Planning for Life

How Does MassHealth Calculate Life Estates?

Posted by Harry S. Margolis on November 12, 2019

By Harry S. Margolis

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Life estates have long been a prime long-term care planning device for protecting the home from MassHealth estate recovery because they're quite simple to create. MassHealth recently changed its rules in terms of how it measures life estates when they are created or when property held in a life estate is sold.

What is a Life Estate?

A life estate is a form of joint ownership of real estate where ownership interests are divided by time. The so-called "life tenant" has the right to occupy the property during his or her life and to collect any rental income earned from the property. The life tenant also has the obligation of maintaining the property.

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Topics: MassHealth planning, MassHealth, life estate

Now or Never, MassHealth to Close Door on Pooled Disability Trusts

Posted by Harry S. Margolis on September 17, 2019

By Harry S. Margolis

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Nursing home residents and their families have long used pooled disability trusts to shelter funds for their future needs that are not covered by MassHealth. These may include extra therapies or medical care, entertainment, hiring geriatric care managers, or the costs of maintaining a home. The funds can also be used to pay nursing homes for any gaps in coverage by MassHealth that sometimes occur.

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Topics: MassHealth, disqualifying transfer, pooled disability trust

Is MassHealth Really a State Budget Buster?

Posted by Harry S. Margolis on July 16, 2019

By Harry S. Margolis

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At a cost to the Commonwealth of almost $17 billion in fiscal year 2019, MassHealth makes up 36% of the total state budget. But according to a recent report from the Massachusetts Budget and Policy Center (MassBudget), about half this expense is reimbursed by the federal government, bringing net MassHealth costs down to $8.4 billion, just under a quarter of the state budget net of federal contributions.

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Topics: MassHealth

D'Agostino Wins MassHealth Trust Case

Posted by Harry S. Margolis on June 10, 2019

By Harry S. Margolis

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The MassHealth Board of Appeals recently decided a case involving real estate held by a trust in favor of Patricia D'Agostino's client, a current nursing home resident who had sought coverage beginning in December 2017. The trust had been created by the client's now-deceased husband back in 1995 and held two vacation rental properties.

The Trust in Question

At issue were two provisions in the trust. The first gave the client the right to use and occupy the vacation properties and to receive the net rental income. The second permitted the dissolution of the trust upon agreement of all the beneficiaries and the sale of the trust property with the proceeds being paid to the beneficiaries listed on "the then current schedule of beneficiaries," the couple's children.

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Topics: trusts, MassHealth, vacation house

The Facts on Alzheimer's Disease and Other Forms of Dementia

Posted by Harry S. Margolis on April 2, 2019

By Harry S. Margolis

The Alzheimer's Association has released its annual report, Alzheimer's Disease Facts and Figures, which as usual contains some daunting figures, especially as Baby Boomers age and we hear the latest news story of an unsuccessful drug trial. Here are some of the results:

  • 5.8 million Americans have been diagnosed with Alzheimer's disease, which is projected to increase to 14 million by 2050.
  • The annual cost of the illness is $290 billion, which is projected to rise to $1 trillion by 2050 (in current dollars). Medicare and Medicaid currently pay $195 billion of this cost
  • More than 16 million Americans provide unpaid care to family members with Alzheimer's or other forms of dementia providing an estimated 18.5 billion hours of care valued at $234 billion.
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Topics: dementia, MassHealth, Alzheimer's disease

Court Faults "Arbitrary and Capricious" MassHealth Hearing Decision

Posted by Harry S. Margolis on December 26, 2018

By Harry S. Margolis

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In the case of Pauline Coko vs. Daniel Tsai, Director of the Office of Medicaid (Essex Sup. Ct. CA No. 2018-00071-A, December 13, 2018), Judge Timothy Q. Feeley faults the arbitrary and capricious conduct of a MassHealth hearing officer in imposing a 193-day transfer penalty for four transfers by Pauline Coko totaling $68,632 in value.

Disqualifying Transfers

The transfers in question included a deed of Mrs. Coko's life interest in her home to her daughter, two disbursements from Mrs. Coko's bank account, and the gift of her 2003 Mitsubishi valued at $1,365 to a granddaughter.

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Topics: MassHealth, disqualifying transfer

MassHealth Held to Violate Notice Requirements in Trust Cases

Posted by Harry S. Margolis on July 3, 2018

By Harry S. Margolis

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In the combined cases of Jean Maas v. Mary Lou Sudders (Suffolk CA No. 18-129-D) and Henry Hirvi and Eva Hirvi v. Mary Lou Sudders (Suffolk CA No. 18-845-D), Superior Court Judge Douglas H. Wilkins finds that in denying applications for MassHealth benefits in cases involving trusts, MassHealth fails to satisfy the requirements of federal regulation 42 C.F.R. sec. 431.210 (b) that it explain the reasons for the denial.

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Topics: trusts, long-term care planning, MassHealth

MassHealth Permitted Late Intervention in Personal Injury Case

Posted by Harry S. Margolis on May 22, 2018

By Harry S. Margolis

Hand about to bang gavel on sounding block in the court room

In 2009, Evelyn E. Gries was hit by a car driven by Annmarie B. Hunt. Ms. Gries died about a year and a half later and a year and a half after that her estate brought suit against Ms. Hunt. In another year and a half (there's a pattern here) at the end of 2013, the parties settled for the full amount of Ms. Hunt's insurance, $250,000. They stipulated to the dismissal of the lawsuit at the beginning of 2014.

None of the parties notified MassHealth

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Topics: MassHealth, personal injury settlement, MassHealth lien

M&B Attorneys Win Two MassHealth Trust Hearings

Posted by Harry S. Margolis on April 11, 2018

By Harry S. Margolis

Applicants for MassHealth who have done advance planning involving sheltering assets in irrevocable trusts have been plagued by MassHealth denials of eligibility based on specious legal arguments. This results in fair hearing and court appeals that can sometimes take years. Two of our clients recently received favorable resolution of their cases before the MassHealth Board of Hearings.

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Topics: MassHealth planning, MassHealth

MassHealth Denial in Trust Case Overturned

Posted by Harry S. Margolis on March 20, 2018

By Harry S. Margolis

In a case argued by Margolis & Bloom senior associate Sarah Hartline, the Essex Superior Court has overturned a MassHealth denial of coverage for a nursing home resident who MassHealth found had countable assets available from a trust she had created.attorney-sarah-foster-headshot-1.jpg

The trust in question in Yanow v. Office of Medicaid (Essex Sup. Ct. CA No. 1677CV00599, March 7, 2018), provided for the payment of income earned on trust assets to the grantor, but barred the distribution of any principal to her. Nevertheless, MassHealth argued that due to an administrative provision in the trust which permits the trustee "to determine what part of the trust property is income and what part is principal" the trustee was able to deem all of the trust property "income" and distribute it to the grantor (the applicant for MassHealth benefits).

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Topics: trusts, MassHealth

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