Pennsylvania
Revises Penalty Divisor for Gifts
Written
By: Attorney
Jeffrey A. Marshall
, CELA*
Medicaid
("Medical Assistance") is the primary source of payment of nursing
home costs in
Pennsylvania
. But, before a nursing home
resident can receive government Medicaid benefits, the resident must meet
the financial need criteria of
the program. For many
residents, this means they first have to "spend down" their personal
financial resources so that they can qualify for this form of government
assistance.
If the resident has given away assets in order to get
down to the required financial qualification level, the gift may create a
waiting period during which the resident will be ineligible for Medicaid.
This waiting period, often called the "penalty period," begins
in the month the gift is made. The
length of the waiting period is determined by dividing the value of the
income or assets given away by a "penalty divisor" which is roughly
equivalent to the average monthly cost of a private nursing home room.
Because the penalty divisor is based on the cost of
nursing home care, the Department of Public Welfare must revise it from
time to time. The Department
has announced that the penalty divisor will increase, effective
July 1, 2003
, to $5,559.25. This new
divisor applies to applications for Medicaid benefits which are filed on
or after July 1st for nursing home care.
It also applies to applications for home care benefits under the
PDA 60+ Waiver program.
This new divisor means that a gift of $100,000 will
create a waiting period of 17 months.
Under the old penalty divisor, the waiting period would have been
18 months. In most cases, if
a gift was made more than three years before the Medicaid application is
filed, it need not be reported. However,
the reporting period can be extended to five years if a gift is made to or
from a trust.
Persons who may need to apply for Medicaid in the
next three years and who want to make gifts should consult with an
experienced elder law attorney. Many
gifts are exempt from the transfer penalty rules.
In addition, the Department of Public Welfare has proposed changes
to the regulations which govern the effect of gifts. At present, it is
unclear whether these regulatory changes will take effect.
Incorrect understanding of the rules regarding gifts
can create significant problems not only for the nursing home resident and
his or her family, but also for the nursing facility.
Nursing facilities can end up with a resident who cannot pay
for care but who is now ineligible for Medical Assistance due to gifts
that were made. Everyone benefits if expert guidance is obtained.
Spousal
Income Allowance Increases
Written By:
Attorney
Jeffrey A. Marshall
, CELA*
I n general,
when your spouse is in a nursing home, he or she will not qualify for
Medical Assistance benefits until your combined savings are reduced to a
certain level. That level of
savings is going to be different for different people.
The general rule is that the community spouse can keep ½ of the
couple's available resources up to the current maximum of $90,660.
(With good advice, a spouse can often keep much more than the
standard savings of $90,660).
In addition to being allowed to keep a certain amount
of savings, the community spouse is also entitled to retain a certain
minimum level of income called the Minimum Monthly Maintenance Needs
Allowance (MMMNA). If the
community spouse's own income is insufficient to provide this income
allowance, income can be diverted from the institutionalized spouse.
The minimum MMMNA is set by federal law and is
adjusted on July 1st of each year to keep up with inflation.
As of
July 1, 2003
, the minimum MMMNA is raised from $1,493 to $1,515 per month.
The MMMNA can be higher depending upon the monthly expenses
incurred by the community spouse.
Online
Nursing Home Comparison Guides Provide New Resource for Nursing Home
Shoppers
By:
Stephanie L. Allegrucci
The
decision to place a loved one in a long term care facility can be one of
the most emotional and stressful choices that a family must make. Often
times the need for nursing home placement may arise urgently, thus making
the already difficult search process even more overwhelming. We all desire
to find the facility that can best care for our loved one; however, in the
past we have relied heavily upon what we hear others say about facilities
rather than perform our own research to obtain factual information.
Personal recommendations from friends, geriatric care managers, other
health care providers, and an elder law attorney remain important; and now
with the availability of the Internet, you can supplement these
recommendations by conducting your own research from your home!
Gannett News Service has issued a special online
report to make available the ratings of
America
's nursing homes. This site provides a searchable database that allows
the user to access patient care quality ratings for 16,000 nursing homes
across the
United States
. http://content.gannettonline.com/gns/nursinghomes/index.html
Gannett News Service uses
Federal Medicare Databases to gather information about the level of
patient care. In a four-month investigation, Gannett conducted interviews
and analyzed four years' worth of data on the 16,000 nursing homes
nationwide. Thanks to Gannet all you have to do is simply select the
state, county, and city you wish to search. You will immediately be
provided with a list of all facilities in your area and a complete report
on each.
- What
information is available?
Two vital pieces of
information are now at your fingertips. First, you have access to
statistics concerning patient well-being. For example, you can view the
percentage of patients who have incurred certain physical ailments while
residing in the facility along with the state and national averages for
this particular problem. Gannett uses a series of stars from one to five
(5 being the best) to rate six factors of patient well-being. This rating
system allows you to compare nursing homes with a quick glance.
Secondly, you have access to nursing home inspection histories. These
inspections occur every 9-15 months. Each nursing home report contains a
list of deficiencies noted in the inspection including a description of
the problem, the severity of the incident, the scope or how many people it
affected, and the date of correction. This database contains incident
reports from 1999-2003.
The great thing about this
database is that it allows you to easily compare the many facilities in
your area in an attempt to narrow down your search. It also draws your
attention to issues of concern that you may not have originally thought to
inquire about.
- What
information should I focus on while reading the reports?
1.
Note the number of nursing personnel available to care for
residents as they provide at least 90% of patient care.
- Compare
the facility's quality score with other facilities' scores to
see how each ranks. Look for ones that score below the state average
when it comes to deficiencies.
- Check
for the most recent report, within the past 9-15 months, to ensure
up-to-date information. Don't forget about old inspection reports
as they may show a trend in problems. If you see a certain area of
deficiency, be sure to question it upon visiting.
Nursing home databases can be an invaluable tool for
anyone involved in the search process, but especially for family members
who may not live in the city or state of the needed facility. Once you
locate the facility that can provide the best match for your loved one's
needs, you have a continued responsibility to remain involved so that you
can rest assured that your loved one receives the highest level of care
possible.
- Voice
concerns and complaints
- Participate
in family council meetings
- Attend
care plan meetings and stress individualized care
- Meet
the staff and share personal information about your loved one
- Follow
up on the care plan and make all staff aware of this plan
- Document
the date, time, and people involved in any problem
- Stay
in touch with community long term care professionals.
Your involvement will help keep databases, like those
provided by Gannet, accurate so that they may be valuable to others
involved in the complex process of finding the right nursing home.
The National Citizens' Coalition for
Nursing Home Reform provides A Consumer Guide to Choosing a Nursing Home.
This guide takes you step by step through the process of nursing home
placement and offers valuable tips for interpreting state inspection
reports like those on the Gannet database.
http://nccnhr.newc.com/public/50_155_3274.CFM
The Center for Medicare
and Medicaid Services offers a Nursing Home Comparison Guide with
information about each facility, the staff, and quality care information.
This resource operates in the same manner as the Gannet database to
provide the user with detailed facility reports.
http://www.medicare.gov/Nhcompare/home.asp
For a Nursing Home
Checklist to help guide you in your search, go to
www.medicare.gov/nursing/checklist.pdf
Stephanie
Allegrucci, our summer intern has just completed her sophomore year
at the
University
of
Pennsylvania
and
is majoring in History of Law and Psychology.
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you know. past issues of the Elder Care Law Alert are available on our
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*Attorney
Marshall
is certified as an
Elder Law Attorney by the National Elder Law Foundation under
authorization from the Pennsylvania Supreme Court
© 2000-2005
Marshall & Associates www.paelderlaw.com
