BPA Blog 02-17-15   New York State Medicaid administers a comprehensive community home care program called Managed Long Term Care (MLTC) on Long Island, and New York City and its boroughs. Long Island is well served by MLTC programs, but there are issues you need to be aware of – that I will discuss in my next two blogs.

What is MLTC?

Managed Long Term Care is the program administered by the local Medicaid department for home care aides in the home; adult day care or dementia care at a senior center (two programs: social model day care and medical model day care); transportation to medical appointments; and nursing in the home and similar services.

To qualify for MLTC, you need to follow a three-step process:

Step 1

Apply for Medicaid at the local department of social services. In 2016, an unmarried person can own up to $14,850 of countable resources. Examples of resources that don’t count: your home (if the net equity value is less than $828,000), a motor vehicle, retirement accounts which are paying the required distributions according to Medicaid rules, term life insurance, a burial plot and a funeral contract. Consult with a qualified elder law attorney to learn about other non-countable resources.

Your family member may also need to legally shelter monthly income. In 2016, an unmarried person may keep up to $825/month of income (pension, social security, interest, retirement distributions, veteran’s pension). Excess income should be deposited to a Community Pooled Trust. Which trust is right for you and what is the timing for joining the trust? Consult with a qualified elder law attorney to learn how this may apply to your unique situation.

There is no “look back” for Medicaid Home Care applications. Typically, three months of financials are submitted plus proof of all transfers from the applicant to other persons. If nursing home care is needed in the future, these transfers may mean Medicaid will not pay for care in a nursing home. A consultation with a qualified elder law attorney is essential.

Important reminder: A non-lawyer cannot give you legal advice.

Step 2 –

After the application is accepted, a Conflict-Free Assessment is required performed by a state-contract agency determines if your family member needs home care assistance for at least 120 days (long term). MAXIMUS is the agency currently scheduling the assessments. A family member should always be present with the applicant when the agency conducts its assessment. To request the assessment, call 1-855-222-8350.

Step 3

Select and contact your managed care agency for delivery of the services. The MLTC must send its own nurse to assess and create the Medicaid recipient’s care plan, and bring enrollment forms. Timing is critical because NY State only allows the MLTC to begin its services on the 1st day of a month. The MLTC must schedule the visit, send its nurse, conduct the assessment and file the assessment by the 20th of the month. If this timetable is not met, the start of services for the Medicaid recipient (home care aide, day care and transportation) will be delayed by another month, creating a ‘gap’ delay. It is important to know that the nurse will bring forms to enroll the Medicaid recipient in the managed care plan. Be sure to sign the enrollment forms IF you decide to use the particular MLTC agency – and give them to the nurse before he or she leaves or send the forms back to the MLTC.

For a list of plans, go to the NYS Department of Health website: http://www.health.ny.gov/health_care/managed_care/mltc/mltcplans.htm

My next blog will discuss the “bumps on the road” to Medicaid for home care services.


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In my previous post, I continued the techniques for ‘self-help’ dispute resolution on elder care and special needs disagreements among family members.

Caucasian Couple Not Looking

Active listening is a key, two-phase strategy used by trained Mediators. Between family members, active listening is more than just hearing and repeating (“I heard you say…Did I understand you correctly?”). Phase 2 of active listening is Acknowledging.

What does Acknowledging mean?

You may not like everything you heard from your parent, spouse, former spouse, or sibling. But you cans always find something in a family member’s statement that is their way of asking for acknowledgement. And then each family member should show appreciation through their acknowledgement reply.

An example:

Sister: “You have no idea what it’s like working full-time, managing my kids’ schedules AND making sure Dad gets to all his medical appointments, then following up with the doctors and prescriptions. How dare you question my judgment about the doctors! When do you think I have time to fill you in on what the doctor said, in addition to everything else on my plate?”

Brother’s acknowledgment response: “If I hear you correctly, this is a very stressful part of your day. I want you to know that I appreciate how you’ve managed Dad’s medical care and the stress this adds to your life. I live 1500 miles away so I can’t be there, but you are wonderful to do this for all of us.”

Acknowledging is a tool used by the neutral Mediator to manage tense and high conflict situations. After Acknowledgment, empathy may follow. The acts of recognizing and acknowledging family members can help shift from their firm confrontational positions (“I’m right, you’re wrong”) towards common interests, and, often are the first step to creating workable solutions.

If you would like to learn more about these self-help techniques, I recommend you read “Mom Always Liked You Best” (Elder Decisions, Boston, Massachusetts, available online at Agreement Resources, LLC).

