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By John M. Bigler New York State provides extensive benefits through the community Medicaid program. This state is as generous, if not more so, than any. However, there are actually people who are residents of nursing homes being paid for by institutional Medicaid who are in the nursing home simply because they couldn't afford to stay at home. This is one of the great injustices of the Medicaid law. Now we may have a new planning device to help people afford to stay in the community.
Worse still, once approved for Medicaid, a recipient can only retain $662 a month of income for the year 2003. For example, if a senior living in Southold receives a Social Security retirement benefit of $1,062 and a pension of $600 for a total income of $1,662, then that individual is $1,000.00 over the income allowance. That means that prior to Medicaid paying for any benefits, that individual must pay $1,000 of his/her income toward certified medical expenses each month. The recipient is now limited to $662 each month to pay for food, shelter, clothing and any other expense that might arise.
Clearly, for most people this is an impossible task. As discussed in the past, there's no penalty or period of ineligibility for transferring resources to make oneself eligible for community Medicaid but it has always been impossible to transfer income. Therefore, fortunate people with maybe $100,000 in resources and a reliable family member to transfer assets to can make themselves eligible for community Medicaid immediately and can then have the family member supplement the $662 each month with some of the transferred money. In this way, such people should be able to afford to stay in the community for a longer period of time. As for those unable to transfer assets, either because they don't have any or because they don't have a reliable person to whom they can make transfers, they, in effect, are at the mercy of the department of social services and very often will simply not be able to remain in the community.
Now, we have a possible method for protecting the monthly income of a Medicaid recipient over and above $662 per month. The New York State department of social services appears to have given its approval to the idea of a charitable pooled income trust for seniors. The idea is that a trust would be set up for the individual Medicaid recipient, which would be linked to a trust for the benefit of a particular charity. Each month an individual's excess income would be transferred to the charity and for a nominal fee, the charity will use the excess income to pay the recipient's monthly expenses. Expenses can include mortgage or rental payments, food, clothing or even entertainment expenses. Rather than the recipient paying these bills directly, the bills will be sent directly to the charity, which will make payments from the trust. If there's any income left in the trust at the time of the recipient's death, that money would go to the charity.
This could be a wonderful way for people with limited assets but significant income to be able to remain in the community. Obviously, it also makes financial sense for the local departments of social services to provide community care rather than institutional care. There's still some uncertainty regarding the effectiveness of these trusts. New York City has challenged the trust and a fair hearing is scheduled. Hopefully, the state and the county departments of social services will realize that the pooled income trust is a good thing not only to reduce the expense of institutional Medicaid, but also as a benefit to charities.
Reprinted with permission of the Suffolk Times © 2005 [ Contact Us ] [ Guestbook ] [ Email ]  The Law Offices of John M. Bigler, Attorney At Law 1421 Wantagh Avenue, Wantagh, New York 11793-2206 1-888-ELDER-LAW · 516-409-6565 · Fax: 516-409-6522 E-Mail: info@biglerlaw.com · Web Site: www.biglerlaw.com |
If you're in a nursing home, obviously all of your needs on a 24-hour-a-day basis are being provided for. However, in the community, the local department of social services will make a determination, after a medical evaluation, as to how many hours a day and how many days a week aides will be provided. More often than not, the hours provided are less than what the applicant and his or her family feel is necessary.