Medicaid Denial Reversed; Agency Failed to Accommodate Disabled Applicant or Assist in Obtaining Information and Documents

After he was admitted to a nursing home in 2013, petitioner, R.P., accrued unpaid bills of $264,146 for nursing care services. As a result, three successive Medicaid applications were filed on R.P.’s behalf. It was undisputed that R.P. lacked the capacity to assist with any of the Medicaid applications.

The first Medicaid application, filed in November 2013, was denied eight months later for failure to provide information and/or documents needed to make an eligibility determination. Petitioner requested a fair hearing, and the administrative law judge affirmed the denial.

In July 2014, petitioner filed a second Medicaid application. The second application was denied in October 2014 for the same reason as the first, i.e., failure to provide information and/or documentation required to make a determination. Petitioner again appealed, requesting a fair hearing. While the appeal was pending, petitioner filed a third Medicaid application in April 2015.

At the hearing on the denial of the second application, petitioner submitted a certification from his attorney describing the information sought by the Medicaid agency and the many attempts counsel made to obtain the requested information from third parties such as banks and the IRS without assistance from the petitioner due to his incapacity. Counsel also showed that much of the bank information sought by the agency was for a period beyond the 5-year look-back period, therefore not required to make a determination.  Based upon the many efforts to obtain the information by counsel, petitioner asserted that the circumstances were beyond his control and that he was entitled to more time to make submissions. In addition, petitioner asserted that the agency was asking for information that does not exist and, that it could have made a determination on the application without the information.

The administrative law judge (ALJ) hearing the appeal reversed the denial of Medicaid benefits. The ALJ ruled that petitioner, as a disabled person, was entitled to accommodations when applying for public benefits which the Medicaid agency failed to provide:

[The law requires that a public entity shall make reasonable modifications in policies, practices, or procedures when the modifications are necessary to avoid discrimination on the basis of disability … And public agencies indeed have a duty to offer reasonable modifications to their policies, practices, and procedures under the Fourteenth Amendment for disabled individuals so they are not effectively or unintentionally denying access to the vital programs which have in fact funded by the applicants. … In the instant matter, petitioner is indisputably a disabled individual that is entitled to an accommodation when applying for a public benefit, which has been deemed a property interest. … When Medicaid applicants are mentally incapable of assisting in their pursuit of Medicaid coverage, the regulations clearly protect them from being penalized; due to their inability to submit in-depth analysis of five years’ worth financial transactions for items; such as stock transactions and thousands of ordinary banking transactions …

The ALJ also found that disabled applicants were entitled to more time when the information sought by the agency is in the possession of third parties:

[T]he regulations include protective provisions directing the [Medicaid agency] that disabled applicants are entitled to more time, if matters are outside the control of the [Medicaid agency], or financial information is unavailable and in the possession of third parties.

In addition, the ALJ found that the equities of the situation weighted in favor of affording the petitioner a decision on the merits of his Medicaid application:

Procedural dismissal of cases involving protected rights of the disabled should be avoided, if possible. … Petitioner is entitled to a decision on the merits his Medicaid application since it is a program that petitioner helped fund over his lifetime. There is considerable prejudice to the petitioner and the long-term care facility while there is no comparable or measureable prejudice to the [Medicaid agency]. Over $250,000 in care was provided to petitioner by the long-term care facility that could or will, go unreimbursed. This is fundamentally unfair because it’s based upon a technical or procedural denial of assistance rather than from a meritorious consideration of the application. The procedural denial is extraordinarily harmfully to the long-term care facilities and its residents …

Finally, the ALJ found that the Medicaid agency had a duty to assist applicants in completing the Medicaid application and in obtaining necessary information and documents:

The processing of Medicaid applications involves shared responsibility. The burden does not rest exclusively with the applicant. N.J.A.C. 10:71-2.2 sets forth responsibilities for both the [Medicaid agency] and the applicant, during the application process. Specifically, N.J.A.C. 10:71-2.2(e) states “as a participant in the application process, an applicant shall: 1. Complete, with the assistance from the [Medicaid agency] if needed, any forms required by the [Medicaid agency] as a part of the application process; 2. Assist the [Medicaid agency] in securing evidence that corroborates his or her statements …

The case is attached here – R.P. v Division of Medical Assistance and Health Services

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Lawyer Awarded $350,000 Based On Negative Online Reviews Posted By Former Client

A Florida appeals court upheld a judgment of $350,000 in a lawsuit filed by a lawyer against her former client alleging defamation based on negative reviews of the lawyer posted on the internet by the former client. Blake v. Giustibelli, __ So.3d __ (Fla. 4th DCA, No. 4D14-3231, 1/6/2016), 2016 WL _______.

