Top 10 Most Important Cuts to MassHealth for Seniors, the Disabled, and their Families

 

Introduction

We at Cohen & Oalican feel it is incumbent on us to keep our Elder, and disadvantaged client base abreast of the changes to our state’s Medicaid program, MassHealth in these economically challenging times.

As a result of the recession, politics, changing demographics, and many other factors, there have been some significant cuts to MassHealth, and other Health Reform programs.

Our job is not to comment on politics or right and wrong, but to help our clients who require services to get those services, without compromising their economic status. A large part of this is navigating MassHealth. Appropriate elder law attorney representation is a tremendous safeguard, our advice is to always PREPARE while you or your loved ones are healthy, not REACT. When you are in need of either, please feel free to contact us.

Briefly, Fiscal Year 2011 has seen an increase of less than 3% in funding, at a time when more demands are being placed on the Medicaid system, with healthcare cost inflation (depending on who is doing the estimates) is running anywhere between 5% and 8%. This means that funding, while it has increased, is not keeping up with healthcare inflation, at a time when overall demand on the fund is increasing due to the pure economics of more and more baby boomers retiring, and more and more younger people entering the Medicaid/MassHealth system due to unemployment from the recession.

to continue…

Alzheimer's and Dementia

 

While most of the country is involved in Valentines activity this week, those who care for elders with special needs are more than aware that this is also Alzheimer’s and Dementia awareness week (February 14th –21st).  This week is the perfect time to show your love for those you care for by having the “tough love” hard conversations with elderly aging parents about their wishes and plans should the disease ever strike.

“Does Dad want to be in an assisted care facility, or a nursing home?”

“Does Grandma look at life with Alzheimer’s or Dementia to be quality of life?”

“Do you have, and where do you keep legal documentation ensuring someone can act financially on mom or dad’s behalf  if they are no longer able to act on their own behalf?”

These are many questions that experts in all fields urge adult children to ask of their parents during this year’s Alzheimer’s and Dementia Awareness Week (February 14th- 21st).  These answers help family’s build a plan, and know how to execute their parents’ wishes in the tragic event that mental illness strikes.  Don’t leave the decisions to when it becomes a battle between siblings, or until there isn’t enough time to financially prepare.  Have these heartfelt conversations now.

“We see so many families that waited on important conversations, that come to us in crisis mode, instead of planning mode regarding Alzheimer’s or Dementia  - Crisis mode is expensive, and results too often in knee jerk, and expensive decisions.” says Boston elder lawyer, Stephen Cohen. “Legally, if an adult child doesn’t know  their parents’ wishes, or can’t put their hands on instruments like a durable power of attorney, they can be left with a legal, financial and tax quagmire, while simultaneously dealing with the physical and emotional needs of this debilitating disease”, adds elder law partner Eric Oalican.

 

to be continued…

Alternatives to Nursing Homes as Nursing Home Populations Swell With Younger Patients - Part 2

 

One of the main reasons cited for this movement of younger people into nursing homes are the budget cuts most states face in Medicare and Medicaid.  In the long term, it is more cost efficient to care for a younger person in their home with part time caretakers.  However, in the short term, this is a more expensive way of treating patients, as the caregivers need to be hired and trained.  In the budget crunch most states are experiencing, short term funding takes priority over long term spending.   Younger people are being moved into nursing homes earlier, as in the short term, this is a more economically viable way of treating them.

According to a study by the AARP Public Policy Institute, the cost of at home care is about a third the cost of providing care in a nursing home or institution.  Many states, however, simply do not have the funding for at home care in their Medicaid programs.

One of the most telling quotes about the movement of younger people to nursing homes is:

“Over the past 20 years, federal laws and policies have established a civil right to get long-term care at home. But NPR's investigation found that is only sporadically enforced.

More than 60 percent of what states spend on long-term care for the elderly and disabled goes to pay for people — like Michelle Fridley — to live in a nursing home. The amount spent on home-based care has grown steadily, but not nearly enough to meet the need. Nationwide, there are some 400,000 people on state waiting lists for home-based care, double the number 10 years ago.”

