Elder Attorney or Medicaid Specialist to Secure Long-Term Nursing Eligibility?

As part of the transition of our patients from short term to long term care, the families will typically apply for Medicaid on behalf of the resident (acting as their proxy) in order to secure a long-term payor source for 24 hour skilled nursing care.

Inevitably, Medicare is synonymous with short term rehab only.

Traditional Medicare is finite and only allocates up to 100 days of in-patient skilled rehab and based upon specific conditions and criteria.

However, Medicaid is the go-to long term payor source for all residents living in a nursing home, because they cover (long term) custodial care.

In securing Medicaid there are financial and clinical criteria to determine eligibility which sometimes requires a private pay ‘spend-down’ period. Thereafter, the patient must be considered ‘Medicaid Pending,’ which is the period during which the Medicaid application has been successfully submitted to the State, but not yet fully executed by the State.

In successfully submitting the application and in order for the application to be considered ‘pending,’ it must be correctly done and without any anticipated difficulties and/or penalties which would preclude the applicant from qualifying once the state takes a close look at the documents.

To this end, families will often require help from a specialist who is versed in the minutiae and tedious nuances of various State mandates and ‘look backs’ and information gathering etc.

There are two types of facilitators in the field of Medicaid applications; there are Elder Attorneys and Medicaid Specialists and families have the ability to choose one over the other.

What is the difference between the two?

Let us first understand the definition of Elder Law and what it encompasses.

What is Elder Law?

The practice of Elder Law is a specialty practice that encompasses a broad understanding of aging and the law, and the interaction between the varied issues which may affect the elderly.

Elder Law addresses a multitude of needs and issues, including:

  • Guardianships
  • Durable Powers of Attorney
  • Health Care Surrogate Designations
  • Planning for Long Term Care and Medicaid
  • Residential Alternatives
  • Special Needs Trusts for Disabled Individuals
  • Trusts – Revocable and Irrevocable
  • Preventing and Correcting Abuse, Exploitation or Neglect of an Elderly Person

What is a “Medicaid Specialist?”

Conversely, a Medicaid Specialist is usually a firm that specializes in the emerging niche market of facilitating Medicaid eligibility for elderly people by coordinating the entire effort to procure the appropriate and requisite documentation which the State requires and actually applying for Medicaid on behalf of the resident.

The Medicaid specialist is typically not an elder attorney and will therefore not specialize in (or otherwise pursue) estates, trusts and other such matters concerning the elderly.

Instead, they focus exclusively on applying for Medicaid on behalf of their clients and on following up with the often time consuming process of seeing the application through to its successful conclusion.

Who to use?

There are benefits inherent in using or preferring each of these two different business models and much of it will be subjective and personal.

I will enumerate and highlight but a few of the differences for your considerations:

  1. Elder Lawyers offer a robust array of services including Medicaid applications, in the event that you wish to use one vendor for all of your senior planning.
  2. Medicaid specialists are often more competitively priced than attorneys and will also offer varied payment options and packages, including a flat fee per application and an hourly fee for consultation and implementation. Therefore, depending on the severity of the case, folks will do better financially by choosing one over the other.

In all instances, however, it is vital that you conduct proper research and do your due diligence before making an important decision of this magnitude.


Good luck!

Regency Nursing Centers NJ Leads The Way During COVID-19

Dear Friends,

With the Regency vaccinations now (successfully) in the rearview mirror (we were in fact, from the first skilled nursing organizations in the state of NJ to vaccinate our residents) it is tough to believe that we are finally starting to turn the corner with the pandemic – and we are so very grateful!

From the very beginning of the pandemic, Regency was at the forefront of the effort to keep our residents safe. Our heroic caregivers stepped up to the plate in a big way to heal our patients amidst this global crisis.

We succeeded.

And we were recognized.

Our Founder and President, David Gross, demonstrated tremendous leadership with his constant email outreach and updates to keep our families informed and empowered.

The grateful letters we received were well received and resonate even 1 year later.

I’d like to remind you of this positively stunning letter we received last year on June 23, 2020.

