Does It Have to Be this Complicated? by Jerold E. Rothkoff

            Last month, during a client meeting, I was attempting to explain to a client’s family why part of the client’s income must be placed into a trust in order to become eligible for Medicaid assisted living coverage in New Jersey.  As I was explaining something that I knew really did not make sense to a reasonable person, I asked myself, does it really need to be this complicated?

A federal court, regarding the complexity of Medicaid law, has stated:

“There can be no doubt but that the statutes and provisions in question, involving the financing of Medicare and Medicaid, are among the most completely impenetrable texts within human experience. Indeed, one approaches them at the level of specificity herein demanded with dread, for not only are they dense reading of the most tortuous kind, but Congress also revisits the area frequently, generously cutting and pruning in the process and making any solid grasp of the matters addressed merely a passing phase.”

Elder law certainly is a challenging area of legal practice.  Heavy emphasis must be placed on continuing legal education, attending meetings, reviewing list serves, and constant communication with other elder law attorneys to remain knowledgeable about the ever changing regulatory field.

Just in year 2014 alone, the following regulatory or legal changes took places effecting seniors and those with disabilities in Pennsylvania and/or New Jersey:

1)      New power of attorney law in PA effective January 1, 2015;

2)      ABLE Act passed in Congress allowing disabled individuals to establish savings accounts to be used for their special needs (see page 2 of this newsletter);

3)      Obama Care continued implementation, including requirement that all Americans must obtain health insurance, as well as all of the exceptions to the personal mandate;

4)      Medicaid expansion eligibility under Obama Care begins in NJ & a modified version begins in PA;

5)      New Jersey implemented changes to its home & community based Medicaid program, now known as MLTSS (Managed Long Term Services and Supports), including moving all Medicaid beneficiaries into managed care;

6)      New Jersey requiring all Medicaid long term care applicants with income above the Medicaid income cap (currently $2,199 per month in 2015) to place excess income above the cap into a qualified income trust;

7)      Implementation of changes to Medicare’s definition of skilled care;

8)      The Veterans Administration changed their financial review process of applications for non-service related disability pension.

The above does not include the constantly changing tax laws, Medicaid eligibility figures, or future changes certain to come to both the Medicare and Medicaid programs.

Our mission is to keep seniors, those with disabilities, their caregivers, and professionals educated as to the rules and how it may impact them.  Is it challenging and sometimes frustrating attempting to make sense out of these complex laws?  Absolutely.

That is why I find great personal fulfillment in this area of law.  Myself and our staff enjoy the challenge of helping families navigate the complex, ever changing regulatory system.    This is why it even more rewarding when we are able to help a family in need.

Does it have to be this difficult in navigating all the rules & regulations when caring for a loved?  No, it should not be. Hopefully, Congress will finally come together in making significant changes to both Medicare & Medicaid which will make planning more user friendly.

Until then, we are here to help advocate for changes, while hopefully making things slightly less complicated.  Have a wonderful and prosperous 2015.

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