Frequently attorney’s like our firm, that specialize in caring for the elderly, and those that have long term care needs, must be engaged to support a patient’s right to at home care.  In 1999, the right to at home care was clearly established in the Supreme Court, in the “Olmstead Case”.   In that decision, the Supreme Court stated that the unnecessary institutionalization of people with disabilities is  a form of discrimination.

 

To be continued…

Alternatives to Nursing Homes as Nursing Home Populations Swell With Younger Patients - Part 1

We heard the other day on National Public Radio, that one of the fastest growing populations in Nursing Homes is not the elderly, but rather adults   aged 31 TO 64.

These patients that are victims of disease, accident, health failure, or mental health problems.  Many of these new patients could be cared for at home, or assisted living facilities, but are instead finding themselves in the Nursing Home System.  Young people aged 31 to 64 are the single fastest growing population of nursing homes.  This population has grown roughly 40% since 2000.

This report underscores the fundamental need for legal advocacy when considering nursing home care, or alternatives to nursing home care.

You can see the full report here.

http://www.npr.org/2010/12/09/131912529/a-new-nursing-home-population-the-young

 

All too often, people think of nursing homes as a repository for the elderly, and disability attorneys like Cohen and Oalican as being entirely elder law.  There is a huge sense of accomplishment for us, however, when  we can use our skills and help young people, and their families, to live a fulfilling life, perhaps outside of institutional care, and despite their disadvantages.  We have long been involved in special needs trusts to help protect family’s finances when there is a young (or younger) family member with special needs.

 

To be continued….

Preview of the Proposed New Tax Relief Act of 2010 - Part 3

 

 

Once again.. this is a preview of what is currently under discussion.  It is NOT law, and should not be looked at as political, legal, or financial advice.  This is only  a brief look at some of the currently debated act, as it impacts our senior clientele.

 

Estate Tax
Top on the list for most of our elder law clients, is preserving their estate.  Below are the changes, verbatim, on what we may expect to see in tax relief in Estate Taxes.

Temporary Estate Tax Relief
Temporary estate, gift and generation skipping transfer tax relief. The EGTRRA phased-out the estate and generation-skipping transfer taxes so that they were fully repealed in 2010, and lowered the gift tax rate to 35 percent and increased the gift tax exemption to $1 million for 2010. The proposal sets the exemption at $5 million per person and $10 million per couple and a top tax rate of 35 percent for the estate, gift, and generation skipping transfer taxes for two years, through 2012. The exemption amount is indexed beginning in 2012. The proposal is effective January 1, 2010, but allows an election to choose no estate tax and modified carryover basis for estates arising on or after January 1, 2010 and before January 1, 2011. The proposal sets a $5 million generation-skipping transfer tax exemption and zero percent rate for the 2010 year. 5 of 12

Conservation Gifts & Capital Gains
For those clients considering the philanthropic disposition of property for purposes  of conservation, the following is being contemplated.

Extension of provision encouraging contributions of capital gain real property for conservation purposes. The bill extends for two years (through 2011) the increased contribution limits and carry forward period for contributions of appreciated real property (including partial interests in real property) for conservation purposes.

 

To be continued…

 

Your friends at…

Cohen & Oalican, LLP

Boston Elder Law Attorneys
Raynham Elder Law Attorneys
Andover Elder Law Attorneys

Scams and our elderly clients

• Unlicensed contractors offering home repairs: "Hey, we just finished a job for the smiths two streets over, and there's leftover tile, would you like a great deal on....."  If it sounds too good to be true, it probably is.  Beware of home repair scams.   Look out for transient work crews, strangers claiming to have extra material, free inspections in your home.. All of these should be red flags.  You should look to licensed bonded and insured professionals.  It may feel more expensive at the outset than these street contractors that show up.. but nothing is more expensive than a botched job, or worse, paying and never seeing your money or the work again.  Shop around for a certified contractor insist on a detailed contract on the work to be done, estimated cost and timetable.

• The state of Massachusetts Executive Office of Elder Affairs should be notified of any scam, or scam attempt by calling 1-800-243-4636.