I actually have it bookmarked because it is a source of constant inspiration for me and for my colleagues.


What inspires you?

Have a great weekend!


Be Sure To Discuss The Crucial Health Issue At Your Annual Exam

Whether you’re 20 or 80, healthy or sick, there is an important conversation you need to have with your doctor at your next annual exam.

It’s not a conversation about your current health concerns, but about your future ones.

It’s a conversation about Advance Care.

Advance Care Planning involves thinking about the types of medical decisions you will want made for you if you are in a situation where you cannot state them yourself.

Sound like a depressing topic? It doesn’t have to be. This is a time for you to think about and communicate your personal values and desires regarding end-of-life care.

If you’re receiving Medicare benefits, this conversation is even covered. Medicare will pay Advance Care Planning at your Welcome to Medicare Exam and at each Annual Wellness Visit.

The Advance Directive

The specific decisions you make are written into a legal document called an advance directive.

Some of the decisions in an advance directive could include whether you want to be put on a ventilator if you cannot breathe on your own, and whether you want CPR if your heart stops.

Bear in mind that these decisions are not set in stone. You can change them at any time, if your situation, your health, or your feelings change.

The Healthcare Proxy

You may have difficulty considering what you would want at some unknown future point, especially if you are currently in good health. For these reasons, it is best to designate a healthcare proxy, someone who you can trust to make medical decisions for you.

Your healthcare proxy might be a relative, but it doesn’t have to be. You might feel that a close friend or someone in your spiritual community might have a better sense of your values — and might have a clearer head in an emergency.

Both the advance directive and healthcare proxy form are legal documents, but in New Jersey they do not need to be notarized or completed by a lawyer. You can find these forms, as well as more information about advance directives and healthcare proxies in New Jersey by clicking here.

If you have Medicare coverage, the best time to have these discussions with your doctor is at the Welcome to Medicare visit or at your Annual Wellness Visit, when Medicare will cover the entire cost. But if you have missed that opportunity this year, don’t let that stop you. Medicare will still cover Advance Care Planning through Medicare Part B.

Exciting New Focus at Regency Nursing Centers!

We are excited to report on a new focus to publish our timely and important healthcare articles on our Regency Corporate Website Blog!

Of course, we will still continue to cover the hot button healthcare topics and updates on this blog as well, but we wish to invite all our readers here, to bookmark our corporate blog and stay abreast of the many additional articles we will be posting there.

Click on the photo below (or on THIS LINK) to read a new article just published today on our Corporate Blog, and see why Regency Nursing continues to set the standard of care for the entire Skilled Nursing industry!


Long-Term Care Hospitals: Wonderful or Waste?

Among the alphabet soup of medical abbreviations, you may have heard of an LTACH and wondered what that was.

Long-term acute care hospitals (LTACH), also known as Long-term Care Hospitals (LTCH) are hospitals specializing in patients who require extended hospitalization. The legal definition of an LTACH is “a hospital that has an average inpatient length of stay of greater than 25 days.”

Patients commonly stay at an LTACH for care when they’re on a ventilator long-term, or when they’re battling more than one condition. Patients with very complicated illnesses that require extended hospital stays are also referred to LTACHs. Very often, their families are told they can get much better care at an LTACH than at a short-term hospital or long-term skilled nursing facility.

But is that really true?

There isn’t a lot of evidence supporting better outcomes for LTACHs. In fact, new research suggests the opposite.

The study, authored by a team from Standford, MIT, and University of Chicago respectively, found that “substitution to LTCHs leaves patients unaffected or worse off on all measurable dimensions.” The study also suggested that Medicare could save 4.6 billion dollars a year by reimbursing long-term hospitals at the same levels as skilled nursing facilities.

In fact, their data showed that LTACHs didn’t produce statistically significant declines in patient mortality over a 90-day period, nor did they improve the odds that a resident would eventually return home.

Most of the services offered at a long-term acute care hospital can also be received at a skilled nursing facility like Regency Nursing and Rehabilitation. At Regency, we offer all skilled nursing services, including IV and oxygen therapy.

