Are You Paying Too Much to Apply for Medicaid?

The requirements imposed upon individuals seeking Medicaid benefits to pay nursing home costs have become less onerous in recent years.  For many years, Medicaid applicants were required to submit monthly statements for every bank and investment account for every one of the 60 months preceding the filing of the Medicaid application.  Under that regime, someone with only 4 bank accounts would have to submit 240 individual account statements.  Then, once those statements were submitted, they were reviewed by a Medicaid caseworker who was on the lookout for any “questionable” transactions.

“Questionable” transactions include unexplained deposits and substantial expenditures.  Therefore, unless the source is obvious from the account statement, any deposit showing up on those 240 statements would be questioned by the Medicaid caseworker seeking to ascertain the source of the funds deposited, and any payment of $1,000 or more likewise would be called into question.  The problem is magnified if the applicant or the applicant’s spouse had any additional bank or investment accounts.

That being the case, in order to be prepared to address a Medicaid caseworker’s questions, lawyers assisting Medicaid applicants under the old system would review all of the bank statements and seek explanations from the applicant or applicant’s family for any transactions that likely would be questioned.  That process could be time consuming, and, if the law firm performing such review billed the client on an hourly basis, then the legal fees to pursue the Medicaid application would be high.

In recent years, however, the Medicaid application process has been streamlined.  No longer is a Medicaid applicant required to submit 60 individual account statements for each of the 60 months preceding the month the Medicaid application is filed.  Now, applicants need only submit a few statements for the most recent months, and then a single statement for a particular month for each of the preceding five years.  Hence, under current practice, rather than submitting 60 statements for each account, an applicant only has to submit 8 statements, and it is only those 8 statements that will be scrutinized by the Medicaid caseworker.   Thus, for a Medicaid applicant with four accounts, the number of statements needed to be submitted for scrutiny was reduced from 240 to 32.

If one were to continue to operate under the old system and submit 60 monthly statements for each account, and then spend the time to closely scrutinize each of those statements and any transactions that might be called into question, then such person would  be doing extra work for little or no added benefit.  While one might argue that such greater scrutiny may enable the lawyer to ferret out potential problems that might arise in the context of the Medicaid application, a prudent consumer must decide whether this added scrutiny is needed.  If the additional documents being reviewed are not even required to be submitted to support the Medicaid application, then one must consider whether reviewing such documents in fact adds value to the representation, particularly when the client is paying by the hour for any work that is being done.

The Gatesman Law Office, on the other hand, works with clients to file Medicaid applications that conform to the streamlined application standards, thereby saving clients time, money, and frustration.  [It can be very costly and frustrating to try to obtain historical monthly account statements if the Medicaid applicant has not retained copies of those documents for the preceding five years.]  Moreover,  when Mr. Gatesman undertakes a Medicaid application case, his clients understand how much the engagement will cost from the outset, rather than entering into an agreement to pay legal fees in an open ended manner, where hourly charges continue to increase as more and more work is done to evaluate account statements.

As with any service provider, it is important that the consumer understand the nature of the services being offered and the terms under which the client will pay for such services.  With that information, the client can ascertain whether the services are a good value.

William M. Gatesman has been assisting clients to obtain Medicaid benefits for nursing home care for 20 years, has successfully pursued appeals of adverse eligibility determinations during that same time period, and has taught numerous continuing education programs for lawyers on Medicaid eligibility, Medicaid applications, and Medicaid appeals.  If you have any questions about Medicaid eligibility or require assistance in obtaining Medicaid benefits, and you would like to work with legal counsel that offers good value, please give us a call at 301-260-0095.


The Steps to Selling Your House Quickly

I often work with people who, in the administration of the estate of a deceased loved one, find themselves in the position of having to sell the deceased person’s house. Useful to such clients, and to anyone else who is selling a house, are these tips, the Steps to Selling Your House Quickly, which tips one of my mentors, who has much experience investing in and selling homes, shared with me.

First, pay attention to the curb appeal of the house. The moment a potential buyer drives up, the house should look neat and tidy, and it should appear to the prospective buyer, before she even sets foot into the house, that the property has value. Then, once the prospective buyer enters the house, she should find the space clean and tidy and all obvious defects should be fixed. There should be clean curtains or dust-free hanging shutters on the windows.

