In the Time of Change

It seems that nothing ever stays the same. In our lifetime nothing is constant, except change.  Recently, I wrote all about the upcoming tax changes on capital gains, income tax, death tax and so forth. But there is a lot more to consider. 

Keeping our older citizens who require such care in a nursing home is a very expensive undertaking. In our state the majority of that cost is paid by Mississippi Medicaid. This is a major portion of the appropriation and the budget each year for Medicaid.

But not all people in the nursing homes in our state need that high level of institutional care.  Some could readily be at home and be taken care of there, but they ran out of money. They don’t have the ability to pay someone and provide that care at home, so they wind up having to move into a nursing home.

A new legislative enactment was recently signed by Governor Barbour which transferred three million dollars to the Disabled Home and Community Based Waiver programs under Medicaid.  The purpose of this redirection of funds was to accomplish two things: First, to allow persons who can be cared for at home to be able to remain there and pay for that homebound level of care (which is much less expensive than nursing home care); and second, to allow some who are presently living in nursing homes to transition back to their home if they could be appropriately cared for in a home setting by providing that monetary assistance. What this will actually do, once fully implemented, will stretch those Medicaid dollars much further, and as a side benefit probably will make some of the persons who are now confined to nursing homes much happier to be cared for at home.

There is also a special portion of veterans benefits, referred to as Aid and Attendance, which is available to provide some financial benefits to many of our veterans. This is additional money which can be utilized in providing that home care. Even at its maximum, these benefits are not sufficient to pay for the nursing home in full, but they certainly can help with assisted living and in-home care.

Even family members can be paid for providing caregiver services if there is a written contract and if that contract is done correctly. This is not a “do-it-yourself” item; families definitely need some help in this area to get it right.

One of the other changes that has now been made part of the rules is that the Medicaid benefit disqualification period will not run for the person who is receiving home or community based services. Therefore, using these services as part of an overall plan for the nursing home has just become much more complicated and professional assistance will be needed by many families more than ever, which brings up another change.

Mississippi Medicaid has decided to put caps on what they will allow attorneys to be paid for providing this type of assistance. While it’s not a true limitation, it has been stated that any amount above their limits will be treated as a “gift” to the attorney and will result in an additional period of disqualification. However, no similar limit has been put on what a family can pay their CPA, or how much they can pay in real estate commission, or how much can be spent for a swimming pool or a trip to Hawaii or for a new car. The only limit is on what you can spend in an effort to legally protect some of those assets that you have worked all your life to accumulate.

This is most assuredly a time of change.

William B. Howell is a member of the National Academy of Elder Law Attorneys and practices law in Ridgeland.