I knew a guy. In the late 90’s, as a young elder law clerk soon to be attorney, the Medicaid system was wildly different than today. The Nursing Home Eligibility Division of New York City had a phone number that I would call regularly. Picking up the phone was a gentleman of advancing years who knew the status of all of my cases. I think his name was Frank, but don’t hold me to it. I looked forward to my conversations with him- his old timey New York good humor and friendly advice. For a city the size of New York, it still amazes me that during those years, only one or two people sat at a bureaucratic intersection and were able to pull information accurately from a motley collection of analog files and slow computers. Years before the Deficit Reduction Act of 2005 complicated Medicaid planning, at least in my experience, elder law practice mimicked the neighborliness of Sesame Street. Paperwork and people merged to create a system that was not perfect, but more manageable.
Medicaid is the US Government health insurance program that covers low income/low resourced individuals and long term care for the disabled and chronically ill. While Medicare pays for basic doctor visits, prescription drugs, short hospital stays and up to 100 days of rehabilitation, Medicaid covers longer, continuous care. Medicaid is means based and requires financial eligibility. The steps required for a disabled or chronically ill person to reach or maintain financial eligibility is called Medicaid planning. Nursing Home planning is more restrictive than Home Care or Assisted Living planning. Luckily for us, New York remains one of the most flexible states for reaching Medicaid financial eligibility.
Elder law attorneys focus on assets and income. Assets include homes, bank accounts, retirement accounts, whole life insurance policies and vehicles. Some assets can be excluded from Medicaid consideration, others cannot. Transferring general assets to spouses and disabled children or homes to caregiver children or siblings residing in the same home are allowed. Irrevocable Trusts are often used to protect assets from Medicaid consideration. Income from Social Security, pensions, rent, interest and dividends are tracked. Community based Medicaid allows income in excess of regulated limits to be protected through the use of Pooled Supplemental Needs Trusts. These special trusts hold excess income, set aside these funds to pay for expenses, and allow a Medicaid recipient to maintain eligibility. The downside is that these funds remain with the Pool after the Medicaid recipient dies. For Nursing Home cases, income is owed to the facility and cannot be protected unless a spouse remains in the community and is under an income threshold.
Working together with Local DSS (Department of Social Services) agencies, the merging of paperwork and people continues, albeit under a slightly more digitized system. Elder attorneys are tasked with obtaining subsidized long term health care solutions for chronically ill people while protecting a family’s money. For many of us, it is a labor of love and an appreciation of the efforts of everyone involved with setting up care for our loved ones.