Pay Attention to the Kitchen.  The astute reader will note that I used the pronoun “she” when referring to the buyer in the paragraph above. That was a conscious word choice on my part because, as my mentor emphasized to me, one who markets a house for sale should market the property to a woman. As my mentor explained it, when a couple buys a house, it is the wife who typically has the final say as to which house is chosen. That being the case, the seller should pay attention to the kitchen when marketing the house. The kitchen should be above average, and it must have a dishwasher. In order to ascertain whether the kitchen is above average, the seller should engage a realtor who sells houses in the price range for which the house will sell. Such a realtor would be best suited to advise the seller as to how well the kitchen stacks up to other houses in the target market.

Lest you think the above paragraph has a sexist tilt, it is important that the kitchen be above average whether it is a man or a woman buyer who will make the final purchasing decision. As my mentor says, “you live in the kitchen, not in the bathroom.” That being the case, any pre-sale improvement budget should be focused on the kitchen, it being sufficient that the bathrooms be clean and serviceable. While that adage may not ring true in the ultra high end housing market where master bathrooms are the size of bedrooms in other houses, it is a good general rule of thumb for those seeking to sell residential real property.

Staging the House. The seller should set up the house to make it most attractive for potential buyers. If rooms are filled with clutter, on the one hand, or are left empty, on the other hand, it leaves the impression that the rooms are small. It is particularly important to stage size-challenged rooms. For example, the seller should place in a small dining room a dining room suite of furniture that fits the dimensions of the space. This strategic removal of clutter and placement of furniture is referred to as “staging” a house to make it more attractive for potential buyers.

The master bedroom should be staged with a bedroom suite that includes a king-sized bed, if possible. For a house with very small rooms, the seller could stage the master bedroom with a queen sized bed and a suite of furniture that does not overwhelm the space. My mentor suggests that the appearance of the master bedroom is of utmost importance and that potential home buyers are less interested in the “kid’s rooms.” Nevertheless, those lesser bedrooms likewise should be staged with furnishings that make the space appear most desireable because, as stated above, a vacant room will seem to be smaller than a room that contains the essential furnishings to make it obvious that such room, regardless of its size, is large enough for its intended purpose.

Also, when deciding how to stage the house, take care not to move furniture or pictures that have been in place for a long time lest you expose carpet or patches of the wall that are of a different color than the rest of the surrounding surfaces, which changes in color accrue over time as the space is exposed to sunlight and day to day living.

Price the House Right from Day One. As a general rule of thumb, it costs 1% of the selling price per month to own a house, so it is best to sell the house quickly and not let it sit on the market. In order to accomplish this goal, the house must be priced right on day one. Indeed, a seller can be confident that potential buyers will know the prices for which houses are selling, especially in this internet age, and such potential buyers can easily identify, and pass on by, houses that are not competitively priced.

In order to achieve the objective of pricing the house right from day one, the seller should work with a realtor who sells a lot of houses in that particular price range.

Offering Practical Client Representation. By following these steps, a home seller will greatly improve the chances of selling the real property quickly and for top dollar.

In addition to assisting clients with managing the administration of an estate when a loved one dies, William M. Gatesman is prepared to provide practical suggestions, such as those addressed above, to ensure that the estate administration is carried out smoothly and efficiently. Mr. Gatesman offers such practical perspective in all his areas of practice to provide the best service and value to his clients.

The Fox is Guarding the Hen House in a Maryland Guardianship

In Maryland, if one asks a Court to appoint a guardian for a person who is alleged to be disabled (the “alleged disabled person”) where such alleged disabled person is believed to be unable to manage his or her own affairs, the Court will appoint a lawyer to represent the alleged disabled person (the “court appointed counsel”). Sometimes, if there is a need to take immediate action to protect the alleged disabled person, the Court might, on the strength of a petition alone, appoint a temporary guardian for the alleged disabled person, which temporary guardian often is a lawyer chosen by the court.

In theory, the court appointed counsel and the temporary guardian are fiduciaries whose job it is to protect the interests of the alleged disabled person. Sometimes, however, it appears that such court appointed fiduciaries do not fulfill that responsibility.

Consider the following circumstance.

