Mr. Peter. J. Losavio, Jr. is giving a workshop “Don’t Go Broke in a Nursing Home” on Thrusday November 12th , 2015 at 4:00 and 6:00 pm at Sunrise of Baton Rouge 8502 Jefferson Hwy., Baton Rouge, LA 70810. To attend please call 1-800-426-6104 to reserve your spot.
Mr. Peter J. Losavio, Jr. will be giving a seminar at the Zachary Branch Library Conference Room Tuesday October 20th @ 4:00pm and 6:00pm and Tuesday October 27th at 4:00pm and 6:00pm. To attend this seminar call 1-800-426-6104 to reserve your seat.
With more people becoming eligible for Medicaid, one question repeatedly comes up: “will receiving Medicaid coverage jeopardize my family home?” Depending on the circumstances, the answer can be complicated. But states can do much to make it less complex.
The fact is that states can recover against the estates of some Medicaid beneficiaries, but only after the beneficiary passes away, and only in certain circumstances. Federal law actually requires that states try to recover from the estates of Medicaid beneficiaries who received nursing facility services and/or home and community-based services when they were age 55 or older. In other words, federal law sets the floor for Medicaid estate recovery by states.
Complicating matters is that states have the option to recover for more than what is federally required. States may recover from individuals age 55 and older for any items or services covered under the state’s Medicaid plan. California is one of just a few states that has taken the option to recover for all covered services provided to individuals age 55 and older. Currently, a bill is moving through the state legislature to limit recovery to only what is federally required. Last year, a similar bill received unanimous support from the California legislature, but was vetoed by the governor due to budgetary concerns.
It is important to keep in mind that there are exceptions to when a state can recover and from whom it can do so. For example, Medicaid estate recovery cannot occur during the lifetime of a surviving spouse or when there is a surviving child under age 21 or a blind or disabled child of any age. Also, states must establish procedures for waiving estate recovery when it would cause an undue hardship. Yet many states do not have clear undue hardship policies, leading to increased denials and making it difficult for family members to figure out who qualifies for a hardship waiver and in which circumstances.
State policy makers should also realize that, for the next couple of years, states will not keep recovered claims for the Medicaid expansion population and after 2016 will still keep only a small amount. When states recover from the estates of former Medicaid beneficiaries, they return to the federal government the portion that represents the federal share of expenditures on an individual’s Medicaid covered services. Since services provided to the Medicaid adult expansion population are 100 percent federally funded for the first three years (2014-16), and almost fully federally funded thereafter, states will have to return to the federal government the full amount collected (and in future years close to the full amount). States are essentially serving as a collection agency for the federal government.
Many have identified estate recovery rules as a potential barrier to enrollment in Medicaid. Individuals may be hesitant to enroll in Medicaid because they own a home that they want to leave to their adult children when they pass away. Advocates must urge states to limit estate recovery to what is federally required, and advocate for clear exceptions policies to ensure that individuals and families feel comfortable enrolling in Medicaid and getting the care that they need.
Peter Losavio of Losavio & DeJean will be presenting five (5) free seminars entitled “Don’t Go Broke in a Nursing Home”. This seminar will provide information regarding long term and crisis planning for you or your loved one’s nursing care needs. If you wish to attend, please call 1-800- 426-6104. Attendees will receive a free book co-written by Peter Losavio as well as free telephone consultations and a discounted initial office conference. The schedule for these five (5) free seminars are as follows:
Tuesday July 21, 2015 at 4:00 pm at the East Baton Rouge Library on Bluebonnet Blvd, Baton Rouge, La.;
Saturday July 25, 2015 at 10:00 am at the East Baton Rouge Library on Bluebonnet Blvd, Baton Rouge, La.;
Tuesday July 28, 2015 at 4:00 pm at the East Baton Rouge Library on Goodwood Blvd, Baton Rouge, La.;
Thursday July 30, 2015 at 4:00 pm at the East Baton Rouge Library on Goodwood Blvd, Baton Rouge, La.;and
Saturday August 1, 2015 at 10:00 am at the East Baton Rouge Library on Goodwood Blvd, Baton Rouge, La..
Call soon since seating may be limited! Hope to see you there!
Mr. Pete Losavio will be speaking at a free workshop at Sunrise of Baton Rouge 8502 Jefferson Hwy. Baton Rouge, LA 70809 on Saturday June 27, 2015 at 9:30 am to discuss his new book he co-authored ” Don’t Go Broke in a Nursing Home”. Please call 1-880-426-6104 to attend.
All U.S. citizens and residents must report worldwide income on their federal income tax return. If you lived outside the U.S. on the regular due date of your tax return, the extended filing deadline for your 2014 tax return is Monday, June 15, 2015. Similarly, the deadline to report interests in certain foreign financial accounts is the end of June. Here are some important tips to know if these reporting rules apply to you:
• FATCA Requirements. FATCA refers to the Foreign Account Tax Compliance Act. In general, federal law requires U.S. citizens and resident aliens to report any worldwide income. You must report the existence of and income from foreign accounts. This includes foreign trusts, banks and securities accounts. In most cases you must report the country where each account is located. To do this file Schedule B, Interest and Ordinary Dividends with your tax return.
