Sep 2, 2015

Florida Treasure Coast Alzheimer's film, symposium free for caregivers and professionals

Attention dementia caregivers and professionals:

Dementia caregivers and professionals are invited to see the film, His Neighbor Phil - A Story of Love, Devotion and Alzheimer's Disease on Sept. 17 from 1:30 to 4:00 pm at The Grace Place in Stuart. The film will be followed by a symposium the following day, Sept. 18, at the Kane Center featuring guest speaker Lori La Bey, founder of Alzheimer's Speaks. 

Both events are presented by the Southeast Florida chapter of the Alzheimer's Association and are free to caregivers and professionals. RSVP's are required. To reserve your seat and for more information, call Donna True at 800-272-3900, ext. 501, by September 10.

Florida Medicaid divisor increases

Effective September 1, 2015, the Florida Medicaid penalty divisor is $8,346.00. (It was $7,995.00). If an otherwise eligible applicant for long-term care Medicaid benefits has made uncompensated transfers during the look-back period (currently five years), the total value of the transfers is divided by the penalty divisor to determine the penalty period - i.e., the number of months that the applicant will be denied benefits.

To learn more about eligibility for long-term care Medicaid benefits in Florida, including the penalty period and look-back period, click here.

Aug 25, 2015

Breakfast workshops cover HIPAA, changing Medicaid and VA rules, managed care and more

The Karp Law Firm had a great turnout at the three August breakfast workshops we conducted for social workers and health care workers! Attendees heard updates about several important topics: Attorney Joseph Karp discussed the health care community's liability in the wake of Florida's criminalization of Medicaid planning by non-lawyers. Attorney Genny Bernstein brought attendees up to speed on proposed changes to V.A. Aid and Attendance eligibility rules. Guest speaker, Attorney Jacqueline Bain of the Florida Health Care Law Firm fielded attendees' questions about their obligations and liabilities under HIPAA. Nancy Partin and Connie Heffelfinger of the Florida CARES unit, and Kim Clawson and Rosa Bruno of Your Aging and Disability Resource Center, provided updates on Florida's Medicaid managed care system. 

Thank you to our friends who hosted the events: Kathy Kalck, Debbie North and the staff at Harbor Place in Port St. Lucie; Sue McCracken and her team at Allegro Senior Living in Jupiter; and Ina Zimmerman and staff at the just-opened Allegro Senior Living in Boynton Beach. All are lovely facilities - with delicious food! We are fortunate to enjoy fine working relationships with so many caring professionals in the community. Supporting one another enhances our effectiveness and ultimately benefits the families we serve.

Last, a shout-out to our own law firm staff who arrived very early in the morning to prepare for the events: Case Manager Supervisor Deeanna Farrington; Assistant Case Managers Zamara Rosete and Angela Olsen; and Executive Assistant Julie (McKeon) Dobson. And Debbie Karp, who could not attend the events this year but coordinated the details from start to finish.

Photos from the events:

Attorney Karp discusses the Florida Supreme Court ruling criminalizing Medicaid planning by non-lawyers

Attorney Jacqueline Bain of the Florida Health Care Law Firm explains the responsibilities of health care workers under HIPAA

Nancy Partin of the CARES unit discusses the Florida Medicaid managed care program
Some of our guests. Front and center is Paola Wierzbicki, director of the PACE program

Kim Clawson, director of Your Aging & Disability Resource Center

Aug 16, 2015

Medicare patients will now be told when their hospital stay is "observation" status

Medicare will pay for up to 20 days of skilled nursing care only if it follows a three-day qualifying hospital stay. But any day in the hospital classified as "observation status" does not count toward the three-day requirement. Without meeting the requirement, you are responsible for the cost of any skilled nursing care you may require post discharge. You may also incur co-payments for doctors' fees and other hospital services.

In the past, many Medicare beneficiaries did not even know they had been admitted under observation status until after they were discharged and the bills began arriving. That's about to change: Under a new law, the Notice of Observation Treatment and Implication for Care Eligibility Act (NOTICE), hospitals must alert Medicare beneficiaries when they are admitted under observation status for more than 24 hours, within 36 hours of admission, or upon discharge if it occurs sooner. The hospital must also explain the financial implications. The law goes into effect August 2, 2016.

The law is a step in the right direction, but it has limitations, to say the least. The new law does NOT change the three-day qualifying stay rule. Nor does it allow a day spent as an observation patient to count toward a qualifying stay. The law merely ensures that you are told that you are not considered an inpatient.

Just what can you do with that knowledge? Not all that much. You can try to convince your doctor to reclassify your stay. But even if you are successful, the status change will only apply to future days, not to any days you have already spent in the hospital. That leaves you only one option: appealing after your discharge, which is exceedingly difficult. 

