Shannon Falcone-Macleod, Esq. is dedicated and committed to providing effective and professional service to her clients. Her expertise in the area of Medicaid issues will provide a guiding hand through a traumatic and difficult time in your family's lives. Choosing to have her on your side throughout the Medicaid process will prove to be the right choice at a time when you need to make decisions that will provide peace of mind to you and your family.
Shannon received her Bachelors of Science in Psychology from Fordham University in 1997. Straight from Fordham University, Shannon began working in the accounting department of an Extended Care Facility. She was promoted within her five-year tenure at the extended care facility from Accounting Clerk to Accounts Receivable Manager/Medicaid Coordinator. Her duties at the facility included supervising all patient accounts, performing financial interviews for in-house patients and potential admissions, preparing Medicaid applications, and recording and tracking daily census records.
In 1999, Shannon entered the evening program at St. John's University's School of Law. She also took a position as a paralegal in 2000 with a Long Island law firm representing over 150 nursing homes within New York State. As a paralegal, and then in 2004 as an attorney, Shannon concentrated her practice on health care collection and reimbursement recovery issues. For eight years, Shannon counseled and represented the firm's nursing home clients on all aspects relating to Medicaid reimbursement.
In 2008, while remaining of counsel to one of the largest law firms on Long Island, Shannon Falcone-Macleod began her own practice. She has combined her vast knowledge of the Medicaid system and her experience with the nursing home industry to provide her clients with individualized legal and professional representation.
Shannon is a member of the Elder Law sections of both the New York State and Suffolk County Bar Associations.
At the present time, the average monthly cost of a nursing home is $10,555 on Long Island and $9,636 in New York City. Medicare will only cover up to approximately 3 months of nursing home care. Medigap policies will cover co-insurance charges only when medicare has covered. Where does this leave your loved one if he has no long term care insurance?
Medicaid is a program for New York residents who cannot afford to pay for the high cost of medical care. The Medicaid program, however, has income and resource limits as conditions of eligibility. Furthermore, an application for nursing home care will require a 36 month* history on all bank and security accounts since any transfers made during this period will affect eligibility.
To determine whether you or your loved one meets the requirements of the Medicaid program, or how you or your loved one may meet the requirements in the very near future, it is wise to seek the advice of an elder care lawyer with a Medicaid background.
*Effective February of 2009, the 36 month history requirement will being increasing by one month with each passing month until 60 months are required on all accounts by February of 2011.
Asset Protection for Medicaid purposes is the practice of protecting your assets by transferring them to another person or to a trust in line with the Medicaid regulations and still qualify for Medicaid benefits. Certain transfers of assets may be considered "compensated" or "uncompensated", "permissible" or "impermissible" and "exempt" or "non-exempt" for Medicaid purposes.
It is advisable to work with a lawyer experienced in the Medicaid area who can assist you in rearranging your assets to make you eligible for Medicaid as soon as possible.
You and your loved one are approached by a hospital social worker with the information that everyone always dreaded. Your loved one needs continuing in-patient care in a nursing home. Or, maybe after you and your family have gone to great lengths to avoid having to place your loved one in a facility, placement becomes inevitable. What do you do next? Where do you even start?
The decisions that your loved and your family will immediately encounter are going to be traumatic and difficult for everyone involved. This is not easy; however, the decisions made will sit better with everyone involved if the proper steps are taken to make the transition to a nursing home as comfortable as possible. My suggestions are as follows:
Tel: (631) 482-1800
Short talk on Medicaid issues and questions period
Overview of Medicaid
Myths About Long Term Medicaid
Shannon Falcone-Macleod, Esq.
1. I have Medicare
and/or a Medicare supplement so I will not need Medicaid.
Not true. Medicare is
a federally administered program and available to every person age 65
and over who are entitled to SSA or Railroad Retirement benefits, as
well as to certain disabled person who meet specific requirements.
Medicare has a maximum long term benefit of 100 days per illness
after a three day hospital qualifying stay. The first 20 days are
covered at 80%, and the following 80 days at 80%. Supplemental
coverage, possibly Medicaid, is needed for day 21-100 and full
coverage will be needed thereafter. The 100 day benefit is not a
given. You must be receiving skilled or rehabilitative services to
be covered by Medicare for in-patient care. There is no Medicare
coverage for custodial care (care that can be provided by non-medical
professionals). A Medicare supplement or Medigap policy will cover
co-insurance charges for day 21-100 so long as Medicare pays
primarily. This begs the question: how will I pay for a nursing
home if I have no skilled need or when my 101st day arrives?
2. I worked and paid
taxes all of my life, of course I am eligible for Medicaid.
