Skip to main content
Category

Medicaid Planning

What is an “incontestability provision” in an insurance policy?

By Asset Protection Planning, Elder Law, Estate Planning, Medicaid Planning, Medicare

Florida Statute §627.455 states:

Every insurance contract shall provide that the policy shall be incontestable after it has been in force during the lifetime of the insured for a period of 2 years from its date of issue except for nonpayment of premiums and except, at the option of the insurer, as to provisions relative to benefits in event of disability and as to provisions which grant additional insurance specifically against death by accident or accidental means.

The incontestability provision is thus the clause included in Florida life insurance policies which limits the time during which the insurer can challenge the validity of the policy to 2 years. Whether the challenge to the policy is based on alleged application fraud or an inability to enforce the policy, all claims must be filed within the 2-year period – or else, the claim is barred.

This provision has its origins in the mid-19th century, when insurance companies began including incontestability provisions to combat the perception that insurance companies would refuse to honor their policies over minor mistakes in a person’s life insurance application. Florida required the inclusion of incontestability provisions by law in 1955.

There is a possible exception to incontestability provisions: imposter fraud. Imposter fraud refers to the impersonation of a life insurance application by someone else during the medical examination of the application process – this type of fraud can be exempt from the incontestability provision.

To review your end-of-life and estate plan documents with experienced and dedicated estate and elder law attorneys, schedule an appointment with Bach, Jacobs & Byrne, P.A. at (941) 906-1231 today.

 

April 18, 2019
Love0

Medicaid Work Requirements Struck Down by Federal Judge

By Elder Law, Medicaid Planning

In June 2018, a federal judge blocked the Kentucky Medicaid plan which would have required many recipients to work or volunteer in order to stay covered. While the plan included exemptions for pregnant individuals, primary caregivers, and full-time students, all Medicaid recipients deemed able to work would have had to train for a job, volunteer, or work in order to continue receiving benefits.

In the future, more cases surrounding the issue of Medicaid work requirements may emerge, as several other states have already gotten approval from the current administration to include work requirements in their statewide Medicaid plans. To learn more about Florida’s Medicaid program, visit the website of the Florida Agency for Health Care Administration, http://www.fdhc.state.fl.us/.

February 1, 2019
Love0

What is the CARES assessment?

By Asset Protection Planning, Long-Term Care, Medicaid Planning

In Florida, Comprehensive Assessment and Review for Long-Term Care Services (CARES) is the federally-mandated screening system for nursing home applicants. It is required by law for any person seeking Medicaid reimbursement for nursing home care or Medicaid waivers for community-based long-term care services. Furthermore, any private-pay applicant who is suspected of having an intellectual ability or mental illness must also take the test.

The CARES process is initiated once a person applies for the Medicaid Institutional Care Program. A registered nurse or other qualified individual performs the assessment, and then a physician or registered nurse reviews the application and determines the best course of action for the patient. You can read more about the process at the CARES website: http://elderaffairs.state.fl.us/doea/cares.php.

The lawyers at Bach, Jacobs & Byrne, P.A. are skilled Medicaid planning and elder law attorneys. To discuss protecting your assets in anticipation of long-term care and Medicaid application, or to learn more about the eligibility requirements of Medicaid, please contact us at (941) 906-1231 to schedule a consultation.

January 10, 2019
Love0

Who runs the Medicaid program?

By Asset Protection Planning, Medicaid Planning

Medicaid is a program jointly run by both the federal and state governments. In some cases, the funding for Medicaid can come from the local government, too. The proportions of funding vary based on the state.

In Florida, $23.5 billion are spent on Medicaid each year. However, only $9.5 billion of these funds comes from the Florida state budget – the remaining $14 billion is drawn from the federal budget.

When it comes to administration of the Medicaid program, it is primarily up to the states. Eligibility standards, type and scope of services, and payment rates are all set at the state level. Sometimes, states even rename their Medicaid programs to titles like “Medi-Cal” (California) and “TennCare” (Tennessee). In Florida, Medicaid is administered by the Department of Children and Families.

November 9, 2018
Love0

Risk Adjustment Payments Suspended

By Medicaid Planning, Medicare

Risk adjustment payments to insurance companies had been funded by the federal government as part of the Affordable Care Act since 2014 as part of the ACA’s prohibition against insurance companies discriminating against individuals with chronic illnesses or pre-existing conditions. However, the federal government in early 2018 suspended the risk adjustment payment program, citing a recent Federal District Court opinion regarding the formula used to determine the size of the payments.

Some have expressed fears that insurance premiums could increase as a result of the suspension, while others argue that the risk adjustment payment program has already done more harm than good, through a bias against small insurance companies. The Centers for Medicare and Medicaid Services have asked the Federal District Court to reconsider its decision, and, in the meantime, the insurance market hangs tensely in the balance.

November 1, 2018
Love0

What is the look-back period for gifts made by a Medicaid applicant or spouse?

By Asset Protection Planning, Elder Law, Medicaid Planning

Because Medicaid applicants must have limited income and assets in order to qualify for Medicaid, a scenario may arise wherein an otherwise well-off applicant gives away all of his/her assets as gifts just before applying. To combat this practice, Medicaid instituted the “look-back period.” This refers to the time period prior to the application for which Medicaid will consider gifts made by an applicant or spouse.