Florida Attorney Ann-Marie Giustibelli represented Copia Blake in a divorce from her husband, Peter Birzon.  After a breakdown in the attorney-client relationship, Blake and Birzon posted negative reviews regarding Giustibelli on various internet sites.  The reviews stated that Giustibelli charged Blake four times the amount of fees originally quoted, that she lacked integrity, and that she falsified a contract.  Alleging that the reviews were defamatory, Giustibelli sued Blake and Birzon for libel, breach of contract and attorney’s fees, alleging that Blake still owed her money related to the divorce representation.

At trial, both Blake and Birzon admitted to posting the negative reviews on various websites. In addition, Blake and Birzon both admitted at trial that Giustibelli had not charged Blake four times more than what was quoted in the agreement. The trial court ruled that Blake had agreed to pay Giustibelli the amount reflected on the parties’ written retainer agreement—$300 an hour. As a result, the court entered judgment in favor of Giustibelli and awarded punitive damages of $350,000.

Blake and Birzon appealed, contending that “their internet reviews constituted statements of opinion and thus were protected by the First Amendment and not actionable as defamation.”  The appeals court disagreed, and affirmed the trial court’s judgment. The appeals court ruled that

[A]n action for libel will lie for a ‘false and unprivileged publication by letter, or otherwise, which exposes a person to distrust, hatred, contempt, ridicule or obloquy or which causes such person to be avoided, or which has a tendency to injure such person in [their] office, occupation, business or employment.’ … Here, all the reviews contained allegations that Giustibelli lied to Blake regarding the attorney’s fee. Two of the reviews contained the allegation that Giustibelli falsified a contract. These are factual allegations, and the evidence showed they were false. [Citations Omitted]

The case is annexed here – Blake v. Giustibelli

To learn more about the qualifications of the Law Office of Donald D. Vanarelli, visit: http://vanarellilaw.com/law-firm-profile/

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Medicaid’s Decision to Deny Disabled Woman’s Application for a Power Wheelchair is Vacated on Appeal

M.S. is a 73-year old residing in at a long-term care facility. She is a hemiplegic who suffers from obesity, diabetes, arthritis, osteoporosis and COPD. Because she is completely paralyzed on her left side, she had been using a manual one-arm wheelchair. She filed an application to the Division of Medical Assistance and Health Services (“Medicaid”), seeking authorization for a power wheelchair based upon the pain and difficulty she suffered from operating the manual wheelchair. Her application was supported by her occupational therapist and doctor.

Medicaid denied her application because the “items requested are considered part of the per diem rate” paid by Medicaid to the facility. M.S. appealed that decision, requesting a fair hearing before an administrative law judge (“ALJ”).

At the hearing, a doctor testified on behalf of Medicaid. He testified that he had denied M.S.’s request after reviewing her written application; he did not examine her or conduct a field evaluation. He noted that M.S.’s doctor had opined that the power chair would benefit M.S. “primarily because she was a very active patient who liked to participate in all the activities of the facility.” However, the Medicaid doctor determined that, based on the Medicaid per diem rate paid to the facility, the facility should already be providing services to M.S. that would enable her to participate in facility activities. Therefore, the doctor determined that the power wheelchair was not “medically necessary.”

A physical therapist who is the facility administrator testified on behalf of M.S. He had treated M.S. and was familiar with her medical history. He testified that, as a result of her manual one-armed wheelchair, M.S.’s right shoulder was deteriorating and causing pain, and that this condition would worsen with continued use. He testified that the pain affected her mobility, and that the power wheelchair would enable her to participate more fully in facility activities and enhance her independence. Therefore, he opined that the power wheelchair was medically necessary.

At the conclusion of the hearing, the ALJ determined that the power wheelchair was medically necessary, and that M.S.’s application should have been granted.

However, the Medicaid Director reversed the ALJ on the following bases: (1) M.S. failed to demonstrate that the wheelchair was medically necessary; (2) the power wheelchair was not cost-effective; and (3) providing “necessary equipment” (such as a wheelchair), as well as assistance with that equipment (such as attendants to transport a resident) is the responsibility of the nursing facility, and is part of the per diem rate already paid to the facility by Medicaid.

