Posts Tagged ‘National Academy of Elder Law Attorneys’

The Affordable Care Act and People with Disabilities


The Affordable Care Act is upon us, or almost so. October 1, 2013, is usually listed as a key date for the ACA, and it is — but nothing actually changes on that date. Quite a few changes have become effective already. The changes receiving the most media attention — the availability of health care exchanges and individual insurance policies, and the related requirement that almost everyone get some sort of health insurance coverage — begin to kick in on January 1, 2014.

October 1 is important, though. That’s when the health exchanges are supposed to be available, even though customers won’t be able to secure policies for another few months after that date. That’s when we should have at least a partial answer to some of our questions, like how much ACA insurance will cost. Many, many other questions will still remain unanswered.

One question that we at Fleming & Curti think should be asked more often: what effect will the Affordable Care Act have on care of people with disabilities? Maybe the reason the question isn’t asked more often is that the answer is (as we look into our Magic 8-Ball): “Reply hazy – try again”.

There have been a few articles written about the relationship between the Affordable Care Act and patients with disabilities. The Obama Administration has a few suggestions about the benefits of the ACA for this population. The Special Needs Alliance (we love the SNA, and we are members) has written about the ACA, and individual SNA members have described the effect of the Supreme Court decision upholding the ACA, the ACA’s impact on people with special needs, and how the new health care exchanges may affect care for those with disabilities (among other topics). The National Academy of Elder Law Attorneys has provided a fair amount of information, too.

But what does it really mean? We can provide some highlights:

  • The ACA means the end of pre-existing conditions limitations. This might be a huge item. People with special needs have largely been frozen out of the health insurance market because they haven’t been able to get coverage. That should now change. People with cerebral palsy, mental illness, physical disabilities — all should be able to qualify for insurance. Coverage might be limited, or expensive, or both — but it should be available. That, of course, only works if almost everyone is insured — we will have to see how that plays out over the next few months.
  • Most patients with disabilities, frankly, will be unaffected. Most already qualify for Medicare or Medicaid — or both. They will not, in most cases, be moving to private insurance (though some undoubtedly will).
  • Family members, including caretaker family members, may suddenly qualify for health care coverage. That just might prove to be a surprisingly strong benefit for patients with disabilities.
  • Some beneficiaries of special needs trusts may be in a position to leave Medicaid plans in favor of private insurance. Some special needs trusts might even be modified to provide better benefits for the beneficiary (since continued eligibility for Medicaid might not be as important). This, of course, will depend on the size of an individual special needs trust, and the cost of insurance. But a significant number of patients may move from the public health system to private insurance coverage.

It is early still, but the ACA might be a real game-changer. We’ll keep monitoring policies as they roll out, and as the industry adapts to change.




Alive and Kicking: New Book Offers Legal Advice to Boomers

APRIL 16, 2007  VOLUME 14, NUMBER 42

Ironies abound as the leading edge of the “Baby Boom” generation heads into its 60s (and retirement). The generation that vowed never to trust anyone over 30 will shortly have to figure out minimum distribution rules from Individual Retirement Accounts, Medicare’s Part D coverage and its limitations, and how to deal with the physical declines and personal losses that accompany aging. A new book released this month may help them navigate some of the currents and shoals.

Authors Kenney Hegland (professor of law at the University of Arizona) and Robert Fleming (elder law attorney with the Tucson firm of Fleming & Curti, PLC, editor of Elder Law Issues and webmaster for have announced the release of Alive and Kicking: Legal Advice for Boomers. The new book is available online at Amazon.comBarnes & Noble and by special order from bookstores everywhere.

“We were going to call the book Geezer’s Law, but cooler heads prevailed,” write the authors. The book is infused with humor, filled with sly cultural references, and fun to read. Dr. Andrew Weil, author of Healthy Aging, calls it “an engaging, even uplifting, book about a subject most of us who are getting on in life often avoid: arranging our affairs for our latter years to avoid medical, financial, and legal troubles. I will use it myself and recommend it to patients, friends, and loved ones.”

