Fong Law Group

Some States Testing Out Medicaid Coverage for Healthy Food

Under a federal pilot program, a number of states are using Medicaid funds to cover healthy food costs for Medicaid recipients. Ultimately, the trial program seeks to determine whether nutrition support can help prevent and manage certain chronic illnesses related to diet.

The pilot program’s structure varies across different states, as do the criteria regarding which Medicaid recipients are eligible to take part. In some instances, Medicaid benefits may cover nutrition counseling, grocery store gift cards, “food prescriptions” for fruits and vegetables, and more.

‘Food as Medicine’

Diet-related chronic conditions are not uncommon in the United States. Today, more than 37 million Americans have diabetes. Nearly one in three adults is overweight. Poor nutrition has also been shown to lead to higher risks of heart disease, certain cancers, and other illnesses.

In the fall of 2022, the Biden administration issued a national strategy to address issues in hunger, nutrition, and health. Included in that document is information on the idea of expanding health insurance coverage for nutrition support and education.

Proponents of the pilot program point to the connections that research has made between nutrition and overall health. From their perspective, helping people make better food choices will positively affect the health care system as a whole over time.

One 2022 Tufts University study examined health outcomes for people with certain illnesses who received deliveries of healthy, medically tailored meals. The researchers estimated that establishing similar programs nationwide could prevent more than a million hospitalizations each year. In addition, they projected billions of dollars in savings for Medicaid and Medicare.

Others believe using Medicaid funding to support a “food as medicine” movement is unnecessary and will overload the program’s resources.

Which States Are Using Medicaid Funds to Cover Food?

In most states, Medicaid does not generally pay for groceries or meals. (Some Medicare Advantage plans do offer an allowance for groceries or delivery of meals.)

However, the following three states are currently putting the Medicaid for food program to the test:

• Arkansas
• Massachusetts
• Oregon

California has also been running a program of its own, called CalAIM, since 2021. Through this program, health care providers can prescribe medically supportive meals to qualifying individuals. This includes people without reliable access to affordable, healthy food or who are restricted to a specific diet for medical reasons.

Five additional states are now seeking the go-ahead to participate in the pilot program. The following have requested federal waivers and are awaiting approval:

• Delaware
• Maine
• New Mexico
• New York
• Washington

Awareness of Nutrition and Health Among Seniors

Research suggests that many older adults may not be familiar with the idea of nutrition being one way to improve health.

According to one poll, less than half of U.S. seniors say they feel knowledgeable about how nutrition connects to mental wellness. (In contrast, 80 percent of American adults ages 18 to 34 say they feel “very” or “somewhat” knowledgeable about this link.)

If you are not sure whether you qualify for Medicaid or you are interested in applying, contact your local Medicaid agency. Consult with your elder law attorney for advice on a plan for your future.

The Consequences of Not Paying Your Property Taxes

When Geraldine Tyler, age 94, relocated to a senior community, she stopped paying property taxes on her home.

After the property was foreclosed on, the county where Tyler’s home was located sold the property for $40,000 to recover about $15,000 in unpaid property taxes. Tyler received none of the remaining profits from the sale.

In a case now before the U.S. Supreme Court, justices are hearing arguments to decide whether Tyler’s local government violated the U.S. Constitution by keeping more money than it was owed and not returning surplus funds to her.

One of the key issues in this case is whether Minnesota’s Hennepin County violated the Fifth Amendment, which prohibits taking private property for public use without just compensation.

Tyler owed $2,300 in property taxes and approximately $12,700 in interest, penalties, and costs. Hennepin County foreclosed on her home and sold it for $40,000. After repaying itself, it kept the $25,000 remaining and left Ms. Tyler with nothing. Tyler contends this is a violation of the U.S. Constitution. The Supreme Court is expected to rule on the case by June.

Why This Case Is Important for Seniors

The Tyler case highlights an all-too-common issue many elderly homeowners experience after transitioning from their home to a nursing home, a senior community, or assisted living facility.

Many seniors do not sell their home because they wish to leave it to their heirs. However, this transition can often lead to seniors losing track of their finances and failing to pay certain obligations such as their property taxes.

The consequences of doing so can be severe. One is the loss of equity in your home. Another is the loss of the opportunity to transfer wealth from one generation to the next and minimize capital gains taxes paid by heirs. For many people, their home is their most valuable asset.