On further appeal to the New Jersey Superior Court, Appellate Division, the Director’s decision was vacated.

The appellate court began by reviewing the regulations governing Medicaid’s duty to cover durable medical equipment (“DME”), such as wheelchairs. While DME that is “routinely used” and essential to furnish the facility’s services to residents is part of the per diem rate, and therefore not covered, exceptions include DME  that is “not routinely used in a nursing facility and which is required due to the medical need of the individual resident.” At the hearing, there had been no evidence that power wheelchairs were “routinely used” or essential to the facility’s services; therefore, the Appellate Division found that they are not part of the per diem rate. As such, the regulations provide that the power chair would be covered if “required due to the medical need” of the resident. Although “medical necessity” is not defined, state and federal regulations require long-term care facilities to include a residential activities program to meet the resident’s physical, mental and psychosocial needs. Moreover, the power chair would prevent further deterioration of M.S.’s shoulder pain and shortness of breath. Therefore, the Appellate Division concluded that the power chair was “medically necessary.”

Medicaid also argued that, because Medicaid is for paying M.S.’s 24-hour care in the facility, it is the facility’s obligation to provide assistance with the wheelchair and attendants to transport M.S. where she desires. The Appellate Division found that the applicable regulations do not explicitly require facility staff to push a resident’s wheelchair, and that such a duty was not established as a matter of fact at the hearing: the ALJ had credited M.S.’s witnesses, not Medicaid’s doctor, and had concluded that “the facility’s staff was not consistently available to wheel [M.S.] to her activity room.”

The Appellate Division concluded that, given the ALJ’s findings, the Medicaid Director’s conclusion that the facility was required to push the wheelchair to her activities was unsupported by the evidence.

However, the Appellate Division remanded the case for further proceedings, and to allow Medicaid to present further evidence regarding the facility’s staffing for pushing the wheelchair on a consistent basis.

During the course of its decision, the Appellate Division also addressed a due process issue: although the Director had stated that the wheelchair should be denied because it was not “cost-effective” pursuant to the regulations, M.S. argued that the Medicaid’s denial notice did not raise that issue, and that she therefore had received inadequate notice of “the reasons for the intended agency action [and] the specific regulations supporting that action,” pursuant to federal regulation. As to this claim, Medicaid’s doctor had testified that M.S. had not received notice of the issue of cost-effectiveness because “the Division is only allowed to put one reason on its denial form.” The Appellate Division responded that,

If such a technical limitation exists, it should be remedied. Advising those seeking DME of all reasons for the Division’s denial will ensure complete notice, and may avoid further litigation by claimants who cannot surmount the Division’s additional reasons.

Nevertheless, because the issue had been raised early in the hearing, and M.S. had not suggested that she would have presented additional evidence if she had received earlier notice, the Appellate Division found that the lack of notice was harmless. The ALJ had made no findings regarding whether the chair was a cost-effective solution to petitioner’s difficulties. The Appellate Division therefore remanded to the ALJ to allow the parties to present further evidence on the issue, and to allow the ALJ to make an appropriate finding.

A copy of M.S. v. DMAHS can be found here – M.S. v. Division of Medical Assistance and Health Services

Congratulations to my colleague Carl G. Archer, Esq. who represented the petitioner, M.S., in this case. Carl achieved a significant victory in the M.S. case which will help many disabled people in New Jersey who depend on Medicaid to pay for necessary durable medical equipment.

For additional information concerning Medicaid applications and appeals, visit: http://vanarellilaw.com/medicaid-applications-medicaid-appeals/

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Top 10 Blog Posts on www.VanarelliLaw.com in 2015

Happy New Year to clients, supporters, friends and readers. Last month, an article on this blog ranked the 25 most popular blog posts and website articles on the Vanarelli Law Office website in 2015. Since then, I decided to narrow my focus a little. In this post, I focused solely on blog posts, and created a list of the "Top Ten (10)" most popular blog posts in 2015. Check out the list to see this year’s highlights. Again, our sincere thanks for taking the time to read our blog! 

The Law Office of Donald D. Vanarelli Launches VanarelliLaw.com Website. Earlier this year, we proudly announced the launch of our new website, located at http://VanarelliLaw.com. Hopefully, the new website accomplishes the goal we set for ourselves: to provide the best-possible user experience for website visitors researching elder law issues; estate, trust and gift tax laws; public benefits laws; special needs planning issues; and court procedures, such as probate litigation, will contests and elder mediation.

