ELDER LAW UPDATE Presented to Chester County Estate Planning Council September 21, 2006

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ELDER LAW UPDATE Presented to Chester County
Estate Planning Council September 21, 2006

• DANA M. BRESLIN, JD, CELA
• LINDA M. ANDERSON, JD, LLM, CELA
• (c) 2005- 2006 AndersonElderLaw

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ELDER LAW UPDATE

• MEDICARE PART D

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NEW MEDICARE LAW

• New Medicare drug plan went into effect January
  6, 2006 (Plan D)
• Enrollment
• For 2006, enrollment period ended 5/15/2006
• For 2007, enrollment period starts 11/15/2006
• Typical Plan D for 2007
• Premium of 35 per month (estimated)
• Annual Deductible of 265 per year
• 75 coverage until 2,400 total costs
• No coverage between 2,400-5,451
• Annual out of pocket limit 3,850/yr (plus 5
  over 5,451)
• 95 coverage above 5,451.25 total

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MESSAGE TO OUR CLIENTS

• Creditable Coverage? Keep letter for later.
• Not Creditable Coverage? Get enrolled.
• Four Quick Steps to Enrollment
• Copy of Medicare Card
• List of Medication
• Choice of Pharmacy
• www.Medicare.gov
• PACE/PACE Net Medicare Part D

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ELDER LAW UPDATE

• CHANGES TO MEDICAID

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CONTINUUM OF CARE PAYMENT SOURCES

• Home Health Care
• Adult Day Services
• Assisted Living
• Nursing Home
• Hospice
• CCRCs

• MA, MC, LTCI you
• MA you
• LTCI, you VA
• LTCI, MC, LTCI, VA you
• MC
• You see above

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OVERVIEW OF CHANGES

• Pennsylvania
• Act 42
• Act 43
• OPS Memo 60603
• OPS Memo 60701
• -------------
• Pending OPS Memo for DPW compliance with DRA

• Federal
• Deficit Reduction Act of 2005 DRA
• CMS Letter to State Medicaid Directors
• CMS Guidance

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MEDICAID ELIGIBILITY RULESPA Act 42, PA Act 43
DRA

• Citizenship documentation
• Look-back period
• Transfer penalty commencement date
• Real Estate
• Notes Loans
• Hardship
• Filial Responsibility (Act 43)
• Special Needs Trusts (Act 42)

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MEDICAID ELIGIBILITY RULES ANNUITY CHANGES
UNDER ACT 42

• Annuities
• Act 42 -Safe Harbor annuity
• Irrevocable guaranteed annuity
• Actuarially sound
• Equal monthly installments
• Names DPW as residuary beneficiary of funds
  remaining due at annuitants death-up to amount
  of funds DPW has paid to time of death
• Issued by insurance company licensed/approved in
  PA
• Purchased after 10/1/05
• Act 42, Section 441.6 Upon approval of the
  federal Government of any required State plan
  amendment

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MEDICAID ELIGIBILITY RULES ANNUITIES UNDER ACT
42, CONTINUED

• Annuities
• Act 42 -CS MMNA Annuity
• Irrevocable guaranteed annuity
• Actuarially sound
• Equal monthly installments
• Names DPW as residuary beneficiary of funds
  remaining due during term certain at CS death up
  to amount DPW has paid for IS through CS death
• Issued by insurance company licensed/approved in
  PA
• Purchased after 10/1/05

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MEDICAID ELIGIBILITY RULES ANNUITIES UNDER ACT
42 AND DRA of 2005 INCOME FIRST UNDER DRA OF 2005

• Annuities
• DRA of 2005
• Irrevocable non-assignable annuity
• Actuarially sound
• Equal monthly installments
• Names DPW as 1st remainder beneficiary of funds
  remaining due for amount DPW has paid for
  annuitant through annuitants date of death or as
  2nd remainder beneficiary after CS or minor or
  disabled child
• Purchased (or transaction) after 2/8/06
• PA Interpretation of new DRA rules

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MEDICAID LTCI

• EXPANSION OF STATE LONG-TERM CARE PARTNERSHIP
  PROGRAMS

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MEDICAID PLANNINGThe debate

• SHOULD THE MIDDLE CLASS BENEFIT FROM MEDICAID FOR
  THE PAYMENT OF LONG-TERM CARE EXPENSES?