A health care facility is caring for Husband. Wife is unhappy with the facility’s treatment and wants husband to come home, and for the moment is withholding payment. Wife holds a financial power of attorney and a medical power of attorney for her husband, meaning that she has authority to manage his personal, medical, and financial affairs.

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Medicaid Updates Transfer Penalty Rule

If one applies for Medicaid to pay for long term care in a nursing home, the state will look to see if the applicant made any gifts in the five years preceding the Medicaid application. If so, then (with some exceptions addressed in various articles on this website) a period of Medicaid ineligibility will be imposed.

For many years before 2014, the period of ineligibility was determined by dividing the amount of the gift by $6,800, which amount was supposed to be the average monthly cost of care in a nursing home. In July, 2014, that number was changed to $7,940. Medicaid has again updated the divisor to take into account Nursing Home care cost inflation.

Effective July 1, 2016, the divisor to determine the number of months of Medicaid ineligibility for gift transfers is $8,684, which means that one would be ineligible for one month for every $8,684 in gifts made during the five years preceding the Medicaid application.

Bear in mind that the term “gift” means any transfer of resources with respect to which the transferor did not receive full value. Thus, if a person sold her house for less than it’s fair market value (Medicaid uses assessed value or an appraisal to determine fair market value), then Medicaid will treat the difference between the sales price and the deemed fair market value to be a gift transfer even if such sale was made to a third party in a bona fide arms length transaction.

We at the Gatesman Law Office endeavor to stay at the cutting edge of new developments in Medicaid law and policy.

Should you have any questions as to how this new policy might affect you or a loved one, please contact us by clicking the Contact link on this website.

Bill Gatesman

Medicaid Exclusion for Joint Assets Under Attack

It is a well established principle of the Maryland Medicaid rules that certain jointly owned assets such as stocks or real property will not be counted as available resources to a nursing home resident who applies for Medicaid benefits if the other joint owner refuses to participate in a sale of the property.

For decades, such assets have been disclosed by nursing home residents on their Medicaid applications and such assets have been valued at zero for purposes of determining Medicaid eligibility.

Recently, however, a Medicaid applicant was denied Medicaid coverage for nursing home care because the applicant owned stock, in certificate form, with her son in joint ownership, even though the son had refused to participate in a sale of the stock. Ordinarily, such a denial by a Medicaid caseworker would be overturned when the case was appealed to an Administrative Law Judge, but in this case, the Administrative Law Judge ignored the specific regulation in the Maryland Medicaid Manual that explicitly states that jointly owned stock should not be a countable asset where the joint owner refuses to sell.

Such denial has implications, not only for the particular individual whose Medicaid application was denied, but for Medicaid applicants statewide. Indeed, this case has been appealed to the Circuit Court of Maryland where a senior Assistant Attorney General, representing Maryland’s Medicaid authority, the Department of Health and Mental Hygiene, essentially has requested the Circuit Court to issue a decision that radically revises the long standing Medicaid policy concerning such jointly owned assets.

If the Circuit Court were to uphold the decision of the Administrative Law Judge in this particular case, then it would shroud the process of dealing with jointly owned assets in a cloud of uncertainty. No longer would Medicaid applicants and their advisers be able to act with certainty regarding jointly owned assets, as there would exist the possibility that Medicaid caseworkers could arbitrarily ignore the applicable rule on the strength of judicial precedent.

This is not the proper way for the Medicaid authorities to change their policy. The proper way is to propose rule changes, either by changing the Code of Maryland Regulations, or by changing the Maryland Medicaid manual. Simply leaving a rule in place that exempts joint assets from consideration, but then attacking such an arrangement by imposing Medicaid ineligibility on a case-by-case basis on unsuspecting Medicaid applicants is bad public policy.

The State’s efforts to deny benefits in the case under discussion in this article is an example of such bad public policy.

William M. Gatesman is following the progress of this case closely and will inform the readers of this website of any new developments as they arise.

In the meantime, Mr. Gatesman stands ready to assist clients with prudent Medicaid eligibility and asset protection planning in the context of a changing landscape.

Protecting Property After Death

Mother dies with a will leaving all of her assets to her three children in equal shares. One of her adult daughters receives Medicaid benefits because her assets are less than $2,000 and she has a very low income due to a disability. Such daughter is expected to receive a distribution of $25,000 from mother’s estate. This will cause daughter to lose her public benefits, which will be disastrous for daughter given the very high costs of her medications.