You may also have to file Form 8938, Statement of Special Foreign Financial Assets with your tax return. Use the form to report specified foreign financial assets if the aggregate value of those assets exceeds certain thresholds. See the form instructions for details.
• FBAR Requirements. FBAR refers to Form 114, Report of Foreign Bank and Financial Accounts. If you must file this form you file it with the Financial Crimes Enforcement Network, or FinCEN. FinCEN is a bureau of the Treasury Department. You generally must file the form if you had an interest in foreign financial accounts whose aggregate value exceeded $10,000 at any time during 2014. This also applies if you had signature or other authority over those accounts. You must file Form 114 electronically. It is available online through the BSA E-Filing System website. The FBAR filing requirement is not part of filing a tax return. The deadline to file Form 114 is June 30.
• View the IRS Webinar. You can get help and learn about FBAR rules by watching the IRS webinar on this topic. The title is “Reporting of Foreign Financial Accounts on the Electronic FBAR.” The presentation is one hour long. You can find it by entering “FBAR” in the search box of the IRS Video Portal home page. Topics include:
o FBAR legal authorities
o FBAR mandatory e-filing overview
o Using FinCEN Form 114; and Form 114a
o FBAR filing requirements
o FBAR filing exceptions
o Special filing rules
o Administrative guidance
You can access IRS forms, videos and tools on IRS.gov at any time
When Bruce Hodgins went to the doctor for a checkup in Sioux City, Iowa, he was asked to complete a lengthy survey to gauge his health risks. In return for filling it out, he saved a $10 monthly premium for his Medicaid coverage.
In Las Cruces, N.M., Isabel Juarez had her eyes tested, her teeth cleaned and recorded how many steps she walked. In exchange, she received a $100 gift card from Medicaid to help her buy health care products including mouthwash, vitamins, soap and toothpaste.
Taking a cue from workplace wellness programs in the private sector, Iowa and New Mexico are among more than a dozen states offering incentives to Medicaid beneficiaries to get them to make healthier decisions — and potentially save money for the state-federal health insurance program for the poor. The stakes are huge because Medicaid enrollees are more likely to engage in unhealthy practices, such as smoking, and are less likely to get preventive care, studies show.
For years, private employers and insurers have used incentives to spur employees and members to quit smoking, lose weight and get prenatal care, although the record of those programs for changing long-term behavior is mixed. “Financial incentives are effective at improving healthy behaviors, though the effect of incentives may decrease over time,” said a report last year by the Center for Health Care Strategies, a research group based in Hamilton, N.J.
The Affordable Care Act is behind the latest push of wellness incentives in Medicaid. Besides Iowa and New Mexico, several other states that have expanded Medicaid have incorporated such incentives, including Indiana, Pennsylvania, New Hampshire and Michigan. Montana, which is about to become the 29th state to extend Medicaid, also plans to include such incentives.
“People are looking for some creative ways to pass Medicaid expansion and incentivizing healthy behaviors is pretty palatable to both conservatives and liberals,” said Maia Crawford, program officer of the Center for Health Care Strategies.
But getting Medicaid enrollees to participate in incentive programs can be challenging. For example, an Idaho program that offered a $100 voucher to entice Medicaid recipients to lose weight or quit smoking attracted less than 2% of eligible adults after two years.
Among the biggest obstacles is simply getting the word out to enrollees, Crawford said. But there are other issues: Poor people are less likely to understand how the incentives work and to face transportation and other barriers to get to doctor appointments or educational classes that are part of the program.
Little is actually known about what types of incentives get people’s attention or help change their behavior, said Jean Abraham, associate professor of health policy and management at the University of Minnesota. It’s not clear, for instance, whether rewards are more effective in prodding people to take a concrete step, such as getting a colonoscopy or a mammogram, rather than in changing long-term behaviors, such as smoking.
“We have a long way to go to understand what’s most effective,” Abraham said.
The health law sought to get answers to some of these questions by providing $85 million to test incentives in 10 state Medicaid programs.
States started the studies in 2012 and 2013 and some are struggling to get participants. Connecticut, for instance, has enrolled only half of the 6,000 people it sought for a smoking cessation program. The program pays recipients as much as $350 in gift cards over a year for participating in smoking cessation counseling, using a counseling phone line and having a breathalyzer test showing they haven’t recently smoked. The $10 million, three-year study will compare that group’s health costs against those of a control group of Medicaid recipients who smoke but received no help.
Other states that received funding are California, Hawaii, Minnesota, New York, Nevada, New Hampshire, Montana, Texas and Wisconsin.