As people age and depend on a fixed income, many fall behind on their taxes. While this may be a stressful issue, it should not be ignored as it can lead to them losing all the equity they have in their homes.

If you or a loved one may be facing this situation, talk about it before it gets out of hand or unmanageable.

What You Should Do

What can you do if you or a loved one have questions about your property tax obligations as the transition to a different stage of life happens?

First, understand that as long as a person is a homeowner, they must pay property taxes. However, in many states, once a homeowner reaches a certain age or their income decreases, they may be entitled to a property tax exemption or discount. The homeowner should apply for this as soon as possible once they become eligible, as in some states, it can reduce the obligation amount significantly.

If your loved one is in a nursing home or elder care facility, speak with them about the issue and see if they are up to date. If you have a power of attorney for an elderly family member or friend, check in with the local tax assessor and verify where things stand.

Finally, if you are behind on property taxes, be proactive about resolving the delinquency. Many local governments have programs to help homeowners repay their debt and keep their property.

In the Tyler case, Tyler, by law, had the right to redeem her property and repay her unpaid taxes, interest, penalties, and fees over three years. Other states have similar programs. However, these generally must be entered into within a specific timeframe. This is why addressing the issue as soon as possible is crucial.

Helping Senior Homeowners

The bottom line is that a homeowner, regardless of their age, needs to pay their property taxes to preserve the ability to transfer generational wealth to their heirs in the form of equity from their home.

Children, trusted friends, or caretakers may need to be proactive in helping senior homeowners assess whether they may have a delinquency to avoid the severe consequences of not paying property taxes imposed by some states.

Consult with your elder law or attorney for further guidance. 

Editor's Note: In late May 2023, the U.S. Supreme Court ruled in favor of Geraldine Tyler. 

Some States Testing Out Medicaid Coverage for Healthy Food

Under a federal pilot program, a number of states are using Medicaid funds to cover healthy food costs for Medicaid recipients. Ultimately, the trial program seeks to determine whether nutrition support can help prevent and manage certain chronic illnesses related to diet.

The pilot program’s structure varies across different states, as do the criteria regarding which Medicaid recipients are eligible to take part. In some instances, Medicaid benefits may cover nutrition counseling, grocery store gift cards, “food prescriptions” for fruits and vegetables, and more.

‘Food as Medicine’

Diet-related chronic conditions are not uncommon in the United States. Today, more than 37 million Americans have diabetes. Nearly one in three adults is overweight. Poor nutrition has also been shown to lead to higher risks of heart disease, certain cancers, and other illnesses.

In the fall of 2022, the Biden administration issued a national strategy to address issues in hunger, nutrition, and health. Included in that document is information on the idea of expanding health insurance coverage for nutrition support and education.

Proponents of the pilot program point to the connections that research has made between nutrition and overall health. From their perspective, helping people make better food choices will positively affect the health care system as a whole over time.

One 2022 Tufts University study examined health outcomes for people with certain illnesses who received deliveries of healthy, medically tailored meals. The researchers estimated that establishing similar programs nationwide could prevent more than a million hospitalizations each year. In addition, they projected billions of dollars in savings for Medicaid and Medicare.

Others believe using Medicaid funding to support a “food as medicine” movement is unnecessary and will overload the program’s resources.

Which States Are Using Medicaid Funds to Cover Food?

In most states, Medicaid does not generally pay for groceries or meals. (Some Medicare Advantage plans do offer an allowance for groceries or delivery of meals.)

However, the following three states are currently putting the Medicaid for food program to the test:

• Arkansas
• Massachusetts
• Oregon

California has also been running a program of its own, called CalAIM, since 2021. Through this program, health care providers can prescribe medically supportive meals to qualifying individuals. This includes people without reliable access to affordable, healthy food or who are restricted to a specific diet for medical reasons.

Five additional states are now seeking the go-ahead to participate in the pilot program. The following have requested federal waivers and are awaiting approval:

• Delaware
• Maine
• New Mexico
• New York
• Washington

Awareness of Nutrition and Health Among Seniors

Research suggests that many older adults may not be familiar with the idea of nutrition being one way to improve health.

According to one poll, less than half of U.S. seniors say they feel knowledgeable about how nutrition connects to mental wellness. (In contrast, 80 percent of American adults ages 18 to 34 say they feel “very” or “somewhat” knowledgeable about this link.)

