Bill Puts Seniors at Risk

Written By: Attorney Jeffrey A. Marshall , CELA*

  Congress is about to pass a new law that will make it harder for frail seniors to pay for long term care. Senate Bill 1932 includes changes to the Medicaid program that will make seniors ineligible for government financial assistance if they have given anything away over the past five years.

Since few individuals have insurance that covers nursing home care, most people in nursing homes are on Medicaid.  Medicaid pays for needed care for people who have limited financial resources.   The proposed law attempts to save the Government money by shifting more of the cost of long-term care to families and nursing homes.

Most harmful is a provision in the legislation that will change the way gifts are treated. Giving assets away makes the donor ineligible for Medicaid help for a period of time.  Under current law, the penalty period starts to run when the gift is made.  Under SB 1932, the penalty period will not begin to run until the donor needs nursing home care and has run out of money to pay for it.  This means that our nursing homes will soon be filled with residents who need care but have no way to pay for it.

Regrettably this is not a joke.  Congress is about to pass this law.  The grandparent who helped pay for a grandchild's education, the church supporter who contributed to the church building fund, the parent who helps a child with medical bills, the family farmer who passes on the farm, will all be caught by this law if they get sick within 5 years of making the gift.   

AARP, the Alzheimer's Association, the Catholic Health Association and over 40 aging advocacy organizations oppose these changes.  They believe the new law will put the health of many older Americans at risk.  The nursing home industry also strongly opposes the change in the calculation of the penalty period, since nursing homes will have to provide care to residents who have no source of payment. 

The penalty start date change is particularly significant in Pennsylvania since the Pennsylvania Legislature recently re-enacted a law that makes children liable for the financial support of their indigent parents.  Nursing homes, stuck with residents who have no means to pay for care, may seek reimbursement from the residents' children. Litigation between nursing homes and children is likely to flourish.  Nursing homes will sue children who will counter-sue for sub-standard care. 

The change in the transfer penalty is not the only provision of the legislation that will harm seniors.  Spouses of nursing home residents will also be hard-hit. States, like Pennsylvania , will no longer be allowed to let low-income community spouses keep additional financial resources to avoid later spousal impoverishment.  Farmers may be required to sell their farms to pay for their long term care costs.  Individuals owning annuities may be required to name the state as a beneficiary. 

Unfortunately, the legislation does nothing to address our country's growing long-term care crisis. Its provisions don't even cut much government spending.  It certainly doesn't address our desperate need to find ways to provide older Americans with affordable means to pay for long-term care. SB 1932 is yet another example of Congress passing laws that diminish the ability of seniors to live a modest and safe life. 

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

The Philanthropist Next Door

Written By: William "Bill" Fox, Vice President for Philanthropic Services

First Community Foundation of Pennsylvania

  You may associate the concept of philanthropy with names like Carnegie, Mellon and Heinz, but did you know that you could be the philanthropist next door? 

You can make an impact in your own community, while maximizing tax and estate planning benefits, and you do not need to be a wealthy industrialist or a billionaire to do it.  You can establish your own community legacy simply by using your community foundation for your charitable giving. 

One of the fastest growing sectors of philanthropy, community foundations use gifts of all sizes for the betterment of residents of a specific geographic area.  Community foundations share common traits:  they use donated assets to create permanent, endowed funds that generate grants to qualified charitable organizations and scholarships to promising young people. 

Establishing a fund at a community foundation differs from making a gift to a nonprofit organization for a specific program.  Instead of spending donors' dollars immediately, the foundation creates endowed funds with the money.  Income from the funds is used for grants and scholarships, and the principal continues to grow.  Over time, the donation will provide many times over the amount of the original gift to the community.

Because community foundations are nonprofit charitable organizations, gifts made to them are tax-deductible to the fullest extent allowed by the IRS.  The foundations can accept many different types of gifts, making them a flexible giving option for donors.  Community foundations may also offer professional gift planning expertise for individuals and can work closely with their professional advisors as they structure their gifts.

Gifts that may be accepted by community foundations include:

·         Cash Gifts and Memorials

·         Gifts of Appreciated Assets

·         Bequests Via Wills or Living Trusts

·         Gifts of Homes, Farms and Vacation Property

·         Gifts of IRA's and Retirement Accounts

·         Gifts of Life Insurance

·         Charitable Gift Annuities

·         Charitable Remainder Trusts

·         Charitable Lead Trusts

Donors also have many options to decide how the community will benefit from their donation.  Funds that may be established at a community foundation include:

Unrestricted Funds

For donors who prefer to use the community foundation's knowledge of community needs, unrestricted funds award grants to charitable organizations through the foundation's competitive grant process.  Unrestricted funds benefit a variety of causes, based on community needs.

Field of Interest Funds

Grants are made to benefit causes within a broad field of interest (i.e. the arts, youth, animals, or the environment).

Designated Funds 

Grants are made to a charitable agency, or agencies, designated by the donor at the time of the donation.  Designated funds allow donors to provide perpetual income for their favorite charities.

Donor Advised Funds

The donor or the donor's fund representative(s) make recommendations on grants.  Donor advised funds are ideal for individuals who want to stay connected with their gift, or who want to involve their family in making recommendations on grants. 

Scholarship Funds

Income from these funds provides scholarships.  The donor may specify criteria for the scholarship at the time of the gift.

So how can a community foundation help you become the philanthropist next door?  By offering many options to donors, community foundations make giving to your favorite causes easy and highly personalized.  

