Tag: Elder Law

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Medicaid Redeterminations: Act Now!

The COVID-19 pandemic public health emergency is scheduled to expire as of May 11, 2023. https://www.cms.gov/About-CMS/Agency-Information/Emergency/EPRO/Current-Emergencies/Current-Emergencies-page. As a result, Medicaid recipients need to remain focused to protect their benefits from termination.

What are Medicaid Benefits?

Medicaid is a federally funded health care program which can pay for long-term care. https://www.medicaid.gov/medicaid/long-term-services-supports/index.html. The MLTSS Medicaid program in New Jersey provides benefits for long-term care in nursing homes and assisted living facilities, as well as in the home.

Participation in the Medicaid program is means-tested and strictly regulated. Only people with low assets and low income qualify for MLTSS Medicaid. https://www.nj.gov/humanservices/dmahs/clients/medicaid/#:~:text=To%20be%20eligible%20for%20New%20Jersey%20Medicaid%2C%20a,meet%20specific%20standards%20for%20financial%20income%20and%20resources.

In Burlington County, where my elder law office is located, and throughout New Jersey, a single individual cannot have more than $2,000 in countable assets and qualify for MLTSS Medicaid. Having even one dollar over the $2,000 countable asset limit on the first day of the month can disqualify an individual ineligibility for Medicaid for the entire month. Surprisingly, retirement account balances are included in the $2,000 countable resource limit.

Under federal law, New Jersey (and other states which have opted to receiving Medicaid funding) must follow certain requirements. One of those requirements is processing periodic Medicaid eligibility redeterminations.

What is a Medicaid Eligibility Redetermination?

A Medicaid redetermination is a review by the county Medicaid office of a Medicaid enrollee’s finances. The purpose of the redetermination is to re-confirm that despite the passage of time, the Medicaid enrollee’s resources are still below the $2,000 Medicaid eligibility threshold.

Fortunately, a Medicaid redetermination may involve only a review of one month of financial statements, unlike the Medicaid application, which takes into account sixty months of bank statements.

In a Medicaid redetermination, the Medicaid enrollee (or his or her authorized agent) completes the Medicaid eligibility redetermination form. They provide one month of bank statements for the enrollee. The agency scrutinizes the statements for changes like an inheritance, a death of a spouse, bank balances over $2,000 and large gifts during the period reviewed.

It’s a good idea to take care in completing a Medicaid redetermination, because an increase in the bank balance on the first day of the month can trigger a termination of the entire month of Medicaid eligibility. This can translate into liability for thousands of dollars of medical expenses for someone with very limited assets and income.

What Has Changed

During the public health emergency, the government recognized that there were significant disruptions in living situations, and employment. As a policy matter, health insurance coverage needed to be kept in place until the pandemic ended. New rules curtailed Medicaid terminations during the public health emergency. Now that the end of the public health emergency is drawing near, some of those protections are being lifted.

What You Need to Do

In Marlton, New Jersey and the surrounding counties where I practice elder and disability law, I have noticed that redetermination packets are being sent out to many Medicaid enrollees. https://fearnzimmerelderlaw.com/The redetermination forms must be completed and returned promptly. If you moved during the pandemic, this can be a problem, because you may not receive the forms if they are sent to an old address.

If you receive Medicaid and you have moved since January 2020, contact your county Medicaid office with your new address and email.

Check your mail for the Medicaid redetermination form. Be sure to complete and submit the form promptly, using a delivery method that allows you to confirm receipt by the county Medicaid office. It is a good idea to consult an attorney if you have questions about the Medicaid redetermination form or if you receive a termination notice.

Contact your attorney right away, in the event of a Medicaid termination notice. Medicaid terminations can jeapardize important benefits, leaving you or your spouse responsible for thousands of dollars in long term care and other medical bills, with limited funds to pay them.

On By Jane Fearn-Zimmer, Esq.In Medicaid, UncategorizedLeave a comment
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Helping Someone With Dementia Sell the Home

On By Jane Fearn-Zimmer, Esq.In Dementia, Elder Law, Estate Planning, Guardianship, Long-term care, MedicaidLeave a comment

Selling the home through guadrianship

Sometimes, a home must be sold, but the homeowner is no longer able to sign a listing or sale agreement due to cognitive impairment, confusion, advanced dementia or severe and persistent addiction issues (i.e., Wernicke-Korsakoff syndrome), or new onset dementia after recovering from COVID-19.  covid-19-pneumonia-increases-risk-of-dementia-study-says  Others may be temporarily incapacitated due to cardiac issues, surgery, or severe illness.  These conditions can prevent an adult from being temporarily or permanently able to make important financial, medical or legal decisions.  Adults who can no longer make decisions may be incapacitated.  And in real estate bubble with many residential properties reaching their peak value, it’s critical to act fast to accept the best home sale offer.