Some individuals, such as some ventilator-dependent patients, may require extended acute care. But according to this study, most patients—and Medicare—may be better off with skilled nursing.

New Jersey Residents Receiving New Medicare Cards this Month

Hey, New Jersey Medicare beneficiaries. As we mentioned in a previous post, you should soon be receiving your new Medicare cards if you haven’t already.

Here are some things you should know:

Your new card contains a new, eleven-character Medicare Beneficiary Identifier, consisting of both numbers and letters. The new identifier is completely random and is not associated with your social security number.

Besides for an update to the overall design, only your identifier number is changing. Your coverage and benefits, and social security number remain the same.

Beware of scammers asking for money or bank information over the phone. The new cards are free, and Medicare will NEVER call you and ask for your personal information without you asking them to call. If you receive a call from “Medicare” asking for your information or money, or threatening to cancel your healthcare benefits, hang up and call Medicare at 1-800-633-4227.

Your new card will arrive in the regular mail. You can check with Social Security by calling 1-800-772-1213 to make sure your mailing address is up to date. You can also visit your online account at ssa.gov/myaccount. Don’t worry if your neighbor receives their card before you do. Yours is on the way.

Your new card can be used as soon as you receive it. Make sure to destroy your old red, white, and blue Medicare card. Keep any Medigap, Part D, Medicare Advantage or retiree health plan cards—those did not change.

Starting January 1, 2020, only the new card and new identifier can be used. If you forget to bring your card with you, your health care providers can look up the number for you.

Medicare began mailing the cards at the beginning of the month, and they say it can take over a month to mail replacement cards to every beneficiary in the state. If you still haven’t received your new card by September 15, call Medicare’s office at 1-800-633-4227.

Caregiving Children: Don’t Neglect Your Own Long-Term Care

Dear Adult Children of Regency Nursing Residents,

First of all, we want to tell you we think you’re incredible. You come to visit as often as you can, you make sure your parent receives the care and compassion he or she deserves, and you handle any issue that comes up with composure and devotion.

You chose Regency Nursing because you love your parent and wanted the best for them. We’re deeply honored that your loved one is here with us.

But today, let’s talk about you and your future.

You know only too well how expensive aging can be. Your income is fixed, your health is declining, and the medical costs keep piling up. There are co-payments for drugs, hospital stays, doctor’s visits, and procedures. Not everyone can get on Medicaid, and if you need skilled nursing care, well, let’s hope you have a 3-day qualifying hospital stay so Medicare will cover it.

And of course, you know that custodial care—that is, non-skilled long-term nursing care—isn’t covered by Medicare at all. Nursing home stays in New Jersey average $100,000 a year. Will you be able to shoulder these costs in your retirement?

Dear friend, you may be perfectly healthy and feel a world away from facing these financial challenges. But the time to plan is now. Experts say it’s never too early to start planning for long-term care, and starting in your 50s, or even 60s, isn’t too late.

Here are two ways to fund your own long-term care that you might want to explore:

Long-Term Care Insurance

Traditional Long-Term Care (LTC) Insurance  is a separate insurance policy that covers home, hospice, nursing home, and assisted living care. You may also be able to add an LTC rider to a new or existing life insurance plan.

Self-Fund Your Long-Term Care

You can prepare for your LTC needs using a reverse mortgage, annuity, or trust. If you’re young enough, you can also start saving now using a high-interest account or stock portfolio.

We urge you to sit down with your financial planner to explore your options as soon as possible. You know the costs—both financial and emotional—of long-term health problems. You know these challenges are almost always an inevitable part of aging. Why wait?

For more information, check out this page from the Administration on Aging: LongTermCare.gov Costs & How to Pay

Thank you for partnering with us in caring for your loved one, and we wish you a wonderful weekend!

Regency Nursing


Medicare Advantage Plans Closer to Covering Long-Term Care

The Centers for Medicare & Medicaid Services announced in May that Medicare Advantage plans can expand their coverage of supplemental benefits. Starting in 2019, Medicare Advantage plans will be able to offer coverage of services like respite care, non-hospice palliative care or home safety modifications. Industry experts are saying this can move Medicare Advantage closer to covering long-term residential care one day.

