Posts Tagged ‘NAELA Institute’

1995 ALTCS Figures


As anyone working with the elderly knows, the Arizona Long Term Care System (ALTCS) is a welter of acronyms and dollar figures. Many of those figures change each year with the cost of living; most are indexed to the Social Security increases. New numbers for 1995 are now available; the new numbers (and the significance of each) include:

Income Cap–$1374. This is the maximum monthly income an individual may earn and still qualify for ALTCS. For married couples, the maximum community income will be $2748. The single-person income level is up from $1338.

MaxMMNA–$1,870.50. This is the maximum monthly maintenance needs allowance which a community spouse may be allowed to retain from a combination of her own income and that of her institutionalized spouse.

CSRA–$14,964 to $74,820. When a spouse is institutionalized, the community spouse is permitted to retain half the available community assets. There is, however, both a maximum and minimum amount which may be retained. These new limits (changed from $14,532 and $72,660, respectively, for 1994) mean that a couple with less than $16,964 of total assets will be immediately eligible, and that a couple with more than $149,640 in total assets will be required to spend down to the $76,820 level (both total community figures include the $2,000 which the institutionalized spouse is permitted to retain).

Average Cost of Care–$2509.50 (Pima, Maricopa and Pinal Counties). The significance of this number is in calculating the penalty period for gifts made by the applicant prior to ALTCS application. The period of ineligibility is the number of months determined by dividing the total gift by the “Average Cost of Care” figure (based on the logic that the applicant could have purchased that many months of nursing home service with the money if it had not been given away). The Average Cost of Care for 1994 had been $2406.30 in Maricopa and Pima Counties. The 1995 figure for counties outside the urban center of the state will be $2426.40.

Thank goodness this all makes sense and is simple to understand. Think of how difficult it would be if applicants had to hire lawyers to figure out if they were able to afford long-term care.

New Orleans Gem

One idea that emerged from the recent National Academy of Elder Law Attorneys Institute in New Orleans: The federal government is adamant that gifts by the community spouse after eligibility do not affect eligibility. Arizona takes a different view, so using the federal approach may be dangerous, but it does open up a whole area for planning.

All That Jazz


Last weekend we spent an entertaining and productive four days in New Orleans. We made the trip to attend the National Academy of Elder Law Attorneys’ annual Institute, an intensive series of continuing education programs. Participants represented 37 states and the District of Columbia, and presentations ranged from Medicaid policy developments to issues of capacity and undue influence among the elderly.

In addition to the excellent seminar presentations, of course, there was wonderful food at Antoine’s and other New Orleans eateries, and the night life was exceptional. The principal reason for the trip, however, was continuing education, and the information was timely and relevant.

Sally K. Richardson, Director of the Health Care Financing Administration Medicaid Bureau, spoke to those in attendance. She signalled a new spirit of cooperation from the federal bureaucracy, raising hopes for more simple and understandable Medicaid/ALTCS regulations sometime in the future.

Denver attorney Jim Hill put on an entertaining and informative demonstration of a will contest case. It was interesting, but not surprising, to hear about family disputes over probate estates in other states.

Considerable discussion centered on the use of “Miller” trusts for nursing home residents with too much income to qualify for ALTCS. Fewer than half of the states have rules excluding patients with too much income, but the problems in those states are dramatic, and Arizonans took some perhaps perverse comfort from the shared difficulties. Several participants pointed out the absurdity of denying eligibility for excess income, but only until the applicant has paid an attorney to prepare an income trust; the effect is to take money from health care and send it to lawyers.

Sunday morning, Institute attendees awoke to a front-page spread in the New Orleans Times-Picayune on the devastation caused by Alzheimer’s Disease. The articles, the first in a multi-day series, effectively highlighted the change in public perceptions of Alzheimer’s generated by former President Ronald Reagan’s recent announcement that he has been diagnosed as suffering from dementia. The articles reinforced both the national prevalence of the problem and the need for financial and medical planning.

We picked up many tips for dealing with ALTCS, guardianship and conservatorship, and estate planning issues. Next week we will share a few.

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