Although most first think only of “means-tested” (assets and income) eligibility for various Medicaid programs, one of the other requirements is a “medical necessity”. The standard for nursing home Medicaid, Community Based Alternative (a Medicaid program which provides personal care services at home and in...
A Texas appeals court has upheld the conviction of an agent under a power of attorney who transferred funds to himself, supposedly to qualify his former grandmother-in-law for Medicaid. In an earlier proceeding, a jury sentenced the agent to 25 years in prison. Natho v....
Although the government agreed to settle a lawsuit (Jimnov v. Sebelius) in early 2013 whereby the government agreed that Medicare has been incorrect in requiring a patient to progress or improve to get skilled nursing services, home health and out-patient therapy covered by Medicare, the...
As of January 1, 2014 here are a few of the important changes resulting from the implementation of the Affordable Care Act (“ACA”). You cannot be denied insurance coverage due to a pre-existing condition. This has resulted in the elimination of the Texas Health Insurance...
The Social Security Administration (SSA) has issued new policy interpretations in 2014 that affect Special Needs Trusts (trusts created for a disabled person in which the assets held in the trusts are not counted as a resource which would have otherwise resulted in the loss...
Veterans who served during wartime (not dishonorably discharged), or the surviving spouse of the wartime veteran, will be getting a slight increase (considered a pension) to be used for care at home, assisted living facilities or in a nursing home from the Department of Veterans...
Texas Insurance Commission Proposes Rules to Regulate “Navigators” who help Apply for Health Care Programs On December 7, the Texas Insurance Commissioner published proposed rules to regulate “navigators” who will help Texas residents to apply for health care affordability including Medicaid and the Children’s Health Insurance...
As many of you know, Texas is an income cap state in connection with long-term care Medicaid eligibility. Presently, if an applicant for nursing home Medicaid has "countable" income (certain income is exempt or excluded) over $2130 per month, then such applicant is ineligible for...
On October 28, 2013, the U.S. House of Representatives passed a bill (HR 2189) that has a three (3) year look-back period and penalizes a claimant for VA pension benefits (typically made by the veteran or his or her surviving spouse when such person has...
2014 Protected Resource Amount Increase - Government Helps Pay Nursing Home Cost Although not officially released, projections for the 2014 Protected Resource Amount (“PRA”) dollar figures can now be estimated in light of the consumer price index update recently made. These figures are used to determine how much...