If you have been victimized, keeping quiet will not help the next victim in line.  Just last month (October 20/2010) in Ipswitch an elderly citizen was approached by someone saying that they were the recipient of funds from the federal government, and asked to provide personal information in order to claim his windfall.  The man intelligently informed local police, and the scammer was investigated and arrested.  We applaud this anonymous individual.  Our elders cannot be a doormat waiting for the next scam artist to come knocking. 

If you are subjected to a scam, contact local authorities, and your elder law attorney.

 

At Cohen & Olican we take pride in protecting our clients.

Scams and our elderly clients–Fake Charities

Fake Charities:  

Scam artists create fake charities, often sounding like a real charity... they can spend a few dollars at a local copy store to dummy up credible looking ID, and they go on the prowl.  These ruthless con men (and women) not only steal from the vulnerable, but they also make it harder and harder for legitimate charities to do the worthy work that they are chartered to do.  We recommend that you make a conscious decision and a real plan for your charitable giving and philanthropy.  Check out the organizations that you intend to support, and support them for the good works that they do.  Do not be moved by the compelling story of a young woman knocking on your doorstep.  Legitimate charities are registered with the state of Massachusetts.  Here's a website to go to to validate whether or not a charity is registered with the state. 

At Cohen and Olican we take pride in protecting our clients.

Scams and our elderly clients.

Our elder law firm, Cohen & Olican LLP, works hard to protect the rights and assets of our elderly and handicapped clients.  When we champion your rights, it is totally upsetting to us to see our clients preyed on by unscrupulous con artists. 

So, in this article, we are going to do our best to alert you to some of the more common scams, and how to protect yourself.  Of course, should you fall victim to one of these scam artist, turning to professional law enforcement, and your elder law attorney is far more important than protecting yourself from embarrassment.  Acting against these scam artists is the only way to protect the next victim.

You've hear the adage "If it sounds to good to be true......"   Well, frankly, more often than not, it is too good to be true.   Yet still the vulnerable are constantly preyed on by con men and women, leaving financial devastation in their wake.

 

Tomorrow we will present some of the most common scams you should be on the look out for.

Sharing of Data Leads to Progress on Alzheimer’s Disease - Part 1

A project was initiated in the year 2003 when the National Institutes of Health, the Food and Drug Administration, the drug and medical-imaging industries, universities and nonprofit groups joined hands in a joint endeavor to find the biomarkers that reveal the progress and evolution of Alzheimer’s disease in the human brain. It was a unique project in the annals of medical research and it is yielding results now, which are evident in a deluge of research papers on the subject.

Early diagnosis of Alzheimer’s is being done with PET scans and spinal fluid analysis and more than 100 drug studies are in progress to find formulations that might slow down or even cure the disease. This remarkable collaborative effort is showing the way for more such projects and a similar one has begun for Parkinson’s disease. The Michael J. Fox Foundation has sponsored a $40 million study to find the biological markers for Parkinson’s disease that will enlist 600 subjects in Europe and the USA.

The project has generated great excitement among the research fraternity as the agreement to share all data and make all findings public was something unheard of in the scientific world. Anybody with a computer anywhere can access all the data and go through the findings of all the research studies on the subject. The objective was not just to raise funds, or do research but share all the facts and figures and everything going on in the project on a global scale. There would be no ownership or patent of the data or the research finding and everything would be in the public domain. Private pharmaceutical companies would of course benefit in the long run from the drug formulations or imaging tests that were being developed during the project.

Dr. John Q. Trojanowski, an Alzheimer’s researcher at the University of Pennsylvania is stunned by the amazing scope of the project. It is a project that is unique and path-breaking in scientific research, according to him. But it is the only way to do it, as unless we kept aside our egos and intellectual property issues, the task of finding the biomarkers for these diseases would be an impossible one, he says. It does not mean that a person having the biomarkers would definitely get the disease, but that is also part of the project. The study aims to find those biomarkers that herald the onset of the degenerative disease.