Separate from the health law, one of the largest incentives program is New Mexico Medicaid’s Centennial Rewards, which gives most of the state’s 600,000 recipients the chance to earn points to buy health care items. They gain points each time they engage in a healthy behavior, such as getting a checkup or seeing a dentist. So far, only about 45,000 have registered and only half of those have redeemed points for gift cards.
But Juarez, 57, the Las Cruces woman, is a convert. She said the program has motivated her to walk every day at the mall where she works as a hair stylist and helped bring down her blood sugar levels.
“I’ve never felt this good,” she said. “This program motivates me to do more — it’s not so much the money as it’s the improvement in my body.”
Iowa has also faced challenges getting enrollees to complete the wellness exam and health risk assessment survey— even though some will have to pay a $5 or $10 monthly Medicaid premium if they don’t. About 19,500 of the state’s 125,000 enrollees have faced the potential penalty. Of those, about a third completed the wellness exam and assessment.
Hodgins, who enrolled in Iowa Medicaid in January, said he’s glad his community health center advised him about the wellness exam and health survey —not because it saved him money but because he found out that he had high cholesterol and blood sugar, which he’s now working to bring under control.
“I’ve been blessed with decent health for 57 years,” said Hodgins, who recently started a delivery company. “I have to be responsible for my own health. That’s my obligation.”
The Medicaid rules take a very harsh position on gifts and look back five years to determine if gifts (called “improper transfers” by Medicaid) have occurred. In addition to many people not even knowing there are problems with gifting, even more people don’t know what might be considered a gift. When a gift is made, it will cause a penalty period to be imposed by Medicaid such that Medicaid will not pay for care during the penalty period if the gift was made within five years of needing Medicaid.
Depending on the part of the country you live in, the following may be considered gifts that cause a transfer penalty to be imposed by Medicaid: Christmas gifts to your children and grandchildren, wedding gifts, graduation gifts, paying tuition for a child or grandchild, giving to charities, giving to your church, etc. Adding a child’s name to real estate causes a gift. Selling an asset for less than it is worth causes a gift equal to the amount Medicaid says you undersold the property.
Another area where unsuspecting gifts can occur can be called the “incomplete gift.” For example, when a parent “gives” their children vehicles and even real estate, and even if the “gifts” were made more than five years prior to the parent needing Medicaid, it can still be an issue if the title is never transferred. This renders the gifts as not complete as far as Medicaid is concerned.
This is not to say that you should stop making such gifts, but be sure to find out the possible effects such gifts might have on you if you ever need Medicaid so that you don’t have any surprises down the road. Gifts are often fine if done as part of a well thought out plan created with the assistance of an elder law attorney. You must have a plan that covers the possibility that Medicaid will be needed within five years. Not having a plan is like jumping out of an airplane without a parachute.
Arkansas Department of Human Services v. Ahlborn (Ahlborn case) is a landmark medicaid collection case decided by the United States Supreme Court in 2006. The Supreme Court decided that the Arkansas Department of Human Services had no authority to assert a lien on Ahlborn’s personal injury settlement that exceeded the amount for past medical expenses stipulated by the parties in the settlement. This decision is favorable to personal injury attorneys and their clients since it limits the amount of recovery of government medicaid collection agencies. The case also eliminates the chilling effect it would have on promoting settlements.
Initially, it was believed that the Bipartisan Budget Act of 2013 overturned the Ahlborn decision. However, Section 202(c) of the Bipartisan Budget Act was extended for two years by the Protecting Access to Medicare Act of 2014 which was signed by President Obama on April 1, 2014. Therefore, you may continue to rely on Ahlborn until October 2016.
The Louisiana Department of Health and Hospitals is pleased to announce that Medicaid now covers Applied Behavioral Analysis (ABA) services for persons who meet the following guidelines published in the February 2014 Emergency Rule (Louisiana Register, Volume 40, Number 2). All of the criteria below must be met to receive services:
- be from birth up to 21 years of age;
- exhibit the presence of excesses and/or deficits of behaviors that significantly interfere with home or community activities (examples include, but are not limited to aggression, self-injury, elopement, etc.);
- be medically stable and not require 24-hour medical/nursing monitoring or procedures provided in a hospital or intermediate care facility for persons with intellectual disabilities (ICF/ID);
- be diagnosed by a qualified health care professional with a condition for which ABA-based therapy services are recognized as therapeutically appropriate, including autism spectrum disorder;
- have a comprehensive diagnostic evaluation by a qualified health care professional; and
- have a prescription for ABA-based therapy services ordered by a qualified health care professional.
To access these services a person should select a Medicaid enrolled ABA provider who will submit the request for prior authorization to Molina Medicaid Solutions for approval.
For assistance locating these providers, call the Specialty Care Resource Line at 1-877-455-9955 or DHH directly at 1-844-423-4762.