Author Archives: Adam Roa

Elder Exploitation

Our firm was recently successful in helping a family recover funds for an elderly mother and her adult disabled son who was subject to guardianship.  The person of interest was a neighbor who posed as an accountant to prepare the elder mother’s and her disabled son’s tax returns. Unknown to our client was that this this individual opened numerous accounts and credit cards and misappropriated over $100,000 worth of their assets. Our firm was successful in obtaining the return of those assets. We recently were informed by the family that the perpetrator was successfully prosecuted and is now serving a significant jail time for her actions in taking funds from our client and her disabled son.

Another Win! – Will Contest

We had another will contest win.  Our client was gracious enough to send us a card expressing her thanks.  This is what she had to say:

“Thank all of you for the way you handled our case.  You guys are wonderful.  Along with being very professional, you showed us such compassion.  You guys went over and beyond to make sure the wrong to us was made right.  We cannot thank you enough.  We will highly recommend you.  Thank God for all of you.  Sincerely, B.J.

P.S.  Wow!!! What a check (smile).”

Another Win! – Medical Assistance Issue

We just won another Medical Assistance appeal issue.  In this case, Medical Assitance was initially denied for nursing home benefits and the son of the Medical Assistance applicant was handed an invoice from the nursing home for over $100,000.  Needless to say, he was upset.  We were able to successfully argue that that the transactions at issue were not Medicaid Penalty transfers and that full Medical Assistance benefits should have been granted from day 1.  We received the Administrative Law Judge opinion today removing approximatley 98% of the penalty.  Client is happy.

Should I Sign the Nursing Home Contract?

A very common situation for my clients (or potential clients)  find themselves in is the chaotic situation of transferring their parent from a hospital to an area nursing home for rehabilitation.  It is in this situation, when emotions are high, people are tired, that the nursing home will, at the last second, wants the son or daughter admitting the parent to sign a 60+ page nursing home contract.  Of course, the nursing home contact (usually the nursing home admissions director) is very friendly and advises that “don’t worry” this is just for your parent’s assets and does not obligate you to use your own funds for nursing home expenses.  Often times the nursing home will demand that the contract be signed before admission (even if the hospital is in the process of discharging from the hospital).  Often times this is an extremely hectic situation and the last thing that is on the son’s or daughter’s mind is a careful review of the nursing home contract.  To be clear:  under no circumstances should the contract be signed until an elder law attorney reviews the contract.  It is a very routine question to ask the nursing home to allow time for their elder law attorney to review the contract.  No matter how friendly the director of admissions person is, if there is a shortfall in payment or the Medical Assisstance application goes awry, the nursing will look for however signed the contract to pay the nursing home bill in full.  I had a recent case where the nursing home assured the son that there was nothing to worry about and had him sign the contract in his name.  The nursing home handeled the Medical Assistnace application.  Unfortunately, the Medical Assistance application was denied.  The next day, the nursing home delivered an invoice to the son for immediate payment for $100,000 for unpaid nursing home bills.  Nursing home contracts are sophisticated documents with good attorneys hired by the nursing home that will use this contract against you.  It is absolutely critical that an elder law attorney review that contract as soon as possible.  If the contract is already signed, then the situation becomes more complex.  In either event, a competent elder law attorney should be immediately contacted.

Two Guardians?

Can We Have Two Guardians Serve at the Same Time?

The answer to this is easy: yes.   However, the more interesting question is should you have two individuals serve as guardians at the same time.  Remember, that as co-guardians each of you would have to agree on every decision.  If you didn’t agree each of you would have to petition the court for resolution.  That is time consuming and expensive.  My general advice for guardianship is to have only one person appointed at a a time.  If that person can no longer serve, then this person should submit a resignation with a petition from the new proposed guardian with, ideally, the written consent of the previous guardian.