The First Community Foundation of Pennsylvania serves donors in Central and Northcentral Pennsylvania .  Bill Fox can be reached at the First Community Foundation of Pennsylvania at (570) 321-1500 or toll free (866) 901-2372.  For more information on the Foundation, visit its website at www.fcfpa.org.

End of Life Care for Veterans

Written By: Don Cohick, Lycoming County VA Coordinator

  Do you know how many veterans die each day? More than 1800 - about a quarter of all deaths in America .  About 85% of veterans do not receive care through the VA health system: and most die in the community, with only about 4% of them dying in VA facilities. Many of these veterans could benefit from hospice or palliative care. 

Can veterans access hospice and/or palliative care? Hospice care is part of the basic eligibility package for veterans enrolled in the Veterans Health Administration (VHA). (See Title 38 Code of Federal Regulations (CFR) 17.38(a) (1) (xi) (A).  If hospice care is appropriate for enrolled veterans, VA Medical Centers either provide hospice care directly or purchase it from community hospices. 

All Medicare-eligible veterans, whether or not they are enrolled in VHA, have access to hospice through Medicare.  Veterans not eligible for Medicare may have hospice benefits through Medicaid or other private insurance.

However, like 90% of all Americans, most veterans simply do not know that these options for hospice care exist.  Sometimes even VA and hospice providers do not know about all the options: community hospices may know of the hospice units in VA facilities, and VA facilities may not know about the service community hospices can offer.  Sometimes there is some confusion about payment and how to work with each other.  Many VA Medical Centers have Pallative Care Consultation Teams.

Where can veterans find hospice and/or palliative care?  Go to the National Hospice and Palliative Organization's website: www.nhpco.org.  Click on "Find a Provider" which is towards the right hand side of the page.  From there, you can be guided to hospice(s) in a specific state or zip code, or by its name.

What is a Hospice-Veteran Partnership (HVP)?  In November 2001, to improve end-of-life care for veterans, the Department of Veterans Affairs established the VA Hospice and Palliative Care Initiative (VAHPC).  One of the programs launched by the VAHPC is the National Hospice Veteran Partnership (HVP) Program, which is working with the National Hospice and Palliative Care Organization, and other end-of-life care advocates to develop a national network of HVPs.

HVPs are coalitions of community hospices, VA providers, and organizations such as end-of-life care community coalitions, and others working together to ensure that excellent care at the end of life is available for our nation's veterans and support is available for their families.  These partnerships can be community-based or statewide and may function independently or within existing structure.  Some HVPs are hosted by state hospice organizations or VA Medical Centers, while others are coordinated by community end-of-life care coalitions.

For further information and assistance, please contact Don Cohick, Lycoming County VA Coordinator at dcohick@lyco.org  or 570-327-2365.

Pennsylvania to Collect Premiums from Some Parents of Special Needs Children

Written By: Attorney Jeffrey A. Marshall , CELA*

  Under Federal law, states have the option to provide Medicaid coverage to children with physical and mental disabilities if the child needs an institutional level of care but can receive that care at home. Pennsylvania is one of twenty states that have chosen to provide this benefit. 

To receive benefits in this category, a child must meet the level of disability established by the Social Security Administration.  This year Pennsylvania will spend almost $400 million to serve over 38,000 children with special needs. 

In the past, Pennsylvania generously allowed these special needs children to become eligible for Medicaid benefits without consideration of their parents' incomes.  However, Act 42 of 2005 directed the Department of Public Welfare to begin to collect a premium from families if the custodial parent's income is above 200% of Federal Poverty Income Guidelines.

Act 42 requires the Department to verify income of the custodial parent of the child with a disability who is applying for or receiving Medicaid.  If the custodial parent's total gross adjusted earned and unearned income is greater than 200% of the Federal Poverty Income Guidelines, the Department will collect a premium. 

The Department has issued rules implementing these provisions of Act 42. The rulemaking is available online at http://www.pabulletin.com/secure/data/vol35/35-53/2401.html.

The Department estimates Fiscal Year 2005-2006 savings to the Government will be $13.015 million ($5.813 million in State funds) with annualized savings of $26.764 million ($12.130 million in State funds) estimated in Fiscal Year 2006-2007.

The new premium requirements will not be immediately effective because a waiver must be received from the Federal Government.  The waiver is required because Federal law does not otherwise allow states to collect premiums for children who are determined Medicaid eligible.  It is anticipated that the waiver will be received. 

A copy of the Medicaid for Children with Special N eeds Monthly Premium Chart is available on our website at http://www.paelderlaw.com/pdf/special_needs.pdf   

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

He Wrote the Book on Elder Law :

Williamsport Sun-Gazette features article on Attorney Marshall's new book

  Attorney Jeff Marshall has always had an affinity for older people - he loves to hear their histories and the stories of their lives.  It wasn't a surprise that when he moved his law practice "back home" in 1980, that he decided to focus on planning for seniors. Back then, the term " Elder Law " didn't exist, but as Attorney Marshall began to counsel more and more families about legal, financial and nursing home planning, word slowly spread that there was a lawyer who understood the rules and could help families struggling with nursing home costs protect their financial security.  N ow, after more than twenty-five years in practice and blazing the trail for so many other elder law attorneys, Attorney Marshall has written the book Elder Law in Pennsylvania .  The January 8^th, 2006 edition of The Williamsport Sun-Gazette 's Business Section featured an interview with Attorney Marshall about the book.  The entire article is available online at http://www.sungazette.com/articles.asp?articleID=1628.  More information about Elder Law in Pennsylvania is also available at www.paelderlaw.com/book.html, and from the publisher at www.pbi.org. 

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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.