Elder Law Blog

Wednesday, November 29, 2017

Tax Bill Cuts Medicare, Repeals ACA, Threatens Social Security and Medicaid

Senate leaders are working to ram through a tax bill this week which will greatly increase deficits, triggering $25 billion in Medicare cuts and leading to major cuts in Social Security and Medicaid to pay for the deficit.  The bill would chiefly benefit the highest earners while hurting the middle class, according to the Congressional Budget Office, the Joint Committee on Taxation, and other experts. In addition, the bill would repeal the Affordable Care Act's individual mandate to purchase health insurance, leading to higher health insurance premiums and making access to health care unaffordable for as many as 13 million. 

Read more . . .

Tuesday, September 19, 2017

New Bill Guts Healthcare, Medicaid


A new healthcare bill in the U.S. Senate would cap Medicaid spending per beneficiary, which means the program would no longer be an open-ended entitlement that covers everyone who qualifies for benefits.  Medicaid provides crucial funding of costly long-term care services for low-income elderly and disabled beneficiaries - services that Medicare does not cover.  The Graham-Cassidy bill would also "repeal and replace" key ACA provisions which ensure individuals, particularly those with a pre-existing condition, have access to adequate, affordable medical care.

Read more . . .

Tuesday, June 20, 2017

Senators Secretly Crafting Bill to Cut Eldercare


Following widespread protests at congressional town hall meetings over the American Health Care Act - the bill passed by the House which would repeal key ACA ("Obamacare") provisions, end Medicaid as an entitlement, and leave 23 million uninsured - Senate leaders are crafting their own version of the health care bill in secrecy, with no committee hearings, debate, or public input from stakeholders.   Only 10-12 Republican senators are writing far-reaching health care legislation to "repeal and replace Obamacare," which will instead deprive millions of people, including the sick, elderly and disabled, of access to needed, and in some cases life-saving, medical care.  Senate majority leader Mitch McConnell's goal is to have the full Senate vote on the bill before the July 4th recess, before other senators, the Congressional Budget Office, and the public have reviewed the sweeping legislation, and before the impact of the legislation on the American people can be analyzed and debated in a public forum.  

Read more . . .

Wednesday, December 7, 2016

Republicans Plan Eldercare Cuts

The Houston Chronicle published the following editorial on April 6, 2016: 

"Cutting the safety net: 

Republicans plan to reduce the federal government's contribution to health care. 

It's the time of year when we face, once again, the specter of Ebenezer Scrooge, that most parsimonious and black-hearted of, well, scrooges. This year, however, he has a modern counterpart whose heart may be even blacker: Speaker of the U.S. House of Representatives, Paul Ryan, R-Wis.

Read more . . .

Tuesday, November 15, 2016

Will Trump Dump Medicaid on the States?

How will elder care be affected when Donald Trump becomes president and a Republican-controlled Congress convenes in January?  We should prepare for potentially severe budget cuts in Medicaid and other programs affecting seniors and people with disabilities, according to news sources, experts, and advocates

Read more . . .

Tuesday, October 20, 2015

New Rules Proposed for Veterans Aid and Attendance Pension

New Rules Proposed for Veterans Aid & Attendance Pension


Sweeping changes to the Veterans Aid and Attendance Pension may be implemented soon.  The Department of Veterans Affairs (VA) has published proposed new rules that would clarify the amount of property and income a veteran or widow can have to be eligible for the pension.  In addition, the proposed rules would implement a look back period and a penalty for giving away property during the 36 months before applying for the pension. Transfers to trusts would also be penalized, with few exceptions.  Furthermore, the purchase of an annuity to reduce net worth could be penalized if the annuity would not have been in the claimant’s financial interest but for the claimant’s application for the pension.


The proposed rules would also limit the definition of Activities of Daily Living (ADL’s) for purposes of medical eligibility and unreimbursed medical expenses that can be deducted from income.  ADL’s would include assistance with dressing, bathing, toileting, transferring, and eating, but not medication administration and other instrumental activities of daily living.  The home care hourly rate would be capped at a national average rate.  Payments to independent living facilities would not be deductible medical expenses.