If you are not sure whether you qualify for Medicaid or you are interested in applying, contact your local Medicaid agency. Consult with your elder law attorney for advice on a plan for your future.

Is "Aging in Place" Right for Me?

Most older adults want to remain in their homes and communities as they age rather than move into assisted living facilities or nursing homes.

For those who wish to maintain their independence and continue living at home as they grow older, taking certain steps to protect their physical, mental, and financial welfare is essential.

What Does It Mean to Age in Place?

The Centers for Disease Control and Prevention defines aging in place as a senior’s “ability to live in one’s own home and community safely, independently, and comfortably, regardless of age, income, or ability level.” According to 2021 data from AARP, more than three-quarters of adults 50 and older say they would prefer to age in place.

Health Considerations for Older Americans Aging in Place

Older adults must consider their physical, emotional, and social well-being when deciding where to spend their later years. They may consider adding supplemental services over time to help improve their quality of life.

To ensure that you will have the support you need for safely aging in place, take the following into consideration:

Resources to Manage Chronic Diseases

Disease management is vital for anyone, especially an older person with a chronic illness. Many older people suffer from at least one chronic illness. If a senior has a chronic disease and wants to age in place, they and their caregivers should focus on:

• Ensuring that spaces in the home are safe and easily accessible to make getting around easier;
• Learning about proper nutrition; and
• Increasing access to dental health services. Research has found that proper oral care can help prevent the progression of many chronic diseases.

Eating Well While Aging at Home

Proper nutrition is a vital part of caring for yourself at home. In facing potential changes to your financial situation after retirement, you may need help buying nutritious meals even after budgeting.

If you find yourself in need of meals, community resources may be available. Neighborhood senior centers, places of worship, and charities may provide a hot meal while you make new friends. If you cannot leave your home, some meal delivery services drop off food at your door for little or no cost.

Support for Mobility

Exercise and maintaining your mobility can increase overall physical and mental health even as you grow older. Seniors aging in place need to be able to move around their homes and neighborhoods safely. Aging in place is a much more realistic goal if you can walk for exercise, access transportation to medical appointments and errands, and maintain a safe environment at home, free from increased fall risks.

If you desire to age in place, consider simple changes you can make to your home to promote your safety. Examples of helpful modifications around the house include handrails, temporary ramps, no-slip bath rugs, and assistive seating.

Mental Health, Substance Abuse, and Memory Care Services

There is an increased need among older adults for mental health, substance abuse, and memory care services. An estimated 20 percent of older adults have a mental health disorder, and the total number of seniors with a mental health or memory care diagnosis is likely to increase over time.

Suggestions for addressing mental health concerns among older people include:

• Focusing on preventative care. Seniors and their caregivers should work with their primary care physician to identify warning signs of depression, anxiety, other mood disorders, and memory care problems. Preventative care can help mitigate the progress of these disorders and improve quality of life.
   
• Looking for common signs of a substance abuse problem. This is an often overlooked area of older adult mental health care. Older adults may turn to substances to deal with unresolved childhood problems or to avoid a feeling of loss of meaning and purpose. Some common signs to watch for include reduced hygiene, unexplained bruises, erratic behavior, and the smell of alcohol on their breath.
  
  If you are a senior’s caregiver and suspect substance abuse, you can find resources and support through the Substance Abuse and Mental Health Services Administration (SAMHSA).

The Need for Social Connection Among Aging Adults

Older adults benefit tremendously from social connections and interaction. People over 65 are likely to live alone, so creating a community outside the home is necessary. Feeling a sense of purpose is beneficial to mental and physical health. For seniors looking to create a sense of community and purpose, they may benefit from such activities as:

• Joining an organization or social club

• Volunteering for a cause close to their hearts

• Learning a new hobby

• Attending a religious institution

• Adopting or fostering a pet

• Using technology to stay in touch with friends and family

Wearables and Smart Monitoring Devices

Technology can help us not only remain connected to one another, but also monitor our health and that of our aging loved ones. Many devices make detailed health information readily available at our fingertips. These devices benefit seniors because they can learn more about their health and make the most of doctor’s visits by communicating effectively about their medical needs.