Read the text of the NOTICE Act here.

Aug 14, 2015

Happy birthday Social Security - but no COLA gift for seniors in 2016

Happy 80th birthday, Social Security! President Roosevelt signed the groundbreaking program into law on August 14, 1935. While celebrating the profound improvement the program has made in the lives of millions of older Americans, there is one piece of not-so-great news just ahead: It looks like there will be no COLA increase next year. The final announcement will be made in October, but unless there is a dramatic uptick in the Consumer Price Index soon, seniors' checks will remain unchanged next year.

Some argue that tying Social Security increases to the Consumer Price Index shortchanges beneficiaries. Among them is U.S. Rep. Alan Grayson of Florida. He contends that the CPI factors in prices for goods such as gasoline that don't have that much of an impact on most seniors. Instead, Grayson wants Social Security to base cost-of-living increases on the Consumer Price Index for the Elderly (CPI-E), a statistic that puts greater weight on items such as health care that figure more importantly in seniors' lives.

Of course, this is not Social Security's only problem. With an election months away, the system is under more intense scrutiny than usual. Nearly 10,000 Americans turn 65 every day. With fewer workers to keep the system solvent, and retirees living longer than President Roosevelt could have imagined back in 1935, the system is under immense strain. Its problems will be resolved. They must be. The real question is, how?

Aug 13, 2015

Home health agency ratings at

Earlier this year Medicare released its five-star evaluation system for nursing homes. Now, home health care agencies are being rated in a similar way. Ratings are available online and should be useful for anyone seeking help for themselves or a loved one. And there are a lot of people doing just that: In 2014, over three million Medicare beneficiaries received help from home health agencies.

About 9,000 agencies were rated under the five-star system, using measures such as how quickly agencies replied to requests for visits after hospital discharge, improvement of patients, etc. As you look at the data, remember that three stars is considered a good rating for a home health agency. (Unlike other industries, such as the restaurant industry, where three out of five stars is considered only so-so.)

To use the new ratings tool, click here.

Aug 6, 2015

Portability option may be worthwhile even for estates that are not currently taxable

In June the IRS issued final regulations regarding the federal estate and gift tax portability provision. The tax break for married couples was introduced by Congress in 2010 and made permanent in 2013. Portability allows a surviving spouse to transfer to himself/herself any unused portion of the deceased spouse's federal estate tax exemption, effectively permitting the survivor to use  two exemptions and pass more tax-free money to heirs. Until portability came along, most married couples accomplished this by setting up a joint AB (credit shelter) trust.

The option to elect portability is not open-ended, though: The personal representative (executor) or trustee of the decedent's estate must file a federal estate tax return (Form 706) and take the portability election, within nine months of the spouse's death. Moreover, this must be done even if the estate is not currently taxable and therefore not legally required to file a 706. The IRS rules alleviate the filing burden for non-taxable estates only to the extent that the value of assets can be approximate.

If you are among the 99% of Americans whose estate is not taxable  - thanks to a generous $5.43 million federal estate tax exemption at this point in time - don't automatically conclude it's not worth the time or effort to file an estate tax return. Depending on the size of your deceased spouse's estate, your age and other circumstances, choosing to preserve your spouse's exemption could be a prudent move, just in case you end up with a taxable estate of your own.

How could you end up with a taxable estate? Well, there's always the lottery. More realistically, your estate could increase to a taxable level if you are relatively young and your assets have many years to grow. You might end up receiving an inheritance of your own. And Congress is always a wild card: Who knows what the next election cycle, or the cycle after that, will bring? The estate tax has been a moving target for years. 

Better safe than sorry. Surviving spouses should talk with their estate planning attorney about whether to file a 706. If there's a reasonable chance the spousal exemption might be needed in the future, filing the 706 and electing portability will preserve the tax break.

Aug 4, 2015

Proposed change in the way Medicaid treats annuity income

If you're seeking Medicaid long-term care benefits and want to preserve assets, consult a certified elder law attorney. Medicaid law is extraordinarily complex and always in a state of flux, so relying on an expert is essential. The Medicaid office will not provide tips on how to secure benefits any more than the IRS will point you to the latest tax-saving strategies!

Among the proposed changes to Medicaid law currently on the table is HB 1771, introduced in Congress last spring. The experts seem to think passage is a long shot, but it still merits monitoring. If  passed, it would dramatically modify the way in which Medicaid treats annuity income for married couples. 

