What are Medicaid Transfer Penalties?

medicaid

Medicaid can be a complicated system, and you may benefit from speaking with an elder law attorney who can help clear up any confusion you might have. It’s normal to want to complete all the Medicaid enrollment paperwork yourself, however, in order to avoid a Medicaid transfer penalty, we recommend speaking with an attorney who specializes in elder law.

To understand what a Medicaid transfer penalty is, let’s go back a few steps. In order to be eligible for Medicaid, you cannot have recently transferred assets, because the government wants to prevent seniors from simply giving away all their assets to family and friends, then enrolling in long-term care paid for by Medicaid. 

When a new application is submitted, Medicaid’s system reviews the applicant’s past financial information within a specific frame of time, known as the look-back period. Each state has slightly varying look-back periods, and in New Jersey it’s five years, meaning all the applicant’s financial information dating back five years will be thoroughly examined. 

What exactly are they looking for? They’re looking for any gifts the applicant gave, or any assets the applicant transferred, for less than what is called fair market value. If any assets or money changed hands for less than the fair market value during the five-year look-back period, the applicant will be ineligible for Medicaid for a certain period of time, known as the penalty period.

For example, if you give your adult daughter a car worth $100,000 and in return your daughter pays you $200, Medicaid will delay covering the cost of any of your expenses, because if you had received a fair market value price for the car you could have used that money to pay for your care instead of enrolling in Medicaid. The delay in covering your care is the Medicaid transfer penalty, and the length of the penalty period depends on the total amount of assets transferred and gifts given. 

Incurring a Medicaid transfer penalty means you are responsible for the full cost of your care until the delay is over. For seniors on a budget this can be difficult and stressful, especially those with more complex medical needs.

Advice from New Jersey elder law attorneys 

The Medicaid transfer penalty system does have exceptions and exemptions, and if you’re unsure about how it works, we are happy to talk through your specific situation step by step. We are proud to be trusted attorneys in many areas of elder law, including healthcare proxy, power of attorney, medical directive, and Medicaid, so please contact us today and let us know how we can help. 

NJ Medicaid Penalties You Need to Be Aware Of

Medicaid is health insurance that the government offers to people who may have low income or certain health conditions. This means it’s paid for with public funds that are collected through income taxes. Eligibility can vary by income, household size, and citizenship status, depending on your state. While Medicaid is a great option for many there are some penalties you should be aware of. 

The Medicaid Look-Back Period and transfer penalties

The Medicaid look-back period and transfer family rules is a scary thing for most applicants applying for Medicaid. There is a question on the Medicaid application that asks whether you have given away or transferred any assets for less than fair market value within five years before the application. The five years before the form is called the look-back period. If you answered yes to this question on the application, then you won’t face what’s known as a transfer penalty unless you have resolved it before you apply. A Transfer penalty is a temporary delay in eligibility starting from the time of application how long that delay depends on which state you’re in.

Medicaid fraud penalties

Medicaid fraud happens when a health provider misrepresents the services rendered and thereby increases the reimbursement from Medicaid. A provider can be any individual or company that provides services to Medicaid participants.

Examples of Medicaid fraud?

  • Phantom billing: Billing for any services not performed, 
  • Upcoding: Billing for a more expensive service than was rendered
  • Unbundling: Billing for several services that should be combined into one billing
  • Billing twice for the same medical service;
  • Dispensing generic drugs and billing for brand-name drugs;
  • Giving or accepting something in return for medical services, known as a kickback;
  • Bribery;
  • Billing for unnecessary services;
  • Submitting false cost reports; and
  • Falsifying timesheets or signatures in connection with the provision of personal care or consumer-directed home health services.

The legal consequences for this type of fraud conviction can vary depending upon the circumstances of each case but are generally very strict. A person convicted can face up to five years in prison per count, even for a first-time offense. A company or corporation that is convicted of felony Medicare or Medicaid fraud can be fined up to five hundred thousand dollars per count. A misdemeanor conviction can bring up to two hundred and fifty thousand dollars for a corporation, and a person found guilty of misdemeanor Medicare fraud can face a fine up to one hundred thousand dollars. 

