New Jersey Medicare And Medicaid Legal Questions

You should call the company that is going to take over.  They will explain the benefits.  It probably provides prescription drug coverage and will pay for Medicare deductibles.  You may use it in place of the AARP but its not possible to advise you until you know what the other plan is intended to cover.  Good luck to you. ... Read More

If your parents have a disabled child, they can transfer assets to that child and not cause a Medicaid penalty.  The assets your parents transferred to the disabled child should be placed into a SPecial Needs Trust to keep the disabled child from becoming ineligible for SSI.  You can either transfer it, or cash it in and give the disabled child the money.   ... Read More

There would be no penalty if your father did not apply for Medicaid for five years after he gave you the money.  Its true, there is no crime committed, and yes, this is still America, but Medicaid is "medical welfare".  Think about the implications of that.  Should a person be allowed to give all of their assets away, and then have the govenrment pay for all of their care?  If that was permitted, no one would pay for nay of the care needed.  If your transfer is outside of the five year look back no lien will accrue. ... Read More

If you receive social security disability, you are eligible to get medicare earlier than the normal time.  The disability payments you get are considered income, and you will have to use a small portion of that income to pay for Medicare, which will provide medical care.  If you currently have medical insurance from some other source, then you will still sign up for MEdicare, but MEdicare will be your secondary provider.  ... Read More

Medicare?  Or Medicaid?   Was this in relation to a car accident?  And was there a separate claim for the estate?  Make sure to see the breakdown of what is owed, it should be calculated on a percentage of payback if Medicare was the insurance provider, or if Medicaid was used.  It may also depend on whether your father's car insurance provided personal injury protection or if the medical insurance was supposed to be primary.... Read More

the monthly amounts given are all added up on the date of the Medicaid application and then the amount is used to calculate the period of ineligibility.  there is no "allowable" amount in New Jersey.  If she pays you - it has to be done pursuant to a Medicaid Care Agreement. ... Read More

If you live in New Jersey, and you have been careful to sign your name AS POA FOR DAD and not just your own name, and if you have used all of dad's money for dad's care and not taken any of it, then no, NJ Medicaid willnot come after you for anything.  If there is anything left in dad's estate when he passes, they may put a lien on that, but you will still be able to use it to pay final bills, funeral costs, etc.... Read More

I do not believe that MRSA is a "never" event.  A "never" event is an event that is never supposed to occur - such as he amputation of the wrong limb.  there are certain "punishments" that are enacted if a hospital or facility are found to have done a "never" event - such as the facility does not receive payment from Medicaid or Medicare.  I do not believe an infection such as MRSA falls into that category.... Read More

You need to look at the Caregiver Child Exemption.  Its complicated, but I believe form the facts you have given that the house would be an excludable resource for your mom becuase of the care you have been providing her.   N.J.A.C. 10:71-4.10(d), which contains the caregiver exemption, provides as follows: (d)[A]n individual shall not be ineligible for an institutional level of care because of the transfer of his or her equity interest in a home which serves (or served immediately prior to entry into institutional care) as the individual's principal place of residence and the title to the home was transferred to: . . . . 4. A son or daughter of the institutionalized individual . . . who was residing in the individual's home for a period of at least two years immediately before the date the individual becomes an institutionalized individual and who has provided care to such individual which permitted the individual to reside in the home rather than in an institution or facility. i. The care provided by the individual's son or daughter for the purposes of this subchapter shall have exceeded normal personal support activities (for example, routine transportation and shopping). The individual's physical or mental condition shall have been such as to require special attention and care. The care provided by the son or daughter shall have been essential to the health and safety of the individual and shall have consisted of activities such as, but not limited to, supervision of medication, monitoring of nutritional status, and insuring the safety of the individual.... Read More

Before you do anything further - talk to a lawyer about creating a Special Needs Trust for you to protect this money from Medicaid.  It should be done BEFORE you accept the settlement.  If your personal injury lawyer does not know anything about this, have the lawyer call a certified elder law attorney to find out what needs to be done.  ... Read More

No - there is no upper limited on Medicaid - if she is on Medicaid, her medical care should be covered.  Depending on what coverage she had - she could have exhausted her Medicare benefits, and now needs to apply for Medicaid, they are two different programs.  You need to ask for clarification from the nursing home.... Read More

The Medicaid look back goes back five years from the date the application for Medicaid is made.  Its not as simple as the look back, they have to divide the assets, regardless of whose name they are in, and there could be additional planning things to do.  You should go to an attorney. ... Read More

Unless the daughter can prove that she contributed to the account, the account is considered an account of "convenience" and is not considered the daughter's asset.  You wold have to prove that the daughter inherited one half of the account when the father died, otherwise, the account will have to be used for the mother's care until depleted.... Read More

You should be able to remain in the house, and to have the house transferred to you under the "Care-giver child" exemption.  You will have to prove that you lived in the house for at least two years prior to the transfer, and that during that time you cared for your mother.  the care has to be pretty specific, simply transporting her to doctor's visits, or shopping is not sufficient.  You will need to get a doctor's statement that the care you provided for your mom allowed her to live at home, and without that care, she would have had to go to a nursing home.... Read More

You might want to try Social Security Disability first, or New Jersey Disability.  If your cousin is unable to work, then she might be entitled to disability, and then she might be entitled to SSI supplemental Security Income, and possibly Medicaid.  If she is denied, she should appeal.  You can do that online.  She will need doctors who are willing to provide a report indicating she is unable to work due to her disability.  ... Read More

It is my understanding that Social Security Disability is base don your work history and your disability and that it does not require income or asset limits in order to become eligible.  You can inherit money and still be eligible as long as you continue to be disabled.    If you are receiving other benefits, like SSI or Medicaid, that are based on your income or assets, you could loose those benefits.... Read More

Its hard to tell what happened from the information you provided.  You were probably dropped from Medicaid because the amount of assets you had for a short period of time during one month exceeded the limit.  Remember that the asset limits are strict.  For example, if you have $800 in the bank, and get a deposit of $1800 in social security, and your asset limit is $2000 you have exceeded your limit even if you immediately write a rent check for $800 and with draw the amount.  If your records were reviewed by Medicaid at a time when you exceeded the limit, that might have caused you to be disqualified.  if you are able to work part-time, you might still be eligible for Medically Needy Medicaid, which is Medicaid but a different program.  You need to call the Board of Social Services in the County in which you live and find out more about why you were dropped.... Read More

they will not notify you to tell you what you are eligible to receive !!  Apply for the benefits, the worse they can do is say "no".  Are you receiving Social Security Disability?  It sounds like you should be - and qualification for that will also help with other programs like PAAD for prescriptions. ... Read More