Gifting

You have $50,000 and want to give to your grandchildren so that the State of AZ (ALTCS) can pay for your care. Why? Because you do not want the State to take it.

Well, the State does not take it but they do expect you to pay for some of your care and if you give away your money you will be penalized.  Meaning you will have to pay for your care until the penalty is over.

Example:
Assisted Living Home payment will be $3,000 a month; you gave away $50,000 which is divided by the private pay rate for Maricopa county ($6,726.48) equals about 8 months of penalty.

In this scenario the person would shelter about $30,000 from the $50,000.

In theory it sounds good but who will help pay the $3,000 while the penalty is in place?

Will those loving grandchildren that accepted the gift help?  The Assisted Living Home places people on ALTCS in shared rooms; are you willing to share a room with someone you do not know?

This might not even be doable if the person does not meet the medical portion of the eligibility process.

Making the right move

When a loved one needs placement and you are in the middle of an application for assistance from AZ Medicaid program/ALTCS you need to make sure the home you are moving to is an ALTCS approved home.

This means that the home or community is licensed by the State and is enrolled with a program contractor to provide the care.

Sometimes homes say they are approved but in reality they have applied with AHCCCS/ALTCS for approval and have not yet been provided with a provider number.

If you are working with a Placement service they should know if the home is already approved or is in the process.

2016 Medicare Premiums

On Tuesday, November 10, 2015, the Centers for Medicare & Medicaid Services (CMS) announced the 2016 premiums and deductibles for Medicare Parts A & B:

 

• Most people with Medicare Part B will be "held harmless" from any increase in premiums in 2016 and will pay the same monthly premium as last year, which is $104.90.
• Beneficiaries not subject to the "hold harmless" provision will pay $121.80.
• The annual deductible for all Medicare Part B beneficiaries will be $166.00 in 2016.
• The Medicare Part A deductible that beneficiaries pay when admitted to the hospital will be $1,288.00.  The Part A deductible covers beneficiaries' share of costs for the first 60 days of Medicare-covered inpatient hospital care in a benefit period.

Resource Assessments

When a married couple apply for Medicaid assistance assets are looked at differently from a single person.  Married couples (well-spouse) can keep up to $119,220 and the applicant $2,000.

In order for these amounts to be allowed a resource assessment needs to be completed by the State workers.  While this seems an easy feat it is not.

A customer does not have to make application for ALTCS/Medicaid benefits to request a resource assessment. However, a first continuous period of institutionalization must be established before a resource assessment can be completed.

This means a medical assessment will have to be completed by the State or if the applicant has been in a community/receiving in home care or other type assistance that can be used to determine what month the State will be looking at to determine how much of the total assets will be assigned to the well-spouse.

Assets owned by either spouse, jointly owned or individually owned will be used to determine the amount to be calculated.

Example:  

The customer and community spouse completed a resource assessment in 3/13. At that time the minimum CSRD was $23,181 and the maximum CSRD was $115,920. Their combined countable resources were $140,000 and the spousal share was $70,000. The couple was notified that they qualified for the CSRD of $70,000. In February 2014 the customer applies for ALTCS, show proof of assets below the $70,000 Community Spouse Resource Deduction and are approved.

Burning bridges

One of the things about being your own boss is that you have to be careful about what you say and do.  No one likes to be offended or ignored.

Most people need something from just about anyone and once you have denied that person the privileged you can forget about getting a good referral from them.

I saw a post on Facebook about a poor gentleman having an accident at as eating establishment inside a dept. store. He was rudely treated by the workers and he probably had Alzheimer's or dementia but most people would not know it and treated him rather rudely.

I do not shop at this store because of their lack of customer service so when I saw this post on Facebook I was not surprised.  Hopefully, someone took action and apologized to this gentleman or family.

Always do your best and act the way you want to be treated. I have found that if you smile, are courteous and honest people respond well to you.

Medicaid applications in AZ

Most people think that when you hire a law firm or elder care specialist they are going to get the application done in no time.

Unfortunately, the State has a mind set of their own and it does not include anyone else.

 Per AHCCCS, MS 1006 states "The application period is 45 days for an ALTCS application.

In some situations, such as a referral made by an AHCCCS Health Plan on a customer who is hospitalized, the case must be treated as a priority and the PAS (medical assessment) must be completed as soon as possible."

While this appears to be set in stone it is not.  An application can take more than 3 months to complete depending on issues such as gifts, Trust reviews, resource assessments, etc...

You also have to consider holidays, vacation time, illness or workers working out in virtual offices.

So the bottom line, yes it is best to have assistance when applying as 73% of those that apply on their own will be denied.  The process will still be long but you will be approved.

How often should I update my estate plan by Scott Jensen, Attorney

How often should I update my estate plan?

This question is one of the most popular that I get from clients and there are many factors that go into the answer. 

As a general rule, I recommend my clients to dust off their documents every three to five years and review their plan.  However, there are many things that can prompt an earlier review than the fact that three years have passed.  Some questions that should be asked if you should come in to update your documents include: 

-Has anything changed financially to my estate?

-Have there been any children born or adopted into my family?

-Has there been a marriage or divorce?

-Has there been a death in the family?

-Have any trustees, personal representatives or other fiduciaries named in my documents passed away? 

-Have I moved?

-What is my current relationship with those chosen as fiduciaries or beneficiaries under my estate plan?

-Has there been a change in the law?

-Have I retired?

As my clients’ family, financial or geographic location changes over time, so can their estate plan. 

Sometimes a person we choose as a fiduciary might be getting older and struggling with good health.  It would be important to update the documents to put in a fiduciary that is better able to carry out those responsibilities. 

Other times, when a person moves there may be differences in the law from state to state that could affect an estate plan.  Furthermore, after a move, a personal residence or other property may need to be titled to a trust to avoid probate or additional administration in the new state. 

There also may be conflicts or reconciliations between you and those named as beneficiaries under your estate plan.  If you fail to update your documents, that beneficiary may receive more or less than your wish.  In other cases it could be important that a beneficiary receive their inheritance at a different age or in a different way protect their inheritance from creditors or in some cases themselves. 

If you are not sure whether or not updates in your documents are needed, it is my recommendation to have an estate planning attorney review your documents and discuss with them your current situation to determine your best options moving forward.