Unfortunately, incapacitated adults are unable to enter into a binding contract, such as an agreement to list or sell the home. When this happens, one option may be to use a general durable power of attorney or a real estate power of attorney to sell the home.  But that can only be successful where there is already a valid general durable power of attorney or real estate power of attorney in place.  If there is a power of attorney, and the homeowner is able to make decisions, the home cannot be sold through a power of attorney without the homeowner’s consent to the sale.  Giving a power of attorney to a trusted adult child or friend is like giving them an extra set of keys to the car. You can always take back the keys when you wish.

More to the point, a power of attorney is an important legal document by which the principal (i.e., the person signing the power of attorney) gives authority to an agent to carry out the affairs of the principal.  The catch-22 is that in order to make a power of attorney, the principal must have legal capacity.  Unfortunately, there are many incapacitated persons who never bothered to obtain a power of attorney before they lost capacity.   Another risk is that there may be a valid power of attorney, but the agent named may be deceased, very ill, or no longer available to serve.  Once again, there is no one with legal authority to sign the home sale agreement and the house cannot be sold even if there is a buyer.

The solution is to seek a court order for authority to sell the home.  This involves filing a lawsuit in the Superior Court for a judgment of incapacitation and award of guardianship.  The guardianship process is not a simple one. There are several different types of guardianships and the correct type must be selected.  Various court rules, required information and forms must be complied with.

The guardianship process requires doctor’s reports and an investigation into the finances and health of the alleged incapacitated person. As part of the process, the Superior Court judge appoints an independent attorney to investigate these matters and to write a report.  This attorney is referred to as the court-appointed attorney.  Often, that attorney’s report carries great weight with the court.  Testimony by the doctors may be waived, or if the guardianship is disputed, there may be an adversarial hearing.  If the evidence, any testimony and the court-appointed attorney’s report indicates that the alleged incapacitated person cannot make any significant decisions as to his person or property, then a plenary guardianship may be awarded.

But this is only the first step in obtaining court-authority to sell the home of the incapacitated person, who may urgently need the anticipated net home sale proceeds to pay for long-term care.  The next step is to file a motion with the court to sell the home through the guardianship.  The court can potentially award the requested order.  Only when such an order is in place, can the home be legally sold.

Not surprisingly, this process requires additional legal work and documentation.  The guardian must show that the proposed sale is fair and reasonable and in the “best interests” of the incapacitated person. In deciding whether this standard is satisfied, the judge may consider whether the incapacitated person will ever be able to return to the home to live there independently or with the assistance of paid caregivers, provided there are sufficient funds.  The fair market value and the tax-assessed value of the home will also be considered, as will the outcome of any prior attempts to sell the property, the cost of continued homeownership, and whether the anticipated net house sale proceeds are needed to pay for long-term care. In many cases, the home must be sold as a condition of Medicaid eligibility for the former homeowner in a nursing home.

This process takes time.   In limited cases where the safety of the alleged incapacitated person is endangered, or a very good purchase offer may be lost without swift court approval, the guardianship process can be expedited in New Jersey.

The bottom line, is that when capacity is in issue, selling the home a general durable power of attorney or a real estate power of attorney is much more efficient than through a guardianship. However, selling the home through a guardianship can be done in the difficult cases where there is no legal authority in place to sell the home.

Questions, or if you need help clearing title to sell a home through a guardianship? Let Jane know.

Do You Know How To Protect Yourself From Catfishing and Financial Abuse?

On By Jane Fearn-Zimmer, Esq.In Catfishing, Elder LawLeave a comment

A version of this article ran in the April 2021 edition of The Elder Law Report, Including Special Needs Planning

Senior citizens and members of the disabled community have always been a major target for catfishing schemes, but since the pandemic hit last year it’s at an all-time high.  According to the Elder Justice Center, fraud increased to over $3.3 billion in 2020, well above the 2019 report. This blog post is intended to warn of catfishing schemes, which are no joke, especially when the most vulnerable members of our community could be victimized. That is why it is so important to remain on high-alert in the event you encounter financial and other forms of abuse. 

