New guide available for appeals of Medicaid Managed Care Decisions
Medicaid services are now provided through managed care organizations (MCO’s), which are required by federal law to provide a grievance and appeal process for the enrollees. An enrollee may be dissatisfied with the number of hours of service, or the services being provided, or a host of other issues. Three major nonprofits have collaborated on a new guide for advocates to help them in...
Trouble afoot for Special Needs Trusts in New Jersey
A trend is developing in the State of New Jersey when it comes to the State’s review of the payments made by Trustees of Special Needs Trusts. Trustees are reporting that the State is raising objections to numerous types of disbursements made by the trustees. New Jersey rules require the trustee to file an annual accounting with the Division of Medical Assistance and Health Services, as...
Tenancy by the Entirety – a form of ownership with special protections
In the recent case of Jimenez v. Jimenez, N.J. Super. App. Div.(MAY 8, 2018) (approved for publication), the NJ Superior Court, Appellate Division rebuffed the efforts of a creditor to force the sale of a home owned by the debtor and his spouse as tenants by the entireties. Relying upon a New Jersey statute, the Court held that the legislature has prohibited spouses from severing their...
Who’s doing that Medicaid application?
An application for Medicaid to pay for nursing home care can be filed by the individual himself, his spouse, another relative by blood or marriage, a staff member of an agency of which the person is a client, the person’s physician, the person’s attorney, or a designated staff member at the nursing home. Of course, a court-appointed Guardian or Agent under Power of Attorney could...
Questions the Executor should ask the Estate’s Accountant
The house is sold, the estate’s debts and bills have all been paid, the accounting has been presented to the beneficiaries, they have signed off on the Release & Refunding Bonds, and now it’s time for the estate’s Executor or Administrator to distribute the estate to the beneficiaries according to the Will or according to the requirements of the law. The estate may have...
CMS confirms that transfer penalty for Medicaid home care applicants starts to run at time of application
Followers of this blog know that when a person applies for Medicaid under the New Jersey MLTSS program or other state programs that pay for nursing homes, assisted living or home health care services, there is a 5-year look-back that is done by the agency to determine if a transfer penalty should be imposed for gifts made during the 5 years preceding the application. The penalty is a period of...
Trustee of Special Needs Trust must be cautious in making reimbursements
A person who is receiving Supplemental Security Income (SSI) from the Social Security Administration must report changes in his income or resources (assets) to SSI, because this can affect his eligibility or the amount of benefits. If countable resources exceed $2,000 on the first of a month, eligibility can be lost. If the issue is detected after the fact, there can be a resulting overpayment...
WW II Crew memoirs available for interested readers
I have a group of books about World War II bombers that I would love to give to any of my readers who are interested in these subjects. Some of the books are crew memoirs with photos and mission descriptions from the Air Force campaigns in Foggia, Italy and North Africa, others are about related incidents in the Italian and eastern European Campaigns. Why do I have these? My late father...
State efforts to impose work requirements for Medicaid benefits is subject of lawsuit
Under the federal Medicaid statute 42 USC 1396__ there is a provision called “Section 1115 waiver” which is designed to enable States to try out variations on their Medicaid programs to reach broader segments of the population. The pertinent section of the Waiver is: QUOTE HERE
In mid-January this year, CMS announced a policy in which it authorized States to develop programs that...
Beauty and pleasure of growing old with a positive attitude
New York Times writer John Leland wrote a marvellous, lengthy article that was published by the Times on December 31st. Three years ago, he began following the life activity of six New Yorkers who are in their 90’s. I just loved the article and wanted to give it a “shout-out” here. Click HERE for link to read the piece for yourself. One woman told him, “What keeps me...