Examples of wearable health and smart-home monitoring devices include:

• Smartwatches and smartphones, which can track your cardiac health, fitness activity, and sleep patterns
• Medical alert bracelets and personal alert necklaces, which can aid in detecting falls or contacting emergency services when necessary
• Contact sensors and smart locks, devices that can alert caregivers when their loved one living at home leaves a window, garage, or door open, or has forgotten to lock them
• Smart plugs, which can automatically turn on and off lights, space heaters, thermostats, security cameras, and more

Money Management While Aging in Place

Money management can also be an area of concern for seniors and caretakers. Seniors want to make sure they have sufficient financial resources to remain in their homes and communities comfortably, eat well, care for their medical needs, and have fun.

Creating a budget with the help of financial counselors and geriatric care managers can benefit someone on a fixed income. There may even be volunteers in your area that offer a similar service. Being aware of how to prevent and avoid common types of scams that target the senior population is equally as important.

How Can Caregivers Help Seniors Age in Place?

Seniors often choose to age in place to remain independent and avoid becoming a burden to their family. Caregivers can support their goal by teaching them to use technology to communicate and track their health, helping them establish a budget, and setting them up with a routine that may include visiting their doctor, running errands, and making time to socialize.

There is nonmedical support that your loved one will need, too. Caregivers may opt to support their aging loved ones by pitching in with or hiring services for lawn care, cleaning, cooking, laundry, or pet care.

Is Aging in Place Right for You?

Careful planning is the best way to accomplish your goal of staying home as you age. If you are considering plans to age in place and want assistance, contact your elder care attorney.

What Is Hospice Care at Home?

Hospice care is a type of health care that patients with terminally ill conditions rely on at the end of their lives. This type of care focuses on pain management and emotional, spiritual, and familial support for patients nearing the end of their lives.

There are several options for receiving hospice care, including being cared for at home. The type of intimate care a patient receives while in hospice is more conducive to being received at the patient’s home. This becomes a team effort, and it helps to have a peaceful environment when receiving care.

Who Can Benefit From This Type of Care?

Patients with serious illnesses like cancer, heart disease, dementia, kidney failure, or other fatal conditions benefit from hospice care. This type of care can help the patient live a more comfortable life while decreasing the emotional burden of grief for families by preparing them for the loss of their loved one.

When Is Hospice Recommended?

Hospice care should not only be considered by those who have loved ones nearing the end of their lives. While most of these services are generally reserved for people with six months or less to live, early hospice care can be beneficial for patients and their families as well.

You may wish to consider such services in the following cases:

• The patient has a serious decline in their physical well-being
• After a diagnosis of Alzheimer’s disease or dementia
• You have decided to forgo any treatment to improve your physical treatment or care for your illness

Who Makes Up a Hospice Care Team?

Your hospice team can consist of many different types of people. Various professionals and volunteers may be involved in end-of-life care. Some of those you may see on your care team can include:

• Doctors
• Nurses
• Social workers
• Spiritual advisors
• Trained volunteers

Who Pays for Hospice Home Care?

Like any other health care option, these services can quickly become very expensive. Fortunately, there are several ways to cover the cost, including:

Government Programs

If you qualify for government assistance, there may be insurance plans specifically designed to cover the cost of hospice care.

Seniors enrolled in Medicare Part A may qualify for a Medicare hospice care benefit. This benefit program allocates money to pay for such care at home.

For terminally ill patients on Medicaid, hospice care may be covered depending on the state.  

The Department of Veterans Affairs may also provide coverage for these care benefits for seniors who have served our country.

Private Insurance

Check the terms of your insurance policy to determine if your health insurance covers hospice care. Your policy may cover all or part of your hospice care needs.

Options for Uninsured Patients

Even if you do not have health insurance, you may still have coverage options. There are charitable organizations that work with elderly and disabled individuals who need help paying for hospice care services. Hospice care organizations also often have internal departments that work with patients who qualify for this type of care but are indigent or do not have health insurance.

Is In-Home Hospice Right For You?

Making this choice is an important part of your end-of-life care plan. Be sure to gather as much information as you can before deciding whether this type o care is best for you. For example, you may want to consult Medicare’s hospice compare website or CaringInfo.org’s website for other hospice locator tools.

If you have questions about Medicare or Medicaid, contact your elder law attorney to learn more.

Bill Advocates for Seniors Who Seek At-Home Medicaid Care

Seniors who need assistance with everyday activities such as dressing, bathing, and eating are eligible for Medicaid Long-Term Services and Supports (LTSS). Unfortunately, hundreds of thousands of people who qualify for these services – but wish to receive them in their homes or a community setting – end up on extended waiting lists.

