Elder
Law Update
Georgia Edition
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PLEASE VISIT MASON LAW
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I WANT TO KNOW
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Dear Stacey,
Many of you have been regularly following our series
on
Medicaid, which began in December. My initial
intent was to run a series until I had covered the
topic, then compile the series into a single,
readable, downloadable tract. I have received
numerous favorable comments, and quite a bit of
inquiry as to when I was going to wrap the series up
and bless everyone with a single document. The
clincher, however, is that I am tired of writing
about Medicaid and am ready to move on to other
topics.
So . . . the last installment on Medicaid nursing
home rules begins below. But it doesn't end there.
If you would like to read the whole document, you
may follow the link to the Mason Law, PC website and
read it there. In addition to being packed full of
useful information, you'll be able to find the
photos of all your favorite "confused people"
featured in the series (yes, believe it or not, a
number of you commented on "confused guy at the
computer" and "surprised granny" and "aghast guy" .
. . "surprised granny" seemed to be the hands down
favorite . . . she looks so . . . nice). You'll also
find a convenient printer-friendly version of the
memo, as well.
All levity aside, I help clients with many stressful
situations, but "losing-my-home-to-the-nursing-home"
concerns (not the biggest thing to be concerned
about, by the way) take the prize. It is my hope
that the series will provide an easily readable
overview of the topic and lower the stress levels
out there a notch or two.
Dr. Hodges is back this month with a piece on
hospice care, and hopefully she can dispel some
common misperceptions about what hospice does.
Rose Shevlin (below) reminds us that summer travel
time is nearly here, and for those heading across
the Big Pond she has some "age-less" advice
concerning money (as in what to have in your
pocket!). One of my favorite commercials involves
the little travel gnome who attempts to stick an
American plug into a European outlet ("Oh, grow
UP!" he says before being blown across the room in a
flash). I can attest, as a former European/Middle
East hand, that sometimes your 'Merikun plastic
won't get you too far when you try to stick it into
Le ATM. Rose
offers a few good pointers below.
And finally, Social Security Guy Waren Coble is
beginning a series on how your Social Security
benefit is calculated. As the first 'Boomers begin
to ponder early retirement benefits, this could make
for timely reading. Warren and I both agree that
taking early Social Security benefits may not be too
smart. In fact I took a look at this very topic in
the March edition of
Coastal Senior
(Savannah-Hilton Head) in
"Ladies, Is Your Husband a Cad?" (if you care to
take a look).
Bob Mason
Certified Elder Law Attorney
Certified by the
National Elder Law Foundation,
recognized by the American Bar Association as the
certifying entity for specialization in Elder Law.
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MEDICAID BASICS AFTER DEFICIT REDUCTION ACT:
Part Last!
Bob Mason
This is the last
of a multipart series that jumped into the whacky
world of Medicaid nursing home benefits after the
Deficit Reduction Act.
This last
installment starts below. If you like, you can read
the entire document by going to
Georgia Medicaid Explanation - The Basic Rules of
Nursing Home Medicaid Eligibility on the
Mason Law, PC website.
Previous
installments of this series have dealt with Medicaid
rules applicable to various assets. The memo now
moves on to the much misunderstood topic of
"Transfer Penalties".
THE TRANSFER PENALTY
The other major rule of Medicaid eligibility is the
penalty for transferring assets. Medicaid has always
imposed some sort of restriction on transferring
assets before entering a Medicaid application - were
it not for such restrictions, anyone could qualify
for Medicaid simply by giving assets away at the
time nursing home entry became necessary.
Early in 2006 Congress passed, and on February 8,
2006, President Bush signed, the Deficit Reduction
Act ("DRA"). DRA mandates tough new restrictions on
the transfer of assets made on or after the
effective date of February 8, 2006.
The effects of DRA have been trickling down to the
states and each of them has been grappling with how
to implement DRA locally. Georgia began enforcement
of the new rules on February 1, 2007, retroactive to
transfers made on or after February 8, 2006.
There will continue to be many details to hammer out
as DCH, county DFACs and
advocates sort through the new Medicaid manual
changes. Advocates (and DCH) continue to interpret
new rules and manuals issued by DCH (many of which
are not a model of clarity). Expect confusion and
differing rules interpretations through 2008 and
into 2009. The remainder of this memo will refer to
February 8, 2006 (the date with respect to which DCH
is applying the new DRA Rules) as the "Effective
Date".
Read the rest of the memo by clicking
HERE.
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HOSPICE
AND END OF LIFE CARE
Beth Hodges, M.D.
There are certain tasks in medicine that I have
always felt to be special: the first examination of
a new baby, the first school physical, telling a
young couple they are expecting, and caring for a
patient at the end of his or her life.
 Most
of the first examples listed are happy occasions.
