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In a recent post we discussed how Medi-Cal, California’s Medicaid system, can go after the assets of a deceased beneficiary recipient’s probate estate or revocable living trust for reimbursement of medical costs paid during the person’s lifetime. There is some good news for future Medi-Cal beneficiaries and their potential heirs. California’s recently adopted state budget includes important provisions designed to limit Medi-Cal “recovery” against estates. This is an important decision that will help many low-income California residents and their families by protecting their homes and savings from mandatory state seizure.

Legislature Adopts Important Protections for Medi-Cal Recipients and Families

There are actually two categories of reimbursements sought by Medi-Cal. The first is for “specified medical assistance, including nursing facility services, home and community-based services, and related hospital and prescription drug services” provided to California residents ages 55 and over. Federal law requires California to seek reimbursement from a recipient’s estate in these cases.

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Estate planning is not just about taking care of your family. It is also about taking care of your creditors. Your death does not magically make your debts disappear. The personal representative of your estate has a legal obligation to pay your valid debts from the assets in your probate estate before distributing the remainder to your heirs or the beneficiaries named in your will.

Death of NBA Team Co-Owner Raises Creditor Concerns Over Potential Sale

Creditor claims can significantly complicate the administration of a probate estate. An ongoing high-profile probate case in Oklahoma offers a useful illustration. In March of this year, Aubrey McLendon, a well-known natural gas company executive, died in a single-car crash. Among his many assets, McLendon owned approximately 20% of the NBA’s Oklahoma City Thunder franchise. McLendon was part of a group that purchased and relocated the former Seattle Sonics to Oklahoma City in 2008.

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We applaud clients that have had the foresight to get an estate plan in place, before they need it. It makes it much easier on your family if you have taken the time to prepare an estate plan ( a will or a trust), specifically setting forth who you want to inherit your estate, who you want to pay your final bills and distribute your estate, how you want your personal effects divided, etc. Sometimes however, doing estate planning can be just the beginning of your planning. Some people discover that on down the road they also need financial planning, long-term health care planning, or Medi-Cal planning.

Especially long term planning and Medi-Cal planning are subjects that most people know little about. You may have questions about how to pay for long-term care? How do I know if I need it? Can I plan now for the possibility I will need it in the future?

AARP (American Association of Retired Peersons has a great article tthat discusses some of these issues. According to AARP, about 60% of people over the age of 65 will require some type of long-term care during their lifetime. There are many choices for long-term care from having your family members care for you to long-term health insurance and Medi-Cal. Sometimes you need a combination of services.

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Many seniors have serious concerns about going into a nursing home. They have questions such as whether they can be forced to go into a nursing home, how to pay for nursing home care, and how to choose a nursing home facility that will provide good care. They also wonder if they can qualify for Medi-Cal to pay for such costs.

No one can be forced into a nursing home. If you do not believe you need nursing home care, the only way you can be forced into such a situation is through a court ordered conservatorship. An interested party can file a petition to have a conservator appointed if you are unable to take care of yourself. You have the right to appear at the hearing, present evidence that you do not need a conservator, and have a lawyer represent you.

If you do need nursing home care, there are many reputable ones. Choosing the right nursing home can be an important decision for you and your family. Nursing homes are strictly regulated by the state and federal government. There are regular inspections and procedures for complaints. In San Diego, there are many nursing homes. You can get information about how to choose one from AARP and California Advocates for Nursing Home Reform. Personal referrals from friends, senior centers, or churches can help narrow your search. Make sure you personally visit the ones you are considering and if Medi-Cal may be paying for such care at some point, choose a place that accepts Medi-Cal so that the individual will not have to be moved once Med-Cal is paying for the care.

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With the aging baby boomers now becoming seniors and people living longer in general, one of the issues seniors face, especially in this economy, is the possibility of needing long term care. The cost of nursing home care has risen tremendously in the last decade. A survey done by Metlife in October 2008 listed the average cost of a private room in San Diego as $240 per day. Assisted living facilities can run anywhere from $2500 – $5000 per month, even more for specialized care such as for Alzheimer’s patients.

You can read more about long term care planning in an article here on our website. One option to pay for nursing home care is Medi-Cal, the California state-funded needs based program. Medi-Cal provides health and long term coverage to over 10 million Californians. To qualify for Medi-Cal for 24 hour care in a skilled nursing home,an applicant must pass the Income Test and the Asset Test. Medi-Cal has certain income limitations and also only pays for the cost of nursing home care if the “countable” or “non-exempt” assets of the person needing care and their spouse are below certain limits.

There are some assets that are “exempt” meaning they do not count in figuring your assets. Some of these “exempt assets” are a home, car, personal property, $1500 in life insurance, and prepaid funeral plans. You can also convert some of your countable assets into exempt assets before entering a nursing home.