In many cases, these seniors then find themselves with no choice but to live in nursing homes or other institutional facilities for months, or even years, if it is the only way they can access the day-to-day support on which they rely.

A piece of legislation focused on meeting the needs of this population of older adults has recently been reintroduced to Congress by U.S. Sen. Bob Casey (D-PA) and U.S. Rep. Debbie Dingell (D-MI).

Aging in Place: When You Want to Live Independently

Living at home as you grow older can have a positive impact on your physical and emotional health, as well as on your wallet. According to one 2022 study, aging in place includes such benefits as the following:

• Maintaining a sense of independence and autonomy in one’s community
• Living in a familiar setting
• Enjoying a more fulfilling social network
• Decreasing feelings of loneliness
• Saving on the cost of long-term care facilities

Where Does the Medicaid Waiver Fit Into HCBS?

Older adults qualifying for Medicaid LTSS who wish to receive services in their home or community generally must wait to be granted a waiver before Medicaid will cover the cost of their home care.

As each state administers its own Medicaid system and waiver program, the wait time can vary depending on where you live. The income and asset thresholds for waiver programs can also differ from state to state, as can the types of home care that are covered.

These are among the main reasons why you may want to consult with your elder law attorney, who knows the rules and regulations specific to the state where you reside.

Home and Community Based Services (HCBS) Access Act

The Home and Community Based Services (HCBS) Access Act, originally introduced in 2021, seeks to secure for these seniors a real choice between receiving care at home or in an institution.

A one-page PDF summary of the HBCS Access Act outlines six specific steps that the proposed legislation is designed to provide:

• Enhanced Medicaid funding for HCBS
• Grant funding for states that would develop their capacity to serve individuals who prefer to receive home care
• Resources for states meant to ensure professional caregivers have stable jobs and wages
• A stronger workforce in home care
• Training for family caregivers
• Improved methods for evaluating the quality of HCBS

According to a 2021 report from Justice in Aging, 25 of the 50 states spend twice as much on institutional care as on HCBS for seniors and people with disabilities.

In addition to seniors eligible for Medicaid LTSS, many people with disabilities would benefit from the legislation if it is passed.

Support From Others

Sixteen U.S. representatives are co-sponsoring the HCBS Access Act, and numerous advocacy organizations for older adults have endorsed the legislation as well.

“I’m helping introduce the HCBS Access Act, which expands Medicaid HCBS funding that will help ensure Americans don’t have unnecessary delays in accessing the care they need,” U.S. Sen. Jeanne Shaheen (D-NH), one co-sponsor, said in a news release about the Act. "This bill is an important investment not only in the accessibility of care, but also in creating better jobs for home care workers and support for family caregivers.”

Earlier this year, Sen. Casey and Rep. Dingell also reintroduced a related bill, the Better Care Better Jobs Act. The goals of this legislation are to boost funding for HCBS, make millions more individuals on Medicaid eligible for these services, and create new jobs for home care workers.

Because Medicaid can be such a complex system to navigate, be sure to consider consulting with your elder law attorney.

What Is a Health Savings Account? Will Medicare Affect Mine?

A health savings account may help you save money on medical expenses, depending on your insurance type. If you are eligible, you can use your health savings account (HSA) to cover certain medical costs, according to HealthCare.gov.

How Does an HSA Work?

If you have a high deductible health plan, you can contribute to an HSA and use the untaxed money to cover medical costs, decreasing your total medical expenses.

High deductible health plans typically have lower monthly premiums than other insurance plans. However, individuals may pay more for medical services before coverage starts, per HealthCare.gov.

What Do Health Savings Accounts Cover?

You can use an HSA to pay for deductibles, copayments, and coinsurance.

Examples of typical expenses for which you can use a health savings account include:

• Acupuncture
• Ambulance costs
• Doctor visits
• Hearing aids
• Medications
• Psychiatric care and psychological therapy
• Certain long-term care services

However, you generally cannot use money from an HSA for monthly insurance premiums, unless you receive Medicare, health care continuation coverage, or unemployment compensation.

For long-term care insurance, you may be able to pay your premiums through a health savings account.

The Benefits of Health Savings Accounts

The advantage of using a health savings account is that funds are not subject to federal taxes when you contribute or withdraw money to pay for qualified medical expenses. You can also earn tax-free interest.