Not true. Having paid
or not paid taxes has nothing to do with whether you will be found
eligible for Medicaid. Medicaid is a means tested program that has
income and resource limits as conditions of eligibility. The program
is means tested as it is directed at the poor. At the present time,
a single individual is eligible for Medicaid if he has no more than
$14,550 in available resources. In addition to being allowed no more
than $14,550, the Medicaid program will require a transaction history
of 60 months on each and every account held by the applicant to
ascertain whether any transfers were made for the purpose of
qualifying for long term Medicaid. Any transfers made within this
"look back period" will result in a penalty which will
delay the commencement of coverage.
3. I qualified for
Medicaid in the community, so I must be eligible for long
term/nursing home Medicaid benefits.
Not true. Community
Medicaid eligibility and long term Medicaid eligibility vastly differ
in that one is not subject to a lookback period at all. So long as
the available resources are $14,550 and below, one can qualify
financially for community Medicaid benefits. Upon admission to a
long term facility, a full 60 month history on all accounts must be
disclosed and a conversion application submitted. Any transfers made
within the look back period will need to be explained and, again, any
transfers made for the purpose of qualifying for Medicaid will be
4. With the new
Medicaid rules, I have no choice but to spend down my assets on long
Not true. Before
spending down your assets on long term care, one is entitled to pay
all outstanding medical bills and purchase a prepaid funeral
arrangement. In addition, certain transfers can be made in
compliance with the Federal Deficit Reduction Act of 2005 that was
signed into law on February 8, 2006. A Medicaid applicant may
preserve and protect assets with proper planning. Seeking the advice
of an elder law attorney well-versed in the area of Medicaid
regulations will prove beneficial.
5. You can transfer
up to $10,000/$13,000/$14,000 per person per year and still be
eligible for Medicaid.
Not true. There is an
annual exclusion of $14,000 per donee per calendar year for federal
gift tax purposes. The use of this gift tax exclusion should not be
confused with Medicaid gifting regulations. Regardless of the fact
that the gift of $14,000 per donee per calendar year is excluded for
gift tax purposes does not excuse or exclude the gift for Medicaid
purposes. Medicaid will assess a penalty on such a gift if it is
made within the lookback period.
6. When you apply
and qualify for Medicaid, the State takes over your income, home and
Not true. The State
does not “take over” your income or resources –
neither does the nursing home or hospital. A Medicaid applicant is
expected to contribute his net available monthly income (total gross
income minus any health insurance premiums paid minus a $50 personal
needs allowance) towards his cost of care. This payment would be
made to the nursing home. An applicant’s home will be deemed
exempt for Medicaid purposes so long as a spouse, minor child or
disabled child are residing there or so long as the applicant
expresses an intent to return to that home once he is able to do so.
More on that in #7. Resources must be spent down to an allowable
level (presently $14,550 for a single person) before Medicaid will
authorize coverage. A permissible way to spend down assets is by
paying any outstanding medical bills and prepaying a funeral.
7. One cannot own a
home and be on Medicaid.
Not true. As touched
on in #6, a Medicaid applicant can own a home and qualify for
Medicaid. A Medicaid applicant can retain his home if a spouse,
minor child or disabled child is residing there. In addition, so
long as the home is in New York State and the applicant’s
equity interest in the home no greater than $814,000. A Medicaid
applicant can also execute an Intent to Return Home form. In this
scenario, the county DSS office will place a lien on the property
until such time that the Medicaid recipient returns home. Once
returned to the home, the lien will be lifted. Should the Medicaid
recipient not return home, the county DSS will execute on the lien up
to the amount that was paid out on the recipient’s behalf.
8. There is a joint owner on my bank account so only 50% of
this account is available to me for Medicaid purposes.
Not true. Medicaid
regulations clearly state that 100% of the balance of a joint bank
account will be deemed to be available to the Medicaid applicant and
will be counted when determining eligibility. This is a rebuttable
presumption, however, and the burden of proof is placed upon the
applicant to prove that the co-owner made substantial deposits to the
account. A joint brokerage account, however, will be deemed 50/50.
9. My spouse will be
left with nothing.
Not true. A couple is
entitled to $74,820 in assets and still qualify for Medicaid benefits
for the ill spouse. Even if the couple's assets exceeds the
allowable level, Medicaid may be available with the submission of a
Spousal Refusal. With a spousal refusal, The county does retain the
right to sue the refusing spouse for her spouse’s support. As
far as income, the Medicaid regulations require a non-applying spouse
to contribute 25% of her income that exceeds the maximum allowed of
$2,931. The community spouse may refuse to contribute her income
that reaches above the allowable $2,931, however, again the county
retains the right to pursue her for support.
10. A nursing home
will not accept you with Medicaid coverage.
Not true. The vast
majority of patients within a nursing home are being covered by
Medicaid. In fact, being eligible fo Mdicaid coverage makes a patient
a very attractive admission, even moreso than a private paying
The above explanations
are brief and simplified for purposes of this publication. To find
out more, you should do your own research and possible seek a
consultation with an elder law attorney with a background in Medicaid
planning and eligibilty.