Looking for IRA Assets

The issue of whether or not an IRA asset is a countable asset is an interesting issue from a Maryland Medical Assistance perspective.   For individuals and their spouses, when an ill spouse goes into a nursing home and reviews the issue of applying for Medical Assistance for the ill spouse, the issue that routinely comes up is the issue of what is a countable asset towards the Medical Assistance threshold for the community spouse and ill spouse (i.e. how much can the ill spouse and community spouse own and still be eligible for Medical Assistance benefits).  From a Maryland perspective, and IRA account and other forms of retirement accounts are fully countable assets.  This is specifically addressed in the Maryland Medical Assistance Manual and all of the caseworkers are processing Medical Assistance applications counting IRA and other forms of retirement assets as countable assets.  The real question is whether or not Maryland is correct in treating the IRA and other forms of retirement assets as countable assets.  The answer is Maryland may well indeed be incorrect.  We are looking for the right client scenario to push this issue and clarify and correct this fundamental determination that IRA and other retirement assets should not be countable assets.

New Medicaid Numbers

Medicaid Spousal Impoverishment Figures for 2012

The new minimum community spouse resource allowance (CSRA) is $22,728, and the new maximum CSRA is $113,640. The new maximum monthly maintenance needs allowance is $2,841. The minimum monthly maintenance needs allowance remains $1,838.75.  This has yet to be implemented for Maryland.  It is expected to come out shortly.  It is unclear if this will be retroactive to January 1, 2012.

In part, what this means is that the community spouse of a Medical Assistance applicant can have no more than $113,640 in countable assets at the point when she is seeking eligiblity for the nursing home spouse.  The prior maximum amount allowed was $109,560.

Increase in Nursing Home Costs

According to the newly published survey by Metlife, the average cost of long term care continues to rise.  According to the report the average room nursing home rates rose nationwide by 4.4 percent to $87,235 a year or $239 a day, while assisted living facility costs jumped 5.6 percent on average to $41,724 a year or $3,477 a month.

According to the Metlife survey, Baltimore area nursing homes ranged in monthly costs (for a semi private room) from $6,944 to $9,424 a month. The Baltimore area average assisted living costs grew to $3,830 a month. The Baltimore area average home health aide charged $19/hour.

What is a countable asset?

For Medical Assistance (i.e. Medicaid) eligibilty, Maryland will examine the amount of assets held by the applicant and by the applicant’s spouse (if any).  The most the applicant may have at the time of filing is $2,500 and the most a spouse may have (currently) is $109,560.  The bigger question is what is a counable asset?  This may seem to be very straightforward but is absolutely not an easy question to answer.  For example, we often are asked if automobiles are countable assets.  The answer is no, so long as it is not a luxury automobile (however, there is no set defination of a luxury automobile).  Some assets are relatively straightfoward and it is easy to see how they are countable assets.  This includes bank accounts in the applicant’s name.  But what about burial plots?  The applicant is allowed to have 2 burial plots.  But, what if he has his name on 3 burial plots, then what?  That’s when you call your elder law attorney.  What happens if I jointly hold my account with mom and I contributed my own money into mom’s account.  Is “my money” part of her countable asset.  That is when you call your elder law attorney.  What happens if my mom has a reverse mortgage on her house, is this a countable asset?  Again, you need to call your elder law attorney.  The point is, this area of elder law is confusing, it changes, and the deteermination of what is a countable asset does vary state to state.  And, most importantly, the determination of a countable assets will be absolutely critical when filing the Medical Assistance application and determining which assets can be saved.

Nursing Home Asset Protection

A good portion of our clients engaged in virtually no planning (before they came to our office) when faced with a parent or loved one entering a nursing home.  Even in this late stage of the game, there are plenty of opportunities to protect a parent’s or loved ones’ assets from nursing home related costs.  The key document to this process is the financial power of attorney for the nursing home resident.  Without a doubt, this document will be key to the asset protection process.  Ideally, this power of attorney was drafted by an attorney and, if recently executed, conforms with the new Maryland provisions relating to financial powers of attorney.  Without this document, the next question is whether or not the nursing home resident can sign a new financial power of attorney.  Even if this person cannot sign (or should not sign), then seeking court authorization will be neccessary.  The absolute key is that just because one enters the nursing home do not assume that you can’t save assets at that point.  That assumption is totally incorrect.