Elder Law Attorney/Lawyer Archives -

Typically, people think of estate planning as a means of passing assets on to future generations. However, there is another part of estate planning that doesn’t get as much attention. It concerns advance health care planning.

Have you thought about what type of medical care and treatments you want, or don’t want, if you become incapacitated or terminally ill?
Who would you trust to make health care decisions for you if you were not able to make decisions or communicate with the medical professionals who were caring for you?

If you don’t have the answers to these questions in writing ahead of time, decisions may need to be made in court by a judge. The care you get may be different from your wishes or beliefs. And the person selected to make decisions for you may not know what you want or share your values.

To ensure your health care wishes are honored, you need to spell them out in appropriate legal documents commonly referred to as advance directives. You don’t need to wait for later years. Every adult should have advance directives since a serious medical emergency could happen at any time.

Living Will

A living will is a legal document to specify which medical treatments you want to keep you alive if the need arises. You can also use a living will to express your pain management and organ donation preferences.

When considering what to put in your living will, think about your lifestyle, how you want to live, and what aligns with your beliefs and values. Here are some questions to ask when thinking about your living will:

Would you want medical treatments that would extend your life in any situation or just particular situations?
Do you want a life-saving treatment only if a cure is available or you have a good chance of a full recovery?
Under what circumstances would you consider your life not worth living?
If you can’t eat solid or pureed foods, do you want to be tube fed? If so, for how long?
Do you want mechanical ventilation if you can’t breathe on your own? If so, for how long?
Do you want to be revived by CPR or similar methods if your heart stops?
What type of palliative care do you want if you are terminally ill? Do you wish to die at home or in a medical facility?
Would you like to donate your organs and tissues for transplant purposes?
Would you like to donate your body to science?

There are other options you can consider. An attorney experienced in estate planning and elder law can help you determine the best options for your situation.

Power of Attorney

In a health care power of attorney document, you name a person or persons who can make health care decisions on your behalf if you are unable to make decisions on your own. The name of this document varies from state to state. And how your chosen person (agent or proxy) is referred to also varies from place to place.

Even if you cover several scenarios in your living will, some situations you didn’t anticipate may arise. Having someone you trust to make decisions for you is especially important. When choosing a person to be your health care agent, choose someone who understands you well enough to know what you want and that you trust to make potentially difficult decisions if necessary. It is a good idea to choose at least one backup agent in case your primary agent is unable or unwilling to act.

HIPAA Form

A Health Insurance Portability and Accountability Act form allows you to name individuals who may receive information regarding your medical condition and history from health care professionals who are caring for you. Your HIPAA form should include all the agents you name in your health care directives.

Creating Your Advance Directives

Some attorneys combine a living will with a power of attorney into a single advance health care directive document. This is convenient since all the information is in one place. As mentioned before, health care documents are usually part of an estate plan, but they may also be stand-alone documents.

Reviewing and Updating Your Advance Directives

Over time your views and wishes regarding your end-of-life treatment may change. Also, you may change your mind about the person you want to make decisions for you. If you decide to update your advance health care directive, talk with your attorney. After updating your directive, make sure it replaces all existing originals and copies of the previous directive to avoid any confusion later.

We hope you found this article helpful. If you have questions or would like to discuss your personal situation, please don’t hesitate to contact our Reno office by calling us at (775) 853-5700.

Estate Planning

Having a Will versus Not Having a Will

March 6, 2023February 24, 2023 SchulzeLawGroup

It’s a difficult thing to think about your own death, let alone what will happen to your assets after your death, which is one reason why so few people have made wills or other estate planning documents.

According to a 2021 Gallup poll, only 46% of US adults have a will. This is a slight increase from 2016 when 44% had a will. Still, less than half of US adults have taken the time to create this important document. The poll also showed that older adults are more likely to have a will than younger adults. Of those polled who were over the age of 65, 76% said they have a will.

Dying Without a Will

If you were to die without creating a will, a state probate court would choose an administrator to manage the probate process for your estate and choose a guardian for any minor children you have, provided the children’s other biological parent is deceased or unable to care for them. The downside to this process is that the decisions the probate court and the administrator would make may not align with what you would want.

Dying without a will is known as dying intestate, and it can create problems beyond state laws dictating what happens to your assets and children. When your intentions aren’t known before you die, you set the stage for potential conflict among your family members and heirs. Without the will to use as a guide, the administrator has to guess what you would want and have the probate court approve it. This places an undue burden on the administrator, who is often a family member.

The administrator’s duties include the following:

Locating all your living heirs and notifying them of your death
Publishing a notice of your death so that any creditors you may have can submit their claims
Compiling a list of your assets
Paying off any debts and taxes that are owed
Collecting any money owed to your estate
Distributing any remaining assets to beneficiaries deemed valid by the probate judge

To avoid creating conflict that could cause rifts in your family, draft and execute a valid will spelling out how you want your estate distributed, who should become the guardian for any minor children, address funeral arrangements, and what should be done with your remains.

Dying With a Will

When you have a valid will, it makes life for your survivors much easier. In a will, you can appoint a person you trust to manage your estate after your death. The person you appoint is known as the executor or personal representative for your estate. A will acts as their guide.

