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The Marshall Parker Law Alert, October 2012

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Federal Government to End “Medicare Improvement Standard”

Written By: Attorney Matthew J. Parker, CELA*

In a landmark decision that will dramatically alter the amount of Medicare coverage received by people with chronic conditions and disabilities, the Federal government has agreed to end the practice of requiring Medicare beneficiaries to show a likelihood of medical or functional improvement before Medicare would pay for skilled nursing or therapy services.   In the settlement of a class action lawsuit that will affect all Medicare beneficiaries (Anderson v. Sebelius, 2010 WL 4273238, No. 09-16 (D.Vt., Oct. 25, 2010)), Medicare’s coverage rules will be amended to permit payment for services that are needed to “maintain the patient’s current condition or prevent or slow further deterioration.” Neither the Medicare law nor the regulations have an improvement standard.  Unfortunately, the contractors who process Medicare eligibility determinations use Medicare manuals and guidelines that suggest that a patient should not be entitled to Medicare coverage if a patient is not improving or has “plateaued”. Disability accompanies many chronic conditions such as Alzheimer’s disease and Parkinson’s disease.  Rehabilitation, physical therapy, home health care and other forms of skilled care help maintain a person’s functional ability and quality of life.   They also serve to help avoid more expensive care in hospitals and nursing homes.  The clarified standard of review will allow more disabled patients to obtain and stay on Medicare. Experts have predicted that the cost of such expansion could be substantial. These changes will apply to traditional Medicare recipients and to private Medicare Advantage Plans.  They will apply to those 65 years of age and older as well as to those who qualify for Medicare due to a disability that renders them eligible for Social Security Disability for a period of two (2) years. The Federal District Court in Vermont is expected to approve the settlement agreement, negotiated by the Justice Department, the Department of Health and Human Services along with the Plaintiffs.   This settlement is also likely to resolve the similar class action lawsuit in Pennsylvania, entitled Papciak v. Sebelius.


Federal Annual Gift Tax Exclusion Scheduled to Increase

Written By: Attorney Matthew J. Parker, CELA*

That Federal Gift Tax exclusion amount is scheduled to increase to $14,000 in 2013.   This permits individuals to gift $14,000 to any number of persons each year, free of Federal Gift Taxes and without the requirement to report those gifts to the IRS.

Any amounts gifted in excess of the annual exclusion amount would reduce the lifetime exclusion from Federal Gift Taxes.  That lifetime exclusion amount is $5,120,000 in 2012.  However, that figure may change in 2013 as this current lifetime exclusion amount is scheduled to expire at the end of 2012.  If no agreement is reached in Congress to continue the current lifetime exclusion amount, it may be reduced to $1,000,000 in 2013.

Many individuals gift within the annual exclusion ($13,000 in 2012) in an effort to reduce the size of their estate that could be subject to both Federal and state inheritance taxes. Imagine a couple with five (5) children and ten (10) grandchildren.  A couple can gift $26,000 this year to each child and grandchild.  If fifteen (15) people receive $26,000 in 2012, that would reduce a person’s taxable estate by $390,000 in 2012.  None of those gifts are subject to the IRS reporting requirements or any Federal Gift Tax.  Keep in mind that gifts for tuition expenses and medical expenses as defined by IRS regulations do not have a cap on the amount that can be gifted free from Federal Gift Taxes.

Contact an attorney at Marshall, Parker & Associates or talk to your financial advisor about whether gifting within the Federal Gift Tax exclusion makes sense for you.


New Medicaid Spousal Impoverishment & Aging Waiver Qualification Figures for 2013

Written By: Attorney Jeffery A. Marshall, CELA*

On October 16th, the Social Security Administration released its cost-of-living adjustment (COLA) for 2013. And the U.S. Department of Labor Bureau of Labor Statistics has recently released the consumer price index figures for September. These important numbers will impact tens of millions of seniors in 2013.

More information is available on my blog for the following figures and calculations:

– Increase in Social Security and SSI Benefit Payment

– Increase in Aging Waiver Program Income Limit

The Federal Government has also published the consumer price index for all urban consumers, all items, U.S. city average (the CPI-U) for the month of September 2012. Using these figures it is possible to project some 2013 numbers that are critical to planning for married couples where one spouse is seeking Medicaid-funded long-term care benefits.

These community spouse resource and income allowances are adjusted annually.  Although the new figures have not yet been announced by the Centers for Medicare and Medicaid Services, I can project that effective January 1, 2013, the new standard community spouse allowances should be as follows:

Minimum Community Spouse Resource Allowance = $23,184.

Maximum Community Spouse Resource Allowance = $115,920.

Maximum Community Spouse Monthly Income Allowance = $2,898.

Note: The current Minimum Monthly Income Allowance remains at $1,891.25 – it will be adjusted on July 1, 2013.

Readers should also note that a Community Spouse can often protect resources in excess of the above amounts through a number of planning techniques including the purchase of a Medicaid Annuity. (Be sure to consult an experienced elder law attorney before purchasing a Medicaid Annuity.)

Attorney Marshall’s article on this topic was also posted on Elder Law Answers, a national online resource for seniors, their families and qualified elder law attorneys.


New Consumer Seminar Focuses on “Starting the Conversation” about Long-Term Care

Talking with your family about long-term care issues can be one of the most difficult conversations you can have, but it can also be the most wonderful gift you can give your loved ones.

Learning how to begin that conversation can be a challenge – whether you want to speak with your children OR if you need to talk to your own aging parents about their wishes.

Join Marshall, Parker & Associates for a free seminar for practical tips and ideas to learn how to:

-Decide when & how to talk to your children or your aging parents. 

-Discuss options for a health care crisis.

-Develop a plan to age in place and pay for it.


Peace of mind is a priceless! Bring a friend!

Saturday, November 17 from 10 AM – 12 PM

The Holiday Inn Downtown

100 Pine St. Williamsport, PA 17701

A free hot breakfast will be provided. If you would like to register or have questions, please email us or call 321-9008.


Please join us for our Open House and Ribbon Cutting at our new office in Scranton

Please join us for our Open House and Ribbon Cutting at our new office in Scranton

Marshall, Parker & Associates is excited to announce the move of our Scranton office to a great, more client-friendly location.

Our new home in Lackawanna County is in the Scranton Enterprise Center, conveniently located across from the Steamtown Mall at 201 Lackawanna Avenue in Suite 301.

Free Visitor Parking is available for our clients behind the building from the Franklin Avenue entrance. Handicapped parking is available under the building in the designated spots.

Join us for the OPEN HOUSE with Cocktails & Appetizers on Thursday, November 29, 2012

4:00 PM – 5:30 PM
RSVP today!