Topics covered include advice on health care, estate planning, divorce, remarriage, starting a business, living wills, nursing homes and more. You can read about how to protect yourself from scams, age discrimination and elder abuse. You can gain insight into the important questions that accompany the condition of aging: What can you do to make your own children treat you better than you did your parents? Will you have to give up both driving and sex?

“If you are getting older (or hope to),” write the authors, “you’ve picked up the right book.” Hegland and Fleming believe that the condition of geezerhood should not be accompanied by a loss of intellectual interest. Instead, “we’ll come and go, talking of Michelangelo, telling bad jokes, and reciting wonderful poetry: spoonfuls of spice with your maturity medicine.”

“Studies tell us that learning new things is good exercise and Alive and Kicking is one heck of a workout,” writes Joy Loverde, author of The Complete Eldercare PlannerBaird Brown, pioneering elder law attorney, describes Alive and Kicking as “a must read for anyone who wants to understand many of life’s imponderable questions,” and Professor Rebecca Morgan, former President of the National Academy of Elder Law Attorneys, calls it “a truly valuable resource for everyone needing to learn more about the issues that they, or their parents, will face”

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.

Choosing a Caregiver

MAY 30, 1994 VOLUME 1, NUMBER 27

By Joan Ardern, Community Liaison, Care Coordinators, Inc.

(Second of three parts)

There are advantages to hiring a home health agency rather than hiring someone privately. Agencies are on-call twenty-four hours a day. A progressive agency will have updated training programs for their caregivers. Another advantage of an agency is that it has the ability to provide a substitute in case of an emergency. The agency also assumes responsibility for payroll, worker’s compensation insurance, and related paperwork.

A major pitfall with either hiring privately or through an agency is the potential for a well-intentioned caregiver to assume more responsibility than intended. Clients may find themselves by-passed on major decisions concerning their care. A good agency will monitor the care being provided and ensure that the caregiver adheres strictly to the assigned responsibilities.

Another way to find a caregiver is to use a new type of service that emerged in the late 1980s–the private case management company. The case management company can provide an assessment and evaluation of client needs, financial management, hiring and monitoring of caregivers, and (in some cases) protective services such as guardianship and conservatorship. The case management company can be an effective choice for the family who does not want to deal directly with the process of hiring the caregiver. A private case manager will first assess the needs of the client and then coordinate appropriate services from professionals for the individual’s care. Essentially, you will be paying the case manager to conduct the research to find the proper caregiver and to monitor the caregiver. The cost of the caregiver should remain the same whether provided through a home health agency or a case management company.

About this Series

Joan Ardern, Community Liaison for Care Coordinators, Inc. has written this three-part series on “Choosing a Caregiver.” The first installment appeared in last week’s Elder Law Issues, and the final segment will be printed next week.

Lawyer Sentenced

Phoenix lawyer David Mason was sentenced to seven years in prison last week on fraud and theft charges. Mason was also ordered to pay almost $400,000 in restitution to several clients and estates he had administered.

Mason plead guilty to the charges last month. He admitted using his Sun City law office to gain control of clients’ estates and then misappropriate funds.

Mason has been suspended by the State Bar of Arizona since 1992. His conviction and sentence will result in automatic disbarment. Mason had previously served as a circuit judge in Aledo, Illinois, before moving to Sun City.

A Jolly Good Fellow

Elder Law Issues’ Editor, Publisher and Author Robert B. Fleming has been named as a Fellow of the National Academy of Elder Law Attorneys. The Academy, at its annual Symposium in Seattle last week, named Fleming and five other elder law attorneys as Fellows in recognition of their contributions to their respective communities and the practice of elder law generally. The other new Fellows hail from Florida, California, Ohio and Georgia. They join the fifteen national elder law leaders already selected for Fellowship in previous years.

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