In response to the proposed rules, the Assisted Living Federation of America (ALFA) submitted comments to the VA, suggesting three changes to the proposed rules.  First, ALFA commented that the proposed rule regarding ADL’s is “excessively limiting by eliminating two frequent reasons seniors move into assisted or memory care communities:  the inability to ambulate on their own, and inability to administer their own medications “.  ALFA recommended that VA expand the definition of ADL’s and allow room and board at an independent living facility to be a deductible medical expense if certain conditions are met.  Finally, ALFA suggested that VA consider other sources in setting the limit for the home care hourly rate, including an industry cost survey and differences in rates across the country.


For several years, legislation has been filed in the U.S. Congress to implement a look back period for the pension, however the legislation has never been passed.  Instead, VA is using the rule-making process to implement a look back period and other far-reaching changes.  The final rules are scheduled to be published in fiscal year 2016, which began October 1st.  For more information, please contact The Stone Law Firm at 713.434.6310.

Monday, September 28, 2015

Conference Focuses on Special Needs Children Transition to Adult Care

Most parents of special needs children in the U.S. believe their children are not adequately prepared to transition to adult health care, work, and independence.  Consequently, the transition from pediatric to adult-based care for special needs children is the focus of the 16th Annual Chronic Illness and Disability Conference, Oct. 1-2, organized by Baylor College of Medicine and Texas Children’s Hospital, which will provide information on health care, legal, financial, employment, and residential issues.  The target audience includes youth/young adults with chronic illness and their parents/guardians, as well as physicians and health care providers.  The conference website and brochure are available at


Tuesday, September 22, 2015

Recent Changes in Elder Law

On this first day of autumn, the Stone Law Firm is launching a new series of blogs on Recent Changes in Elder Law.


Veterans Aid and Attendance Pension

Proposed new rules for the Veterans Aid and Attendance Pension could make sweeping changes to the pension, if implemented.  The proposed new rules would add a 36-month look-back period and a penalty for gifting property, similar to Medicaid.  Another goal of the new rules is to clarify the maximum amount of assets that the veteran or widow can have in order to qualify.  Medical eligibility criteria may also be tightened.  The rules may be implemented as soon as October 1st or later in February, 2016.  We do not know what the final rules will be or whether pending applications will be grandfathered.


Texas Medicaid

With the legalization of same-sex marriage by the U.S. Supreme Court, the Texas Medicaid Nursing Home program has extended spousal impoverishment protections to all married couples, including same-sex married couples.  Spousal impoverishment protections are designed to protect the finances of the beneficiary’s spouse by providing a minimum monthly income to the spouse and allowing the spouse to keep one-half or more of the couple’s assets.


A Medicaid rule change has occurred in regard to Applied Income, or the co-payment that a beneficiary pays to the nursing home.  Medicaid will no longer exclude as an expense the withholding of taxes from Social Security and pension checks.


Estate Planning, Advance Directives, Guardianship

The Texas Legislature has enacted changes to the Statutory Durable Power of Attorney, Directive to Physicians, and Appointment of Agent for Disposition of Remains.  In addition, the Legislature added certain patient protections to the controversial futile care law by providing a medical standard for the withdrawal of pain medication and artificially administered nutrition and hydration. 


The Legislature also approved statutory changes that emphasize the use of less restrictive alternatives to guardianship, which deprives an incapacitated person of many legal rights.


Future blogs will provide additional details and updates on changes in elder law.  For more information contact Nancy Stone at 713.434.6310.



Wednesday, December 24, 2014

Holiday Greetings & Medicare's 50th Birthday

This holiday season we celebrate the opportunity to work with you and your family on elder law, disability, and estate matters.  We greatly appreciate your continued support and wish everyone, especially those who have suffered a loss this year, a peaceful holiday and a New Year filled with hope.