Attorneys Representing An Estate May Owe A Duty Of Care To Non-Clients Who Are Beneficiaries Of The Estate. In an important case, a New Jersey appeals court ruled that estate attorneys may owe a duty of care to non-clients when the attorneys know, or should know, that the non-clients will rely on the attorneys’ representations.

Ethics Rules Clarified for NY Lawyers Who Use LinkedIn. The New York County Lawyers Association, in Formal Opinion 748, addressed the ethical impact on lawyers of their use of the social media website “LinkedIn.”

Lawsuit May Proceed Against CCRC For Misleading Marketing. Here, a New Jersey appeals court, reversing a trial court order dismissing a complaint filed by the son of a deceased former resident of a Continuing Care Retirement Community (CCRC), held that marketing pamphlets distributed by the CCRC could be the basis of a lawsuit alleging consumer fraud and similar claims regarding the CCRCs’ refund policy.

New Jersey Settles Federal Lawsuit, Amending its Medicaid Program to Exclude VA Pension as Countable Income. In 2015, the State of New Jersey entered into a Consent Order agreeing to amend the rules governing its Medicaid program in order to exclude pension benefits paid by the Department of Veterans Affairs when determining an applicant’s eligibility for Medicaid benefits. Our law firm represented the Alma Galletta, the lead plaintiff in this federal class action lawsuit.

Federal Appeals Court Rules Short-Term Annuities Are Not “Available Resources” Preventing Medicaid Eligibility. In this case, the United States Court of Appeals for the Third Circuit, reversing an earlier federal district court judgment, ruled that “short-term annuities” purchased by applicants for nursing home Medicaid cannot be treated as an “available resource” preventing Medicaid eligibility.

Reduction in PCA Hours Reversed; Assessment Tool Imposed Artificial Cap of 25 Hours of Care. The decision by United Healthcare, a managed care organization, to reduce the Personal Care Assistant (PCA) hours awarded to a disabled Medicaid recipient from forty (40) hours per week to twenty-five (25) hours per week was reversed on appeal. 

Top 10 New Jersey Elder Law and Special Needs Trust Cases Decided in 2015. In this blog post, I summarized the top elder and disability law cases decided from September 2014 through August 2015.

Lifetime Achievement Award Presented to Donald D. Vanarelli, New Jersey Elder Law and Estate Planning Attorney. In this post, I described my surprise and delight upon receiving the Marilyn Askin Lifetime Achievement Award from the New Jersey State Bar Association’s Elder and Disability Law Section. The Lifetime Achievement Award, the Elder and Disability Law Section’s highest honor, is bestowed on an attorney with an established history of distinguished service who has made significant contributions in the field of elder and disability law throughout his or her career.

Disabled Vet Ordered Into VA Nursing Home Against His Wishes So His Limited Income Can Be Used To Pay Alimony. A New Jersey appeals court required a disabled 89 year old veteran to receive end-of-life care in a VA facility against his wishes rather than at home in order to use his limited income to continue paying alimony to his ex-wives.

Thank you for making these our top blog posts in 2015. We promise to continue bringing readers new developments in 2016 in elder law, estate planning and administration, will contests and probate litigation, guardianships, public benefit laws involving veterans pension and compensation, Social Security, Medicaid and Medicare, special education cases and special needs trusts, among other topics. If you or a loved one need legal assistance, please contact us for a consultation, either via email, at dvanarelli@VanarelliLaw.com, or via phone, at (908) 232-7400.

For additional information concerning NJ elder law and special needs planning visit: http://vanarellilaw.com/legalv-services/

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New Jersey’s Achieving a Better Life Experience (ABLE) Act is Now Law

The New Jersey Achieving a Better Life Experience (ABLE) Act became law today.

Under the new Act, New Jersey’s Department of Human Services and the Department of the Treasury are required to establish the ABLE Program pursuant to federal law. Under the program, persons who became disabled before age 26 and are found to meet the disability requirements for Social Security disability benefits may establish an ABLE account, and become the beneficiary of that account. ABLE accounts are designed to enable people with disabilities and their families to save and pay for disability-related expenses.

ABLE accounts are exempt from state income taxation. Also, an ABLE account will not be counted when determining the beneficiary’s eligibility for public benefit programs based upon financial need, or in determining the amount of any benefit provided under those programs.