The Alzheimer ’s disease Neuro-imaging Initiative or ADNI came about during a normal conversation about 10 years ago. Neil S. Buckholtz, chief of the Dementias of Aging Branch at the National Institute on Aging was being driven to the airport in Indianapolis by Dr. William Potter who was himself a neuroscientist at Eli Lilly. Dr. Potter was seriously thinking about the ways to hasten the progress of the drug research on Alzheimer’s. He wanted to come out of the typical drug development syndrome of the 19^th century, where a drug was administered and then everyone waited around for it to work. He felt that there must be some other method, where one could view the brain as Alzheimer’s developed and then formulate drugs to halt that development. There were efforts to locate biomarkers, but there was not much progress as different scientists in many different parts of the world were doing their own studies in their universities and with their own patients. They were obviously coming up with different results due to this.

Could someone you love have Alzheimer’s? Do you have a long term plan to deal with the Medicaid issues surrounding this? Call Cohen & Oalican, LLP to draw up a plan.

New Pathways to Parkinson’s and Alzheimer’s Diseases

Cohen & Oalican, LLP share recent Alzheimer's research.

Although Alzheimer's disease, Parkinson's disease and Huntington's disease have different genetic causes and pathways, all these ailments have one thing in common. All of them cause untimely death of the brain cells and the reason that this happens has been a dilemma to the treatment of these fatal diseases.

A recent study by a group of doctors and others at the Sanford-Burnham Medical Research Institute that was published in the July 30 issue of the medical journal Molecular Cell, throws some light on this brain cell death in patients of these diseases. The sudden and untimely transfer of a gaseous molecule called NO or nitric oxide from one cell protein to another could be the answer. Earlier research had revealed that NO and other molecules were responsible for nerve cell death or survival, but in this case, NO was seen to actually move from one protein to another through new molecular channels, triggering cellular suicide.

This was explained by the senior author of the research study group and the director of the Del E. Web Center for Neuroscience, Aging and Stem Cell Research at Sanford-Burnham, Stuart A. Lipton, M.D., Ph.D. Since this molecular evidence for the untimely cell death in Parkinson’s, Alzheimer's, and Huntington's diseases has been discovered, it would be possible now to utilize this new breakthrough to diagnose, treat and hopefully prevent these illnesses in the near future. As a Harvard-educated neurologist who runs his own clinical practice, Dr. Lipton is familiar with these fatal diseases as he observes his patients.

This research study has revealed that NO molecules relocate from the caspases to the XIAP proteins; the former are proteins that usually trigger cell death while the latter inhibit it. The caspases protein throws the NO molecule away like a “hot potato” to the XIAP protein to avoid the imminent cell death and this process happens through a chemical reaction called transnitrosylation. This action brings about a dual distress for the brain cells, as these cells are programmed to self-destruct when caspases do not have NO on them or XIAP have the molecule attached to them. Either way then it is death for the brain cells, as both these fatal actions happen simultaneously. In the study, it was shown that persons with neurodegenerative diseases had the NO molecule attached to the XIAP protein more frequently than those with normal brains. This reinforced the theory that this change in protein structure brings about cell degeneration.

The research group used a new arrangement of the Nernst equation to understand and analyze whether the caspases or the XIAP protein is more likely to end up with the NO molecule. The Nernst equation is taught in every chemistry class and is a mathematical equation that was found in the 19^th century. This possible prediction of the NO attachment to the brain cell proteins may ultimately help doctors to make earlier diagnosis of these neurodegenerative ailments, thereby kindling hope for treatment and cure. Cerebrospinal fluid and brain tissue from patients suffering from Parkinson's and Alzheimer’s is being studied and analyzed to find out whether the NO-attached proteins could be utilized as biomarkers to understand the progress and evolution of these diseases.

In ongoing research based on these findings, to formulate treatment and therapy to treat these neurodegenerative ailments, Dr. Lipton and his team are using robotic technology in Sanford-Burnham's Conrad Prebys Center for Chemical Genomics. Chemicals are being screened in their thousands to discover drugs that may stop the movement of the NO molecule from one protein to another, which may soon prevent brain cell death.

Do you have a plan if nursing home care is needed for yourself or your spouse? Will your home be protected?

Call Cohen & Oalican, LLP, they will help you to protect your home and all of you savings so you can focus on your loved one.

