Elder Law Firm of Marshall & Associates

Community Spouse Minimum Income Allowance Increases July 1

Written By: Attorney Jeffrey A. Marshall , CELA*

A nursing home resident on Medicaid is usually required to pay most of their income to the nursing home. However, if the resident is married, a number of financial protections exist for their spouse.

If the spouse of a nursing home resident is living in the community and has low income, he or she may be entitled to an allowance from the institutional spouse's income. The amount of this income allowance is dependent on the income and housing expenses of the community spouse.

In Pennsylvania , the minimum income allowance is set at 150 percent of the federal poverty level for a family of two plus an excess shelter allowance. The excess shelter allowance is the amount by which certain housing-related expenses of the community spouse exceeds the standard shelter allowance that is built into the minimum.

If the income of the community spouse is not sufficient to yield income equal to or above the required allowance, the amount of the shortfall is diverted to the community spouse from the income of the institutionalized spouse. This additional support is called the "community spouse monthly income allowance" (CSMIA).

The community spouse income allowance is subject to a ceiling and a flo or. The current ceiling (which is adjusted each January 1^st) is $2,488.50. The flo or, or base amount, is adjusted each July 1^st. On July 1, 2006 it will increase from $1,604 a month to $1,650 per month.

In addition to any amount of support paid to the community spouse, a nursing home resident on Medicaid is allowed to keep a personal needs allowance (currently $40 per month) and enough income to pay medical expenses that are not covered by Medicaid. Once these items are deducted from the institutionalized spouse's income, any remaining income is contributed toward the cost of his or her care in the institution.

Attorney Marshall can be contacted at webmail@paelderlaw.com or at 1-800-401-4552

Marshall , Parker & Associates’ “Nursing Home Guide” is available online at

http://www.paelderlaw.com/pdf/NH_Guide.pdf.

The Hospice Benefit: Myths Unraveled

Written By: Angela Stringfellow, Community Relations Director at SouthernCare Inc.

To many families, the word Hospice is a dreaded one to hear. Traditionally Hospice was for cancer patients, providing support during the last few weeks, days, or even hours of life. Although the concept of Hospice has greatly evolved since its inception in Europe in the 1800s, not much publicity has been brought with the changes, leaving families with the same dreaded notion, “Is my loved one going to die so soon?”

Today there are over 3600 Hospice providers in the United States alone and Hospice is a Medicare benefit offered to qualifying individuals at absolutely zero out-of-pocket cost to the patient and family. Medicaid and some private insurance companies also offer Hospice benefits to beneficiaries. In addition to the program being free of out-of-pocket expenses, Hospice also actually provides additional benefits to the patient and family.

What does Hospice offer the Patient and Family?

Medicare covers all services provided by Hospice at 100%, with no co-pay and no out-of-pocket expense to the patient.
RN Case Manager, Home Health Aide, Chaplain Services, Volunteers, and access to an On-Call RN 24-7.
Symptom control, medications for the admitting diagnosis, wound care supplies, nutritional supplements, adult briefs, blue pads, creams, wipes, cath supplies, and a peg tube can be maintained if they come to Hospice with it in place.
Any durable medical equipment required, such as hospital beds, wheelchairs, bedside commodes, shower chairs, canes, walkers, oxygen, nebulizers, etc.
Coverage of ALL medications for pain, nausea, constipation, sleeplessness, anxiety, and depression, regardless of diagnosis.
Hospice is not limited to cancer patients, as was the traditional mindset for Hospice. Diagnoses can include, but are not limited to: congestive heart failure, coronary artery disease, end-stage dementia and alzheimers, COPD (emphysema), acute or chronic renal failure, stroke/coma, cancer, ALS (Lou Gehrig’s disease), liver disease, HIV and AIDS and other combinations of illnesses that would lead to a limited life expectancy.
Bereavement support is offered to the family for a period of 13 months after their loved one has expired.

Contrary to popular belief, Medicare does not require patients to have a “do not resuscitate” order or advance directive to be admitted to a hospice program. Also, Medicare does not require a patient to be homebound in order to receive Hospice services. Although some Hospice programs may tell you that you may not go to the emergency room while on Hospice, patients have the right to remain in control of their plan of care and also have the right to revoke their Hospice benefit at any time and seek whatever treatment they desire. Most agencies have the capability to be somewhat flexible with patients on these issues.

Some programs also offer something called “continuous care,” which is limited periods of continuous staffing by Hospice professionals if a crisis situation is identified (i.e. active dying process, uncontrolled pain, etc.). Of course, all agencies are regulated by the Department of Health, but some individual policies may vary. Be sure to ask what these policies are before deciding on a Hospice provider.

So What About the “Six Months to Live” Requirement?

Hospice beneficiaries are not restricted to six months of coverage. There is no limit on how long an individual can receive Hospice care, as long as they continue to meet the eligibility criteria set forth by Medicare. Medicare and Medicaid will not stop paying for a patient to receive Hospice care as long as the patient is still deemed appropriate. A physician still has to certify that the patient has a 50% or greater chance of having a POOR prognosis should their disease process run its NATURAL course in the next six months. Natural is defined as no interventions of medications or physicians.

Medicare intermediaries have actually created a set of criteria for each diagnosis that could make a person appropriate for Hospice care, to aid physicians in determining what types of patients are appropriate. These criteria are now the gold standard for Hospice appropriateness, where the gold standard previously was the “six months or less” prognosis.

Hospice care can be offered in private homes, skilled nursing facilities, personal care homes, assisted living facilities, virtually anywhere a Patient calls “home.” Hospice can even be provided in hospital settings in some circumstances. No longer is Hospice a word mentioned only when a loved one is actively dying, but a word mentioned when someone is in need of some extra TLC. Hospice today is a multifunctional organization providing care and cost savings to patients and families, but most importantly, a full staff of caring and compassionate individuals waiting to help you and your family cope with all aspects at a difficult time of need.

