“In general, in order to maintain an action, a party “must establish standing to sue on the ground asserted, which requires showing an injury in fact that was caused by the breach of a duty owed by the defendants to the plaintiffs and that will be redressed by a favorable decision from the court.” Ames […]
In L.U. v. Division of Medical Assistance (N.J. Superior Court Docket A-2937-20, May 23, 2023), the Superior Court affirmed denial of L.U.’s request for a fair hearing. How, you ask? “I thought everyone had a right to a fair hearing!!! Well, apparently not. L.U. was an unrepresented Medicaid recipient. He appealed from a May 11, […]
In Henderson v. Dept. of Health and Human Services (May 18, 2023), a Medicaid applicant transferred significant resources, including the full value of her retirement account, to an irrevocable trust. When she applied for Medicaid during the 60 month look back period, the Medicaid agency found the resources were not countable, but imposed a transfer […]
The following Georgia Medicaid cases were litigated outside the context of an administrative hearing, or were appealed beyond that point. Of course, we are not representing there are no other published decisions on point. United Cerebral Palsy of Georgia v. Ga. Dep’t of Behavioral Health and Dev. Disabilities, 331 Ga. App. 616 (2015). A provider […]
July 18, 2011 Paul A. Kryglik, Director Office of Regulations Social Security Administration 6401 Security Blvd Baltimore, MD 21235 Re: Program Operations Manual System SI 1120.220, cash loans Dear Director Kryglik: I am requesting a ruling from your office on an issue involving Program Operations Manual System (POMS) SI 1120.220, cash loans, with respect to […]
During the week of May 1, 2023, the VA updated its Adjudication Procedures Manual to clarify that a claim in which funds were withheld pending a fiduciary appointment is a claim pending at the time of death and may be paid as accrued benefits. The updated section is M21-1, Part XI, Subpart ii, Chapter 3, […]
On May 4, 2023, the Department of Community Health announced the new state-wide average nursing facility private pay rate increased from $9,034.00 to $9,584.00. This rate is the divisor when calculating the length of a transfer penalty when resources or income are transferred for less than fair market value.
When applying for Medicaid, the nursing home spouse (called the Institutionalized Spouse) is often a joint owner (or sole owner) on checking, savings and other acounts. Should those resource be taken out of the name of the Institutionalized Spouse? The answer is generally “yes,” but it requires some context and some qualifications. The context and […]
In the Matter of the Medical Assistance Pooled Special Needs Trust of Scott Hewitt (Iowa 2023), the State Medicaid agency had a contigent interest in the trust remainder due to the payback requirement in 42 U.S.C. § 1396p(d)(4)(C). However, after the beneficiary died, the master trust informed the Department that it would retain the remainder, […]
On April 25, 2023, the VA issued the following announcement: The Caregiver Support Program (CSP) is introducing a new nationwide service offering comprehensive legal and financial planning services to Primary Family Caregivers enrolled in the Program of Comprehensive Assistance for Family Caregivers (PCAFC). A network of licensed attorneys and certified financial counselors are readily accessible […]
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