Law attorney New Jersey can help with Medicaid legal services

SCC legal will provide you with the highest quality legal expertise and guidance you need from Frank R. Campisano. In addition to Medicaid legal services, we can also prepare additional estate planning documents, such as your Last Will and Testament, Health Care Proxy/Medical Directive, Power of Attorney documents and trusts. For more compassionate legal guidance and a free consultation, please contact us or visit our website at http://www.scclegal.com/

Your Guide to Proactive Medicaid Planning in 2020

Elderly woman touching face of young female nurse

The senior population is growing, with over 47 million people in the USA aged 65 and above. Obviously, as we age, our need for high-quality, accessible healthcare becomes critical. Medicaid plays an important role in providing seniors with quality long-term care. But, accessing this care can be a complex process. Your elder law and estate planning attorney can assist you in not only understanding your options, but also proactively implementing a strategy to ensure that you can access these options when the time comes that you need them.


Why Being Proactive About Medicaid Planning Matters

Medicaid is a federal program that provides coverage for the costs associated with long term care and healthcare for seniors. However, it is incredibly complex. Each year, Medicaid is tweaked and changed, all to help define the limits of who as well as what services are eligible for these benefits. Even the simplest errors or oversights in your application can mean you get denied benefits, which can be devastating.

As a result, legal specialists are often the most valuable resource in not only understanding this system, but for putting Medicaid planning strategies in place to ensure that when you need the benefits offered by Medicaid, you have the best possible chance of being positioned correctly to meet their very strict and complicated criteria.

Medicaid Planning Needs to be Customized

There is no one-size-fits-all Medicaid planning solution, and your estate planning attorney should tailor your strategy to you or your loved one’s financial position and needs. For example, if you are married, your strategy needs to include the possibility of one spouse being able to live independently at home while the other requires long-term care. You also need to consider how to manage assets to ensure that they are passed on to your children and grandchildren, rather than them being absorbed by costly penalties when you apply for Medicaid.

Being proactive about Medicaid planning is not about waiting until you or a loved one needs to access these benefits. Rather, it is about taking an active role to ensure peace of mind about your health and assets when that time comes.

Find Out More About Medicaid Planning – Book a Free Consultation with Your Estate Planning Attorney Today

At Sedita, Campisano and Campisano in New Jersey, otherwise known as SCC Legal, estate planning attorney Frank Campisano is ready to assist you with all your Medicaid and estate planning needs, including planning for Medicaid eligibility, business succession planning, personal estate plans, your Last Will and Testament, Power of Attorney, trusts or minimizing inheritance tax on your estate.

Contact us today and let us deliver expert estate planning advice to take care of all your Medicaid and estate planning needs. For more information, please visit our website at:http://www.scclegal.com/

Should You Have a Medicaid-Qualified Annuity for Your Spouse?

Medicaid planning

A Medicaid-qualified annuity is a useful tool for protecting your assets for a spouse when the other spouse is applying for Medicaid. As with all Medicaid planning, it’s best to consult with your elder law attorney in New Jersey to see if it’s right for you.

  • Excess Resources in the Medicaid Application Process

Your estate is made up of a range of assets, all of which will be considered in the Medicaid application process, which covers a lookback period of 5 years from the date of the application. This means that any Medicaid planning strategy has to begin well before any benefits are required.

In order to qualify for Medicaid, you’ll need to be below their threshold, so any assets over this threshold are excessive resources. Essentially, these need to be removed from the household for more than 5 years before you make a Medicaid application. A Medicaid-qualified annuity can do this.

  • What are the Benefits of a Medicaid-Qualified Annuity?

A Medicaid-qualified annuity is a good option for spouses where only one spouse requires Medicaid, as it can be used to provide income for them. Without this type of measure in place, a household’s excess resources would be used for nursing home or long-term care instead.

This annuity is a single premium immediate annuity, which means that you pay in a lump sum (your excess resources) in return for a stream of income in the form of monthly payments until the lump sum runs out.

  • What are the Requirements of a Medicaid-Qualified Annuity?

There are legal requirements that define whether or not an annuity product is Medicaid-qualified. This includes:

  • That it has to be an immediate annuity,
  • That it pays income in equal installments (usually monthly),
  • That it has no balloon payments at the end,
  • That the terms of the annuity do not extend beyond the receiving spouse’s 

life expectancy, and

  • That it is irrevocable and non-assignable.

This means that if the spouse receiving the income dies during the period before the annuity is fully paid out, any remaining money will be used to pay the other’s spouse’s Medicaid bills first before it will go to a beneficiary.

Is This the Right Medicaid Planning Option for You? Speak to an Elder Law Attorney in New Jersey

Frank R. Campisano is a highly experienced and compassionate elder law attorney with considerable knowledge of Medicaid issues. In addition to Medicaid planning, he is also able to assist with applications, appeals, and other Medicaid issues. If you or a family member needs assistance with their Medicaid planning or protecting their assets effectively, don’t hesitate to get help today.

