Walnut Creek Elder Law Blog

     Medicare is a Federal health insurance program. Social Security funds are used to pay the costs of the program. Individuals who are over the age of 65, and who have made Social Secuirty contributions during their working lives are entitled to benefits. Part A of Medicare pays for hospitalization, hospice and some health care. It also pays for rehabilitation in a nursing home for specific periods of time. Part B is designed to pay for outpatient hospital care and doctors’ visits. Co-payments, deductibles and monthly payments may be required for Part B.  

     If a person is hospitalized for three days under Medicare, and then goes into a skilled nursing facility (SNF), Medicare will pay pay 100% of the bill for up to 20 days in the SNF. After that, for days 21 to 100, Medicare will pay only for 80% of the cost. During this time, the Medicare recipient will be required to make a co-payment, through supplemental insurance or will pay privately.

    After 100 days, there is no Medicare coverage for a SNF. After that time, you must pay privately, pay through your long term insurance policy (if  you have one) , or qualify for Medi-Cal to pay for the SNF. The average stay in a SNF under Medicare is under 24 days. Medicare and Medi-Cal are two different programs, and are not related to each other.

     Planning for Medi-Cal qualification should be made early on, through your elder law attorney. There are qualification requirements with regard to assets, income,  spending down, gifting, and a share of cost which goes to the the nursing home. There are legitimate and legal methods through the Medi-Cal regulations to protect assets and create qualification for Medi-Cal. You may visit our web site at htt://WalnutCreekElderLaw.com, for information on how to plan for and how to qualify for Medi-Cal. The estate planning documents, including the financial durable powers of attorney and revocable living trust are usually updated to include government benefits and asset protection language. If a client loses mental capacity, and this language is not present in the estate planning documents, qualification for government benefits, including Medi-Cal, and asset protection is much more difficult.

 Written Michael J. Young, lawyoung1@gmail.com, elder law attorney in Walnut Creek, CA. www.WalnutCreekElderLaw.com mike@WalnutCreekElderLaw.com. 1931 San Miguel Dr., Suite 220, Walnut Creek, CA 94596. 925-256-0298. Mr. Young, who also advises on Medi-Cal qualification, asset protection, nursing homes and the VA Aid & Attendance qualification, serves Contra Costa and Alameda Counties in CA, including the cities of Walnut Creek, Alamo, Danville, Concord, Brentwood, Pleasant Hill, Antioch, Clayton, etc.

VA BENEFITS MAY COVER THE COST OF AN ASSITED LIVING FACILITY OR IN HOME CARE

www.WalnutCreekElderLaw.com. As we discussed in previous Elder Law Today newsletters, the Veteran’s Administration provides a wonderful pension benefit for those individuals who served at least one day during a period of wartime and are now disabled due to non-service connected reasons (aging related issues,  Alzheimer’s, Parkinson’s, multiple sclerosis, and/or other physical disabilities).  This pension, referred to as “Aid and Attendance Allowance”, may pay  the long term care provided in an assisted living facility, or in-home care.  

The “Aid and Attendance” (A and A) benefit is available to a veteran who is disabled and requires the aid of another person to perform the personal functions required in everyday living.  A veteran can show they are eligible if they have a substantial need for assistance with the activities of daily living.  Such activities include bathing, dressing, meal preparation, etc.  A veteran would also qualify for this pension if they can show they need the attendance of another person in order to avoid the hazards of his or her daily environment.  The need for assistance does not have to be permanent.

 Under this program, a veteran can receive up to  $1,644.00 per month or $19,736 per year in benefits, and a widowed spouse can receive up to $1,056.00 per month of $12,681 per year in benefits.  The applicant must be “permanently and totally disabled” under the VA rules.

The vet does not need to be helpless under the rules. He only needs to show that he is in need of aid and attendance on a regular basis. Someone who is housebound or in an assisted living facility and over the age of 65 is presumed by the Veterans Administration to be in need of Aid and Attendance.

Eligibility for the program is based on the income and assets of the veteran. In determining income, deductions are allowed for unreimbursed medical expenses (UMEs). In home care workers are an allowable deduction, provided that some medical or nursing services are provided. Also, the cost of an assisted living facility, or a portion thereof, can be an allowable medical deduction against gross income. 

 In addition, a family member can provide in-home care for a veteran who is applying for aid and attendance.  In order to meet the disability criteria, the care services provided by an unlicensed relative must be prescribed by a health care professional (ex. doctor, RN, LPN or licensed physical therapist) and the professional must consult with the unlicensed relative caregiver at least once a month (in person or by telephone) to monitor the regimen.  In addition, there must be a valid care contract in place and the caregiver must be receiving no more than fair market value for services he or she is providing.

If you or someone you know is a Veteran receiving care in an assisted living facility, or at home, please encourage them to file a claim for this benefit. It would be prudent to seek the guidance of an experiended elder law attorney who is accredited by the VA.

