The AFA’s Educating America tour is a nation-wide educational initiative connecting communities with information about Alzheimer’s disease, brain health, caregiving, and more. Participants had the opportunity to hear from experts on Alzheimer’s research, caregiving, elder law, and advance planning.
Mark’s presentation was titled, Why a Will is Not Enough, and included a range of topics from lifetime planning and financial decision making, to long-term care and medicaid planning.
Update! Mark’s presentation has been made available and is embedded below:
Comments Off on Presentation Slides for Providence Retired Teachers Association
On October 24th, I was pleased to present to a meeting of the Providence Retired Teachers Association (PRTA), a program entitled Estate and Medicaid Planning. As promised, posted below are the slides from the presentation.
This presentation was the sixth time—the first being in 2003–that I have been privileged to present to the PRTA. As a proud and grateful graduate of the Warwick public schools, I am glad make whatever contribution I can to retired public school teachers.
It was great to see many familiar faces, as well to meet new members. One member missed by all, of course, was the PRTA’s long-time former President, Anthony Mancini. I was pleased hear of the efforts to develop a scholarship fund in Anthony’s name. When asked to what organization I would like a contribution in my name to made by the PRTA, the answer was easy—the Anthony Mancini Scholarship Fund! Once the requisite documentation from the IRS is received by the PRTA, I and many others look forward to making direct contributions in honor of a man who did so much for the PRTA.
If you have specific questions, or wish to consult with me about your individual circumstances, please contact me. Again, it was a pleasure to be with you again.
Comments Off on “Navigating Mom’s Final Years” Recap: Tools for Supporting Aging Loved Ones
I was delighted and privileged to serve as a panelist on a seminar sponsored by The Catholic Foundation of Rhode Island on October 4th entitled Navigating Mom’s Final Years.
Expertly organized by Andrea Krupp, Esq. of the Catholic Foundation, the fact pattern presented was honed by my fellow panelist Betsey Purinton, CFP of StrategicPoint. The scenarios developed by Betsey enabled us and our fellow panelist, The Reverend Monsignor John Darcy, to outline the circumstances commonly experienced by aging baby-boomers, elders and their family.
Betsy’s fact patterns, highlighted by the deft skills of our moderator, Nicholas Denice of Hinckley Allen, were an excellent starting point for us panelists to discuss the financial, legal and spiritual issues confronting aging people and their families in these increasingly common situations.
As promised, I am including two links referred in my presentation. The first, Why Am l Left in the Waiting Room? Understanding the 4 C’s of Elder Law Ethics, is a brochure which I assign to the students in my Elder Law class at Roger Williams University Law School. As Betsey pointed out in her presentation, it is important for both legal and financial professionals to focus on who the client is.
The second is a link to the Center for Medicare Advocacy’s FAQ guide on the Medicare “Improvement Standard”. It dispels the persistent myth that a long-term nursing home resident needs to be “improving” in order to continue receiving the skilled nursing home benefit available under Part A of Medicare. This link contains advocacy tools for family members seeking to maximize the Medicare benefits of a loved one in a nursing home.
Thanks to the Foundation, sponsors (listed below), fellow panelists and attendees for an excellent learning experience.
Comments Off on Attorney Heffner Testifies Before House Finance Committee on Governor’s Medicaid Budget
On March 15th, I testified before the Finance Committee of Rhode Island House of Representative on the Governor’s proposed 2018-2019 budget. I specifically wished to alert the members of the Finance Committee to provisions contained in Articles 13 and 14 of the proposed which would enable the Rhode Island Office of Health and Human Services (OHHS) to promulgate regulations directly affecting eligibility for long-term care Medicaid benefits.
As I reminded the members, the General Assembly when it enacted the “Global Waiver” in 2009, specifically retained for itself through the legislative process the ability to change rules affecting eligibility. This was wise. For however imperfect the legislative process may be, it light-years more transparent to the people of Rhode Island than the “rule making process” of OHHS or any other state agency.
The House Finance Committee hearing that evening was a perfect example of the contrast between the two processes. Chairman Abney began the hearing by welcoming the many members of the public who had come to testify. He and other members of the Committee listened patiently and respectfully to all testimony, with members occasionally raising questions of the witnesses to gain further insight.
Having the privilege of serving as member of the House of Representatives for ten years, I am familiar with this process. Based on the testimony that evening-which lasted for nearly two hours—members of the Committee will reflect on what they heard, consult with the exceptionally able and professional staff of the Finance Committee regarding details of the budget articles, and confer with their colleagues. Most importantly, the members will able to continue to hear directly from the people they are privileged to represent regarding how any proposed changes in eligibility would affect them.