Even if you have a will, your estate still has to go through the probate process. The first step in the process is for the named executor to file your will with the probate court. The court then determines the authenticity of your will. Upon confirming that your will is valid, the probate court officially appoints the executor, most likely the person named in your will, to carry out the administrator duties.

Avoiding Probate

Regardless of whether a person dies with a will or not, the probate process exists to help ensure the decedent’s bills and taxes are paid and that their assets are distributed fairly. Though this sounds good in principle, the probate process can be a long and expensive process. And since the process takes place in the court system, it’s open to the public and the will can be contested. For these reasons, some people create trusts for their assets before they die. Their estates can settle outside of probate court and there is less of a chance that family members can successfully contest the will.

Consult with an estate planning attorney about your options. You may be able to keep your estate out of probate and leave a better legacy for your heirs. We hope you found this article helpful. If you have questions or would like to discuss your personal situation, please don’t hesitate to contact our Reno office by calling us at (775) 853-5700

Elder Law

Understanding Medicaid

February 6, 2023January 27, 2023 SchulzeLawGroup

Federal and state Medicaid programs offer comprehensive health insurance and financial protection to millions of Americans. The program helps low-income families, individuals, and people with disabilities receive adequate health care and provides nursing home or community long-term care services. As of August 2022, more than 90.5 million individuals were part of the Medicaid and Children’s Health Insurance Programs (CHIP).

States Follow Federal Guidelines But Have Some Autonomy

Although Medicaid funding is a federal-state partnership, states administer the programs and have some flexibility in determining who to cover, delivery models, and payment methods for physicians and hospitals. States may apply for a Section 1115 waiver to experiment with different implementation approaches as federal statutes require; however, the Secretary of the US Department of Health & Human Services (HHS) determines advanced program objectives.

Medicaid entitlement has two basic guarantees. First, all Americans who meet Medicaid eligibility requirements are guaranteed healthcare coverage. Second, states receive guarantees for federally matched funds without a cap for enrollees’ qualified services. Under current law, nearly all Medicaid federal funding is open-ended, but this may change for cost containment.

According to the Congressional Budget Office (CBO), the federal government pays anywhere from 54 percent to 79 percent of each state’s annual Medicaid outlays, with the states’ picking up the remainder. Beyond enrollment expansion due to COVID-19 for the fiscal year 2022, nearly one-third of states saw upward pressure on spending due to increasing costs for managed care and provider rate increases.

Medicaid Coverage Continues to Evolve

Medicaid began in 1965 and was a cash assistance program for qualifying individuals or families. In the following years, Congress expanded federal minimum requirements to provide more new coverage types, particularly for children, pregnant women, and people with disabilities. The broader health care coverage of the Affordable Care Act (ACA) in 2010 expanded Medicaid to non-elderly adults with qualifying low incomes and continues to meet changing needs.

A Broad Range of Health and Long-Term Care Services

In addition to the Medicaid federal law service requirements, many states provide optional services. These services include physical therapy, prescription drugs, eyeglasses, and dental care. Medicaid expansion for adults is part of the ACA’s ten “essential health benefits,” which include the following:

Ambulatory patient services
Emergency services
Hospitalization
Pregnancy, maternity, and newborn care
Mental health and substance abuse disorders
Prescription drugs
Rehabilitative and habilitative services and devices
Laboratory services
Preventative and wellness services
Pediatric services

Medicaid covers the cost of long-term care, including nursing homes and many community-based long-term services. Over half of all Medicaid long-term care spending is for home and community-based services (HCBS), enabling seniors and those with disabilities to live more independently. Emphasis is shifting away from institutional settings, although intermediate care facilities for adults with intellectual disabilities remain a priority.

Privately Managed Care Plans for Enrollees

More than two-thirds of Medicaid beneficiaries account for privately managed care plan enrollments contracting with states to provide comprehensive services. Other enrollees receive their care in a fee-for-service system.

Most states cover long-term services through risk-based managed care arrangements to contain costs. These managed care organizations (MCOs) are comprised of various entities, as some involve physicians while others combine physicians, hospitals, and other providers.

The blended approach of public and private partnerships to provide Medicaid care allows each participating group to function at their highest level, integrating efforts instead of trying to solve issues outside their expertise.

Medicaid beneficiaries have far better access to healthcare than the uninsured and seek medical care before health problems become severe and more costly. The satisfaction ratings of Medicaid recipients are comparable to those rates for individuals with private health insurance.

Conclusions

Despite experiencing low income, the rate of Medicaid enrollment is similar to those with private coverage. Medicaid covers preventative, rehabilitative, and acute health care in addition to costly long-term care for millions of Americans.

Medicaid services account for one-fifth of healthcare spending and receive a lot of attention regarding:

Capacity expansion to address addictions, in particular opioids
Refining payment and delivery systems
Lowering prescription drug costs
Refining eligibility requirements
Increasing community-based long-term care services

Medicaid funding is a major financial support for hospitals, doctors, nursing homes, and many other jobs in the healthcare sector. Federal matching funds guarantee an open-ended basis to provide flexibility in supporting each state’s population’s healthcare needs.

Medicaid is an extensive program and varies by state, making it difficult to know what is available to beneficiaries or potential enrollees. Attorneys specializing in Medicaid and disability can help you understand how to benefit from your state’s programs. They can guide your application process, ensuring you receive the necessary benefits.