Should you have money left over in your account at the end of the year, it rolls over. The funds stay active, remaining in your account until you need them. Even if you change jobs or retire, you can keep your HSA.

In some cases, you can use your health savings account to cover your spouse’s and dependents’ medical expenses, even if they are not on your plan.

Health Savings Account Rules

2023 Contribution Amounts

The Internal Revenue Service sets contribution limits on HSA’s.

• For 2023, individuals can contribute up to $3,850, and families can put up to $7,300 into a health savings account, Investopedia reports.
• People who are 55 and older by the end of the tax year can make an additional $1,000 catch-up contribution.

Other Insurance Types

Other insurance plans can disqualify you from contributing funds to an HSA.

• Individuals with dollar-first insurance plans – in which the insurer takes care of its share of an included service before the insured individual pays deductibles or copayments – cannot put funds into a health savings account for their outstanding health care fees.
• Those on Medicare cannot add money to health savings accounts, though they can withdraw capital from their accounts to pay medical expenses that Medicare does not cover. While people using health savings accounts typically cannot use the funds to cover monthly premiums, there is an exception for Medicare beneficiaries.

Penalties

Although health savings accounts have several advantages, they also impose restrictions on how you use your money.

Taking money from your account for nonmedical or unqualified expenses before you reach 65 results in a 20 percent tax penalty. The 20 percent tax penalty for ineligible withdrawals does not apply if you are 65 and older. Still, you must pay income tax.

Opening a Health Savings Account

There are several ways to open an HSA.

• Employers can offer them, with the employer and the employee jointly funding the account.
• Some health insurance companies provide health savings accounts with high deductible health plans.
• Banks and financial institutions offer accounts for individuals.

How Does Medicare Affect Your Health Savings Account?

When you enroll in Medicare, you can no longer contribute pre-tax dollars to your health savings account. To put untaxed money in an HSA, you must have high deductible health insurance without additional disqualifying coverage, such as Medicare. Once you have Medicare, you can no longer add tax-free funds to your account.

After you enroll in Medicare, however, you can still access your health savings account. One of the advantages of health savings accounts is that they are vested. As a Medicare beneficiary, you can continue using untaxed funds to cover the medical expenses your insurance does not bear, such as deductibles, coinsurance, and copayments. You cannot, however, use tax-free money to pay for Medicare supplemental insurance.

While the Internal Revenue Service (IRS) prohibits people from using untaxed capital for high deductible health insurance plan premiums, the rule differs for Medicare. When you enroll, you can use your HSA to pay your Medicare premiums without taxes.

Withdrawing Money From Your HSA

People over 65 can withdraw funds from their health savings accounts for nonmedical expenses. Although these withdrawals are no longer tax-free, older adults do not incur the 20 percent tax penalty the IRS imposes on younger people taking funds HSA’s for ineligible expenses.

Since medical costs tend to increase with age, many prefer to keep their money in their health savings accounts to cover eligible medical expenses tax-free.

Delaying Medicare Enrollment

Some people with health savings accounts enroll in Medicare when they initially become eligible, forfeiting the ability to make HSA deposits for Medicare’s coverage. Others delay enrollment in order to continue making health savings account contributions.

• According to the Journal of Accountancy, only individuals with employer-sponsored high deductible health insurance as their primary coverage can continue adding to their health savings accounts past retirement age by delaying Medicare enrollment.
  
  Individuals with private insurance, continuation of health coverage (COBRA), or a health care exchange cannot fund their HSA’s after reaching retirement age.
   
• People who continue to work at small companies after becoming eligible for Medicare must enroll in the program immediately to have any health insurance coverage.
  
  Per MedicareInteractive.org, Medicare must be the primary insurance for those working at companies with fewer than 20 employees. Since the small employer’s health plan does not have to pay until after Medicare contributes, these individuals risk losing health coverage if they delay enrolling in Medicare. Deferment also results in a late penalty.
   
• Those with health insurance from businesses with 20 or more employees can put off Medicare enrollment and continue placing funds into their health savings accounts. Because the company insurance would remain the primary insurer when they join Medicare, they can continue receiving health insurance coverage without Medicare.

Individuals who wish to delay enrolling in Medicare should not accept Social Security payments. This is because Social Security automatically registers beneficiaries for Medicare Part A, rendering them unable to make HSA deposits.