In addition, you can also prepare additional estate planning documents, such as your Last Will and Testament, Health Care Proxy, Power of Attorney documents, and trusts.

For a free consultation with an NJ elder law specialist for Medicaid assistance, please contact us today, and speak to Frank R. Campisano or visit our website at http://www.scclegal.com/.

Everything You Need to Know About Medicare Advantage Open Enrolment in 2019

Medicaid planning

Medicare Advantage open enrolment is running from January to March 2019, with the traditional open enrolment period running from mid-October to early December. Here’s a guide to what this means, from your elder law attorney in New Jersey.

Changing Your Coverage – Medicare Advantage Open Enrolment in 2019 

If you are currently enrolled in a Medicare Advantage program, you are able to leave your current plan during this period. You can also move onto an alternative plan, like Original Medicare with a Part D prescription plan for medication, or onto a different Medicare Advantage plan – something that has not been allowed in previous years.

You are only allowed to switch once a year and it must happen within this period. If you signed up for a Medicare Advantage plan during the October-December enrolment period and it didn’t work for you, you can change during the January-March period. Once this change is made, however, you will have to stick with it until the next January-March period.

Important Things to do Before You Switch Medicare Plans 

If you are planning to change your Medicare plan, check to make sure that your preferred medical providers (doctor, local hospital, etc.) are part of the network for that plan in 2019. Also, confirm with them that any medications you are taking are also covered by the plan you want to take.

Be Aware of Fraud 

From April 2019, Medicare will be sending out new ID cards. This is a measure designed to protect beneficiaries from identity theft and fraud. You will receive this new card during the year and you’ll notice it does not have your social security number on it. Instead, it will have a unique but randomly generated ID number. You can use your old card until the new one arrives, and it is important to properly destroy the old card once the new one is in use. When destroying the cars, make sure that your social security number is made unreadable.

Need Help Applying for Medicaid or Qualifying for Coverage? Speak to Your Elder Law Attorney in New Jersey 

Frank R. Campisano is highly experienced and compassionate elder law attorney with considerable knowledge of Medicaid issues. In addition to planning ahead financially for Medicaid eligibility, he is also able to assist with applications, appeals and other Medicaid issues. If you or a family member needs assistance with their Medicaid planning or protecting their assets effectively, don’t hesitate to get help today.

In addition, you can also prepare additional estate planning documents, such as your Last Will and Testament, Healthcare Proxy, Power of Attorney documents and trusts.

For a free consultation and Medicaid assistance or NJ estate planning, please contact us today and speak to Frank R. Campisano.

What to do When You’ve Been Denied Medicaid for Excess Resources

Medicaid planning

There are many reasons someone can be denied access to Medicaid, from missing documentation to incorrectly filled in forms, but one of the most common issues is for having excess resources. Here is some helpful advice on what to do in this situation, from a Medicaid eligibility specialist and elder law attorney in New Jersey.

What are Excess Resources? 

Part of the Medicaid application process includes listing all the assets that you own, including those of your spouse if you are married. This means bank accounts, property, savings bonds, investments and more. Some assets are exempt from this list, like your home, household goods, one vehicle per home and pension. You may also keep up to $8,000 of non-exempt assets, and your spouse can keep a certain amount of assets under the terms of the Community Spouse Resource Allowance, or CSRA.

All of your assets that are non-exempt after this are considered excess resources. If this is above a certain amount (this differs from state to state and may change from year to year depending on legislation), then you will be denied Medicaid as the state feels that you are essentially too wealthy for this type of support.

Why Were You Denied Medicaid? 

There are several reasons why this denial may occur.

  • An error: The agency may have made a mistake when calculating your assets, by classifying an exempt asset as non-exempt, for example. You can appeal an error of this kind within 30 days of the mailing date of your denial.
  • Calculations were correct, but your excess resources are not very high: This means that you just missed qualifying for Medicaid, but that your application can be approved if you reduce your excess resources (by buying an irrevocable burial reserve or spending on nursing care), you should qualify with ease.
  • You applied too far in advance: This often happens to people who apply too soon and simply have too many assets to be considered eligible, especially in circumstances where a nursing home has insisted on an application. This will require the implementation of a well-considered spend-down strategy, where the best choices are outlined to ensure that you achieve Medicaid eligibility upon reapplication at a later point. There are several legal avenues to achieve this while still utilizing your assets to the benefit of yourself and loved ones, and your elder law attorney is critical to developing a reliable strategy for you to follow.