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Seniors in San Diego as in other cities across California have many issues that are unique to them: Elder abuse, Medi-Cal planning and eligibility, social security, health care directives and powers of attorney, rights as a grandparent, and various estate planning issues.

There is a great publication published by the California State Bar that will be coming out in May. The guide called Seniors and the Law: A Guide for Maturing Californians is a comprehensive publication which addresses laws and legal issues relating to seniors.

The publication was first printed in 2003 but has been updated for the estimated 5.5 million residents of California who are over 60.

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The simple answer to this question is “before you need it” however knowing when that is can often be difficult. Most of us know to plan for retirement but sometimes we don’t recognize the need to plan for when we or our parents can no longer take care of ourselves.

People are living longer and more people will need long term care than in past generations. Some people do not realize that often what strikes the elderly is not a physical ailment but a mental condition which Medicare will not cover. Medicare typically covers such things as skilled nursing but it usually does not cover custodial care. Paid caregivers at home or home health aides, a nursing home, or other assisted living facilities will not usually be paid for by Medicare.

The time to consider the expenses of long term care is before it is needed so that you can explore such options as long term health care insurance, a spend down of assets to qualify for Medi-Cal, or community services that may be available. Taking the time now to plan, before there is a need, will give you peace of mind to deal with the difficult decisions that arise when the time comes.

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The San Diego County Courts hear many cases where a conservatorship is sought of an individual’s estate or person. When an individual cannot take care of his or her financial or personal affairs, it may be necessary to have the probate court appoint a conservator of the estate or of the person. A conservator of the estate is responsible for handling the finances of the conservatee. The individual appointed has broad powers to manage assets, write checks, make investments, etc. A conservator of the person is an individual appointed to make decisions about the conservatee’s personal needs such as health care, residence, food, clothing, etc.

A conservatorship can be an expensive process and may not always be necessary. Before the court appoints a conservator for an individual, it must be shown that no other alternatives are available to the proposed conservatee. These alternatives are durable powers of attorney, trusts, or the voluntary acceptance of assistance.

1. A power of attorney is a written document whereby one person (the principal) appoints another ( the agent) to act on his behalf upon incapacity. Powers of attorney for finances and for health care may provide a viable alternative to a conservatorship.

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According to the Alzheimer’s Association, there are an estimated 5 million Americans suffering from Alzheimer’s disease. Fortunately, San Diego has a lot of resources for families living with the disease. The George G. Glenner Alzheimer’s Family Centers is one resource that helps families with adult day care, respite programs, and support groups. The Southern California Caregiver Resource Cener also provides assistance in the form of support groups, seminars, respite care, etc. Information on geriatric care managers is available through the National Association of Professional Geriatric Care Manager’s Association.

Alzeimer’s eventually results in disorientation, memory loss, cognitive dysfunction, and inability to take care of oneself and one’s finances. Planning ahead can be vital for family members caring for the Alzheimer patient. Once the individual loses the capacity to make financial decisions, it is too late to execute important documents like powers of attorney and wills or trusts. All such documents require that a person have the ability to understand what they are signing and the legal effect of signing the document. If a person becomes incapacitated before someone can be named to make important decisions, the only alternative may be a conservatorship which is costly, requires court approval, and takes time.

If you are coping with a person who has Alzheimer’s or any other type of dementia, take advantage of all the resources available. Contact us at Law Office of Scott C. Soady, A Professional Corporation if we can help with powers of attorney or other legal documents to enable other individuals to take over health care and financial decisions when the person becomes unable to do it personally.

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At Law Office of Scott C. Soady, A Professional Corporation, we want to make sure our clients and other seniors in San Diego are aware of matters important to them. Medicare is the nation’s largest health care plan covering nearly 40 million Americans. From November 15 until the end of the year is the Annual Election Period (AEP). Those eligible for Medicare or those already enrolled can change their enrollment in or out of Medicare Part D and Part C.

If you currently are on Medicare you know that there are four parts. Most people with Medicare have Part A which is basically hopsital coverage and Part B which covers doctors and oher practicioners. Part C is the Medicare Advantage Plans under which Medicare pays a private insurance company to administer your Medicare benefits. Part D is the prescription drug coverage.

Many people will receive information from the Advantage companies before November 15 advising them of any intended changes to existing plans in 2009. This may be called an Annual Notice of Change. If you receive information that your plan is changing, you should review it carefully in order to make an intelligent decision on whether to enroll or remain in the Medicare Advantage Plans. At the Medicare website you can read about the various plans and the step by step process of the decision making in the Medicare Handbook for 2009. National Care Planning Council also has information on the Medicare approved advantage plans in California.

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