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Vol.
2, No. 4 October 2005 |
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Federal
and State laws affecting the lives of children and adults
with disabilities, and seniors, are complex and always changing.
Special legal services are needed in order to protect rights
and insure that access to services and programs are maximized.
Hinkle & Fingles can help. |
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The
State's Lien Law
by
Paul S. Prior, Esq.
Q:
How will changes in the laws governing financial liability
and institutional liens affect my family?
A:
Last spring, a new ‘lien law’ was signed by
Acting Governor Cody. The law eliminates institutional liens
against individuals who have been treated at State and County
psychiatric hospitals for recoupment of their cost of care
at the psychiatric facility.
The
changes to the law mean that all liens filed against a person
treated at a psychiatric facility now have no legal effect.
In addition, the State cannot file new liens against a person
for treatment at such a facility. If you or a family member
had a lien assessed against you in the past, you are entitled
to have that lien discharged.
Q:
Does this mean that our family no longer has to pay for
a portion of care provided by DDD?
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more
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If
you would like to submit questions for consideration in this column,
please
the law offices. |
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Each edition
contains new information related to living with disability or
caring for a loved one with disabilities.
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Advice for Siblings
Elder
Law Considerations
By
Herbert D. Hinkle, Esq. and Valerie A. Powers Smith, Esq.
As
someone with an adult sibling with disabilities, you must also consider
not only the financial planning needs of your brother or sister,
but also financial planning for your parents as they age. First
and foremost is the question of whether your parents’ assets
will be exhausted by nursing home care, leaving nothing to you,
or to protect your sibling with a disability. Here are some thoughts:
1.
Long Term Care Insurance (LTCI) - Standard health insurance and
Medicare will not pay for custodial care on an extended basis. Therefore,
separate insurance should be considered. Generally, such insurance
cannot be purchased by those in poor health or those over age 80.
LTCI can preserve assets and allow freedom of choice in terms of
a facility.
2.
Transfer Rules - Medicaid will pay for long term care; but in order
to qualify, an applicant cannot have more than $2,000 in countable
resources. Assets can be transferred in order to qualify; however,
there are look-back rules and potential negative tax consequences.
There is an important exception to the transfer rules and penalties:
assets can be transferred to
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Dealing
with Denials of Service
If
you or your family member are denied eligibility for services, or
denied access to a particular service or program, always ask that
the reason for denial be provided to you in writing. Similarly,
if you are told that a policy, rule, or regulation prohibits access,
ask for a written copy of the policy, rule, or regulation.
In
the experience of this office, often times well-meaning staff may
answer your question or interpret a rule or regulation incorrectly.
For
example, clients have been told that their could not attend a school
or program because state code prohibited a child with disabilities
from being on a bus in excess of 30 minutes. No such rule or regulation
exists. Similarly, clients have been ill-advised by agency staff
on matters of eligibility for Medicaid, SSI, and SSDI. It is good
practice to appeal any denial of services.
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Greivance
and Appeal Rights Under Private Insurance Managed Care Plan
by
Valerie A. Powers Smith, Esq.
This
article provides an overview of the rights that are afforded to
an individual who has a managed care plan, which was either provided
by an employer or individually purchased.
Complaints
about quality of care issues are properly addressed by filing a
grievance with the insurance plan. First, contact your Primary Care
Physician (PCP). If your PCP is unable to resolve the issue, you
should call the managed care organization’s (MCO) patient
or member services department. The MCO must respond to your grievance
within 30 days. If you are still dissatisfied, contact the New Jersey
Departments of Health & Senior Services (DOHSS) or Banking &
Insurance (DOBI) to complain.
If
a covered health benefit has been denied, reduced, or terminated,
you may file an appeal. Private insurance managed care plans provide
a three-stage appeal process.
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