Contributions can be made to an ABLE account on an annual basis in a total amount up to the annual gift tax exclusion amount, currently $14,000. Distributions from an ABLE account are tax-free if used to pay “qualified disability expenses.”

“Qualified disability expenses” are expenses that relate to the beneficiary’s blindness or disability and help that person maintain or improve health, independence and quality of life. For example, qualified disability expenses can include housing, education, transportation, health, prevention and wellness, employment training and support, assistive technology and personal support services and other expenses.

An ABLE account holding up to $100,000 is not counted in determining the beneficiary’s eligibility for needs-based public benefit programs. Public benefit providers consider an ABLE account to be a countable resource to the extent that the ABLE account balance exceeds $100,000. When the beneficiary dies, any funds remaining in an ABLE account must be used to repay the public benefit providers for all amounts the public benefit providers spent on the beneficiary.

An ABLE account is a useful tool to assist people with disabilities. However, ABLE accounts have significant limitations which prevent ABLE accounts from replacing special needs trusts.  Due to the limit on annual contributions ($14,000) and the total account balance limit ($100,000), Special needs trusts are needed for large inheritances and large lawsuit awards. Also, although ABLE accounts must repay public benefit providers for public benefits received by the account beneficiary, third-party special needs trusts have no obligation to repay.

The New Jersey ABLE Act will take effect in October 2016.

The new ABLE Act enacted in New Jersey on January 11, 2016 is annexed here – Senate Bill No. 2770

For additional information concerning special needs trusts & disability planning, visit: http://vanarellilaw.com/special-needs-disability-planning/

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Daughter/Executrix Who Disputed Terms of Mother’s Will is Denied Commissions

Linda Hall was the executrix of her mother’s estate. Hall had initially had a 2005 will admitted to probate.

When Hall’s sister, Carol Polak-Reid (“Reid”) filed a complaint alleging that their mother had executed another will in 2011, Hall represented that she had attempted to have the 2011 will admitted, but the surrogate had rejected the 2011 will because it contained “scratch-outs.” The trial court set aside probate of the 2005 will and admitted the 2011 will to probate, although Hall remained the executrix. The trial judge denied Reid’s request for an accounting as premature, and denied Reid’s request to remove Hall as executrix, finding insufficient evidence to support the request.

Reid later filed a motion seeking information regarding the decedent’s property in Englewood, and seeking distribution of personal property, an inventory of the decedent’s assets, counsel fees, and a plenary hearing regarding Hall’s removal as executrix. The trial court awarded Reid counsel fees from the estate and ordered Hall to provide an inventory of assets, but denied Reid’s other requests.

Thereafter, the decedent’s Englewood property was sold.

A trial was conducted, which resulted in the trial judge making the following findings. Prior to her death, the decedent had been living with Hall and paying Hall $1,000/month in rent. The decedent had obtained a loan for $79,000, secured by a mortgage on the Englewood property. The decedent had retained $10,000 of that loan. Contrary to Hall’s denial, the trial judge found Hall had borrowed the remaining $69,000 to renovate her home. The court found that the decedent’s payment of the $922 monthly mortgage was in lieu of her paying rent to Hall. The judge also found that, according to the decedent’s will, Hall was to be responsible for repaying that loan at the time of sale of the Englewood property. The trial judge found that the testimony presented at trial demonstrated that the decedent had intended to have Hall repay that loan.

Although the trial court ordered that the loan balance was to be repaid by Hall, he credited Hall for the $922/month mortgage payments, since they were in lieu of rent. He entered judgment against Hall for the balance of the loan, to be paid to the estate.

The trial judge also ordered that, because there were no funds remaining to be distributed pursuant to the residuary clause, Hall would not be paid an executor’s commission.

On appeal, Hall first claimed that, contrary to the provision of the will, Hall had never received the loan proceeds and never signed any documents obligating herself to repay the mortgage. The Appellate Division rejected these arguments.

The Appellate Division found that the evidence at trial had established that Hall had received the loan proceeds and that the decedent had intended Hall to repay her estate for the loan balance remaining at her death.

Hall’s second argument on appeal was that the trial judge’s refusal to award her an executor’s commission was erroneous, because she had not been found to have engaged in any misconduct. The Appellate Division rejected this argument. It found that Hall’s assertions regarding the loan were not credible, and that,

the record shows that Hall was not seeking to effectuate [the decedent’s] intentions. Rather, Hall was endeavoring to avoid her responsibility for the loan in direct contravention of her mother’s expressed intentions in the will.