If instead the General Assembly gives up this prerogative to OHHS, the process will be dramatically different. There will be a public announcement by OHHS of the proposed promulgation of new eligibility rules. “Interested parties”—including members of the public will be able to come to a hearing and submit written or oral testimony to whomever at OHHS is given authority to make this eligibility changes.
However, unlike the potential for interaction with members of the Finance Committee, there will be no response from the OHHS officials presiding at such a “hearing”. And in contrast to the legislative process, that will be the first and last time members of the public will have an opportunity to have any input. Plus, there will be no way to ascertain whether that public input made any difference in the making of the rule. Rather, the end result will be pronouncement of a rule by an unelected “policy” bureaucrat at OHHS.
The General Assembly wisely retained the responsibility for making rules regarding Medicaid eligibility. OHHS is still trying to dig out from the damage done by this Administration’s “original sin” in September, 2016 of rolling out an new computer system to process Medicaid eligibility while simultaneously terminating experienced and dedicated caseworkers and supervisors with collectively hundreds of man and woman hours of actually helping applicants. Yet this Administration in Articles 13 and 14 of its proposed budget somehow thinks it a good idea to add to an already burdened OHHS more responsibility.
I was grateful for the opportunity in my testimony to provide this context to the members of the Committee. And I am confident that they will not throw away the prerogative retained by a previous General Assembly to make rules regarding the Medicaid eligibility on which many of their constituents depend.
Comments Off on Elder Care Law Presentation Slides for Wellness at Brown
Many thanks to Wellness at Brown for hosting Friday’s program on Elder Care Law. It was an excellent turnout with many astute questions from participants.
As promised, attached are the slides which I presented. In the continuing Q&A after the program, I indicated I would post a link to a blog post which I had written on the myth of the requirement for “improvement” to obtain or continue benefits under Medicare for skilled nursing home care. If you review this post, I encourage you to link through to my earlier post which explains the basics of the issue.
If you and your family are facing these types of issues now or in the future, please don’t hesitate to reach out to us.
Comments Off on My Latest CLE Now Available as Webinar On Demand
A couple weeks ago I was pleased to speak at a CLE on Current Developments in Medicare and Medicaid for Long-Term Care offered by the Rhode Island Bar Association.
Two seniors members of the Executive Office of Health and Human Services, Jennifer Wood, Esq. and Deborah George, Esq., and I shared an under-used technique to enable clients to obtain extended access to the Medicare Part A skilled nursing home benefit.
We also discussed changes in the structure and procedures at the Rhode Island Offices of Health and Human Services (OHHS) and the Department of Human Services (DHS) and how to assist clients with Medicaid applications.
As reported by the RI Bar Association, the CLE was very well-attended, with the in-person presentation and live webinar each drawing more than 70 participants.
If you missed the live presentation, the On Demand webinar is now available; details are below.
Comments Off on Financial Planning for a Life with MS: Slides from the Rhode Island Spring Education Conference
It was my pleasure and privilege to participate recently as a presenter at the Rhode Island Spring Education Conference of the Greater New England Chapter of the National Multiple Sclerosis Society. My topic was entitled Adapting: Financial Planning for a Life with MS. You can view the slides from my presentation here:
The conference included valuable information for those with MS and their caregivers, including nutrition and MS; preparing for MS doctor visits; managing fatigue and bladder/bowel symptoms related to MS; and moving forward after an MS diagnosis.
Particular thanks and kudos to Meredith Sheehan, Program Manager – Community Programs, and her staff for an excellent program.
For more information on local programming for people living with MS, along with the latest MS research findings, first-person stories, advocacy updates, upcoming events, and fundraisers, you can subscribe to the MSConnection quarterly newsletter.
Comments Off on Upcoming CLE: Current Developments in Medicare and Medicaid for Long-Term Care
Rhode Island attorneys who practice elder law or advise healthcare facilities may be interested to know about an upcoming RI Bar Association CLE seminar on Medicare and Medicaid. I’m pleased to announce that I’ll be speaking at this seminar along with two senior members of the Rhode Island Executive Office of Health and Human Services next month. Here are the details:
*Unable to attend in person? A live webcast takes place at the same time*
Many Americans rely on Medicare and Medicaid, and they are critical in paying for long-term care. As an attorney advising a client or representing a hospital or nursing home facility, it is imperative to keep up with the changing laws.
This program will review an under-utilized technique to enable clients to obtain extended access to the Medicare Part A skilled nursing home benefit. It will also review changes in the structure and procedures at the Rhode Island Offices of Health and Human Services (OHHS) and the Department of Human Services (DHS) and how to assist clients with Medicaid applications.