Internet friendly seniors need to be vigilant for cat fishers.  Catfishing involves schemes in which the perpetrator creates and holds out to the victim an offer which is too good to be true, to entice the victim into giving up personal information, money, or something of value for fraudulent purposes.  Catfishing comes in various degrees of sophistication and can involve the creation of a false identity which is held out to the public.  In one local catfishing scheme, the perpetrator held himself out as a lonely man working on an isolated oil rig looking for long distance love online.  The isolation of an oil rig is a convenient excuse for providing limited photos and for declining to meet in person or talk on the telephone. Communication tends to be via instant message or in online hang outs and chatrooms or via text messages.  Red flags for a catfishing scheme can include:  poor English, lack of communication by video, FaceTime, or any method which allows you to see who are talking with, a rapid paced romance, requests for you to use a particular type of software or program, requests for you to download a computer program (which may contain malware or ransomware), and requests for your social security number, Medicare number, bank account or credit card number or for you to purchase gift cards and to send them the gift card numbers.  Often the perpetrators of catfishing schemes are overseas. 

Another financial abuse scheme is unemployment fraud.  In these schemes, the perpetrator files an unemployment claim based on the victim’s work record and then opens up a new bank account into which the victim’s fraudulently claimed unemployment benefits are deposited.  Earmarks of unemployment fraud include receiving a letter from the unemployment office confirming the filing of a claim based on the victim’s work record.   Sometimes, the victim may be unaware of the scheme until he or she receives income tax forms in January of the following year, reporting unemployment income which the victim did not receive. File a complaint with the local police department and report the matter to your local unemployment office, which typically will have a fraud hotline.  

Then there are COVID-19 financial abuse schemes, which include: 

  • An offer for COVID-19 treatment, a vaccine or a booster shot from anyone other than a medical professional or a government health department
  • Being offered the chance to “jump the line” for the COVID-19 vaccine by paying a fee
  • Being offered quicker utility service restoration by paying a fee, particularly using a gift card, or a payment app such as Venmo, PayPal or Zelle 

Here are some general precautions you can take to minimize the risk of elder financial abuse:

  • Review your mail and bank statements regularly and contact your credit card company or the merchant regarding any unfamiliar transactions 
  • Do not let others access your money. Put your bank and financial statements away in a locked cabinet or drawer out of sight. Do not leave them in your car or in plain view in your house.  Refrain from carrying a lot of cash. 
  • Keep in regular contact with friends and family who can help you. 
  • Order a copy of your credit report and review it. 
  • Do not keep passwords or ATM or telephone passwords in writing in your wallet, purse, glove compartment or anywhere easily accessible in your home. 
  • Don’t ever give a power of attorney to someone you don’t know very well and trust.  Your power of attorney should be trustworthy, available, and respectful and should put your interests before their own. 

If you still have questions, there is a helpful senior financial safety risk assessment tool offered free to the public by the Center for Elder Law and Justice, a New York organization, in collaboration with the Pro Bono Net.  The online tool can be used to assess whether there are red flags for elder financial abuse and what you can do in response.  The tool is available online at https://elderjusticeny.org/.

Additional support and resources may be available through your local Adult Protective Services office, the county Office on Aging, local law enforcement and the county prosecutors offices. Resources at the state level include the Office of the Public Guardian, and the Office of the Ombudsman for the Institutionalized Elderly. 

Questions? Let Jane know. 

National Caregiver’s Day: A Look at Elder Care in the Age of COVID-19

On By Jane Fearn-Zimmer, Esq.In Caregivers Resources, Elder Law, Elder Law & COVID-191 Comment

It’s National Caregiver’s Day, and another year filled with countless and unimaginable changes has passed. This year especially, my heart goes out to caregivers and their loved ones everywhere! Even before the COVID-19 pandemic, caregiving was no bed of roses. But this year, caregivers are facing an onslaught of new challenges, not the least of which are combatting senior isolation and reduced access to face-to-face therapies and delayed medical examinations. 

How has the COVID-19 pandemic changed care options?  Adult medical day care centers are not providing in person care at their customary location but may deliver services via telehealth and in person visits in the home. This leaves care in the home and care in a long-term care facility as the remaining options for senior care.  

The long-term care industry has been hard hit by the pandemic. From a medical standpoint, until the pandemic subsides, full-time care in the home is probably the safest option. A good option for private care in the home would be hiring a home health aide through an agency.  Benefits of a full-time caregiver (whether hired or by a loved one) include stronger protection of the vulnerable senior, since the caregiver is not moving from home to home (or from home to a nursing home) caring for multiple patients in multiple settings. It can also give the family members or friends who are overseeing the care an opportunity to recharge, which is important to prevent burn out. The right caregiver can provide social companionship to the senior.  