If your family requires a neutral Mediator, please contact my office to learn about my mediation services, BPA Mediation, and visit www.bpamediate.com

For legal representation in elder law, Medicaid, estate and special needs planning and guardianship, visit www.bpaelderlaw.com


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Recap of my previous post: I introduced you to Mediation and recommended a self-help book, Mom Always Liked You Best: A Guide for Resolving Family Feuds, Inheritance Battles & Eldercare Crises,”. I also explained my role as a neutral Mediator through my company, BPA Mediation, to help resolve elder care and special needs disagreements.


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This quote from Stephen R. Covey may describe your family: “Most people do not listen with the intent to understand; they listen with the intent to reply.” (The 7 Habits of Highly Effective People: Powerful Lessons in Personal Change)

For head-to-head family conflict, here is a mediation strategy from “Mom Always Liked You Best”:

The goal:

  • Try to understand what your parent, sibling, spouse or other family member is trying to tell you, from their perspective.
  • As a Mediator, I refer to this as ‘active listening,’ because you are really listening, not thinking about what you want to say next.

The process:

  • All available family members who are involved in the dispute or disagreement gather in a quiet room, with ample time so the process is not rushed.
  • Each participant – including the senior if this is an elder care issue that involves them – is given an equal opportunity to speak without being interrupted.
  • After one family member speaks, each of the others repeat, in a positive way, what they think they heard that person say. For example, “I heard you say that you are unhappy with my decisions about bill paying and that I have not given you enough information for you to stay informed about this. Did I hear you correctly or did I understand you correctly?”
  • If the person replies that you did not hear them correctly, the next step is for each family member to gather more information by asking the speaker ‘nonthreatening’ and ‘I’m not accusing you’ questions. As a Mediator, I use this technique to help mediation participants understand what it feels like to ‘be in the other person’s shoes.’
  • When everyone in the room has enough information, take a break so each participant can think about how what they learned affects their own position or what they thought was happening prior to this discussion and the disagreement.
  • This is the point where I, as a Mediator, would facilitate by asking each family member to take a step back from their ‘stand’ or position on the dispute or disagreement.

If your family requires a neutral Mediator, please contact my office to learn how my BPA Mediation services can help, and visit www.bpamediate.com.

Next blog: More self-help techniques for managing elder care and special needs disputes.

For legal representation in elder law, Medicaid, estate and special needs planning and guardianship, visit www.bpaelderlaw.com.

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Caucasian Couple Not Looking

“I’m right, you’re wrong.” Whether you’ve said this out loud to a spouse, children, senior parents, siblings, or just thought it, family conflict can become a part of our personal lives.

Often, when conflict escalates, tempers flare, people take sides, lawsuits are filed, costly legal fees chip away at savings, and family relations can be disrupted, altered or even irrevocably destroyed.

My professional advice: Stop the madness – and choose Mediation, the alternative way to resolve conflict.

What is Mediation?

Mediation is a process that brings disagreeing or disputing persons or parties together for facilitated conversations, which can result in a settlement or compromise of the disagreement or legal dispute. The person who acts as the neutral facilitator is called the Mediator.

What kinds of family issues can you bring to Mediation to avoid lawsuits and the associated high legal costs?

The issues suitable for Mediation fall into two categories:

  • Elder care disagreements between siblings, spouses and other family members about health care decisions, caregiving, financial management, and guardian designation for incapacitated seniors; and
  • Special needs disagreements between divorced (or divorcing) parents over visitation, future planning, and guardianship for intellectually disabled adult children.

Can you use a Mediator’s techniques before new disputes surface or existing disputes re-appear?

Yes. I recommend you read the popular book, “Mom Always Liked You Best: A Guide for Resolving Family Feuds, Inheritance Battles & Eldercare Crises,” by Arline Kardasis (Elder Decisions of Boston, Massachusetts), available online at Amazon.com and Agreement Resources, LLC.

My upcoming blogs will describe some of the tools you can try with your own family.

But, for families with mushrooming conflict, a neutral Mediator may be the best or only way to avoid costly litigation or to manage and shorten existing litigation in elder care, guardianship and special needs planning.

For more information about my work as a Mediator, BPA Mediation, please visit www.bpamediate.com.

For legal representation in elder law, Medicaid, estate and special needs planning and guardianship, please visit www.bpaelderlaw.com.


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Posted by: BlogMaster | April 13, 2015

Spring Estate Planning Update: Inheritance Tax Laws and More

If you follow an annual spring cleaning ritual, we suggest you add an estate planning and overall financial review to your “To do” list. Here’s an update on legal changes and common sense reminders to help you get started. 

New York State changed the inheritance tax laws Happy successful attractive elderly couple reading together outd in April 2014, increasing the tax-free threshold from $1 million to more than $2 million for persons who die after April 1, 2014. The threshold for taxation will increase again in 2015 to more than $3 million and continue to increase until 2017 when an individual must own more than $5 million before state and federal inheritances taxes must be paid.

