Writing Your Tulsa Estate Planning Blog

Even though a vote over the Senate’s bill to repeal Obamacare (Affordable Care Act) has been delayed, it is important to know whether or not it cuts Medicaid. The answer depends on how you look at it.

Very little in government is ever straightforward. One example is the Senate Republican plan to repeal and replace the Affordable Care Act.

A vote on the bill has been delayed. However, it is likely to still come at some point in the future. Therefore, what the bill proposes to do with Medicaid funding, is important for elderly people who rely on the program for their nursing home care.

On one side of the debate over the bill are Democrats, who claim that it will slash Medicaid spending. On the other side, are Republicans who claim that the bill will increase Medicaid funding, as Fox News reports in “Fact Check: Dem claims that Senate bill guts Medicaid ignore billions in new funding.”

Which side is right depends entirely on how you look at the issue. If the Senate bill passes and eventually becomes law, then Medicaid funding would increase by $71 billion by 2026. However, if the Senate bill does not become law and the current law remains in place, then Medicaid funding would increase by $231 billion during the same time period.

Under either scenario, Medicaid funding increases.

The argument is over how much it should increase and whether any increases are enough to meet future costs.

In the current highly partisan climate, it can be difficult to understand what is going on, as politicians and the media discuss policy changes. For that reason, it is important to look carefully at the facts to determine what the real question is.

For Medicaid that question is this: are politicians making sure the program can continue to do what it was designed to do without the country going broke?

Reference: Fox News (June 27, 2017) “Fact Check: Dem claims that Senate bill guts Medicaid ignore billions in new funding.”

Repeal of the Affordable Care Act has been one the biggest news items in recent weeks. Changes to Medicaid in Republican proposals have received a lot of attention, but many people do not know exactly what Medicaid does.

You probably know that Medicaid is the federal government program that provides health care coverage to poor Americans. However, in the debate about the repeal of Obamacare (Affordable Care Act) and possible reductions to Medicaid in various appeal proposals, what often gets lost is exactly what that federal government program for the poor does.

Facts about the program get lost in the media noise.

It is important to know the facts, because only then can you really decide if you are for or against any changes.

NPR recently published a list of some lesser known facts about Medicaid in “From Birth To Death, Medicaid Affects The Lives of Millions,” including:

•It is very expensive. Medicaid currently takes up approximately 10% of the federal budget. State governments contribute even more on top of that to the costs of the program.

•Half of all births in the U.S. are covered by Medicaid. The program has been expanded multiple times to include more and more pregnant women.

•Some 62% of nursing home residents have their care through Medicaid.

•Disabled people and the people who take care of them are often eligible to receive their care through Medicaid.

•Medicaid is a major source of funding for the fight against opioid addiction.

Reference: NPR (June 27, 2017) “From Birth To Death, Medicaid Affects The Lives of Millions.”

The new fiduciary rule for financial advisers has caused a lot of confusion about what is and is not allowed with retirement accounts.

On June 9, a controversial new Department of Labor rule went into effect. The rule seems simple enough. Financial advisors who give investment advice to consumers about their retirement accounts, must act as fiduciaries of those consumers.

At least for attorneys, that is a very simple idea to understand.

Nevertheless, for consumers and their advisors the new rule has caused a lot of confusion, as the Washington Post details in “A new conflict-of-interest rule for retirement savers is causing a lot of confusion.”

The easiest way to understand what the new rule means, is that advisors have to act in the best interests of the people they are advising. Investment advice must be based on the best thing for the saver, not the advisor.

Therefore, if an advisor would earn a higher fee from suggesting one investment rather than another, he, or she cannot advise the saver on that basis. If the investment that pays the least to the advisor is better for the consumer, then that is the investment that must be recommended.

Many advisors are taking advantage of the new rule to make changes to how they manage retirement accounts.

The confusion surrounding the rule has given them the opportunity to make changes customers may not like and place the blame for them on the new rule.

If you are not sure if a change your advisor is making is really required by the new rule or if you should look for a different advisor, ask an estate planning attorney.

Reference: Washington Post (June 19, 2017) “A new conflict-of-interest rule for retirement savers is causing a lot of confusion.”

