Does it Have to Be this Complicated?
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Does it Have to Be this Complicated?

Public Benefits

Does it Have to Be this Complicated?

Once, 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 to become eligible for Medicaid assisted living coverage in New Jersey. As I was explaining something that I knew 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 [...]

Jerold Rothkoff2024-03-08T11:21:02-05:00November 4, 2022|

An Unexpected Support System in Our Public Benefits Department
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An Unexpected Support System in Our Public Benefits Department

Public Benefits

An Unexpected Support System in Our Public Benefits Department

Written by Kaitlin Dirkx, Director of Public Benefits. Fall 2022 marks my seventh anniversary with Rothkoff Law Group, working as Director of Public Benefits. It also marks the longest I have ever worked for the same employer. When people ask what has kept me here for seven years, I always return to the relationships that I build with clients and the fulfillment that it brings me. As I meet more and more families struggling with enormous financial stress and anxiety while managing a loved one’s illness, it reinforces how much I enjoy helping people in this way at one of [...]

Rothkoff Law Group2024-03-08T11:24:20-05:00September 2, 2022|

What is the Community Spouse and the MMNA in Medicaid?
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What is the Community Spouse and the MMNA in Medicaid?

Public Benefits

What is the Community Spouse and the MMNA in Medicaid?

What is a community spouse, and how is one eligible for spousal allowance in the event their loved one is moved to a nursing facility? Before we answer, it’s important to first understand cost-sharing in Medicaid and qualifications based on income. Medicaid is a cost-sharing program, meaning that the Medicaid recipient shares in the cost of their care. Each nursing home has its own Medicaid reimbursement rate, or the daily rate that Medicaid pays them for its nursing home residents. The resident contributes a portion of their monthly income, and Medicaid makes up the difference. The resident’s income contribution is [...]

Rothkoff Law Group2024-03-08T11:28:03-05:00July 1, 2022|

How Can I Fight a Medicaid Transfer Penalty?
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How Can I Fight a Medicaid Transfer Penalty?

Public Benefits

How Can I Fight a Medicaid Transfer Penalty?

If you are planning to apply for Medicaid, whether for yourself or a loved one, it can be important to be aware of and, if possible, prepare for a Medicaid transfer penalty. If a Medicaid applicant has given away assets, inclusive of cash, bank account transfers, properties and/or vehicles, without receiving fair market compensation within the last five years, the Medicaid caseworker processing the application will impose a Medicaid penalty. What is a Medicaid Transfer Penalty? A Medicaid transfer penalty is a period of time during which Medicaid will not reimburse your long-term care provider for services, including home and [...]

Rothkoff Law Group2024-03-08T11:29:52-05:00May 13, 2022|

Will Your Traditional Medicare Change?
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Will Your Traditional Medicare Change?

Public Benefits

Will Your Traditional Medicare Change?

When a new Medicare beneficiary becomes eligible for enrollment, there are two general options for coverage, Traditional Medicare or Medicare Advantage. While Medicare Advantage is gaining in popularity, the majority of seniors still elect Traditional Medicare because it gives them the freedom to choose their providers and manage their own care. However, with the creation of the pilot Medicare Direct Contracting program (DC), some seniors may unknowingly have their care managed by for-profit companies anyway. Created by the Center for Medicare and Medicaid Services late in the Trump administration, the Medicare DC program allows private insurance companies and other for-profit [...]

Rothkoff Law Group2024-03-08T11:31:41-05:00April 1, 2022|

Social Workers: The Unsung Heroes
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Social Workers: The Unsung Heroes

Caregiver, Public Benefits

Social Workers: The Unsung Heroes

March is the month to honor unsung heroes of the workforce: social workers. There are over 700,000 social workers in the United States, and the profession is growing. Social workers dedicate their lives to helping others navigate challenges. They counsel those with mental health and addiction issues, help families navigate foster care and adoption, counsel students, and are essential in a myriad of interdisciplinary teams, including those in hospitals, advocacy organizations, and elder law firms. When I transitioned to the practice of elder law, it was important to me to work for a firm employing social workers. After 10 years [...]

Rothkoff Law Group2024-03-08T11:31:57-05:00March 25, 2022|

Medicare Fraud and Unlawful Practices
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Medicare Fraud and Unlawful Practices

Public Benefits

Medicare Fraud and Unlawful Practices

Most Medicare enrollees have suffered phone calls, commercials, and mailings trying to entice them into switching plans, but how do you know when these offerings are legitimate? If you are feeling pressured into joining a plan, it is important to remember that many insurance agents and brokers may receive a large fee for securing your enrollment. It is important to recognize when a health insurance company or a health insurance advisor may not have your best interests in mind. The widespread privatization of Medicare benefits can lead some seniors, or disabled individuals, to experience Medicare fraud. Medicare has many regulations [...]

Rothkoff Law Group2024-03-08T11:33:46-05:00February 25, 2022|

Changes to Medicare in 2022
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Changes to Medicare in 2022

Public Benefits

Changes to Medicare in 2022

Every year there are a few tweaks and changes to Medicare, the federal health insurance program for those 65 and older. The most predictable changes: increased premiums and deductibles. 2022 brings the largest Medicare Part B increase in history–a $21.60 increase. The 2022 premium is $170.10. Medicare Part B covers physician appointments and outpatient services. Reasons for the increase include: Rising healthcare costs due in part to COVID-19 A congressional act to lower the planned 2021 Part B premium with the difference being repaid via the 2022 increase CMS’s decision to save money to cover the expense of the potentially [...]

Rothkoff Law Group2024-03-08T11:34:45-05:00February 11, 2022|

Extension of the 3-Day Prior Hospitalization Waiver
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Extension of the 3-Day Prior Hospitalization Waiver

Public Benefits

Extension of the 3-Day Prior Hospitalization Waiver

What does the 3-Day Prior Hospitalization waiver extension mean for seniors seeking skilled nursing facility-level care? Over the course of the COVID-19 pandemic, the Centers for Medicare and Medicaid Services issued several waivers in response to the Public Health Emergency. These waivers were scheduled through at least January 2022. In January, it was determined that the 3-Day Prior Hospitalization waiver would remain in effect at least through April 16, 2022. This waiver allows for Medicare coverage of skilled nursing facility level of care without a qualifying hospitalization. Under the traditional Medicare guidelines, a Medicare beneficiary must be admitted to a [...]

Rothkoff Law Group2024-03-08T12:10:18-05:00February 4, 2022|

Aduhelm Coverage: Medicare’s Decision for the New Alzheimer’s Drug
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Aduhelm Coverage: Medicare’s Decision for the New Alzheimer’s Drug

Health Law, Public Benefits

Aduhelm Coverage: Medicare’s Decision for the New Alzheimer’s Drug

On January 11, 2022, the Centers for Medicare and Medicaid Services (CMS) proposed that Medicare would offer Aduhelm coverage. Aduhelm is a drug for the treatment of mild Alzheimer’s disease, only as part of a clinical trial approved by CMS or supported by the National Institutes of Health (NIH). The trial will help to generate the evidence that CMS suggests is currently lacking regarding whether Aduhelm is reasonable and necessary for the treatment of Alzheimer’s disease. This preliminary National Coverage Determination (NCD) comes after months of handwringing over the potential impact of this new high-priced drug on Medicare spending and [...]

Jerold Rothkoff2024-03-08T12:10:31-05:00January 28, 2022|