Work with a Qualified and Experienced Elder Law Attorney in NJ to Develop Your Medicaid Strategy 

 

 

Frank R. Campisano is highly experienced and compassionate elder law attorney with considerable knowledge of Medicaid issues. In addition to planning ahead financially for Medicaid eligibility, he is also able to assist with applications, appeals and other Medicaid issues. If you or a family member needs assistance with their Medicaid planning or protecting their assets effectively, don’t hesitate to get help today.

In addition, you can also prepare additional estate planning documents, such as your Last Will and Testament, Healthcare Proxy, Power of Attorney documents and trusts.

For a free consultation and Medicaid assistance, please contact us today and speak to Frank R. Campisano or visit our website at http://www.scclegal.com/

 

 

Popular Medicare Questions Answered by NJ Elder Law Attorney

Medicare can be complex and confusing, especially when it comes to planning for your future. Here are some of the most common questions people ask, answered by an elder law attorney in New Jersey experienced in Medicaid assistance.

  • When can I enroll in Medicare? The Medicare enrollment period is open for 7 months for each individual. This period runs from 3 months before the month of your 65th birthday, your birth month, and 3 months after your birth month. For anyone on Social Security, you are automatically signed up from the first day of the month in which you turn 65.
  • Is my plan the same as my spouse/neighbor/friend? All plans are issued on an individual basis according to your unique criteria, so there may be differences between your plan and someone else’s.
  • How much does Medicare cost? The cost depends on the level of coverage you choose. Most people don’t have to pay monthly premiums for Part A, while Part B is dependent on your income with most people paying $134 per month (this may be higher if your income is higher, and will be lower if you are on Social Security). Part C and D monthly premiums vary by plan and income as well.
  • What long-term care does Medicare cover? Medicare will not cover long-term care if it is not medical in nature. It will cover long-term hospital care, skilled nursing, certain home health services, hospice care and respite care. Medicare Part A only covers nursing home care in a certified facility if certain individual conditions are met.
  • Medicare Part A and Part B vs. Medicare Advantage Plan – What is better? This depends on your individual circumstances, but it may be a good idea to choose the Advantage plan if you are on prescription drugs, you want to cap your out-of-pocket health spending, you want vision and dental coverage, or you want an alternative to the 20% coinsurance on Part B.

Speak to a Leading Elder Law Attorney in NJ Today to Plan for Medicare Eligibility 

If you would like assistance in applying, understanding and accessing your Medicaid and Medicare benefits, speak to Frank R. Campisano today. Experienced in elder law, compassionate and committed to his clients, you’ll receive the highest quality legal expertise and guidance that will help you secure better care. In addition, you can also prepare additional estate planning documents, such as your Last Will and Testament, Healthcare Proxy, Power of Attorney documents and trusts. For more compassionate legal guidance and a free consultation, please contact us or visit our website at http://www.scclegal.com/

Tips to Help Avoid Medicare Scams

Medicaid Application

Seniors are especially vulnerable to scam artists and there are many fraudsters who operate under the guise of Medicare as a result. Here are some tips from your elder law attorney in New Jersey to help identify scams and keep seniors safe.

  • New cards: One of the most common Medicare scams is an identity theft scam that involves fake employees contacting seniors by phone, email or in person and informing them that Medicare is issuing new cards. Seniors then hand over details including Medicare numbers, birth dates and even financial account numbers to get their new card. To avoid this scam, remember that Medicare employees won’t contact you through unsolicited calls, emails or visits, and that they will never ask for identifying information unless you have contacted them directly.
  • Free offers: These scams start off with an unsolicited phone call or email offering a free medical check-up or free medical supplies and may even know details of your medical condition. They will invite the person to another location where they will ask for personal identification information and even credit card information that will be used to commit fraud. The best course of action is to ignore offers that seem too good to be true, never give out personal identification or credit card information, and stick with healthcare providers you know and trust.
  • Refund scams: Here, a scammer will claim that you are entitled to a refund due to changes in Medicare costs, changes in private insurance, or even as a result of a lawsuit. They will then ask for personal identifying information and back account details to use for fraudulent purposes. It’s best to remember that if you are entitled to any genuine refunds, these will come into your bank account automatically and you will never have to give your personal and financial information to another representative as Medicare will already have you on file.

The most important thing to remember is that if you are unsure if someone is a genuine Medicare representative or not, contact Medicare directly at 877-486-2048 and confirm their identity first. Making these checks will never get you in trouble with Medicare, and they are happy for you to take the extra steps to prevent falling victim to fraud.