 CAVEAT: When planning for this VA benefit, you should also plan for Medi-Cal benefits and coordinate all of this with your elder law estate plan at the same time. An elder law estate planning attorney, who is also accredited by the VA, is best equipped to help you with this planning. When seeking help for this VA benefit, always ask if the person helping you is accredited by the VA.  

 The following are some additional requirements for eligibility:

 a. Be a veteran who served at least 90 days of active duty.

b. At least one day of active duty had to be during wartime: WWII – 12/7/41 to 7/25/47 – Korea – 6/27/50 to 12/31/55 – Vietnam – 8/5/64 to 5/7/75;

c. Does not need to have been in combat;

d. Discharged other than dishonorably;

e. Income less than $1,644 per month, once out-of-pocket medical expenses are considered.

f. Net worth less than approximately $50,000 for singles or $80,000 for couples.

g. Gifting of assets is allowed with no look-back period, but must be coordinated with Medi-Cal planning and gifting, which does have a look-back period.

 If you or someone you know is a Veteran receiving care in an assisted living facility, or at home, please encourage them to file a claim for this benefit. It would be prudent to seek the guidance of an experiended elder law attorney who is accredited by the VA.

Elder Law Today is written by Michael J. Young, Attorney at Law, 1931 San Miguel Dr., Ste. 220,  Walnut Creek, CA 94596. This information is for general informational purposes only, and does not constitute legal advice. For specific questions, you should consult a qualified attorney. MIKE@WALNUTCREEKELDERLAW.COM

For additional information, such as upcoming seminars, past newsletters, and to listen to an interview with attorney Michael J. Young, visit  www.WalnutCreekElderLaw.com.

Office: (925)-256-0298

UPCOMING SEMINARS BY ELDER LAW ATTORNEY MICHAEL J. YOUNG:

Dates: Fridays, January 8 and 22, from 2:00 to 3:30 p.m. at the Law Offices of Michael J. Young, in the Channell Room. For reservations call 925-256-0298.

For Medi-Cal qualification, the community spouse (well spouse) is allowed to have $109,560 (in 2009) in non-exempt, or countable assets. This is called the Community Spouse Resource Allowance, or CSRA, which increases yearly based upon the Consumer Price Index.

Only non-exempt assets are counted for the CSRA. As a result, IRA’s in the name of the well spouse, which are exempt, are not counted. Also not counted are a car, the house, household goods and jewelry in the name of the well spouse, plus the $109,560. Once the ill spouse is eligible for Medi-Cal, any assets acquired by the well spouse will not affect eligibility of the ill spouse. So, an inheritance received by the well spouse after the ill spouse is qualified, will not affect eligibility of the ill spouse.

In addition, under California law, the well spouse can keep all of her income. In addition, she is allowed to have what is called a minimum monthly maintenance needs allowance of income (MMMNA) of $2,739. If she is under that amount, she can receive a portion of her ill spouse’s income, to bring her up to that amount. 

The impoverished spouse statutes state that if the $109,560 CSRA, and/or the $2,739 MMMNA are insufficient for the well spouse to live on, she can file for an administrative hearing or file a petition with the court to have these amounts raised.

 By Michael J. Young, elder law attorney in Contra Costa County. Our offices are located at 1931 San Miguel Dr., Ste. 220, Walnut Creek, CA 94596. (925) 256-0298. Please visit our website at www.WalnutCreekElderLaw.com

 Michael J. Young, elder law attorney advises clients in Walnut Creek, as well as surrounding  towns such as Danville, Concord, Brentwood and Antioch.

If you die after having been on Medi-Cal, the State can pursue a claim against your estate for recoupment of the money they paid to the nursing home. But, if there are no assets in your estate when you die, there will be nothing for the State to recover. The State will not pursue a claim however while the surviving spouse is alive. There are also exemptions if there is a minor, blind or disabled child of the recipient, living at the time of the recipient’s death.

 It is a common misconception that the revocable living trust of the recipient provides protection against a State lien. California will pursue claims against assets in living trusts. They will also pursue claims against joint tenancy interests and tenants in common, for instance. The amount of the potential recovery is limited to the amount of the benefits paid by Medi-Cal, or the value of the recipient’s estate, whichever is less. If your home is encumbered by a mortgage, this will reduce the available equity the State could pursue.

 An elder law attorney who is familiar with the Medi-Cal rules and regulations, can help you qualify for Medi-Cal, and can help you legally arrange your assets so that they will not be susceptible to a lien after you die. This process will also allow you to preserve your assets for a longer period of time while you are live. Remember, that if you run out of money, you run out of options.

 By Michael J. Young, Elder Law Attorney.

 Mr. Young practices elder law in Contra Costa County, and his office is located at 1931 San Miguel Dr., Ste., 220, Walnut Creek CA 94596. (925)-256-0298. He advises clients in cities such as Walnut Creek, Concord, Danville, Alamo, Antioch and Brentwood. You may visit his website at www.WalnutCreekElderLaw.com.  Mr. Young helps clients qualify for Medi-Cal benefits to pay for nursing home costs. He also helps clients qualify for the V.A. Aid & Attendance pension benefit for wartime veterans to help pay for in-home care. Many of Mr. Young’s clients are Alzheimer’s or Parkinsons’s disease patients.