The Appellate Division found that, because the matter did not involve a legitimate dispute regarding the terms of the will, and because there were insufficient estate assets to pay residuary bequests and an executor’s commission would reduce amounts received by the other beneficiaries, the judge did not abuse his discretion in refusing an executor’s commission to Hall.

The case is annexed here – Estate of Polak

For additional information concerning estate planning and administration, visit: http://vanarellilaw.com/estate-planning-administration/

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Medicare Now Covers Conversations About End-of-Life Care

Medicare beneficiaries may now discuss options for end-of-life care with their health care providers.

Beneficiaries were always free to talk about advance care planning with their doctors or other qualified health professionals. Unfortunately, however, until recently practitioners could be reimbursed for such discussions only during a patient’s “Welcome to Medicare” visit. Under new regulations effective January 1, 2016, advance care planning discussions can take place during the annual wellness visit or at a separate appointment.  The discussions are a reimbursable benefit under Medicare Part B and there will be a copayment if the conversation is not part of the annual wellness visit.

Now that discussions about advance care planning are a regular Medicare benefit, seniors and other Medicare beneficiaries will be able to learn about health care options that are available for end-of-life care, such as advance directives, palliative care and hospice care.  They can then determine which types of care they would like to have, and share their wishes with their practitioners and family.  After sufficient conversations with their doctors and other health professionals, the beneficiaries may be ready to execute legal documents, such as advance directives or “POLST” forms, and name a  health care proxy to ensure that their wishes will be carried out. Studies have found that 40% of people over age 65 have not written down their wishes for end-of-life treatment. Thus, these conversations may help enable patients to end their lives on their own terms.

In addition, life-prolonging medical procedures are unwanted and unwelcome for many patients.  A 2011 study found that when medical personnel know what kind of care a patient wants at the end of life, the patient is more likely to die at home rather than in a hospital.

Talk to an attorney at the Law Office of Donald D. Vanarelli about drawing up the documents to help ensure you receive the end-of-life medical treatment you want — no more and no less.

(This article was adapted from an article on the ElderLaw Answers website.)

For additional information concerning NJ elder law and special needs planning, visit: http://vanarellilaw.com/legal-services/

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Roundup of Key Elder Law Numbers for 2016

Below are figures for 2016 that are frequently used in the elder law practice or are of interest to clients.

Medicaid

Medicaid Spousal Impoverishment Figures for 2016

These figures are unchanged from 2015.  The minimum community spouse resource allowance (CSRA) is $23,844 and the maximum CSRA remains $119,220. The maximum monthly maintenance needs allowance is $2,980.50. The minimum monthly maintenance needs allowance will be $1,991.25 until July 1, 2016.

Medicaid Home Equity Limits

Also no change from 2015: Minimum: $552,000; Maximum: $828,000.

Income Cap

The income cap for 2016 applicable in “income cap” states remains $2,199 a month.

Federal Estate and Gift Tax Exemption Amounts

Federal estate tax exemption: $5.45 million for individuals

Lifetime tax exclusion for gifts: $5.45 million

Generation-skipping transfer tax exemption: $5.45 million

Non-citizen spouse annual gift tax exclusion: $148,000

The annual gift tax exclusion remains at $14,000

Federal Income Taxation of Estates and Trusts

If Taxable Income Is:                                   The Tax Is:      

• Not over $2,550                                            15% of the taxable income
• Over $2,550 but not over $5,950                $382.50+25% of excess over $2,550
• Over $5,950 but not over $9,050                $1,232.50+28% of excess over $5,950
• Over $9,050 but not over $12,400              $2,100.50 + 33% of excess over $9,050
• Over $12,400                                                $3,206 + 39.6% of excess over $12,400

New Jersey and New York State Estate Tax Exemption Amounts

The New Jersey state estate tax exemption amount remains unchanged at $675,000, one of the lowest state estate tax exemption amounts in the nation. In comparison, the New York state estate tax exemption amount is much more generous. The New York state estate tax exemption amount, which was changed as of April 1, 2014, is as follows:

• $2.0625 million for decedents dying between April 1, 2014 through March 31, 2015;
• $3.125 million for decedents dying between April 1, 2015 through March 31, 2016;
• $4.1875 million for decedents dying between April 1, 2016 through March 31, 2017;
• $5.25 million for decedents dying between April 1, 2017 through December 31, 2018.

