation.  Their reports are well researched, and not slanted one way or the other.  Just the facts.

Here’s their summary of RyanCare.  Obviously, being from a think tank rather than a newspaper, a lot of the report requires some background knowledge that most of us don’t have, but it’s still worth reading.

Elder Care Workshop Series at Norwell Public Library

March 7, 2017

 

Getting older? Taking care of someone who is? Come to this three-part series to learn some helpful tips from local Elder Services professionals.

Wednesday, March 8:

“Who Can Help Me?”

Find out how to access elder services in your community.

Presented by Susan Curtin, Director at Norwell Council on Aging.

 

“Elder Law 101”

Get to know the basics of preparing for your future.

Presented by Attorney Alexis B. Levitt.

 

Wednesday, March 15:

“Learn to Speak Alzheimereze”

Discover tips to work with a person who is changing before your eyes and to learn to speak ‘Alzheimereze.’

Presented by Alzheimer’s coach Beverly Moore.

 

Wednesday, March 29: 

“Hospital to Home”

Understand how to make a successful transition from hospital to home.

Presented by Kim Bennett, LSW, of Visiting Angels, Inc.

 

“Do I Need Palliative or Hospice Care?”

Learn about the difference in important care choices.

Presented by Catherine Harrington, BA, RN, of Norwell VNA and Hospice.

 

***Workshops will be held at the Norwell Public Library from 6:00 – 7:30 p.m. Registration is requested, but not required via email at Doreen@alexislevitt.com or calling 781.740.7269.

 

This series is sponsored by the Law Office of Alexis B. Levitt, the Norwell Council on Aging, and the Norwell Public Library.

 

 

 

Gifts and the Five-Year Lookback

November 19, 2014

Filed under: MassHealth,Medicaid (MassHealth) — Alexis @ 5:47 PM

I often hear from clients that they “have made gifts in the last five years – but it’s ok, they were all less than $14,000 so they won’t count under the five-year lookback – right?”

Unfortunately, that’s simply not the case. While it IS true that you can give up to $14,000 per year (as of 2014), per recipient without paying a gift tax for federal income tax purposes, MassHealth (Medicaid) views the situation very differently. Should you need a nursing home and ask the state to help pay for your care, any gifts you have made within the last five years will be scrutinized and will render you ineligible from receiving MassHealth assistance in paying for your nursing home care until the amount of the gift(s) is paid back.

In fact, any asset transferred for less than fair market value will be scrutinized and can potentially disqualify you from MassHealth assistance. For example, if you sell your son-in-law your $20,000 Mercedes for $1,000, or add your children’s names to the deed on your house (and they didn’t pay you fair market value), MassHealth will view these transactions as assets transferred for less than fair market value.

How does the disqualification work? Let’s say in the last 5 years you have gifted $50,000 in assets. You will be disqualified from MassHealth assistance for $50,000 worth of care – and the disqualification only begins to toll once you have spent down your other assets to the allowable $2,000. In other words, you will pay privately for your care until you have just $2,000 in the bank, then you’re responsible for the $50,000. But now you only have $2,000 left – so who pays it? Either the recipients can return the gifts to “cure the defect,” or someone else – likely a spouse or child, will have to foot the bill for the next $50,000. Then and only then will you be eligible for MassHealth assistance. This is a scary prospect, for you and your family alike!

Of course, there are exceptions to the no-gifting rule. You may always transfer assets to your spouse. Likewise, if your child has been living in your home and taking care of you for two years, you may be able to transfer your home to the caretaker child without penalty. You may also be able to transfer assets to a special needs trust or pooled trust for a disabled child, though you should consult with an elder law attorney before making any transfers in the latter two of these scenarios.

Gifting to your family and loved ones during your lifetime can be a wonderful, helpful, and rewarding thing. Before making any gifts, however, you should consult with a trusted financial professional, an elder law attorney, or better yet, both. If you’re wondering if giving gifts during your lifetime is plausible in your situation, don’t hesitate to contact our office to set up an appointment.

Caregiver Contracts – Tax Benefits

April 30, 2014

Filed under: Living at Home,MassHealth,Medicaid (MassHealth) — Alexis @ 10:28 AM

If you would like to care for your parents full-time, or close to it, and your parents want to pay you for this, then there are some tax issues that you need to be aware of.

Most importantly, if you are providing hands-on care, making meals, doing the shopping, taking your parents to doctors’ appointments, etc., then you are an employee (as opposed to an independent contractor).  And if you are an employee, then there are some rules that you need to comply with.

First, you and your parents need to report your income.  Second, you and your parents need to pay taxes (they pay employer taxes, you pay income taxes).  Now before you throw something at your computer screen, consider this: You want to pay payroll taxes.  Why?  Because FICA earnings will translate down the road into your own retirement Social Security check.  Spending years working but not contributing to FICA can result in a lower Social Security check when you eventually retire.  Same goes for Social Security Disability (SSDI) if you become disabled before 65.

Also consider this: Your parents can recapture part of the employer taxes they are paying in the form of a tax deduction – If they spend more than 7.5% of their AGI (adjusted gross income) on health care, then they can deduct health care costs.  If they are paying for your many hours of care, in addition to other out-of-pocket health care costs, it is quite likely that they are spending over 7.5% AGI on those costs.