Here, from my website, is the current rule regarding annuity income and Medicaid eligibility: "Annuities will be considered an asset, unless they are annuitized and the applicant or applicant’s spouse is taking equal monthly installments in an actuarially sound fashion. Applicants and their spouses must disclose to the State of Florida any interest they have in annuities. If the annuity was purchased on or after November 1, 2007, or if other transactions that change the course of an annuity payment or treatment of income or principal have been made on or after November 1, 2007, the state must be named as the remainder beneficiary either at the time of Medicaid benefits approval, or upon recertification. Also, the state must be named as a remainder beneficiary in the first position for the total amount of Medicaid assistance paid by the state on the applicant’s behalf. If the applicant has a spouse, minor child or disabled child, the state must be named as the remainder beneficiary either in the first position, or the second position after the spouse, minor child or disabled child."

If the proposed law passes, a portion of the well spouse's annuity income would be available to the Medicaid applicant: 
  • One half of the income the well spouse receives from an annuity that pays income only to the well spouse, would be considered the Medicaid applicant's available income.
  • If the annuity pays income to both the well spouse and applicant, one-half of the well spouse's income would be considered available to the applicant. 
  • If the annuity pays income to the well spouse and another person, then one-half of the well spouse’s portion would be considered available to the applicant.
These changes could conceivably push an applicant's income out of eligibility range ($2,199.00/month effective 1/1/15), requiring the use of a Qualified Income Trust for Medicaid planning purposes.

Generally speaking, I am wary about using annuities as Medicaid planning tools. There are serious downsides to doing so, and purchasing an annuity is no guarantee of Medicaid eligibility. However, if you already have one, the proposed change could make a big impact on you if you are married and apply for benefits. 

We'll keep an eye on this important issue for you. Subscribe to this blog, get our newsletter, and/or check our website news for further information about this and related issues. You can also keep us with us on Facebook.

Click here to read about current Medicaid eligibility rules in Florida. 

Read the text of HR 1771 here.

Jul 31, 2015

Help our WWII vets: Keep Honor Flights flying

You can help fulfill a dream for South Florida's aging World War II veterans: a visit to the Washington, DC memorial that was built to honor them. The vets are aging, and time is growing short.

Honor Flights Southeast Florida has made the dream come true for 1,600 veterans since 2009, flying our aging heroes to the World War II Memorial for a day, at no cost to them, sometimes with volunteer guardians who assist them to get around during the trip. You can see pictures of the 2011 trip here. 

Honor Flights needs our help to keep the dream aloft. The next trip is scheduled for October 24, 2015, but with a major donor recently bowing out, the non-profit is scrambling to find $65,000 to cover expenses, which include chartering an American Airlines jet, bus transportation to and from airports and around Washington, a police escort, meals for the day and t-shirts and hats. The typical trip accommodates 85 veterans.

Here is how you can help: Roger Dean Stadium is hosting a fundraiser film night on August 26 at 7:30, featuring a film about the evolution of honor flights and the World War II vets. Find out more here.

You can also make a direct donation; see how here. Also, if you would like to volunteer in any capacity, click here

I would be remiss if I did not mention two outstanding members of our community who have stepped up to make sure the October Honor Flight is a go: Dr. Shamsher Singh, a Port St. Lucie dermatologist who has accompanied many frail vets on prior trips, and has pledged to match every dollar of the first $10,000 raised. Also notable is Max Houss, a Palm Beach Gardens retiree and World War II vet, who has made the same pledge. Our hats are off to these wonderful people.

Let's do it for the veterans.

Jul 29, 2015

What happens to Whitney Houston's millions now?

Bobbi Kristina Brown, daughter of the late singer Whitney Houston, has just passed away at the too-tender age of 22, following six months of medical limbo. Now, it's her estate, and her mother's estate, that may be in limbo. 

Houston's only child, Brown was set to inherit her mother's millions by the age of 30, in installments, and had already received one installment at age 21. As I noted in my February post, a pivotal question now is, was Brown married at the time of her death? On social media she referred to her longtime boyfriend Nick Gordon as her husband, but to date there has been no proof that they were legally married. The State of Georgia, where she resided, does not recognize common law marriage. 

If they were married, Gordon inherits Bobbi's estate. If not, her father, Bobby Brown, will get it. That assumes that Bobbi died without a will, which appears to be the case.

Further complicating things: authorities are investigating how Brown came to be found, unconscious, in her bathtub in January. Various family members have speculated about Gordon's possible involvement. If he is criminally charged, that will obviously be a game-changer. He is also being charged with physically abusing Kristina and stealing money from her in a civil suit filed by her guardian.  

As to the her mother's millions that remain in trust for Brown, Houston's estate plan calls for that to be distributed to Houston's two brothers and mother.

This family tragedy could well morph into a legal morass that keeps a lot of lawyers busy for a long time. Very sad.

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