Parkinson’s disease is a brain disorder, wherein certain nerve cells in the brain become impaired or die. These nerve cells, called “neurons” normally produce a chemical known as dopamine. This chemical allows for smooth, coordinated functions of the body’s muscles and movements.

When a high percentage of the brain cells which produce dopamine are impaired, symptoms of Parkinson’s disease may appear. Symptoms may include tremors, changes in facial expression, imbalance, small handwriting and slowness of movement. In time, the symptoms may become worse. Mild tremors can become more severe. Body movements may also become slower, and mobility problems may become worse. The use of eating utensils, dressing, and performing various activities of daily living may become more difficult.

Parkinson’s disease, which is difficult to diagnose officially, affects both sexes in equal numbers, and does not discriminate on the basis of ethnicity, social status or where you live. There are different rates of progression for the disease. We encourage our clients who have Parkinson’s disease and their familiy members to seek the help of support groups, to pursue ongoing medical care, and to learn adaptive techniques from medical professionals.

 Parkinson’s disease is the most common brain disorder, after Alzheimer’s disease, that we see with our clients. When symptoms of Parkinson’s disease appear, as with symptoms of Alzheimer’s disease, we receive inquiries from individuals who may have the disease, or from their loved ones. They want know what should be done now regarding the establishment of a long term care plan for the person with the disease.

We help clients review and update their existing estate planning documents, to be sure the documents contain the requisite asset protection language. We then help the family plan for long term in-home care, which is the preference of most of our clients. We help the family plan for the VA Aid and Attendance benefit, which can help pay for in home care, for veterans. We also help with planning for Medi-Cal benefits, which can pay for nursing home care.   

 If you or a loved one has symptoms of Parkinson’s disease, please feel free to call elder law attorney Michael J. Young, with offices in Walnut Creek, CA, at 925-256-0298. Mr. Young serves clients principally in Contra Costa and Alameda Counties. You can visit our web site at www.WalnutCreekElderLaw.com

If you run a home health agency, you probably feel like you are wearing a hundred different hats, from finding the right employees,  to dealing with all of the issues they bring with them. Moreover, you are communicating with clients who are stressed out and who are wondering how they are going to be able to pay for your valuable services.

Did you know that there is a Federal program that can pay your clients directly, to help defray the cost of their in home healthcare.  This is the Veterans Administration Aid & Attendance benefit program that is available to veterans and to their surviving spouses. In order to qualify, clients who are veterans or who are surviving spouses of veterans, need to meet required income and asset limitations. These requirements can be legally and honestly met, through the help of an elder law attorney accredited in this area. 

For married couples, the benefit can be as much $1,949 per month or more, and for surviving spouses of a veteran, the benefit can be as much as $1,056 per month or more. 

The benefit to your clients is that this program provides an additional source of funds to them, to help pay the cost of in home care that you are providing to them.  Our clients all want to stay at home as long as possible, and we all know that it is better for all involved, if our clients can stay home longer.

If you’d like to learn more about how the VA Aid and Attendance program works, then I’d like to invite you to a workshop I will be hosting for home healthcare providers here at our offices. We will be sending additional information to you regarding upcoming programs. We are also available for in-service programs regarding this benefit. You may contact our offices for additional information, and feel fee to check our website at www.WalnutCreekElderLaw.com.

By Michael J. Young, Elder Law Attorney, with offices in Walnut Creek, and serving Contra Costa and Alameda Counties.

The Law Offices of Michael J. Young Present An Elder Law Seminar – “DON’T GO BROKE IN A NURSING HOME” – “How To Get Medi-Cal Coverage For Your Nursing Home Care … Without Selling Your Home or Leaving Your Family Without a Dime”

In the Workshop Learn How to get Medi-Cal coverage for your Nursing Home Care, Without Selling Your Home or Leaving Your Family Without a Dime. One of our biggest fears is having our life savings wiped out if we end up in a nursing home. Whether you or a family member is in a crisis or not, it is important that you understand what to do now to protect your hard-earned assets.

Also, learn about the Veterans Administration Aid & Attendance Benefit, for war time veterans. This V.A. program can help pay for in-home care, board and care costs, and costs for assisted living facilities.

At this workshop, here are some items we will discuss:
How to protect your home against a Medi-Cal lien.
How to avoid having your life savings wiped out by a nursing home spend down.

The asset protection language that most people do not have in their revocable living trusts and financial durable powers of attorney.

The Veterans Administration Aid & Attendance Benefit.
A glimpse at the new Medi-Cal rules under the Deficit Reduction Act, which is coming soon to California

Attendance at this workshop is free, but seating is limited. You can reserve your spot at the workshop by calling (925) 256-0298.

We will also be distributing our Alzheimer’s Legal Survival Guide, and our Nuts and Bolts Guide to Veterans Benefits.

Please check the website for seminar dates.