Senate Republicans are planning to hold a vote on their version of repealing Obamacare by the end of June. No one knows yet what their bill contains.

Republicans in Congress are moving forward with their plans to repeal the Affordable Care Act.

The House of Representatives previously passed a bill that would do just that. It would have cut funding for Medicaid and increased health insurance costs dramatically for many seniors who have not yet reached retirement age.

A Senate version is expected soon, as Politico reports in “Senate GOP prepares for Obamacare repeal vote next week.”

The biggest problem with the Senate bill from an elder law perspective, is that no one knows what the problems are.

Since President Trump is reported to have told Republican Senators in private that the House bill is “mean,” it is expected that the Senate version will contain some softer provisions.

However, the negotiations over the Senate bill are being conducted behind closed doors. It is also expected that no hearings or debate will be held on the bill before it is called for a vote.

That makes it difficult for elder law advocates to determine whether the bill is supportable or not.

When details of the bill are released, it will need to be quickly and thoroughly scrutinized from an elder law perspective.

Reference: Politico (June 20, 2017) “Senate GOP prepares for Obamacare repeal vote next week.”

The state of New Jersey is currently considering proposals to offer tax credits for blood and organ donations. They might be in violation of federal law, if passed.

All over the U.S. many people die unnecessarily. This includes many elderly.

Why?

It is because of a lack of organ donations.

Getting people and their families to agree to donate organs has proven to be exceptionally difficult. In some cases, it is even difficult to find enough blood donors.

There have been many awareness campaigns, but they normally only have a short-term effect, if they have any at all.

The New Jersey assembly is considering another idea to increase donations, according to the Tax Foundation in “Organ Donation Tax Credits: A Life or Death Proposal?.”

The state is considering offering donors small tax credits for donating blood or organs. In the case of a deceased donor, the tax credit could be used on their final tax return filed by the estate.

Whether these credits would do very much to increase donations is uncertain.

These proposals could also be in violation of federal law, which makes it illegal to profit from organ donations. Other states have gotten around that problem, by offering tax exemptions for any expense incurred while donating.

It is important to find more blood and organ donors. However, it appears that these New Jersey proposals are likely not going to be solutions, unless federal laws are changed.

Reference: Tax Foundation (June 7, 2017) “Organ Donation Tax Credits: A Life or Death Proposal?.”

Early signs indicate that Social Security benefits could see a dramatic increase next year. That will be welcome news for seniors whose benefits have lagged far behind their buying power.

Every year the Social Security benefits that millions of senior citizens receive on a monthly basis are supposed to increase with the cost of living. However, it has long been pointed out that it does not really happen.

The methods used by the federal government to determine cost of living adjustments are not an accurate reflection of the purchasing power of recipients. For example, since 2000 benefits have risen 43%, but senior buying power has risen 86% according to advocates.

The average increase in benefits in the last few years has only been 1%, since overall official inflation rates have been low.

That could change next year, according to Barron’s in “Big Social Security Bump Could Be Coming.”
Early signs indicate that a benefit increase of 2.1% is coming next year.

That is good news for seniors who have seen their benefit dollars pay for fewer and fewer of their expenses.

The bad news is what that might mean for the health of the Social Security system itself. It needs to be adjusted to make sure the Social Security Trust Fund does not run out of money in the next couple of decades, which would result in automatic steep benefit cuts.

Benefit increases are only expected for now.

No official announcement will be made until October. Therefore, seniors should not plan for raises yet.

Reference: Barron’s (June 6, 2017) “Big Social Security Bump Could Be Coming.”

People who are eligible for Medicare and who do not sign up on time can face stiff penalties. Some of them have been granted a small window to have those penalties waived.

The federal government has always been particular about Medicare. Eligible people either sign up at the right time or they face stiff penalties, if they attempt to sign up later.

Elder law advocates have always thought that this was a harsh way to penalize many people who simply made honest mistakes and were not aware of those penalties.

Advocates’ complaints have typically fallen on deaf ears, since the government was more concerned about cost controls. However, an important victory has been won for some who would otherwise face penalties for not signing up for Medicare on time.

NPR reports on this latest development in “Feds to Waive Penalties for Some Who Signed up Late for Medicare.”