A major downside of Medicare as it’s currently formulated is that it doesn’t cover custodial long-term care. That means if a senior doesn’t need specific skilled nursing care, but can no longer live on their own, they either need to pay for the facility out of pocket, or exhaust all their assets to go on Medicaid. Paying for long-term care is a huge financial burden on many seniors who aren’t eligible for Medicaid. The new rules will allow Medicare Advantage plans to cover in-home support services, like help with activities of daily living. Such coverage may one day lead to coverage of non-skilled nursing facility stays.

How Big is This Change Exactly?

While the changes will probably be modest in the beginning, the paradigm shift is huge. Until now, Medicare Advantage plans mainly covered whatever Original Medicare covered, with some additions like dental or vision coverage. Now, in an attempt to save more in preventable medical expenses in the long run, they will have an expanded definition of “health-related” services. The new guidelines, according to CMS, will “consider an item or service as primarily health related if it is used to diagnose, compensate for physical impairments, acts to ameliorate the functional/psychological impact of injuries or health conditions, or reduces avoidable emergency and health care utilization.”

This opens the door for long-term care services to gain coverage under CMS. In the beginning it may cover home-health services, and then it may eventually expand to cover some nursing home expenses.

Of course, these services will be subject to restrictions and requirements for coverage. Your doctor or other healthcare provider would have to recommend the service, and there will likely be copious paperwork. It’s also likely that the Medicare Advantage plans will decide eligibility for specific services based on the member’s medical needs and history. Either way, the program expansion is great news for Medicare Advantage members, and will probably increase the private plans’ share of the Medicare market.

Here are some services you can expect to see covered next year:


Funding your Skilled Nursing Facility Stay

We’ve spent all week celebrating skilled nursing care and paying tribute to our amazing staff, residents and families. The American Health Care Association, who established this special week back in 1967, says NSNCW provides an opportunity to recognize the role of skilled nursing care centers in caring for America’s seniors and individuals with disabilities.

And it’s an important role. Approximately 15 percent of the US population is over age 65, and a large portion of them will need skilled nursing care in the next five years. One of the first things seniors and their families ask when they find out they need skilled nursing care is, “How will I pay for this?” Nursing home care can cost a pretty penny; the average price in New Jersey hovers around $100,000 a year. So what’s a middle-to-lower class senior supposed to do when they need the specialized care only a skilled nursing facility can offer?

Financial experts recommend you start planning your long-term care in your 50s or earlier. This can include opening a savings plan to self-fund your care, taking out a long-term care insurance plan, or some combination of the two. But even if you or your parents haven’t planned for long-term care, you still have options.

Who Funds Long-Term Care?

Many people assume Medicare will cover their long-term care needs. In truth, Medicare only covers the first 100 days of nursing care, and then only when certain conditions are met. Think of Medicare as the option for short-term nursing care. If, for instance, your parent needs a few months of rehab after a nasty fall, Medicare will cover their inpatient rehab and skilled nursing care. The general expectation is that your parent will recover and be able to move back home after a short time.

In long-term situations, the patient must either pay privately or get onto Medicaid to cover their care. Medicaid is state-run health insurance for the needy. However, many middle-class seniors find that joining Medicaid is the best option for funding their nursing home stay. To qualify for Medicaid, you generally have to exhaust all your assets. There are many legal ways to lower your net worth to the point where you can be eligible for Medicaid. Some of those options include an income spend-down or creating a trust.

Here are some articles about Medicaid and the application process, written by Regency’s own Judah Gutwein, L.N.H.A.:

Let Me Educate you on Medicaid Eligibility, on njnursing.com

Medicaid Medically Needy Program, on wellness.com

Applying for Medicaid, on senioradvisor.com

Medicaid Specialist vs Elder Law Attorney, on senioradvisor.com

Medicaid Personal Needs Allowance, on njnursing.com

And of course, feel free to contact us directly at Regency Nursing  if you have any questions about applying for Medicaid.