Families considering this option will want to keep in mind that the cost of private, hired live in care will include the cost of groceries for the home health aide, as well as worker’s compensation insurance if the caregiver is providing only companion and housekeeping care. . In such cases, the homeowner’s carrier should be put on notice of the arrangement and the family should work with an accountant to ensure that an accountant or payroll company to ensure compliance with withholding and state insurance requirements. The home’s layout should include a private area with a door that closes for the caregiver, who will need to rest and recharge while the senior is sleeping.  An employment agreement with the caregiver can protect the homeowner and the employer’s rights and ensure that minimum wage and hour requirements are met. If the senior needs care from a certified home health aide, keep in mind that such care can only be provided through a licensed home health care agency with a nurse supervising the implementation of the doctor’s plan of care. Hiring a caregiver to provide such comprehensive care outside of an agency is illegal and potentially places the senior’s well-being at risk.  Agencies do screen their prospective employees, and may be able to identify unsuitable caregivers.  If the caregiver is willing to break state law, how amenable will the caregiver be to calling 9-1-1 if the senior needs emergency medical care of doing so means the caregiver is risking getting caught breaking the law?  The family may expect to save money with an unlicensed, under the table caregiver arrangement, but in addition to being illegal, the fallout from such arrangements tends to be extremely expensive and can take a terrible toll on the senior’s health.  

Another option is care in the home financed through the Veteran’s Special Improved pension/Aid and Attendance, which is a government benefits program for eligible United States military veterans or their surviving spouses to help defray the cost of care.  In cases where the senior qualifies for Medicaid, and is able to remain in the home, programs such as the Personal Preferences Program (PPP), “can provide a source of funding for the senior to choose and hire their preferred caregivers, which can include relatives and friends.” Under the PPP program, the senior chooses the services and schedule they desire. 

The remaining option is care in a long term facility. This may be the best option where the care recipient is a two person assist, has behavioral quirks, or requires a team of trained medical professionals to stabilize and maintain their condition.  In some situations, Medicare dollars can be used for limited periods of time as “key” money to admit the senior to the best facility possible, with the goal of later transitioning to payment for the best care through the   Medicaid program and the senior’s income. 

These are just a few important considerations. For help sorting through your options, consultation with an elder law attorney is recommended.  

For more information about elder care in the age of COVID-19, please feel free to reach out.

Jane Fearn-Zimmer is an Elder and Disability Law, Taxation, and Trusts and Estates attorney. She dedicates her practice to serving clients in the areas of elder and disability law, special needs planning, asset protection, tax and estate planning and estate administration. She also serves as Chair of the Elder & Disability Law section of the NJSBA.

The Free Britney Movement: How the Pop-Star’s Conservatorship Would Play Out in New Jersey

On By Jane Fearn-Zimmer, Esq.In Conservatorship, Elder LawLeave a comment

The Free Britney Movement: How the Pop-Star’s Conservatorship Would Play Out in New Jersey

If you follow pop-star Britney Spears on social media, you’re well aware that her posts as of late seem like less album promoting and more like a cry for help. These posts have gotten the attention of her fans near and far, who are responsible for starting the #FreeBritney movement in an effort to help end an almost two-decade long conservatorship her father has over her, which puts him in full control over everything from her money to her health and almost every aspect of her daily routine. In this post, I’m going to break down what a conservatorship is in New Jersey, what it means, how someone qualifies for one and what you need to do to get one granted.

Little background on Brit:

Britney’s original conservatorship order was entered by a California court to establish a protective arrangement for Britney, as an adult who cannot make her own decisions, similar to a guardianship under New Jersey law. Since every state is so different when it comes to this topic, among other things, I’m going to focus on New Jersey conservatorships since this is the state in which I’ve helped countless families obtain protective arrangements, like guardianship and conservatorship orders, for friends and family.

What is a conservatorship under New Jersey law and how can a conservatorship order benefit the conservatee (the person who is subject to a conservatorship order) and the caregiver of the conservaee?