The last is sad, but in certain circumstances can
nevertheless be a peaceful conclusion to this long
adventure we call life. As a physician, I feel I
have done my job well if the patient is comfortable
and without pain. I also take it a step further--I
wish for the family, though no one can take away
their pain, to have peace with the inevitable and to
have the opportunity to celebrate the life of the
beloved they have lost.
In the hospice arena, we call that a "good death."
Those with less experience may think all deaths are
bad, but I can assure you, there is a difference. A
death where the patient suffers, either from pain or
air hunger, or a family is torn apart by differences
in opinions on or understanding of end of life care,
is a bad death. Hospice staffs (doctors, nurses,
social workers, chaplains, and volunteers) devote
their careers to preventing bad deaths.
Many people think of hospice as only for cancer
patients, but in fact anyone estimated to
potentially be in their last six months of life is
eligible for Hospice services. These days, common
diagnoses are cardiac disease, chronic lung disease,
adult failure to thrive (weight loss and progressive
weakness in someone for unknown reasons), debility
after stroke, cancer, and even end-stage dementia.
Hospice involvement can make a tremendous difference
in the quality of remaining life for a person, but
only 20% of eligible persons ever get referred to
Hospice by a physician. Why? Partly because some
physicians do not think about hospice services for a
noncancer patient, partly out of a reluctance to
bring up the subject to a patient or his family for
fear the family will feel the physician is giving up
on Dad, and sometimes because the physician is
simply not aware of how much the family and patient
are struggling at home alone.
Hospice does not mean the doctor has given up. On
the contrary, as the local medical director for a
hospice organization, I have at times had to
authorize the discharge of a patient who, through
the tender loving care of our staff, has improved to
the point that he is no longer appropriate for
Hospice services. The philosophy of Hospice is to
treat what we can, without employing heroic
measures. That means we might treat a pneumonia in a
cancer patient who is bothered by all the coughing,
but we would not put that patient on life support.
The focus is on quality of life, as opposed to
quantity.
I would encourage you to think about Hospice for
anyone you know who sounds like she fits into the
above scenarios. Most hospice referrals come from
the families of patients, and may be one of the best
phone calls you can make for everyone involved.
Beth
Hodges, M.D., is a principal in Hodges Family
Practice with offices in Asheboro and Ramseur, North
Carolina.
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HOW YOUR SOCIAL SECURITY BENEFIT IS CALCULATED
-Warren Coble
Last month we learned how the base benefit for
Social Security Retirement, Disability, and Survivor
purposes is determined. That base benefit is also
called the Primary Insurance Amount, PIA for short.
As we'll see, calculating the PIA may be just the
starting point for determining the actual benefit
paid.
This month and next month we'll look at some of the
factors that affect the actual benefit paid. Some of
those factors are applied to the PIA, which then
affects the benefit paid. Other factors are applied
directly to the benefit to be paid the beneficiary.
The first factor affecting benefits, which is
totally within the beneficiary's control, is
choosing to receive benefits before full retirement
age. Previously, retirement at age 62 reduced the
PIA 20%. Full retirement age for individuals born
from 1943 through 1954 is age 66. Benefits for
retirees are reduced 5/9 of 1% for each month they
sign up prior to age 66. The current PIA reduction
for age 62 entitlement is now 25% (due to the
increase in the full retirement age).
Starting with individuals born in 1955, full
retirement age will again gradually increase to age
67 for individuals born in 1960 and later. This will
result in the reduction of the PIA to only 70% at
age 62. Thus, over the course of a 23 year birth
span (1937-1960), Social Security has reduced the
amount an individual receives for early retirement
(age 62) from 80% to 70%. It should be noted that
the reduction percentages are different for
retirement, spouse, and survivor benefits.
Cost of living adjustments (COLA's) are the next
major issue affecting benefits payable under Social
Security. Individuals are eligible for COLA
increases starting with the year they become age 62,
even if they do not sign up for benefits until full
retirement age, or later. Cost of living increases
are added to the benefit beginning with the year the
individual reaches 62 up to the year they start
receiving benefits. The subsequent COLA increases
(after entitlement) are added each year in December,
and the increased amounts are reflected in the
December payment paid in January. The COLA's for
2006 and 2007 were 3.3% and 2.3% respectively.
Next month we will look at other issues affecting
the amount of monthly Social Security benefits paid.
Social Security expert Warren Coble welcomes your
questions regarding Medicare, Social Security and
Senior Life in general! Email Warren by clicking
HERE. |
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Your Next Vacation: What Makes Cents!
-Rose deVries,
Darby
Bank & Trust Co.
