Elder Law / ALTCS / Medicaid
Americans have to face complex legal and medical challenges as they age including deteriorating health, financial concerns, and family disputes. Elder law attorney phoenix senior Americans and their loved ones to plan, prepare for and avoid these legal and medical issues.
Our experienced attorneys are specialists in dealing with the following elderly concerns:
• Long-term care planning
• Healthcare planning, including powers of attorneys and living wills (advanced healthcare directives)
• Estate planning
• Business succession planning & asset protection
• Selecting the right long-term care facility
• Qualifying for public benefits such as Social Security, Medicaid and Veterans Benefits
• Conservatorships and Guardianships
• Prevention of financial exploitation and elder abuse
We work diligently to ensure that our senior clients are fully protected, and if required, also communicate with their caregivers, spouses, children, doctors, social workers, and home aides, so that they continue to enjoy a high quality of life.
Long-Term Care Options
The financial burden of long-term care at a rate of $10,000 or more per month, has made “planning” an imperative step for most middle-class seniors and their families, for certainty and peace of mind in future.
• Long-Term Care Insurance / LTC Insurance:
Many can’t afford the high cost of long-term care insurance or are not aware of what their insurance policy covers. Many policies have high deductibles or provide for only a short period of care in the facility and many who have long-term care insurance still have to resort to Medicaid to pay for their care.
Another long-term care option is Medicaid, a joint federal-state program, which provides medical assistance to low-income individuals, including those who are 65 or older, disabled or blind. Medicaid serves as the last resort for people who have no other way to pay for their long-term care. Medicaid eligibility rules vary from state to state; however, federal minimum standards and guidelines must be observed.
Medicaid eligibility has become more complex in the past years due to restrictive rules on Medicaid eligibility requirements like the Deficit Reduction Act of 2005 which went into effect in 2006. There are many regulations involving look-back periods, income caps, transfer penalties, and waiting periods to plan around.
Our attorneys have the expertise to help you avoid the high cost of long-term care and in understanding Medicaid eligibility requirements and applying for it.
• Planning for Incapacity
What happens if you become incapacitated? How will you manage your financial affairs?
Many are under the mistaken impression that our spouse and children will automatically take over our finances. The truth is that in order for our family or others to be able to manage your finances, they must petition a court to declare you legally incompetent. This process can be lengthy, costly and stressful.
Moreover, the person appointed by the court may have to come back to the court every year to show how each and every penny is being spent. If you want your family to immediately take over for you, you must designate a person(s) that you trust who will have the authority to withdraw money from your accounts, pay bills, take distributions from your IRAs, sell stocks, and refinance your home, in case of incapacity. A will does not take effect until you die and a power of attorney may be insufficient.
Planning for medical care during Incapacity
The law allows you to plan for your medical care, by appointing someone you trust to make decisions on your behalf about medical treatment options if you lose the ability to decide for yourself. You can do this by using a durable power of attorney for health care where you designate the person to make such decisions. In addition, you should have a living will which informs others of your preferred medical treatments, in case you become permanently unconscious or terminally ill.
Planning for Long Term Care
What is Long-Term Care?
Long-term care is a range of services and support for your personal care needs or helps with basic personal tasks of everyday life, called activities of daily living.
What is Medicare?
Medicare is the federal health insurance program for people who are 65 or older, and including people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD).
Does Medicare cover Long Term Care?
No, Medicare doesn’t cover long-term care, also called custodial care or nursing home care.
What is nursing home care?
Nursing home care is custodial care, like help with bathing or dressing. Medicare doesn’t cover Nursing home care, but it does cover skilled nursing care (like changing sterile dressings).
What is Medicaid?
Medicaid is different from Medicare. Medicaid is a joint federal and state program that helps with medical costs for people with limited income and resources. It offers benefits not normally covered by Medicare, like nursing home care and personal care services.
Does Medicaid cover Long-term care?
How to apply for Medicaid?
Each state has different rules about eligibility and applying for Medicaid.
Medicaid/ALTCS/ Long-term Care Planning
Medicare is available to help at the onset of any medical issues but only cover long-term care issues for a few months. After which your options to pay for in a home, assisted or skilled (nursing home) care are:
• Self Insurance
• Long-Term Care Insurance: If you were fortunate enough to be able to afford this insurance when you were 50 or 60, such insurance can go a long way to providing the senior the funds they need to pay for long-term care.
• VA Aid and Attendance Pension Benefit: If you or your spouse were a veteran who served during a war era (ie WW II, Korea, Vietnam etc), you can qualify for long-term care benefits of up to $2,100 per month tax-free. Financially qualifying for this benefit is fairly straightforward but may involve shifting some of your assets to an irrevocable trust.