In New Jersey, there are different types of protective arrangements for adults, depending on whether they are able to make their own decisions (incapacitated) or for whatever reason, even if they are able to make decisions, they are not able to manage their affairs independently.  A judgment of incapacitation awarding guardianship is a judicial order finding an adult person incapacitated (legally unable to make decisions) and can be entered against the wishes of the incapacitated person.  In contrast, a judgment of conservatorship is a voluntary arrangement under court order whereby another adult is appointed by the court to assist an adult who is competent but cannot function independently. As a court ordered arrangement, a conservatorship is more rigid and entails more supervision than a general durable power of attorney.  Because a conservatorship involves an individual with capacity (the ability to make decisions), in ordered to be entered, a conservatorship must be consented to by the proposed conservatee and close family members of the proposed conservatee must be notified.

How does a conversatorship differ from a power of attorney? A conservatorship differs from a power of attorney in that there is annual court oversight, through the filing of accountings and reports to the court regarding the well-being and the finances of the conservative.

When in New Jersey would a conservatorship be entered?

The case of In re Conservatorship of Halley, 777 Ad 68 (N.J.App.Div. 2001) is a classic example. There, a 92 year old man was hospitalized for injuries sustained in a motor vehicle accident and upon his discharge from the hospital, arranged for a local attorney who had managed his legal affairs for approximately seven years to serve as his power of attorney.  Although he had a brother and sister-in -aw in another state, he wanted to maintain control of his finances and living arrangements. The attorney managed Mr. Halley’s affairs and his finances and hired home health aides to care for him in his home, as per his wishes, and arranged for him to travel on a Disney cruise and to take a trip to Daytona Beach.

A former aide from the home health care company filed a complaint with Adult Protective Services alleging that the attorney and the home health care company were taking advantage of Mr. Halley. The APS social worker met with Mr. Halley and determined that he was competent after administering a mini mental status examination. APS filed a complaint and the court appointed an attorney to represent Mr. Halley in the proceedings. A guardianship could not be obtained over Mr. Halley, because he was intelligent, conversant, and clearly oriented to person, time and place and was able to make some decisions, but not necessarily to carry them out independently.

Mr. Halley’s nephew, upon being notified through his father of the conservatorship proceedings, attempted to intervene in the proceedings to secure his own appointment and an accounting of his uncle’s finances.  Mr. Halley expressed his concerns that his nephew was only after his money. The court-appointed attorney for Mr. Halley interviewed the attorney who was serving under the power of attorney, Mr. Halley’s physician, and others closely connected with Mr. Halley, and after reviewing medical and financial records, found that the attorney who was serving as the power of attorney should be appointed as Mr. Halley’s conservator. As a result, the attorney originally serving under the power of attorney was appointed as the conservator of Mr. Halley.

There is an old saying that sunlight is the best disinfectant. In the Halley case, the court’s scrutiny of the arrangement, which ultimately was determined to be beneficial to Mr. Halley in allowing him to maintain his independence and some control over his affairs, worked to the benefit of both Mr. Halley and the attorney who was helping him. This is a great example of how a conservatorship can protect both the conservator and the conservatee.  Mr. Halley was able to maintain his independence in the home, and manage his own affairs through the conservatorship arrangement. The attorney serving as the conservator remained subject to court oversight for the protection of Mr. Halley and no one could reasonably question her professional integrity or judgment in caring for Mr. Halley once the court became involved and essentially ratified her work for Mr. Halley

How long does it take to get a conservatorship in New Jersey?

The New Jersey judiciary is one of the best in the nation; however, due to the courts’ heavy dockets, getting a conservatorship will not be a fast process. You will have to schedule examinations with two doctors and obtain completed paperwork from those doctors and then a court filing (called a verified complaint and order for hearing) must be made.  Once the papers are filed with the court, they are reviewed by the Surrogate, sent to the judge for review and assignment of a hearing date, and there is typically a delay of anywhere from 30 days to up to two months between the date of filing and the hearing date.

Key takeaway: If you are caring for a friend or neighbor and you have a professional license, obtaining a judicial blessing of the caregiving relationship through a conservatorship can protect your license and your career from the stress and adverse consequences, which could otherwise result from an investigation and/or complaint by Adult Protective Services. Based on my example above, if Mr. Halley and his attorney had sought a conservatorship from the beginning, they likely would not have had to deal with an APS investigation initiated by a disgruntled former home care company employee.

For more information about conservatorships, guardianships and a power of attorney, please feel free to reach out.

Jane Fearn-Zimmer is an Elder and Disability Law, Taxation, and Trusts and Estates attorney. She dedicates her practice to serving clients in the areas of elder and disability law, special needs planning, asset protection, tax and estate planning and estate administration. She also serves as Chair of the Elder & Disability Law section of the NJSBA.