Don’t miss your chance to expand your proficiency in this unique area of practice and meet with personnel from the Executive Office of Health and Human Services.
Speakers: Deborah A. George, Esq.
Legal Services Administrator
Office of Legal Services
Executive Office of Health and Human Services
Jennifer L. Wood, Esq.
Deputy Secretary/General Counsel
State of Rhode Island
Executive Office of Health and Human Services
Mark B. Heffner, Esq.
Certified Elder Law Attorney*
Heffner & Associates
Comments Off on Estate and Medicaid Planning for Individuals with Alzheimer’s Disease: Slides from a Presentation at the Caregiver’s Journey Conference
Last week, the Rhode Island’s Alzheimer’s Association did another terrific job with its annual Caregiver’s Journey Conference, a day-long conference for Alzheimer’s caregivers and care professionals. I was privileged to present on the topic of “Estate and Medicaid Planning for Individuals with Alzheimer’s Disease”.
I’m posting the slides from my presentation here. Whether or not you attended the program, if you have questions about financial or legal planning for a loved one with dementia or Alzheimer’s, please feel free to contact me.
This post will focus on one of these–Section 6–which seeks to directly affect the limited opportunities for middle-class Rhode Islanders requiring Medicaid long-term care services to preserve some of their assets. The changes in this Section 6are all to Rhode Island General Laws §40-8-15 entitled, “Lien on Deceased Recipient’s Estate for Assistance”.
First, the Governor’s proposal seeks to expand “estate recovery” to assets passing outside the probate estate. Literally twenty years ago, in 1995, the State amended this section of the General Laws to conform with a federal law requiring states to put claims on the probate estates of deceased Medicaid recipients. The federal law, called “OBRA ‘93”, enabled the states to, if they chose, “expand” their estate recovery to non-probate assets.
The large majority of states chose, as Rhode Island did, to limit its estate recovery efforts to probate assets. This was the procedure utilized by the Department of Human Services for the next seventeen years.
In 2012, however, the State sought to expand its estate recovery to include non-probate assets. This would means, for example, that real estate held jointly by a mother in a nursing home on Medicaid with her adult son, which would ordinarily pass without a claim to the adult son, would now be subject to the State’s lien. Due to the dramatically increased efforts which would be required by the Department of Human Services to accomplish this “expansion”, as well as the House Finance Committee’s understandable distaste for adding any additional pain beyond that required by federal law, this proposal was roundly rejected by the House Finance Committee.
Also rejected in 2012 was a proposal by the State to put so-called “lifetime liens” on property of certain Medicaid recipients. Presently, as long as the Medicaid recipient declares an intention to return to his or her home, the home remains an exempt asset. While the home is potentially vulnerable post-death if it passes through probate, there is no impact during the life of the Medicaid recipient (unless the property is sold in which case the Department of Human Services needs to be notified).
In 2012, the House Finance Committee also rejected this effort to impose “lifetime liens”. It did, however, enact two statutes that provided additional protections to the Department of Human Services to prevent properties belonging to current or deceased Medicaid recipients from being sold without the Department’s notice.
Fast forward to May 7, 2015. In Section 6 of “The Reinventing Medicaid Act of 2015”, the current administration “doubles down” on the efforts made in 2012. Apparently unaware of the drubbing these proposals took by the House Finance Committee in 2012, the Raimondo administration has tried them again, adding to them an additional extraordinary provision which would allow the Department to collect interest at the rate of 12% per annum on its claims.
You read that right – 12%. Your CDs are not even getting 1%. The 10-year U.S. Treasury bill is getting slightly more than 2%. But the Governor proposes that the State, unlike any other claimant in a probate estate, receive not only a statutory rate of interest, but a rate equivalent to that which a successful party in civil litigation would enjoy after obtaining a judgment.
But wait – there’s more! Section 6 of “The Reinventing Medicaid Act of 2015” adds an entirely new section which would deal with eligibility for long term care Medicaid, not just estate recoveries. It attempts to graft onto the estate recovery provisions statutes—not regulations as currently exists—regarding asset transfers and eligibility requirements for long-term care Medicaid. And as an added bonus, it is a remarkably poorly written, referring to terms like “annuity”, “penalty period” nowhere defined in the Rhode Island General Laws.
On Tuesday evening, May 19th, I testified (video below) before the House Finance Committee in opposition to Section 6 of the Act. Some of the Committee members were the same Representatives who heard and rejected the previous attempt in 2012.
I am confident that the House Finance Committee and the House the Representatives as a whole will again reject this aggressive and unnecessary attempt by the State to add pain to Rhode Islanders who already have the misfortune of suffering from a chronic illness or condition requiring them to seek long-term care Medicaid benefits.