Medicare and the IRS recommend that people who have delayed enrollment after becoming eligible should cease health savings account contributions six months before joining Medicare to avoid a tax penalty. A six-month lookback period applies, as Medicare’s coverage is retroactive.

If you have an HSA, whether you should delay Medicare enrollment depends on your situation. The decision could significantly impact your finances. Speak to your elder law attorney to learn more about your options for your health savings account as you approach retirement age.

How Medicaid's Money Follows the Person Program Aids Seniors

Congress established the Medicaid Money Follows the Person (MFP) Program to provide states with federal funding to help seniors who are receiving care in institutions but want to live at home.

However, it is not a permanent program and is due to expire in September 2027. Advocates have pushed for Congress to make MFP permanent, ensuring that states have funding for seniors who wish to return home from long-term care facilities.

What Is the Medicaid Money Follows the Pereson (MFP) Program?

MFP was established in 2005 to increase Medicaid enrollees’ access to home- and community-based services (HCBS). In part, its goal is to allow seniors to avoid nursing homes and other institutions, and instead receive care in their own homes and communities if they choose. Other beneficiaries of the program include people with disabilities.

MFP allows the Centers for Medicare and Medicaid Services to remove the restrictions that are placed on how funds are allocated for long-term services. It increases the use of HCBS services instead of long-term services and support.  

How Does MFP Help Older Adults?

Throughout its existence, MFP has helped seniors who otherwise would have been institutionalized maintain control over their lives by providing a chance at independent living. In the nearly two decades since the program began, MFP has helped more than 107,000 people move from a nursing home or a long-term care facility back into their home. One evaluation found that MFP results in greater life satisfaction among participants.

Returning home from an institution is a tall task for most seniors. A major concern is the lack of staff to take care of an individual’s medical and personal needs. In many cases, seniors must rely on family members. MFP helps ease the burden of transitioning from care facilities back home.

Examples of the type of support MFP provides seniors as they move back home typically include:

• Help paying for groceries
• Short-term transitional housing
• Security deposits for rental homes and apartments
• The cost of necessities for setting up a home (e.g., stair-lifts, wheelchair ramps)

Can MFP Help Seniors Secure Housing?

The federal government funds the Medicaid Money Follows the Person program. Medicaid is prohibited from paying for housing directly. MFP allows states to use money from the program to pay for case management and transitional support services for seniors.

To address the needs of low-income seniors, state governments have used MFP funds to partner with housing authorities and developers to ensure more housing options are available for seniors who want to live independently.

Will the Medicaid Money Follows the Person Program End?

MFP has been a Medicaid demonstration program since 2008. Demonstrations are used to determine whether programs should become permanent. More than 40 states and territories currently are a part of MFP.

However, Congress has inconsistently funded MFP. The uncertainty about whether the program will have long-term funding has made it difficult for states to budget, so over time some states have been opting out of the program entirely. If MFP expires in 2027, many more seniors will be forced to live in long-term care facilities, losing the independence they desire.

It remains to be seen whether Congress will make the program permanent. If it does, states will have a set amount of money to increase seniors’ ability to live on their own as they age.

Learn more about the program at Medicaid.gov. For further guidance, speak to your elder law attorney.

Can a Nursing Home Hold Friends or Family Members Responsible For a Resident's Care?

If your loved one is entering a nursing home, you may worry whether you could be liable for their care. Under federal law, a facility cannot require a family member or friend to co-sign an admission agreement and take on personal liability. However, nursing homes around the country still try to do so, and often these matters end up in court.

What can you do to prevent this from happening to you? It starts with educating yourself on what is and is not allowed.

A law known as the Federal Nursing Home Reform Law prohibits a nursing home or facility from requiring or asking for a financial guarantee from a third party. Federal regulations regarding Medicare and Medicaid have similar restrictions.

These laws and regulations state that a home cannot have a resident’s family member or friend co-sign an admission agreement to take on financial liability. However, a nursing facility may obtain the signature of the resident’s agent, who has access to the resident’s income or assets, agreeing to use these resources to pay for care. Still, this agreement may not impose personal financial liability on the agent.

Review Before You Sign

If you are assisting a loved one with entering a nursing home, you should carefully review all the admission paperwork before you sign it. Many facilities have unscrupulous practices of using admission agreements that violate federal law or regulations.

