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Medicaid Trusts

Debunking the Myths

By Dr. David Edward Marcinko; MBA, CPHQ™, CMP™

By Thomas A. Muldowney; MSFS, CLU, ChFC, CFP® CMP™

By Hope Rachel Hetico; RN, MHA, CPHQ™, CMP™fp-book1

Some advisors, doctors, clients, patients and elders may believe that one way of avoiding the consumption of their assets, which they will use for nursing home care, is by transferring their resources into trusts. By putting their assets in trusts, elders and others believe that these assets will not be exposed to unwanted use and will be protected from claims by nursing home providers.

OBRA 1993 and DRA 2005

However, federal and state laws have severely reduced the use of trusts for this purpose; OBRA ’93 provided many of these restrictions. DRA’05 reduced it even more. Under this and earlier legislation, corpus and income of an inter vivos (a living trust) or self-settled trust are deemed to be resources of the grantor (and his or her spouse) even if the terms of the trust give full power of income and principal distribution to the trustee. (If any person creates a trust, even one that is irrevocable, that provides income to the original grantor, the trust is considered a grantor trust and will not work as an asset protection trust against the claims of lawful creditors – such as Nursing homes or medical providers.) 

Eliminated Trusts

Furthermore, certain trusts, including those in which the beneficial interest terminates when the beneficiary becomes institutionalized (conversion trusts) and those that require remaindermen approval for distributions of principal to the lifetime beneficiary (condition precedent trusts), have been eliminated as asset protection trusts.

Approved Trusts

Other trusts have been expressly approved. These include supplemental care trusts for disabled individuals not yet age 65, income assignment trusts for people affected by state income caps, and pooled fund accounts managed by nonprofit corporations.

Ancillary Benefits

The OBRA legislation also appears to have continued to make it possible to create irrevocable trusts in which the grantor retains only the income and the trustee has no discretion to distribute principal. By eliminating a trustee’s discretion to distribute principal, these trusts effectively protect the trust assets from being deemed legally available to the grantor for nursing home costs. Only the mandated income payments could legitimately be considered by state social service agencies.

The Advisor’s Role

Therefore, a financial planner of advisors can recommend “income-only” Medicaid qualifying trusts to those clients who wish to dispose of assets in order to qualify for Medicaid. The client can establish such a trust and receive its income. The income in excess of a personal needs allowance, determined on a state-by-state basis, and must be spent on medical costs. If the income amount is less than the client’s medical needs, the balance of the medical cost will be paid by Medicaid (unless the client lives in an income “cap” state). The trust corpus will not be available, as it has, in effect, been given away. The client’s purpose to protect principal has been carried out.  DRA’05 extends the look-back to sixty months. 

Assessment

So even income only trusts are under scrutiny if they were established as a means by which a grantor expected to qualify for Medicaid. Thus, if an income only trust is established, it must be established long before the application for Medicaid and before the 60 month look-back period.

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com  or Bio: www.stpub.com/pubs/authors/MARCINKO.htm

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About Medical Workplace Violence

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More than Physical Assault

[By Staff Reporters]

Business Med PracticeWorkplace violence is more than physical assault.

According to trauma specialist Eugene Schmuckler; PhD, MBA, CTS opining and writing in www.BusinessofMedicalPractice.com; workplace violence is any act in which a person is abused, threatened, intimidated, harassed, or assaulted in his or her employment. Swearing, verbal abuse, playing “pranks,” spreading rumors, arguments, property damage, vandalism, sabotage, pushing, theft, physical assaults, psychological trauma, anger-related incidents, rape, arson, and murder are all examples of workplace violence.

The RNANS

The Registered Nurses Association of Nova Scotia [RNANS], a leading study group, defines violence as “any behavior that results in injury whether real or perceived by an individual, including, but not limited to, verbal abuse, threats of physical harm, and sexual harassment.” As such, medical workplace violence includes:

· threatening behavior — such as shaking fists, destroying property, or throwing objects;

· verbal or written threats — any expression of intent to inflict harm;

· harassment — any behavior that demeans, embarrasses, humiliates, annoys, alarms, or verbally abuses a person and that is known or would be expected to be unwelcome. This includes words, gestures, intimidation, bullying, or other inappropriate activities;

· verbal abuse — swearing, insults, or condescending language;

· muggings — aggravated assaults, usually conducted by surprise and with intent to rob; or

· physical attacks — hitting, shoving, pushing, or kicking.

Cause and Affect

Workplace violence can be brought about by a number of different actions in the workplace. It may also be the result of non-work related situations such as domestic violence or “road rage.” Workplace violence can be inflicted by an abusive employee, a manager, supervisor, co-worker, customer, family member, patient, physician, nurse, or even a stranger.

The UI-IPRC 

The University of Iowa – Injury Prevention Research Center [UI-IPRC] classifies most workplace violence into one of four categories.

· Type I Criminal Intent — Results while a criminal activity (e.g., robbery) is being committed and the perpetrator had no legitimate relationship to the workplace.

· Type II Customer/Client — The perpetrator is a customer or client at the workplace (e.g., healthcare patient) and becomes violent while being assisted by the worker.

· Type III Worker on Worker — Employees or past employees of the workplace are the perpetrators.

· Type IV Personal Relationship — The perpetrator usually has a personal relationship with an employee (e.g., domestic violence in the workplace).

Conclusion

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Geriatric Care Management

Information for Advisors

By Dr. David Edward Marcinko; MBA, CPHQ™, CMP™

By Thomas A. Muldowney; MSFS, CLU, ChFC, CFP® CMP™

By Hope Rachel Hetico; RN, MHA, CPHQ™, CMP™dhimc-book4

According to the Dictionary of Health Insurance and Managed Care”, www.HealthDictionarySeries.com geriatric care managers (GCMs) and case managers (CMs), including those working with licensed agencies, often develop an initial assessment; design and implement plans; investigate and identify available LTC resources; supervise aides and LTC services; coordinate family support consistent with its resources; and accommodate client needs, preferences, and budget. GCMs and CMs may be the most important contact with many elders on a regular basis, because they are generally familiar with available private and public resources.

Long Term Care Plans

An LTC plan that includes the coordination of all services (legal, medical, social, financial, and so on) has to be developed, implemented, monitored, and modified as necessary. Low-cost or medically insured services should be incorporated into the care plan when available and appropriate. The GCM is usually the best person to coordinate these services.

Private LTC Management and Insurance

Private LTC management has become an industry. The industry is fragmented, but it is starting to operate on a national scale. Services for elders are available from diverse sources. GCMs often run their own licensed agencies or care-management companies. CMs work in licensed private agencies and for government, not-for-profit, and religious agencies.

Assessment

But, the question remains, is there a real need for LTC insurance, or are there better economic and societal ways to deal with this financial issue?

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com  or Bio: www.stpub.com/pubs/authors/MARCINKO.htm

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Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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