{"id":2724,"date":"2023-05-15T09:40:54","date_gmt":"2023-05-15T09:40:54","guid":{"rendered":"https:\/\/alcleanscarpet.site\/Weatherby\/2023\/05\/15\/medicaid-applicant-who-made-transfers-before-major-health-problems-still-subject-to-penalty-period\/"},"modified":"2023-06-06T06:05:32","modified_gmt":"2023-06-06T06:05:32","slug":"medicaid-applicant-who-made-transfers-before-major-health-problems-still-subject-to-penalty-period","status":"publish","type":"post","link":"https:\/\/alcleanscarpet.site\/Weatherby\/medicaid-applicant-who-made-transfers-before-major-health-problems-still-subject-to-penalty-period\/","title":{"rendered":"Medicaid Applicant Who Made Transfers Before Major Health Problems Still Subject to Penalty Period"},"content":{"rendered":"

A recent New Jersey court of appeals case illustrates some of the pitfalls of the Medicaid rules and the problems that can result without proper planning.\u00a0 See S.L. v. Division of Medical Assistance and Health Services<\/a> (N.J. Super. Ct., App. Div., No. A-3520-11T4, Sept. 2, 2014).\u00a0 In December 2009, \u201cS.L.\u201d was a 95 year old woman who moved into a skilled nursing facility following a bad fall preceded by several mild strokes.\u00a0 When she filed for Medicaid benefits, the Essex County Board of Social Services determined that a 5.7 month \u201cpenalty period\u201d would be assessed before her benefits would commence.\u00a0 The premise for the Board\u2019s decision was that S.L. had made a total of 4 gifts in the total amount of $40,000 to her children between 2007 and 2009.\u00a0 S.L. then petitioned the appeals court to overturn the Board\u2019s decision but her appeal was denied.<\/p>\n

There are two important planning lessons to be learned from S.L.\u2019s case.\u00a0 First, the Medicaid rules set forth a firm presumption that any transfers made by a Medicaid applicant within five years of applying for benefits were made to establish Medicaid eligibility.\u00a0 To put it another way, a Medicaid applicant has a very difficult burden of proving that any such transfers were made for some purpose other than trying to become Medicaid eligible.<\/p>\n

S.L.\u2019s testimony reported that during the time period she made the gifts she was \u201ccompletely lucid and managed her own affairs\u201d and that apart from slightly deteriorated vision she was suffering from no physically debilitating conditions and had been diagnosed with no chronic or long term illness.\u00a0 One of the $10,000 gifts was a down payment for her son to purchase a car that was needed primarily to drive S.L. around.\u00a0 She explained she would have purchased it herself except she saw no sense in that since she no longer had a valid driver\u2019s license.<\/p>\n

S.L. testified \u201c[w]hen I gave my children the gifts I anticipated living in Florida with my son for the rest of my life. I wanted to give these monies to my children while I was alive in order to see them enjoy the money. I emphatically deny that these gifts were given to my children because I was anticipating going into a nursing home and giving away my assets to become eligible for Medicaid.\u201d<\/strong>\u00a0 In characterizing her monetary gestures towards her children as \u201cgifts,\u201d S.L. elaborated that her purpose was simply a realization that \u201cI had the money and I thought how nice it would be to see them spend it. . . . Well I thought it would be nice to see them enjoy the money that I had. I had everything I wanted.\u201d\u00a0<\/strong> S.L.\u2019s lawyers asked her directly:<\/p>\n

Q. When you gave them the money, the first money, did you think, “Well I have to give them this money because I am going to go into a nursing home,” or anything like that?<\/em><\/p>\n

A. No, we never discussed nursing home. I was always the type of person I did everything myself [sic].<\/em><\/p>\n

The testimony then adds that following the gifts S.L. retained sufficient funds for herself.\u00a0 That is to say, her gifting in and of itself was not enough divestment of assets to render her Medicaid qualified. After she moved into the skilled nursing facility, S.L. paid privately for some 10 months before she applied for Medicaid benefits.\u00a0 The judicial decision does not state the exact amount she privately paid but we can estimate she had over $70,000 in funds when she first moved into the nursing home.<\/p>\n

Despite all of the above evidence to the contrary, the appeals court was not persuaded! \u00a0The court ruled that there was insufficient evidence to overcome the presumption mandated by the Medicaid rules.\u00a0 The bottom line for planning is that the Medicaid gifting presumption is a very high burden for any Medicaid applicant to overcome.\u00a0 Even when abundant evidence is presented to show that gifts were made long before nursing care was contemplated and for various purposes other than seeking Medicaid eligibility, the presumption will almost always lead to a Medicaid penalty being applied.\u00a0 That is why it is crucial to do pre-Medicaid planning long before there may be a need to start receiving skilled nursing care.<\/p>\n

A second planning point to be learned from the case of S.L. is the lost opportunity to have implemented a family care contract.\u00a0 In describing the circumstances of S.L\u2019s son moving in with her in 2002, she explained that her son helped her perform daily tasks of living, took her to her medical appointments, helped her with shopping, and helped her with many other errands.\u00a0 Those are precisely the sorts of tasks for which a family member could validly be compensated as a caregiver in a formalized Medicaid compliant care contract.\u00a0 If the funds S.L.\u2019s son received could have been properly characterized as compensation for services provided to her rather than as gifts, then the Board would have had no grounds to assess a Medicaid penalty.<\/p>\n

https:\/\/weatherby-associates.com\/medicaid-applicant-made-transfers-major-health-problems-still-subject-penalty-period<\/p>\n","protected":false},"excerpt":{"rendered":"

A recent New Jersey court of appeals case illustrates some of the pitfalls of the Medicaid rules and the problems that can result without proper planning.\u00a0 See S.L. v. Division […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-2724","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"yoast_head":"\nMedicaid Applicant Who Made Transfers Before Major Health Problems Still Subject to Penalty Period<\/title>\n<meta name=\"description\" content=\"To put it another way, a Medicaid applicant has a very difficult burden of proving that any such transfers were made for some purpose other than trying to become Medicaid eligible.\u00a0\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/alcleanscarpet.site\/Weatherby\/medicaid-applicant-who-made-transfers-before-major-health-problems-still-subject-to-penalty-period\/\" \/>\n<meta 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