Money Tips Online

24 September, 2013

I suspect you’ve probably had a family friend or loved one who has spent time in a nursing home.  It’s one of the most difficult things a family can experience yet, ultimately, comforting to know your loved one is cared for and safe.  Just over one-third of seniors in nursing homes today have their bill paid by Medicaid, the federal/state safety net program, because they have exhausted their own financial resources.  That’s an annual tab of $124billion, according to a New York Times article last September.

Long term care planning is always on my discussion checklist once clients hit the big 5-0.

In the past, at least in Massachusetts, if one spouse was in a nursing home and MassHealth (Medicaid) was covering most of the cost, the at-home spouse would not be liable for any of the bill when the infirmed spouse died.  But there was a Superior Court decision about a month ago that appears to have opened the door to liability for surviving spouses.  It’s based on the “Doctrine of Necessaries” and appeared in Attorney Harry Margolis’s blog,www.Margolis.com.   

On April 24, 2010, Milfranciu Jode entered the Emerson Village Nursing Home in Watertown, MA.  During his stay, until his death in March of 2012, Emerson Village received no money for Mr. Jode’s care.  His wife had applied for MassHealth, but hadn’t provided sufficient documentation, so her application was rejected three times.  The nursing home sued Mrs. Jode using the legal concept of Doctrine of Necessaries.  Emerson Village’s attorneys argued that since Mr. Jode wasn’t on MassHealth, his wife had to pay the bill.  Frankly, it’s a logical argument.  If you don’t qualify for MassHealth, then you’re a private-pay patient.

In ruling for the nursing home, the Court wasn’t clear about what constituted necessaries or their value.  But I think it becomes exceedingly clear that if MassHealth (Medicaid) is the only recourse for getting care for a loved one, you’d best be sure you’ve got the MassHealth coverage in place.   If you want the state to pick up the tab, you must provide all of the information they request.  That’s not unreasonable.  Maybe Mrs. Jode was going it alone…overwhelmed with all the paperwork, although I doubt it.  She must have had some help and would have been pretty impoverished for MassHealth to have been considered in the first place.

Proper planning can make these kinds of difficult decisions much easier to make should they ever present themselves.   Don’t assume that no one in your family will ever need long term care.  Start thinking about this now.  Until next time, here’s to good planning!


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