Medicare's 50th birthday in 2015 is drawing attention to the state of health care for older and disabled adults.  While Medicare is more protective than insurance plans that cover people under age 65, a recent survey by the Commonwealth Fund found that the U.S. lags worldwide in health care for those over 65, as reported in a New York Times article this month. The survey compared seniors' health care in the U.S. with that of Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the UK. Here are the survey's findings reported by the Times, with quotes by Robin Osborn of Commonwealth Fund:

'■ Our older population is sicker. We lead the list in the proportion of people over 65 who have two or more chronic diseases (68 percent report hypertension, heart disease, diabetes, cancer, etc.) and who take four or more prescription drugs (53 percent). Only a third of seniors in the United Kingdom have multiple chronic conditions. (The survey didn’t include residents of nursing homes or other care facilities.)

“One thing we know contributes to this is not having an ongoing, stable source of health insurance throughout your life,” Ms. Osborn said. Before they became Medicare-eligible, American seniors may have forgone preventive treatments or let conditions worsen because they couldn’t afford care.

■ Older Americans still struggle to pay for health care. Nineteen percent said that in the past year, cost was a barrier that prevented their seeing a doctor, undergoing a recommended test or treatment or filling a prescription. In only one other surveyed nation (New Zealand, at 10 percent) did that proportion reach double digits.

Among American seniors, 21 percent had out-of-pocket medical expenses that topped $2,000 and 11 percent had problems paying their medical bills. In Norway and Sweden, 1 percent had problems paying; in Germany, 3 percent.

“As good as Medicare is – it provides excellent coverage over all – it still isn’t as protective as the coverage people get in other countries,” Ms. Osborn said. Its deductibles and cost-sharing requirements still leave many Americans scrambling to afford drugs and doctors – which also cost more here.'


Tuesday, September 9, 2014

"3-Strikes" Plan to Protect Seniors in Nursing Homes

"3-Strikes" Plan Spurs Nursing Home Regulation Debate

By Edgar Walters, published in the Texas Tribute, September 7, 2014


At a hearing in August to evaluate the state agency responsible for Texas’ elderly residents, State Sen. Charles Schwertner singled out seven of the 1,200 nursing homes licensed by the Department of Aging and Disability Services.


“These seven facilities are the worst of the worst,” said Schwertner, a Republican from Georgetown. At the hearing, he proposed a “three-strikes” rule that would force the state to close nursing homes found to have the highest-level violations of federal quality standards on three separate days over 24 months.


The department “needs to have this direction from the Legislature that we are serious about protecting our seniors,” said Schwertner, an orthopedic surgeon and chairman of the Senate Health and Human Services Committee. His recommendation emerged from a once-per-decade evaluation of the agency that is stirring arguments about whether the state should do more to supplement federal regulation of the nursing home industry, which in Texas serves nearly 94,000 people. Lawmakers are expected to tackle this issue during the 2015 legislative session.


Nursing facilities have been quick to push back against Schwertner’s proposal. “The nursing home sector remains one of the most heavily regulated settings in health care by both state and federal agencies,” said Kevin Warren, president of the Texas Health Care Association, which advocates for the industry. The state already has “authority in the current regulatory framework to identify infractions, impose financial penalties and require facilities to correct violations within the agency’s state and federal oversight responsibilities,” he said…


AARP Texas has endorsed Schwertner’s proposal and other recommendations that expand the state’s capacity to sanction negligent nursing homes because “almost nothing is being done to improve their performance or to penalize them,"…


Full Story


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Attorney Nancy Stone assists clients with Elder Law, Medicaid Planning, and Estate Planning throughout Harris County, TX. I am now based in Sugar Land and serve all of Houston, Harris County, Bellaire, Jersey Village, Cypress, West University, The Heights, Pearland, Alvin, Sugar Land, Missouri City, Kingwood, Humble, The Woodlands, Spring, Tomball, Richmond, Rosenberg Pasadena, Baytown, La Porte, Clear Lake, Texas City, Katy, Friendswood, Stafford, as well as Fort Bend County, Brazoria County, Montgomery County, Galveston County, Liberty County, Chambers County, Waller County and throughout Southeast TX.

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