The payroll requirements for an employer are detailed.  Rather than asking your parents to try to keep the records and handle the reporting to the IRS and DOR themselves, it is exponentially easier to hire a payroll company to take care of all the details for you.  One payroll company working exclusively for home care situations is Care.com/homepay.    I haven’t worked with them, but I think they are the only payroll company focusing on home care.

You can read here about what goes into a caregiver contract, and you can read here about how your parents can end up in big trouble later with MassHealth if they pay you without a caregiver contract in place.

Nursing Home Care & MassHealth – Eligibility Rules for the Single Person

April 24, 2014

Filed under: MassHealth,Medicaid (MassHealth) — Alexis @ 6:24 PM

As you well know, privately paying a nursing home bill is a very costly undertaking.  Should you need nursing home care someday, typically Medicare and your supplemental insurance cover up to 100 days.  After that, you either privately pay or look to Medicaid (MassHealth) to pay.  This post explains the basic MassHealth rules for a single person needing nursing home care.  See this post for the rules where one member of a couple needs nursing home care.

For a single person to receive MassHealth assistance with paying for nursing home care, generally speaking she can have no more than $2,000 to her name in liquid assets and minimal life insurance.  She can own a home and be accepted into MassHealth, but the agency will require her to sell the home and use the proceeds towards her care.  If the home does not sell during her lifetime, the agency will place a lien on the home and be paid back out of the member’s estate (“estate recovery”).

MassHealth uses a five-year look-back period.  From the date of application, MassHealth looks back five years to see if you have made any gifts (typically anything over $100 must be explained).  MassHealth disqualifies applicants who have made gifts in the last five years.  Read here about what to do if you have over $2000 in assets.

Couples: Protect Your Assets from the Cost of Nursing Home Care

Filed under: MassHealth,Medicaid (MassHealth) — Alexis @ 6:22 PM

As you well know, privately paying a nursing home bill is a very costly undertaking.  Should you need nursing home care, typically Medicare and your supplemental insurance cover up to 100 days.  After that, you either privately pay or look to Medicaid (MassHealth) to pay.

For a married person to receive MassHealth assistance with paying for nursing home care, generally speaking, the couple can have no more than $119,240 in liquid assets (technically, the nursing home spouse can keep $2000, and the at-home spouse can hold the remainder) and minimal life insurance.  The couple (or just one spouse) can own a home.  If the nursing spouse owns an interest in the home, MassHealth will place a lien on the home, to potentially be paid back out of the member’s estate (“estate recovery”).

MassHealth uses a five-year look-back period.  From the date of application, MassHealth looks back five years to see if you have made any gifts (typically anything over $100 must be explained).  MassHealth disqualifies applicants who have made gifts in the last five years.

For many couples, MassHealth is a double-edged sword.  Many at-home spouses are terrified of spending all their savings on their ill spouse’s care – MassHealth spares them that.  On the other hand, if a healthy spouse is young and seems to have a long life ahead of her, then reducing her assets to just $119,240 is a very scary proposition.  Contact our office for strategies to help the at-home spouse keep more of her assets, so that she is not living in fear of becoming impoverished.

The Single Person: Protecting Your Assets from the Cost of Nursing Home Care

Filed under: MassHealth,Medicaid (MassHealth) — Alexis @ 6:21 PM

If your loved one is single and would like MassHealth to pay her nursing home bill, then the basic rules are these: (1) She medically requires nursing home level care, (2) she has no more than $2,000 in “countable” assets (that’s money in the bank, retirement accounts, life insurance, etc.), and (3) she has not made any sizeable gifts in the last five years.  This post focuses on options if she has over $2,000 in liquid assets.

The most important thing to remember is that you want to do what you can to give your loved one in the nursing home the best quality of life you can – keeping in mind that she is frail, perhaps cognitively impaired, not living in her own home anymore, not really in charge of what she eats and when, and other basic comforts.  I usually tell clients to “spend down” on things that their loved one really enjoys – a new tv for her room?  Books on tape?  New clothes?  An iPad loaded with pictures of the grandchildren?  One client loved chocolate frappes from Friendly’s – so as part of her “spend down,” her niece bought a few hundred dollars’ worth of Friendly’s gift certificates and brought her aunt frappes at least twice a week.  The little things make a big difference.

In addition to spending down on the “little things,” you can place extra assets into a “pooled trust.”  This allows you to have a “savings account” for things that will inevitably come up while your loved one is in the nursing home.  For example, if there is a family wedding and you want to bring your loved one home for the weekend, you can use the pooled trust to pay for a wheelchair van and 24-hour aides.

Another example is the “bed hold.”  If your loved one needs to leave the nursing home, say to go to the hospital, MassHealth will pay to hold the room for only ten days.  If your loved one will be out of the nursing home for longer than that, and you want her to be able to keep her room (i.e., not be moved to a new room upon her return), then you can ask the pooled trust to pay for the room until the elder returns.  These are just two examples of things that MassHealth doesn’t cover – and the $2,000 that they permit the member to keep in her own name certainly won’t cover, either.

What happens if you own a home and sell it, putting you over the $2,000 limit?  Once you sell the home and have more than $2,000 in the bank, you are no longer eligible for MassHealth.  One approach often used at this point is to pay for the nursing home privately for some stretch of time, and then spend down on useful things and move some funds into the pooled trust to bring your own account back down to $2,000.  Again, having the funds in the pooled trust gives you a savings account for the things that MassHealth won’t cover and that the minimal assets in your own name won’t either.

If you would like to explore whether placing your funds in a pooled trust is right for you, please call our office.  We are here to help.

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