For married couples, we recommend you still take advantage of flexible tax planning ‘Disclaimer Wills’ during the ‘transition’ period and maximize what can be passed free of inheritance tax on the second spouse to die. This is still an important part of tax planning.

What is a ‘disclaimer’ clause in a Will or Trust? It allows the surviving spouse to give up the right to assets or property in the estate and to place the income into a tax-shelter trust (called a Disclaimer Trust). When drafted properly, the Disclaimer Trust enables the surviving spouse to receive income from the trust for life and have access to the principal of the trust if necessary.

Remember, too, that Living Trusts do not save inheritances taxes without required tax language, such as the disclaimer language. If you wish to leave money or property to your favorite charity, charitable bequests reduce inheritance taxes. The charity must be recognized by the Internal Revenue Service in order for there to be a Tax Free Bequest in your will or trust.

Review your existing Powers of Attorney for financial management and Health Care Proxies for medical decision making to ensure they are current and your designated ‘agents’ are available and still willing to act on your behalf when needed. These are important advance planning directives. If you become ill or incapacitated to the point where you cannot manage your own financial affairs, you must already have these legal documents in place to legally empower your chosen agents. Only a qualified estate planning and elder law attorney can prepare and customize these documents properly to address your unique personal and family needs. As we frequently remind you, ignore advertisements for loose-leaf binders filled with ‘national’ estate planning documents. These are often not specific to New York State and can be detrimental to the handling of your finances or health care decisions in the future.

Only a qualified special needs attorney can counsel your family effectively on these estate planning matters. Call my office to arrange a consultation with me, as a special needs law attorney practicing on Long Island, to learn how proper estate planning can benefit you and your loved ones.

Posted by: BlogMaster | March 29, 2015

Planning for your Special Needs Child: The ABLE Act of 2014

Posted by: BlogMaster | March 14, 2015

Alphabet Soup 2015: Special Needs Planning

If you managed to decipher the Alphabet Soup of Agency and Services Naming in 2014, brace yourself for the new naming and acronym challenges taking effect in 2015.

Medicaid services for persons who are intellectually disabled is generally overseen by the Office of Persons with Developmental Disabilities (OPWDD). As with Medicaid for seniors for home care and nursing home services, Managed Medicaid is now part of OPWDD.

As the names of these programs keep changing, the end result is that advocates – legal, parents, and providers –- have expressed concerns as we enter 2015.Alphabet Soup 1

What was previously called “CSS and Self Direction” is now known as “Self Direction with Budget and Employer Authority”. The program – which encourages families to create an individualized plan for services (and, in theory, for housing) for their adult intellectually disabled child – is part of NY State’s “People First Waiver” for Managed Medicaid with CMS, the federal governing agency.  

Applications for initial services and planning go through the “Front Door”, which means that the applicant’s family must contact their local OPWDD regional office, now called the DDRO (formerly known as DDSO). Pay special attention to this hearty mix of acronyms, which are not yet updated on the OPWDD’s website at www.opwdd.ny.gov.

My professional advice is that the best source of information for New York State families is the New York Self Determination Coalition (http://nyselfd.org) and their online manual. This is a volunteer group of advocate parents.

What is the best role for a qualified special needs attorney in your planning?

The special needs attorney can help ensure that you understand and are accessing the appropriate resources and benefits (including SSI) for your disabled family member – regardless of their specific impairment.

And only an attorney can prepare a special needs trust. This is still the best option to preserve an inheritance for a family member, because Medicaid is expected to reduce services, particularly in the area of housing. There are many ways to write your wishes for managing the special needs trust into your Will or other estate planning documents, such as your own living trust.

Your family’s and your child’s situations are unique. Don’t let anyone tell you otherwise or try to convince you to settle for cookie-cutter planning.

All planning can and should be customized to meet your own family’s needs. Contact my office to arrange a consultation with me, as a special needs attorney practicing on Long Island.

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Posted by: BlogMaster | March 1, 2015

Medicaid and Elder Care Law Updates – Part 2

My previous blog post summarized some of the changes and updates for Medicaid. We continue this week.

elder law attorney long island ny

New York’s Managed Long Term Care Medicaid (MLTC) introduces two new requirements.

  1. All home care applicants residing in Nassau and Suffolk Counties and in New York City (and eventually including upstate New York) require a “conflict-free screening” or evaluation performed by a New York State designated agency called Medicaid Choice. The ‘screen’, to be performed by a nurse, must certify that the applicant will need home care services for at least 120 days – the minimum duration required by MLTC for providing home care, adult day care, and similar services. The timing for scheduling your conflict free screen is crucial to the prompt start of services. Contact my office about the timing element of submission of the Medicaid application, the pooled trust joinder agreement and application, and the conflict-free assessment.
  2. New York State is also rolling-out another aspect of MLTC called FIDA (Fully Integrated Dual Advantage). FIDA will allow an additionally certified MLTC/FIDA agency to coordinate both Medicare services (including doctors) and Medicaid (home aides and senior day care). This may not be necessary for seniors whose Medicare coverage is supplemented with a retiree plan and whose family is involved in day-to-day care and medical decisions. If these conditions are met, the senior must “opt out”. But for Medicaid recipients who lack funds for a supplemental Medicare policy and/or have no family to assist with care coordination, transportation to doctors, etc., FIDA may be the key to successfully remaining in their home. Only an elder law attorney can counsel you on this legal choice.

