Long Term Care & Elder Law
in the New York Area

Medicaid & Long Term Care Planning

Amoruso & Amoruso, LLP advises clients regarding how to obtain public benefits, including Medicaid. The firm utilizes various legal techniques and legal instruments which protect and preserve assets. We help our clients choose the most appropriate long term living arrangements for their particular situation and assist with facility placement if needed.

Our firm develops personalized plans for clients and their families as loved ones age, including the best use and management of personal and financial resources to meet their long term objectives, exploring all home-based care options as a first priority when appropriate and easing transitions in the event a facility placement is required.

Long Term Care Insurance

Amoruso & Amoruso, LLP assists clients in planning for and purchasing long term care insurance, a vital asset preservation tool. Long term care insurance can reduce the financial risk of long term disability and provide financial security for loved ones.

We have established relationships with New York, Connecticut and South Florida's most widely respected insurance agents and companies and are able to pass along this valuable resource to our clients.

Home & Community-Based Medicaid

Many clients are unaware that Medicaid also provides generous long term home care services. Through a variety of programs that are administered by the Department of Social Services, residents may qualify for Medicaid funding even though they remain at home or in an Assisted Living Facility (ALF) and, in many cases, need not enter a skilled nursing facility.

Amoruso & Amoruso, LLP represents the best interests of our clients who most often would prefer to remain at home with assistance or in the more social environment of an ALF. Therefore, we are well-versed in these programs and include them as an integral part of our planning process.

Medicaid Applications

The attorneys at Amoruso & Amoruso, LLP are knowledgeable and experienced in filing and gaining approval for all types of Medicaid applications. Our proven record of success exemplifies the superior service and specialized knowledge we provide to our clients. We maintain excellent working relationships with case workers, perform all follow-up work and keep abreast of agency and statutory modifications and rule-makings.

We are integrally involved in the Elder Law Section of the New York State Bar and the National Academy of Elder Law Attorneys and thus participate in the implementation of new laws like the Deficit Reduction Act of 2005 (DRA). In fact, Michael Amoruso and Howard Krooks are both former Chairs of the Elder Law Section of the New York State Bar Association. We constantly are interpreting the program and policy manuals which contain nuanced information about the application process. Furthermore, we work together with area facilities to achieve superior results for both our clients and the facilities. From the facility, case manager, financial planning, agency and legal professional perspectives, our reputation is unmatched.

Patients' & Residents' Rights

Nursing Home & Assisted Living Facility Residents' Rights

We are strong advocates for our clients who reside in facilities or who are entering a facility for the first time, and their families. We are discrimination watchdogs and pay special attention to the starting points of mistreatment or inferior service. These services include source of payment, resident lifestyle preferences, providing necessary services, limits on use of physical restraints, use of psychoactive medications and feeding tubes, visitors' rights, Admission Agreement prerequisites and arbitration claims.

In addition, we participate in care plans for our clients and their families. Care plans address an individual's particular needs and preferences. Too many families do not have a voice or an advocate at the care plan meeting, creating a potential for dissatisfaction and premature discharge. We fill this vital role for our clients and the value is immeasurable.

Hospital Discharge Planning

Often the most stressful time for a family is learning that their loved one is being discharged from a hospital to a nursing home or the home environment within 24 hours. Facing the shock of discharge before the family feels discharge is appropriate leaves loved ones scrambling to find the most suitable nursing home or home care agency to protect the quality of life of their loved one. At Amoruso & Amoruso, LLP, we have vast experience in preventing a premature discharge and in ensuring the proper coordination of care from the hospital to the nursing home or home setting. Equally important, our amicable relationships with nursing homes and home care agencies eases the stress experienced by the family in this discharge process.

Asset Preservation Planning:

The Deficit Reduction Act of 2005

Asset preservation planning is performed to avoid impoverishment caused by the escalating cost of nursing home and long term care services and to give seniors and persons with disabilities a means to provide a legacy to their families.

A federal law designed to shift more of the burden of nursing home and other long-term care costs onto seniors and people with disabilities has been enacted. President Bush signed the Deficit Reduction Act of 2005 (DRA) on February 6, 2006 and states throughout the country are in the process of implementing the DRA at the state level. New York implemented the DRA for Medicaid Applications filed after August 1, 2006 with a phased in 5 year lookback period retroactive to February 6, 2006. Florida implemented many provisions of the DRA - on November 1, 2007, and the five-year lookback period as of January 1, 2010. Connecticut continues its legislative efforts to implement the DRA.

The DRA's cuts are wide-ranging and affect both old and young. It cuts $39 billion in Federal funding for the poor, the elderly and disabled, students and children.

Seniors will have to cope with provisions that attempt to shift more of the financial burden of nursing home care onto families and nursing facilities. Few seniors have insurance that covers long term care and most nursing home residents rely on Medicaid to cover part of their cost of care. The new law will make it more difficult for these residents to obtain this financial aid.

The most troublesome provision of the new nursing home rules is the treatment of gifts. Under the DRA, a senior who makes a relatively small gift to a family member may be unable to pay if nursing home care is needed three, four or even five years later.

Under prior law, an individual making a gift could be ineligible for Medicaid paid nursing home care for up to three years from the date of making the gift. The DRA changes the start date of the penalty period for transferred assets from the date of the transfer to the date of filing of a Medicaid application. Therefore, the penalty period will not start to run until the individual is receiving institutional level care, which includes residing in a nursing home among other levels of care, and he/she is out of other funds to pay for care. The law also extends the look-back period to five years.

The grandparent who helped pay for a grandchild's education, the parent who helps a child with medical bills, and even the family farmer who passes on the farm will all be caught by this law if they get sick within five years of making the gift.

Because the Medicaid ineligibility period will no longer begin when the nursing home resident is out of funds, there will be a period of time during which neither the nursing home resident nor Medicaid can pay for needed care. The Congressional Budget Office estimates that this change will affect about 15% of individuals who are admitted to nursing homes each year.

Nursing homes will apparently be required to provide uncompensated care to many of these residents. For this reason, the nursing home industry strongly opposed the change in the penalty start date. The American Health Care Association, a group representing nearly 11,000 long-term care providers, said the change "leaves the nursing facility (not the state) to collect from individuals who have no funds to pay privately and are not Medicaid eligible during their penalty phase." As a result, some are referring to the start date change as the "The Nursing Home Bankruptcy Act of 2005."

The Deficit Reduction Act contains many other changes that impact the families of nursing home residents. Some are reasonable approaches to addressing rising long-term care costs under the Medicaid program while others are complicated and ambiguous rule changes that are likely to engender confusion and litigation. All are intended to ensure that persons who are unfortunate enough to encounter a long-term illness spend more of their income and assets to pay for the cost of their care.