People who purchased their health insurance through the Affordable Care Act’s marketplaces were not made aware that they needed to sign up for Medicare, when they became eligible.

When looking at the marketplace website, it appeared they were doing everything properly as long as they continued to purchase insurance on the marketplace. They have been granted a waiver of the penalties.

People affected will need to apply for the waiver. They only have until Sept. 30, 2017 to do so.

This waiver is only being granted to those who continued to purchase insurance through the Affordable Care Act, but it is an important step for many elderly people.

Reference: NPR (June 6, 2017) “Feds to Waive Penalties for Some Who Signed up Late for Medicare.”

Elderly people in the early stages of dementia would be well advised to take walks.

Alzheimer’s disease receives a lot of attention. However, that attention often comes at the cost of other forms of dementia.

While treatments and cures for Alzheimer’s are widely sought after and discussed, there is often correspondingly little research and discussion about other forms of dementia. Therefore, it is refreshing to see that a study has recently been conducted into something that might help people who are in the early stages of vascular dementia.

The New York Times reported on this development in “A 1-Hour Walk, 3 Times a Week, Has Benefits for Dementia.”

A six-month study found that vascular dementia patients who took one hour walks, three times a week had better brain activity than a control group that did not go on walks. Even relatively mild exercise was beneficial.

This suggests that elderly dementia patients who go on walks, while in the early stages of the disease, could see the disease progress at a slower rate than they would if they did not go on walks.

This study will need to be confirmed by further research and it does not offer a cure for vascular dementia. However, anything that helps slow the disease by even a little bit is of great benefit to patients.

In case you were wondering, earlier research revealed that taking walks also helps people in the early stages of Alzheimer’s.

In the end, maybe all elderly people should considering walking for some exercise, just in case.

Reference: New York Times (May 24, 2017) “A 1-Hour Walk, 3 Times a Week, Has Benefits for Dementia.”

A new virtual reality treatment is helping some elderly people with dementia recall their memories.

It has often been said that the cruelest thing about Alzheimer’s and other forms of dementia is the forgetting. People who suffer from dementia forget the important people, places and things in their life.

They do not just forget that the person talking to them is their grown-up child. They also forget the time they took that child to their first baseball game, for example.

Helping patients get back those memories, has proven to be a challenge.

Patients can be told about the memories, but that does not necessarily mean they will remember them.

Technology now might be able to help, as the Daily Mail reports in “Touching moment a virtual reality headset helps elderly people with dementia recall previous memories.”

A virtual reality therapy program has been created that lets patients virtually be at a scene.

A therapist asks a set of leading questions to help jog the patient’s memory. The article mentions that an elderly woman was shown a virtual reality beach scene and was then able to recall the time she visited a beach in Scotland as a child. It was a memory which had previously been lost to her.

There are twelve scenes in total, including a view of the Earth from the International Space Station.

For now, this virtual reality program is costly and not available to everyone. However, if it continues to show promise in helping dementia sufferers, then it is likely to soon be more widely available.

Reference: Daily Mail (May 16, 2017) “Touching moment a virtual reality headset helps elderly people with dementia recall previous memories.”

The last attempt by the Social Security Administration to increase online security was a disaster that did not last long. The agency is about to try again.

It is relatively easy to log in to the Social Security Administration and get access to all of the information about your account. A few basic details are all that is required.

This has led to concerns about privacy and identity theft.

Since it does not take much for a legitimate user to log in, it does not take very much for thieves to log in either. The agency attempted to fix this problem in 2016, by requiring a two-step verification process before account access was granted.

That was short-lived, however, as many people were unable to log in to their accounts.

The agency is going to try again with a modified process, as Investment News reports in “Social Security Administration steps up online security.”

In its last attempt, the agency sent users a code via cellphone to verify their accounts before they could log in. That was a problem, since many elderly people do not use cellphones.

This time around, the agency will let people choose to have the code sent by cellphone or email. It is assumed that if are trying to access their Social Security accounts online, then they will almost certainly have email accounts, even if they do not have cellphones.

This change is scheduled to take effect on June 10, 2017.

Anyone who has problems accessing their Social Security accounts online after that, should speak to an elder law attorney.

Reference: Investment News (May 15, 2017) “Social Security Administration steps up online security.”