Remember – Medicaid can be an essential service if you are ill, impaired, and lack sufficient income or resources to pay for proper care. Contact my office to arrange a consultation with me, as an elder law attorney practicing on Long Island.

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Posted by: BlogMaster | February 16, 2015

Medicaid and Elder Care Law Updates – Part 1

This is the first of several blogs to bring you up-to-date on important changes in elder law, special needs planning and estate planning.

Medicaid and elder care law update

Medicaid and Elder Care Law  Long Island NY

If you need New York State Medicaid for home aides or nursing home care, you will need the help of an elder law attorney. Please note that a non-legal advocate is not qualified to give you the proper guidance and advice to navigate this increasingly complex process.

What is involved?

Selection of a managed long term care agency (MLTC), assessment of services, decisions about service coordination (called FIDA), and whether and how to correctly opt out. The language of Medicaid is difficult for you to understand, as the consumer. Only an elder law attorney is qualified to counsel you on key legal decisions that will impact your future and your family’s.

Spousal refusal is still legal in 2015, but Governor Andrew Cuomo’s budget has once again proposed eliminating spousal refusal for home care/adult day care Medicaid. Spousal refusal occurs when one spouse requires Medicaid services but the other spouse will remain at home or in assisted living without Medicaid. Understanding the benefits and drawbacks of spousal refusal requires an elder care attorney.

New York State Medicaid withdrew a directive for home care income budgeting, which is affecting the monthly income kept by a married Medicaid home care recipient. The policy could have forced seniors into nursing homes.

Medicaid’s decision to revert to the previous policy now means that a married couple with one spouse receiving home care can deposit the Medicaid recipient’s income exceeding $825 per month into a Pooled Community Trust. The couple may still be able to retain the non-Medicaid spouse’s income, invoking spousal refusal if necessary. But this level of legal analysis should only be done by an elder law attorney.

Contact my office to arrange a consultation with me, as an elder law attorney practicing on Long Island.

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Posted by: BlogMaster | February 7, 2015

Still Alice: Candid Look at the Devastation of Alzheimer’s

On the occasion of the film release of “Still Alice”, based on Lisa Genova’s novel of the same name, I am re-publishing my 2009 review from Beth’s Bookshelf blog. 

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Still Alice [Paperback] by Lisa Genova (Gallery. Original edition Jan. 2009)

Alzheimer’s is a devastating disease most often associated with the elderly.  The disease can erase a lifetime of memories, family names and faces, and in some situations, cause aimless wandering, misplaced belongings, as well as loss of any sense of time and perspective.

But it’s not only the aged who are affected.

When the disease occurs in younger persons, ages 40 to 60’s, it is called ‘early-onset Alzheimer’s’. Although less common, early-onset Alzheimer’s can proceed more aggressively to destroy the mind and body.

Still Alice, a compelling novel by Lisa Genova, a Harvard neuroscientist, is the fictional tale of Dr. Alice Howland, a fifty year old psychology and linguistics professor diagnosed with early-onset Alzheimer’s disease. Author Genova traces Alice’s descent into dementia, written from Alice’s perspective.

In each chapter, the story charts, month by month, the original diagnosis through the almost complete loss of memory.  In an early scene, before seeking a medical opinion, Alice goes running on her usual route into Harvard Square past the Charles Hotel and the Kennedy School of Government. She suddenly finds herself lost, unable to return home. “She wanted to continue walking but stood frozen instead. She didn’t know where she was. She looked back across the street…the corridor, the hotel, the stores, the illogically meandering streets. She knew she was in Harvard Square, but she didn’t know which way was home.”

In the end, everything in the family changes. Youngest daughter, Lydia – with whom Alice had a strained relationship after Lydia rejected college and a traditional career path – chooses acting instead, becoming “the actress”. Eldest daughter, Anne, becomes “the mother” after she gives birth to twins. And Alice’s husband, John, also a Harvard professor, becomes “the man.”

Yes, this is a novel – but what makes it special is that it is written as if in Alice’s own voice. We read about her innermost feelings and growing frenzy as she struggles to remember words, faces and locations.

Still Alice allows us to bear witness to heartbreaking – and frightening – events that lead Alice, towards the end of the book, to tell her husband, “I remember I used to be very smart…I miss myself.”

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