For more information, please contact Angela at 570-368-2561 or visit SouthernCare’s Website at http://www.southerncarehospice.com/.

New Tax Law Includes Changes to Roth IRAs and Capital Gains

Written By: Attorney Jeffrey A. Marshall , CELA*

On May 17, 2006 , President Bush signed a new tax bill that makes a number of changes to tax law, including changing who can participate in a Roth IRA, extending the capital gains tax reduction, making unearned income by minors up to age 18 taxable at the parent's tax rate, and increasing the Alternative Minimum Tax exemption.

The new law increases the number of people who can participate in a Roth IRA. With a Roth IRA, unlike a traditional IRA, you don't receive a tax deduction when you invest your money, but your original deposits and the earnings on them are not taxed when you withdraw funds.

One problem with Roth IRAs has been that not everyone could participate. Individuals with incomes of more than $110,000 and couples with more than $160,000 cannot put money into a Roth IRA. Households with income of more than $100,000 cannot convert a traditional IRA into a Roth IRA.

The new law, which takes affect in 2010, doesn't change the income threshold for people who are starting a new Roth IRA, but it will allow people with incomes of more than $100,000 to convert a traditional IRA into a Roth IRA. While you will have to pay taxes on the conversion, if you convert in 2010, you can split the taxes into two payments to be paid in 2011 and 2012. If you convert after 2010, you will have one year to pay the taxes.

The new tax law also extends the capital gains tax reduction passed in 2003. The reduction was supposed to be in effect only until 2008, but the new law extends the lower rates until 2010. The tax rate on taxpayers in the highest tax brackets will remain at no more than 15 percent. Taxpayers in the 10 percent and 15 percent tax bracket will pay a 5 percent rate until 2007, and starting in 2008, they won't have to pay any capital gains taxes when they sell assets, such as stocks or mutual funds.

Another change in the tax law may affect seniors who have opened custodial accounts (or UTMA account) for their grandchildren. The law makes unearned income by minors up to age 18 taxable at the parent's tax rate. Previously, the first $850 of investment gain from a custodial account was tax free, the second $850 was taxed at the child's rate, and any income over that was taxed at the parent's or grandparent's rate. When a child turned 14, anything over $850 was taxed at the child's rate. Under the new law, any income over $1,700 is taxed at the parent's or grandparent's rate until the child turns 18.

Finally, the new law also increases the Alternative Minimum Tax exemption for one year. It was originally scheduled to return the amount to $42,500 for married taxpayers and $33,750 for single taxpayers, but instead will be increased to $62,550 for married taxpayers and $42,500 for single taxpayers.

The above was adapted with permission from an article by ElderLawAnswers.

Attorney Marshall can be contacted at webmail@paelderlaw.com or at 1-800-401-4552

Seniors Growing Healthier

Written By: Attorney Jeffrey A. Marshall , CELA*

We are not just getting older - we are getting healthier! The US Census Bureau reports that today’s seniors are more prosperous, better educated and healthier than their parents were 25 years ago.

The Bureau’s recently released 243 page report, 65+ in the United States : 2005, shows that the overall health of older Americans is improving. The proportion of persons age 65 and over with a disability fell from 26.2 percent in 1982 to 19.7 percent in 1999.

The improving health of seniors is attributed to a number of factors including better financial circumstances and higher levels of education.

The trend is expected to continue as “baby boomers” become “senior boomers.” "Their increased levels of education may accompany better health, higher incomes and more wealth, and consequently higher standards of living in retirement," according to the report.

Unfortunately, not all seniors are benefiting. There are subgroups who have high levels of poverty, especially older women who live alone.

American seniors are also becoming more diverse. In 2003, older Americans were 83 percent non-Hispanic white, 8 percent black, 6 percent Hispanic and 3 percent Asian. By 2030, the proportion of non-Hispanic white should fall to 72 percent with 11 percent Hispanic, 10 percent black and 5 percent Asian.

The U.S. population age 65 and over is expected to double in size within the next 25 years. Currently, there are over 36 million Americans over the age of 65, about 12 percent of the population. By 2030, 20% of the population - some 72 million people - are expected to be 65 years or older.

Currently, Pennsylvania is the second oldest state with 15.6 percent of our residents age 65 and older.

The Census Report is available online at http://www.census.gov/prod/2006pubs/p23-209.pdf.

Attorney Marshall can be contacted at webmail@paelderlaw.com or at 1-800-401-4552

Attorney Marshall’s Book Receives International Recognition with ACLEA Award

Written By: Melissa Bottorf, Director of Marketing & Public Ed ucation

The international Association for Continuing Legal Education (ACLEA) has announced that Attorney Jeff Marshall’s book, Elder Law In Pennsylvania, has been selected for the Award for Outstanding Achievement in Publications for 2006. The book was submitted by the publisher, the Pennsylvania Bar Institute. Elder Law in Pennsylvania was selected out of entries from across the United States , Canada , Great Britain , Australia , New Zealand , Africa , and Mexico .

Representatives from the Pennsylvania Bar Institute will be on hand to accept the award at ACLEA’s 42^nd Annual Meeting in Hawaii this July. Established in 1964, ACLEA is an international association devoted to improving the performance of continuing legal education professionals. Attorney Marshall is managing Attorney of Marshall, Parker & Associates. More information about the book is available at www.paelderlaw.com/book.html.

Melissa can be contacted at webmail@paelderlaw.com or at 1-800-401-4552

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*Attorneys Marshall and Parker are certified as Elder Law Attorneys by the National Elder Law Foundation under authorization from the Pennsylvania Supreme Court.

1-800-401-4552

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