In every state but California, the look-back period is 5 years. This means that, if one applies on August 3rd, 2018, Medicaid will count any gifts (assets given away for free or for less than their market price) dating back to August 3rd, 2013 against the applicant. If an applicant is found to violate the look-back period, Medicaid penalizes him/her by rendering them ineligible for Medicaid until a certain amount of time has passed. This amount of time is determined by the formula: [dollar amount of transferred assets] ÷ [average monthly private patient rate of nursing home care].

So, if you are applying for Medicaid and are found to have gifted $45,000 in assets two summers ago, and Florida’s average monthly private patient rate for nursing home care is $9,000 (to be exact, $9,171, as of 07/01/18), you will be ineligible for Medicaid for 5 months. [45 ÷ 9 = 5]

October 8, 2018
Love0

How much does nursing home care cost?

By Asset Protection Planning, Elder Law, Long-Term Care, Medicaid Planning

The costs of nursing home care vary wildly from state to state, and often within the same state. According to www.payingforseniorcare.com, nursing home care in Florida ranges from $181.00 per day to $506 per day. The average cost in Florida is $260 per day.

On the website for the Florida Health Care Association, one can find yet more information about nursing home care in Florida. For instance, from the 683 licensed nursing homes in Florida, the median annual cost for care is $94,900. Though there are 73,000 nursing home care residents at any given time in our state, Florida maintains one of the lowest over-65 population to nursing home population ratios in the United States.

Other options for long-term care such as assisted living and home care are generally less costly than nursing home care, depending on the care need and level of care. The attorneys at Bach, Jacobs & Byrne, P.A. assist senior citizens and their families in planning for long-term care, including Medicaid planning to protect a family’s assets. If you are in need of assistance, call us at (941) 906-1231.

September 24, 2018
Love0

In what cases are non-citizens eligible for Medicaid?

By Asset Protection Planning, Elder Law, Medicaid Planning

According to the Center for Medicare & Medicaid Services, the list of qualified non-citizens is as follows:

-Lawful permanent residents/ green card holders

-Individuals granted asylum/ refugees

-Cuban and Haitian entrants

-Parolees for more than 1 year

-Battered non-citizens, spouses, and children

-Victims of trafficking

-Veterans and active military, their spouses, and their children

The CHIPRA (Children’s Health Insurance Program Reauthorization Act of 2009) also provides Medicaid services for any lawfully-present pregnant women and children, regardless of date of entry into the United States. One is “lawfully present” in the following circumstances:

-Qualified non-citizens

-Humanitarian status (Temporary Protected status, Special Juvenile status, asylum seekers, Convention against Torture)

-Valid non-immigrant visa holders

-Legal status (Temporary Resident status, LIFE Act, Family Unity)

September 14, 2018
Love0

Which common policy terms should I compare when purchasing long-term care insurance?

By Asset Protection Planning, Elder Law, Long-Term Care, Medicaid Planning

Long-term care insurance policies are not standardized from insurer to insurer, and thus the policies differ in many ways. There are, however, key provisions used across the board by Florida long-term care insurers. The American Health Care Association specifies that, in Florida:

-“Long term care policies… may cover at least 24 months of skilled, intermediate or custodial nursing home coverage supervised or recommended by a doctor.”

– “Long term care policies or certificates must provide at least one lower level of care, such as home health care or adult day care. The benefits for this lower level of care must have at least half the benefits of the nursing home care, in both the benefit period and the benefit amount.”

Beyond these, common policy points to be considered when comparing long-term care insurance policies include the following:

-Reimbursement levels

-Covered services

-Daily benefit amount

-Benefit period

-Payment options

-Inflation protection

Online, one can find many useful tools to help ensure that you are taking all relevant factors into consideration when purchasing long-term care insurance. Some of these tools include the free Long Term Care Partners, LLC “Benefits and Features Worksheet,” as well as the website for the National Association of Insurance Commissioners. An FAQs sheet from the state agency regarding Medicaid can be found here: https://ahca.myflorida.com/Medicaid/ltc_partnership_program/pdfs/Florida_LTCP_FAQs_7-26-11.pdf.

August 21, 2018
Love0

Watch Out for Unlicensed Medicaid Planners

By Elder Law, Medicaid Planning

It has become sadly more common in Florida for unlicensed individuals that have never obtained a law degree to offer Medicaid planning services to senior citizens. These individuals are unqualified and lack the knowledge as well as the skills needed to provide effective Medicaid planning services. Sometimes, senior citizens choose to use these unlicensed planners because they believe it will be cheaper, but many of these individuals charge the same price an attorney would for sub-par work that doesn’t end up helping someone become eligible for Medicaid. In Florida, an individual who is not a lawyer may not provide legal advice regarding qualifying for Medicaid benefits, draft a personal service contract, determine the need for, draft or execute a qualified income trust or sell qualified income trust kits. In Florida, the unlicensed practice of law is a felony punishable by up to five years in prison.

Unlicensed Medicaid planners often give seniors bad advice that causes them to waste their money or take actions that won’t actually help them qualify for Medicaid. If you use an unlicensed Medicaid planner, it is more than likely you will end up having to meet with an attorney to fix the shoddy work that they have done. Additionally, if these Medicaid planners give you advice that is not correct, this could result in a Medicaid penalty period, which means you would have to wait even longer to receive Medicaid benefits. When it comes to planning for Medicaid, it is important to use a trusted legal professional that understands the ins-and-outs of the Medicaid program and will ensure that you are able to qualify for Medicaid. The attorneys of Bach, Jacobs, & Byrne, P.A. have extensive experience in Medicaid planning. To schedule an appointment, contact our office at: 941-906-1231.

 

July 27, 2018
Love0