Beginning in 2019, the exemption would be indexed for inflation, and equal to the federal exclusion.

Long-Term Care Premium Deductibility Limits for 2016

The Internal Revenue Service has announced the 2016 limitations on the deductibility of long-term care insurance premiums from taxes. Any premium amounts above these limits are not considered to be a medical expense.

Attained age before the close of the taxable year	Maximum deduction
40 or less	$390
More than 40 but not more than 50	$730
More than 50 but not more than 60	$1,460
More than 60 but not more than 70	$3,900
More than 70	$4,870

Benefits from per diem or indemnity policies, which pay a predetermined amount each day, are not included in income except amounts that exceed the beneficiary’s total qualified long-term care expenses or $340 per day (for 2016), whichever is greater.

Medicare Premiums, Deductibles and Copayments for 2016

• Part B premium: $104.90/month (unchanged)
• Part B deductible: $147 (unchanged)
• Part A deductible: $1,288 (was $1,260)
• Co-payment for hospital stay days 61-90: $322/day (was $315)
• Co-payment for hospital stay days 91 and beyond: $644/day (was $630)
• Skilled nursing facility co-payment, days 21-100: $161/day (was $157.50)

Premiums for higher-income beneficiaries:

• Individuals with annual incomes between $85,000 and $107,000 and married couples with annual incomes between $170,000 and $214,000 will pay a monthly premium of $170.50 (was $146.90).
• Individuals with annual incomes between $107,000 and $160,000 and married couples with annual incomes between $214,000 and $320,000 will pay a monthly premium of $243.60 (was $209.80).
• Individuals with annual incomes between $160,000 and $214,000 and married couples with annual incomes between $320,000 and $428,000 will pay a monthly premium of $316.70 (was $272.70).
• Individuals with annual incomes of $214,000 or more and married couples with annual incomes of $428,000 or more will pay a monthly premium of $389.80 (was $335.70).

Rates differ for beneficiaries who are married but file a separate tax return from their spouse:

• Those with incomes between $85,000 and $129,000 will pay a monthly premium of $316.70 (was $272.70).
• Those with incomes greater than $129,000 will pay a monthly premium of $389.80 (was $335.70).

Changes in Social Security Benefits for 2016

Cost-of-Living Adjustment (COLA):

Monthly Social Security and Supplemental Security Income (SSI) benefits will not automatically increase in 2016 as there was no increase in the Consumer Price Index (CPI-W) from the third quarter of 2014 to the third quarter of 2015.

Maximum Taxable Earnings:                                            

Social Security (OASDI only) 7.65%                     Limit of $118,500                                                           Medicare 1.45%                                                      No Limit                                                                 Quarter of Coverage:                                                $1,220

Retirement Earnings Exempt Amounts:

Under full retirement age: $15,720/yr.($1,310/mo.)

NOTE: One dollar in benefits will be withheld for every $2 in earnings above the limit.

The year an individual attains full retirement age: $41,880/yr. ($3,490/mo.)

NOTE: Applies only to earnings for months prior to attaining full retirement age. One dollar in benefits will be withheld for every $3 in earnings above the limit.

NOTE: There is no limit on earnings beginning the month an individual attains full retirement age.

Social Security Disability Thresholds:

Substantial Gainful Activity (SGA):       Non-Blind:  $1,090/mo.                    Blind : $1,820/mo.

Trial Work Period:  $780/mo.

Maximum Social Security Benefit for a Worker Retiring at Full Retirement Age:  $2,663/mo.

SSI Federal Payment Standard:     Individual:  $733/mo.            Couple: $1,100/mo.

SSI Resource Limits:                      Individual: $2,000                 Couple: $3,000

For additional information concerning New Jersey elder law, visit: http://vanarellilaw.com/legal-services/

The post Roundup of Key Elder Law Numbers for 2016 appeared first on Elder Law Attorney NJ | The Law Office of Donald D. Vanarelli.

HAPPY NEW YEAR 2016!

Here’s wishing all of you, your families and loved ones a successful, fulfilling and happy new year, with plenty of good luck, good friends and good eating too!

The post HAPPY NEW YEAR 2016! appeared first on Elder Law Attorney NJ | The Law Office of Donald D. Vanarelli.