Protecting your Primary Residence with Changes to MassHealth (Medicaid) laws

Elder law attorneys Cohen & Oalican of Boston, Andover and Raynham want to alert you that on February 8, 2006, President Bush signed the Deficit Reduction Act of 2005, which significantly changes the federal Medicaid laws. The three most important changes concern: 1) the transfer of assets to qualify for Medicaid; 2) Medicaid annuities; and 3) Medicaid’s treatment of the primary residence. This article covers the changes in Medicaid annuities.


The Primary Residence

In the past, Medicaid did not count the value of an applicant’s home in determining eligibility. This meant that an individual did not need to sell his or her home, regardless of value, in order to qualify for Medicaid. Under the new rules, however, a house valued at over $500,000 is now counted in determining Medicaid eligibility. (Massachusetts has the option of increasing this threshold to $750,000.) Under the new rules, a single person whose home is worth more than $500,000 cannot qualify for Medicaid unless he or she agrees to sell the house. However, even under the new rules, a house continues to be non-countable if a spouse, disabled or blind child, or child under the age of 21 lives there.

Conclusion

As you can see, these changes dramatically alter the Medicaid program. Nursing homes will have to work closely with residents and their families to ensure that residents are able to smoothly transition from paying privately to receiving Medical Assistance from MassHealth. As always, our office is available to answer your questions or to provide any assistance you may need.
If you would like to review the full text of the law, go to http://thomas.loc.gov/, and enter "S. 1932" in the “search bill” text box.


This is the final article in a series regarding changes the Deficit Reduction Act of 2005 has made in dealing with Medicaid (MassHealth). Thank you for putting your trust in our Elder Law legal practice, Cohen & Oalican, LLP

Boston Medicaid (MassHealth) Attorney: Medicaid Laws change due to Deficit Reduction Act : Transfer of Assets cont'd

Elder law attorneys Cohen & Oalican of Boston, Andover and Raynham want to alert you that on February 8, 2006, President Bush signed the Deficit Reduction Act of 2005, which significantly changes the federal Medicaid laws. The three most important changes concern: 1) the transfer of assets to qualify for Medicaid; 2) Medicaid annuities; and 3) Medicaid’s treatment of the primary residence.

Transfer of Assets (cont'd)


More significantly, however, the new law also changes the date on which the penalty period begins. Under the old rules, the penalty period started when the transfer was made. The new law shifts the start-date of the penalty period to the date when the person is in a nursing home and his or her funds have run out. The new law will not apply to transfers made prior to February 8, 2006. However, Congress has allowed the states to implement the statute at a later date if they choose to do so, so the effective date in Massachusetts may fall after February 8.
The easiest way to explain the change is by way of an example. Let’s assume Mrs. Smith transfers $20,000 to her grandson on March 15, 2006. On April 15, 2007, Mrs. Smith suffers a stroke and is admitted to a skilled nursing facility. Assume she spends down her assets below $2,000 as of August 2007. Under the old transfer rules, the March 15, 2006, transfer would have made Mrs. Smith ineligible for Medicaid benefits for almost three months, starting March 1, 2006, and ending at the end of May 2006. Thus under the old rules Mrs. Smith would have been eligible in August 2007. Under the new rules, however, the transfer penalty would not start until August 1, 2007 and would end in November. The question then arises: How will Mrs. Smith pay the facility if the transferred funds are gone and she is not eligible for Medicaid?

This is second in a series regarding changes the Deficit Reduction Act of 2005 has made in dealing with Medicaid (MassHealth). Thank you for putting your trust in our Elder Law legal practice, Cohen & Oalican, LLP

Boston MassHealth Lawyer Answers "How do I apply for Medicaid (also known as MassHealth)?

The Medicaid program, which is called MassHealth in Massachusetts is a confusing bureaucracy. It takes an expert to guide you through this maze. MassHealth workers ask for financial statements going back as far as five years looking to see if the applicant or their spouse has made any disqualifying gifts. It is critical to work with an expert in filing the MassHealth application. If you file too late you may lose coverage you would otherwise be entitled to. If you file to early, you may make yourself ineligible for months if not years.
The attorneys at Cohen & Oalican can help you through the process.

This is second in a series of questions and answers regarding your legal rights dealing with MassHealth, Medicaid. Thank you for your trust in our Elder Law legal practice, Cohen & Oalican, LLP