26 The Courier sun • health • march 5, 2015 for breaking news visit www.couriersun.com ▶health The Elder Law Minute TM Medicaid and the Death of a Spouse By Ronald A. Fatoullah, Esq. and Stacey Meshnick, Esq. VISIT QueensCourier.com FOR MORE STORIES When one spouse moves to a nursing home, it is often expected that this individual (the “institutionalized spouse”) will be the first to die, but that is not always the case. There are ramifications if a Medicaid recipient’s spouse (“community spouse”) dies first. If proper steps are not taken, the death of a community spouse can lead to an increase in the institutionalized spouse’s assets, thereby jeopardizing Medicaid eligibility. In order to be eligible for Medicaid benefits a nursing home resident may have no more than $14,850 in non-exempt assets. The community spouse is permitted to retain additional assets. In general, the community spouse may keep one-half of the couple’s total “countable” assets up to a maximum of $119,220. Often when one spouse seeks to qualify for nursing home Medicaid, he or she transfers assets to the community spouse. The death of a community spouse can affect the amount of assets to which the Medicaid recipient is entitled, thereby negatively impacting Medicaid eligibility. An example would be a community spouse who dies and whose last will and testament leaves her estate to her husband, who is in a nursing home and receiving Medicaid. The additional available assets will make the institutionalized husband ineligible for Medicaid. Even if the community spouse’s will did not name her husband as a beneficiary, New York State law does not permit spouses to disinherit elder law one another, and the surviving spouse is entitled to his/her “elective share” (the greater of $50,000 or one-third of the estate). Medicaid can require the recipient to assert this right and can assess a penalty if the survivor on Medicaid does not claim his share. The couple’s house can also become a problem if appropriate steps are not taken. Most spouses own property jointly. When a home is held jointly and the community spouse dies, the Medicaid recipient will own the house. The nursing home resident may have to prove an intention to return home in order for the house to be a noncountable asset that does not jeopardize Medicaid eligibility. (While eligibility may be maintained, a lien will be placed on the home in such a case.) If the resident sells the house, the proceeds from the sale will bring resources above the allowable level, making the resident ineligible for Medicaid. To prevent a community spouse’s death from affecting the institutionalized spouse’s Medicaid eligibility, it is important that the community spouse update his or her estate plan. There are steps the community spouse can take to protect the spouse in the nursing home, including, but not limited to, setting up a trust. To find the plan that would work best for you, it is prudent to contact a knowledgeable elder law attorney. Ronald A. Fatoullah, Esq. is the principal of Ronald Fatoullah & Associates, a law firm that concentrates in elder law, estate planning, Medicaid planning, guardianships, estate administration, trusts, wills, and real estate. Stacey Meshnick, Esq. is a senior staff attorney at the firm who has chaired the firm’s Medicaid department for over 15 years. The law firm can be reached at 718-261-1700, 516-466-4422, or toll free at 1-877-ELDER-LAW or 1-877-ESTATES. Mr. Fatoullah is also the cofounder of JR Wealth Advisors, LLC. The wealth management firm can be reached at 516-466-3300 or 800-353-3775. ROnald Fatoulah, ESQ, CELA* A Common Cause of Pelvic Pain: What You Need to Know If you feel an urgent or frequent need to urinate, along with pain or discomfort coming from the bladder, you may have interstitial cystitis, also known as bladder pain syndrome or IC/BPS. Robert Moldwin, MD, FACS, and Sonia Bahlani, MD, urologists at the Arthur Smith Institute for Urology, part of North Shore-LIJ Health System, discuss what you need to know about this condition. Are there different types of IC/BPS? Yes. About 5 to 10 percent of IC/BPS patients have inflammation (called “Hunner’s lesions”) that can be seen on the bladder surface. In most patients, the bladder wall looks perfectly normal. Further testing will make sure you don’t have signs of infection or any other obvious bladder disease. How can IC/BPS affect me? In mild cases, you may only have to deal with the discomfort and urinary frequency. However, moderate to severe symptoms can include the constant need to have bathroom access, limited ability to travel and lack of sleep due to the pain and constant need to urinate. Pain with sexual activity is common and often adds another dimension of misery. How common is IC/BPS? We used to believe that IC/BPS was relatively rare. However, new studies suggest that the condition may affect 3 million to 8 million women, and 2 million men, in the United States. Who gets IC/BPS? Anyone in any age group can get IC/BPS, but it’s usually found in people in their late 20s through their 70s. Heredity may also play a role: if your parent or sibling has IC/BPS, you are about 17 times more likely to also get the condition. What causes this condition? The etiology of IC/BPS is unclear but appears to be multifactorial. The various causes of IC/BPS may include changes in the surface lining of the bladder, nerve abnormalities of the bladder wall and autoimmune problems. The symptoms may also be related to diseases affecting other parts of the body, because 40 percent of patients have other disorders such as irritable bowel syndrome, fibromyalgia, migraine headaches and even depression. How is IC/BPS diagnosed? A doctor will review your medical history and physical, including a urine test to rule out problems like urinary tract infection. Other tests such as cystoscopy (viewing the bladder surface with a special telescope) may be performed if abnormalities of the bladder wall are of concern. How is IC/BPS treated? Because every IC/BPS patient can have a different range of symptoms, our pelvic pain experts at the Smith Institute for Urology will develop a unique plan for you. Therapy generally progresses from the most conservative forms of care (dietary changes and physical therapy) to more “aggressive” management (oral medications, medications placed directly into the bladder and even surgery). Using a variety of approaches significantly improves quality of life in the vast majority of our patients. If you or a loved one have any of these symptoms, make an appointment today by calling (516) 734-8500. For more information visit NorthShoreLIJ.com/icbps.
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