You do not have to sign or “volunteer” to sign a financial guarantee that makes you personally responsible. It is incorrect if a nursing home claims a guarantee is necessary because the federal law only applies to Medicaid-eligible individuals. Nursing homes are also not allowed to condition admitting or keeping a person on receipt of a third-party guarantee.

Today, the most common tactic used by nursing homes is an admission agreement that obligates the signor as an agent with supposed control over the resident’s money. These agreements stipulate the agent will apply these resources to the nursing home expenses and apply for Medicaid on the resident’s behalf. Often, the person signing this document doesn’t know how to handle this situation, does not have this control, or makes mistakes in the resident’s Medicaid application, causing coverage to be denied.

What follows may be a lawsuit by the nursing home, claiming the agent violated their duties in the agreement and must pay the care costs. Courts have gone both ways on whether these agreements are enforceable, and the agent’s conduct often influences a court’s decision. Egregious conduct can lead to courts ruling in favor of the nursing home. An example is where an agent used the resident’s money for luxury items or other people’s expenses rather than their loved one’s care.

Plan Ahead As Much As Possible

The best action is to plan before nursing home care is necessary. This can put you or your loved ones in a position to be ready to apply for Medicaid should the need arise. At the same time, an aging individual can do proper asset protection planning and avoid look-back periods creditors could otherwise exploit against the resident or an agent.

However, this is not always possible for many older adults and their family members. Individuals who will take on the responsibility of being an agent should understand what this entails and seek the advice of your elder law attorney before starting the admission process.

Miller Trusts Can Help You Qualify for Medicaid

Many seniors find themselves in need of Medicaid to pay for their long-term care but are surprised to learn that their modest monthly income may disqualify them. The reason for this is that Medicaid is a “means-tested” benefit. In other words, you must not have income exceeding certain thresholds in order to qualify and receive Medicaid benefits. For example, in New Jersey, the monthly income limit for nursing home or community-based services is $2,523 for individuals and $5,046 for married couples.

Medicaid expects all of an applicant’s monthly income, besides a monthly personal needs allowance and Medicare premiums, to go toward nursing home costs. So, what if you have more income and other expenses? A Miller Trust may help you resolve this dilemma.

A Miller Trust is a Medicaid planning tool that can assist you in meeting the income limits and qualifying for Medicaid. Unlike other planning tools, Miller Trusts do not have specific disability or age requirements.

How Does a Miller Trust Work?

If your income exceeds Medicaid’s income limit, you can deposit the amount of your excess income into a Miller Trust – also referred to as a “qualified income” trust. Once it is deposited into this trust, it is not counted as income by Medicaid. However, to qualify, a trust must be irrevocable, which means you cannot cancel or change it. Once you put money into the trust, you cannot get it back directly. However, the trust can pay certain expenses on your behalf.

A Miller Trust is a good option for any Medicaid applicant needing long-term care services, whether at home, in their community, or in a skilled nursing care facility. This trust is created by the applicant, a guardian, or a person with a properly drafted power of attorney. A trustee is chosen to manage the trust and the income deposited. Anyone other than the Medicaid applicant can serve as a trustee.

Once the trust is set up, the trustee establishes a bank account to receive excess income from the Medicaid applicant. The income can only be used for certain expenses. For example, it may be used to pay the personal needs allowance of an individual in a nursing home, Medicare premiums, bills not covered by Medicaid, or supplement costs of a nursing home.

Another requirement of a Miller Trust is that the applicant’s state Medicaid agency will be the beneficiary of any remaining funds in the trust upon the death of the Medicaid applicant. The amount the state receives is limited to the total value the state paid in long-term care on behalf of the applicant. Any amount remaining after this payment may go to a person the applicant chooses.

Medicaid Income Cap

You should be aware that not every state allows Miller Trusts as a method to qualify for Medicaid. Currently, only about 25 states, known as “income cap” states, permit it. Other states do not impose an income limit for nursing home care, and so there is no need for a Miller Trust in these locations. For example, in Massachusetts, you would pay all your income, minus certain deductions, to the facility, and Medicaid would pay the remaining cost.

Before creating a trust, it is important to speak with an elder law attorney to ensure this option is right for you. If you live in a state where this is not allowed, there may be other options, such as pooled income trusts, which serve a similar purpose.

For guidance in Medicaid planning, consult your attorney.