Speak to a Leading Elder Law Attorney in NJ Today for Compassionate Advice 

If you would like assistance in understanding and accessing your Medicaid and Medicare benefits, speak to Frank R. Campisano today. Experienced in elder law, compassionate and committed to his clients, you’ll receive the highest quality legal expertise and guidance that will help you secure better care. In addition, you can also prepare additional estate planning documents, such as your Last Will and Testament, Healthcare Proxy, Power of Attorney documents and trusts. For more compassionate legal guidance and a free consultation, please contact us or visit our website at http://www.scclegal.com/

Can Crowd-Funding Your Care Compromise Medicaid Eligibility?

Crowdfunding is a useful tool provided by platforms like Go Fund Me and Kickstarter to help raise money across the country and worldwide for various needs, including funding charitable causes and small businesses, as well as the creation and development of new products. Some people also use these platforms for personal interests, like funding their tuition, travel or personal healthcare costs, making it a very popular tool. However, crowdfunding campaigns need to be carefully considered, as they may affect your eligibility for Medicaid.

Understanding Medicaid eligibility 

As a state and federally funded program, there are certain restrictions in place that limit who can make use of the medical assistance that they provide, and one of these limitations is on your income and assets. Essentially, you have to fall below the value threshold for your income and assets in order to qualify and receive assistance.

Does a crowdfunding campaign count as income? 

This depends on who sets up the campaign and has access to the funds and resources it provides. Medicaid will consider this as part of your income if this is you, but it is more of a grey area if the fund is set up by someone else and you do not have direct access to the income it provides.

What’s the best way to retain Medicaid eligibility? 

This doesn’t mean that you should refrain from using crowdfunding platforms to raise money for your benefit, but it needs to be done in a way that will not count towards your income and prevent you from receiving assistance from Medicaid. The best way to do this is through a Supplemental Needs Trust, as the assets of the trust (that is, the income from your crowdfunding campaign) will be  not by you, but by the beneficiary of the trust (a trusted individual named by you).

Get compassionate legal advice from a trusted NJ elder law attorney in New Jersey 

If you would like assistance in setting up a trust to manage additional income and assets, or other Medicaid assistance, speak to Frank R. Campisano today. Experienced in elder law, compassionate and committed to his clients, you’ll receive the highest quality legal expertise and guidance that will help you secure better care. In addition, you can also prepare additional estate planning documents, such as your Last Will and Testament, Power of Attorney documents and trusts. For more compassionate legal guidance, Medicaid planning information and a free consultation, please contact us or visit our website at http://www.scclegal.com/ today.

Is Medicare enough to take care of you in old age?

Medicaid planning

Recent studies have shown that more than 56 million people – that’s 17% of the population – rely on Medicare to meet their health care needs, which include long-term care for the elderly, dental care, eye, and hearing care. But does this mean that you can sit back and relax knowing that you can rely on Medicare to look after you in your old age? Unfortunately, no. Here’s why, from a leading NJ elder law attorney:

Health care will be your biggest expense in your Golden Years 

Aging means two things:

  1. Less money coming in, due to retirement, and
  2. More money going out as our medical conditions increase.

In fact, if you and your partner retire today at 65, you can expect to spend more than $250,000 on health care premiums alone. This is without including out-of-pocket expenses or long-term care costs for assisted living/hospice and other elder care options.

Long-term care insurance is a popular option for helping to ease this financial burden, but that is becoming more expensive in itself, largely because people are living longer than ever before. Generally, people need care for 3 years, but this time span is increasing as we get better medical care and stay healthier longer. In fact, 20% of today’s older adults will require 5 or more years of long-term care in some form or another.

Medicare is limited 

Medicare places restrictions on the type and the duration of care a person can receive. For example, they will only cover long-term care for short periods of time, like after an operation or sickness. It doesn’t cover daily assistance like bathing, meal preparation, dressing and other services that keep the elderly independent. Long-term care insurance is far less limited with a variety of options that include home health aides, nursing homes, hospice and assisted living. However, these options come at a cost.

It’s never too late to start planning 

If you would like assistance in understanding and accessing your Medicaid and Medicare benefits, speak to Frank R. Campisano today. Experienced in elder law, compassionate and committed to his clients, you’ll receive the highest quality legal expertise and guidance that will help you secure better care. In addition, he can also prepare supplementary estate planning documents, such as your Last Will and Testament, Power of Attorney documents and trusts. For compassionate legal guidance and a free consultation, please contact us or visit our website at http://www.scclegal.com/ today.

 

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