While daughter could petition a court to create a special type of Supplemental Needs Trust, known as a “d4a trust” and once she receives the distribution from the estate, deposit the funds into such trust, there are significant costs to establishing such a d4a trust, and there are administrative burdens associated with such trust, including annual reporting to the State Medicaid authority. Moreover, a d4a trust requires payback to the state for any Medicaid benefits if there are funds remaining in the trust when the trust beneficiary dies. Given the amount to be distributed, one must weigh whether it is worth the cost of setting up a d4a trust if there are other less costly alternatives.

Fortunately, Maryland law provides an opportunity for a trust to be created in a simpler way. Under the Maryland Discretionary Trust Act, a trust may be established for a beneficiary, and the assets in the trust will not be considered to be available resources for Medicaid purposes. Moreover, unlike a d4a trust, there is no requirement to pay back Medicaid for benefits received during lifetime after the beneficiary dies.

While Mother in her will could have provided for a Maryland Discretionary Act trust for daughter, she failed to do so. Nevertheless, the Maryland Discretionary Trust Act provides that “any person having a right to transfer property to another person may create a trust as a transferor under [the Maryland Discretionary Trust Act].” Under this law, the term “person” includes any legal entity, and a probate estate is a legal entity.

William M. Gatesman presently is working with clients to come up with creative solutions to allow estate beneficiaries to retain their essential public benefits where the decedent’s will did not provide for asset protection in light of those public benefits. Establishing a Maryland Discretionary Trust Act trust is one of the tools in Mr. Gatesman’s tool kit to achieve the objective of protecting a beneficiary’s eligibility for public benefits.

How to Prevent The Never Ending Estate

Some workers who have received judgments in their favor from their former employers for work related disease or injury, such as asbestos related injuries or coal mining related diseases, find that the judgments are paid out over time, sometimes in the form of small amounts paid now and then over a period of many years. Some of these individuals have died and their probate estates have been wrapped up and closed. Then, out of the blue, another check arrives with a payment on the injury or disease settlement.

Once such check arrives, notice must be given to the Register of Wills in the county in which the estate had been opened, a supplemental inventory and account filed, and distribution made (with the payment of an additional probate fee in some circumstances). If a lawyer assists with this process, there will be legal fees as well. This is a cumbersome and costly endeavor, sometimes for a very small amount of money.

This continuous process of reopening the estate each time a settlement check arrives can be avoided with the proper assignment of future settlement payments to the beneficiaries of the estate when the final estate administration account is filed and the estate closed. Such assignment can grant the Personal Representative of the estate continuing authority to transact checks to make the distributions to the beneficiaries.

The Gatesman Law Office assists clients with the process of simplifying life for estate beneficiaries by arranging for the distribution of such settlement awards that might be received after an estate is closed without the necessity of continually filing supplemental inventories and accounts year after year.

Legislature Tinkers With Power of Attorney Law

The Maryland legislature once again has tinkered with the law governing powers of attorney in Maryland. That law includes Power of Attorney Forms, which if used, or if one’s power of attorney is “in substantially the same form” as one of the form documents, then the law bestows certain rights on the holder of the power of attorney, namely, the right to obtain payment of one’s legal fees from the person or institution who refuses to honor the power of attorney where a legal action is taken to compel acceptance. This right to legal fees differs from the general “American rule” of jurisprudence which holds that each litigant in a legal action must pay his own legal fees.

Unfortunately, the forms in the statute are generally not sufficiently comprehensive and lack certain important provisions.

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October Brings New Laws Affecting Probate in Maryland

There are several new laws affecting probate in Maryland that became effective October 1, 2012. This article will address those statutory changes.

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When a Mere Guardianship is Not Enough

Father, who had been enjoying late middle age, had a brain aneurysm and now is in a permanent coma. Unfortunately, he did not have a power of attorney or advance directive, so his adult son could not access his bank account, in which he had $20,000. He has no other assets. Father’s hospital and nursing home bills now exceed $300,000.

Son applied for Medicaid for his father but was denied benefits because Medicaid will not be allowed if Father has more than $2,500. Unfortunately, without a power of attorney, no one has the authority to spend the funds in Father’s bank account so that he can get Medicaid benefits.

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