Insights As Elder Law Attorneys Meet in Texas
Sometimes people wonder what difference it makes to belong to a national organization in your field. I would answer for elder law attorneys that the National Academy of Elder Law Attorneys (NAELA), the grandfather of elder law organizations to which I belong, it does matter. It matters because the national organization gives the “broad view” when considering clients’ problems and also because states differ and clients and their families need help deciding whether to move or stay.
One of the most productive programs in my opinion has been NAELA’s “Unprogram” held every year in Texas which I have attended for the past 15 or so years. Next year it will be replaced with an expanded version called the “Summit.” Last week I again had the opportunity to travel to Dallas to learn what elder law attorneys are doing throughout the country and apply that information and knowledge to my own clients’ circumstances back home here in Pennsylvania.
Here are some of the things I learned:
From Len Mondschein, Esq., a friend and elder law attorney in Florida, I learned that Florida is moving ahead with managed care for seniors applying for Medicaid. Len could report first hand that the process is making it more difficult for seniors to receive services. It sounded like confusion and disorganization all around. Applications submitted prior to the managed care change are now not acknowledged as having been received. Forms for at-home care, also known as Home and Community Based Services, do not relate to the questions that are asked applicants over the phone. I care because some of my clients move to Florida or now have joint residence in Pennsylvania and Florida. Although Pennsylvania is not known for the extent or adequacy of its home-based services, it is good to know someone in the other state so that we can compare notes whether it is best to obtain services in Pennsylvania or Florida.
From a Massachusetts attorney I learned that denials of Medicaid applications are becoming more aggressive in that state.
It is gratifying to report that at the program that I have facilitated for the past several years, first on “Family Agreements” and then on “Advanced Family Agreements Using Personal Services Contracts and Real Estate,” there was once again standing room (actually sitting on the floor room) only. Family Agreements are extremely useful for so many purposes, not just Medicaid. Where one family member takes on primary responsibility to care for a parent, these written Agreements can allow that person or that person and her family to be compensated. Where blended parent-child families want to buy a property together or share a property, Family Agreements lay out the terms.
The discussion this year confirmed my belief that, where clients have a choice between seeking services that could be paid for by Medicaid in Pennsylvania or in New Jersey, Pennsylvania is the better location for seeking services.
Where a Medicaid applicant receiving services in Pennsylvania (or New York or Delaware for that matter) has a spouse at home with an IRA or a 401(k), the spouse’s retirement account does not need to be spent down while in New Jersey it does. The difference in cost between receiving care in one state versus another could be huge. Also, New Jersey has a presumption against personal services contracts between parent and child or relative to care for the parent and wants payment, if made, generally to be made at minimum wage or close to it. Not necessarily true in Pennsylvania.
As to practical considerations, I also met up with a San Diego, CA attorney I know and had been trying to reach regarding a Pennsylvania estate I am handling. One of the beneficiaries died in California. Phil Lindsay in San Diego agreed we could work out the Pennsylvania-California connection this week.
I learned that in Texas, at $4,500 per month, the cost of skilled nursing is half the cost it is here and that there is more longer term residential hospice but health insurance generally covers fewer people. The next time I meet with a client who might move to Texas or who came from Texas, that information might prove handy.
About the Author Janet Colliton
Esquire, Colliton Law Associates, P.C. Janet Colliton has practiced law for over 38 years, 37 of them in Chester County, Pennsylvania, a suburb of Philadelphia. Her practice, Colliton Law Associates, PC, is limited to elder law, Medicaid, including advice, applications and appeals, and other benefits planning including Veterans benefits, life care and special needs planning, guardianships, retirement, and estate planning and administration.