The plans for your next big trip are finally
coming together and the excitement is
building, but now it's time to organize the
details. When traveling, especially abroad, it
is essential to plan and prepare your methods of
payment for your expenses. With all the tourist
horror stories, some may find that choosing
monetary exchange methods is a rather
nerve-racking task. But when taking a closer
look at each type of travel money and weighing
out the pros and cons, you will find it much
easier to choose a method that work best for
you.
Cash is the most convenient payment option if
traveling in your native country - due to ease
of acceptance and the perk of having it handy.
Another plus is if you are traveling abroad,
cash is less expensive to exchange for local
currency than other forms of payment. However
on the downside, cash is bulky, awkward to
carry, easily stolen and irreplaceable.
A traveling trend that has recently become more
popular among tourists traveling abroad is the
conversion of funds prior to departure. The
exchange of currencies before the trip can be
necessary if planning to arrive after hours or
during holiday when exchange businesses will be
closed. Remember, immediately upon arrival
there are miscellaneous expenditures such as
tips and taxis that will require local
currencies.
A great resource for currency exchange is
Travelex's My Travel Wallet. It is an online
ordering application through which travelers can
order international travel cash for delivery
direct to their doorstep. They offer competitive
foreign exchange rates as well as no commission
fees on currency or travelers cheques. Go to the
My Travel Wallet link on Darby Bank's homepage,
and spend some time researching rates for your
destinations. Be sure to compare their rates to
that of other currency exchange applications
offered by major banks such as Bank of America,
or even certain international airports. More
than likely, My Travel Wallet will have lower
rates and fewer fees.
For instance, Bank of America does not charge a
fee for exchanging currency online. However,
unlike My Travel Wallet, they do have a 2%
service charge on all American Express Travelers
Cheques which can be rather pricy when
exchanging a few thousand dollars. And for those
who choose to exchange their currency at the
airport, be prepared to pay an additional
convenience fee. Keep in mind that only some
airports even offer the service, Savannah Hilton
Head International is unfortunately one that
doesn't.
Another payment method for consideration is a
debit card. There are again both pros and cons
to debit cards when traveling either in the US
or abroad. For one thing, a debit card can be
properly protected, and is more difficult to
steal than cash. Also if your debit card is part
of a major network, such as Plus or Cirrus, you
can use it in many countries to automatically
withdraw local currency, with associated fees of
course. They are also conveniently small and
easy to carry safely. On the other hand, your
debit card may not work in all ATM machines at
your destination. And if you travel abroad, your
debit card probably won't be accepted at stores
or restaurants. Also keep in mind that in rural
areas, finding an ATM that is part of your
network might be difficult. Another hassle
associated with debit cards is that PIN numbers
are not always transferable in foreign
countries. In some countries, ATMs will not
process PINs with more than four digits. In
others, PINs with zeroes will not work. Worst of
all, if your funds run out, you can't get a cash
advance with your debit card. You may wish to
bring an alternate form of travel money for
emergencies.
Similar to debit cards, credit cards have many
of the same pros and cons. The main differences
are that you can reserve a hotel and/or rental
car on your credit card. Fortunately, Visa and
MasterCard are accepted at many places around
the world and allow cash advances from ATM
machines for a fee. But of course, there is
always the problem with credit card fraud and
the irritating service fees for foreign currency
transactions.
Travelers cheques are yet another option and are
tailored more for the overseas traveler. They
are secure and require a countersignature for
use. But if they are stolen, they are not too
difficult to replace. Another 'pro' is the
ability to buy travelers cheques in some foreign
currencies, including the Euro, British pound,
Japanese yen and Canadian dollar. The problems
associated with travelers cheques are mainly the
expenses and inconvenience of planning an
itinerary around banking hours to exchange for
the local currency. Even more annoying, is that
not all merchants or banks will accept travelers
checks, even those in their local currency, or
they may charge you a fee to accept them.
Many travelers prefer to choose a combination of
payment methods, ones that work for their
traveling needs and are suitable to their
destinations. Before departure, check with your
bank and ask about transaction fees and currency
conversion charges. If they are too high for
your budget, consider switching credit/debit
cards for the trip. Plan well and avoid coming
back with your own tourist horror story.
Rose
de Vries, JD, is Vice President of Private
Banking Services for Darby Bank & Trust Co.
(offices in Vidalia, Lyons, Pooler and Savannah,
Georgia). Rose is based in Darby's main Savannah
office. You may email comments and questions to
Rose by clicking
HERE
or by giving her at 912 944 2612.
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The Usual Disclaimer: This newsletter is for
general information only. Please do not rely on
anything you read in this email as definitive legal
advice applicable to you. All situations are
different, including yours. Nothing you read in this
newsletter is a suitable substitute for professional
advice you may receive from your attorney, your
accountant, or your tax advisor.
All contents copyrighted 2008 by Mason Law, PC.
Contents may be republished with written permission
of Mason Law, PC (which permission will usually be
given!). |
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