• Medi-Cal/Medicaid: Medicaid will pay your long-term care expenses if you have less than $2,000 in liquid assets (cash & securities). However, for most seniors, qualifying for Medicaid is notoriously complicated. Medicaid will help you cover nursing home care costs which are normally very expensive. Our Medicaid Planning Attorneys can help you to qualify for this benefit, understand the Medicaid system and get Medicaid benefits.. Please call to make an appointment at 623-236-2476.
FAQs regarding Medicaid Benefits
How do I qualify for Medicaid benefits in Arizona?
In order to qualify for Medicaid in Arizona, you must be:
1. a resident of Arizona and a U.S. Citizen or have proper immigration status.
2. 65 years or older, blind, or disabled.
3. having the medical need to be in a nursing home. (A state-employed nurse will determine this need.)
4. meet the income cap
Why do I need Medicaid planning?
In order to be eligible for Medicaid in Arizona, in the long term, you must not make over a certain amount. With a 5-year look back period in place, you are not able to spend down in Arizona in order to meet the income standard. The look-back period is in place to evaluate whether you have tried to give away assets in order to meet the income cap and this amount will be applied before your Medicaid will come into effect. This is why Medicaid planning is so important to do years prior to the need for a nursing home. In order to retain Medicaid benefits, planning is very important because benefits will be withdrawn if the income cap is ever exceeded.
Why do I need an attorney for getting Medicaid Benefits?
Medicaid system is incredibly complex. The details of the Arizona Medicaid income cap are extensive.
a) A Medicaid applicant’s income cannot exceed $762 for individuals. If married and only one person is applying, the income cap is $1,123. If both married individuals are applying than the income cap is $1,164.
b) Income may consist of Social Security, VA benefits, annuities, Supplemental Security Income, IRA’s, and other income generating assets.
c) There is an exemption for $50 a month in personal need allowance and so that income will not be included in the Medicaid calculation.
d) There are assets that will be exempt from the Medicaid calculation which includes:
• Exempt assets: $2000 or less in cash or, if married $3,000
• One home up to $552,000 if the applicant is planning to return, or a spouse remains, a child under 21 remains, or a disabled person remains in the home. If the applicant does not return, the home may be sold after a year and the amount applied to care.
• One car
• Burial fund of no more than $1,500 per person, if placed into an irrevocable trust then $7,500
• None saleable property, household furnishings, furniture, clothing, jewelry, and other personal effects.
• Life insurance $1,500 or less.
e) If an available asset is not exempt, it must be sold and the money applied to care before Medicaid will come into effect.
f) Giving assets away for the purpose of qualifying for Medicaid can create severe penalties. If you give away an asset that is worth $100,000 and the state Medicaid penalty is $5,000 per month, this number is usually generated by the average monthly nursing home cost in the state, then you will have to cover your own care for 20 months after you apply for benefits before Medicaid will take over, assuming you otherwise qualify for Medicaid. The penalty period is something to consider when planning for Medicaid.
g) The State of Arizona may also pursue recovery against an estate for recovery of Medicaid benefits paid. More often than not, the only asset remaining in the estate at the death of the individual who received Medicaid benefits is the personal residence. This should also be addressed during the Medicaid planning process. There may be ways to save personal residence from being recovered by the State, but, like all things relating to Medicaid, it can be very legally complicated.
Contact our experienced elder law attorney Phoenix at 623-236-2476 to plan for and get your Medicaid benefits and protect your income and assets.
How do I protect my estate from Medicaid Estate Claim?
To qualify for Medicaid you must have minimal cash or cash equivalents at the end of each month. However, you can still own a personal residence and qualify for Medicaid.
During your lifetime, the state will not do anything to your home no how to matter how much Medicaid benefits you use. However, once you pass on, the state will put an estate claim on any real estate that you or your living trust still owns at that time.
To avoid this encumbrance, you will want to get your property out of your estate and into a Medi-Cal Personal Residence Trust. This trust allows you to continue to live in your home if you leave the nursing home but the home will no longer be in your name and thus no longer subject to the Medi-Cal lien. The trust can be drafted to pass on your interest in your home to your kids upon your passing and because the trust is irrevocable, your home will not be exposed to yours or your children’s creditors. Your kids still get your low proposition 13 property taxes and a stepped-up basis when you pass on.
For more information, Call our Medicaid Attorney today at 623-236-2476.
What is the ALTCS?
ALTCS stands for Arizona Long Term Care System. It is a part of AHCCCS, the Arizona Health Care Cost Containment System. ALTCS is the state program that implements the Federal Medicaid program within the State of Arizona. Approximately 50% of all nursing home patients have part of their stay paid for by the ALTCS Program.
What does ALTCS pay for?
ALTCS pays for room and board, all medical and hospital care, prescription medications.
ALTCS offers a complete array of acute medical care services, institutional services, behavioral health services, home and community-based services (HCBS) and case management services for all eligible persons