3. PA & NJ Elder Law Across State Lines
Jerold E. Rothkoff, Esquire
Rothkoff Law Group

4. JEROLD E. ROTHKOFF, ESQ.
Managing Attorney, Rothkoff Law Group

5. PA & NJ Distinctions Attitude of Medicaid offices
Ease of qualifying for Medicaid
Curing Medicaid eligibility penalties/being over-resourced
Planning with Home
Planning with Retirement Plans
Medicaid income cap
Medicaid eligibility for assisted living
Caregiver child transfer of parent’s primary residence
Advanced directives laws

6. Medicaid - Asset Limits
New Jersey
Pennsylvania
$2,000 – single
$3,000 – applicant couple
$8,000/$2,400 single
$16,000/$4,800 applicant couple

7. Medicaid – Transfer of Asset Rules
New Jersey
Pennsylvania
Transfer penalty imposed for gifts within 60-month look back period
$423.95/day in 2018
$500 monthly aggregate resource disregard
$10, in 2018

8. Medicaid – Home Care New Jersey Pennsylvania
MLTSS
Provides assisted living/adult family care, care management, home health, personal care attendant (up to 40 hours per week) and medical transportation among other things.
Utilizes the same eligibility requirements as the institutional Medicaid programs and transfer of assets rules apply.
PDA Waiver Program, $8,000 asset limit.
Provides assisted living/adult family care, care management, home health, personal care attendant (up to 40 hours per week) and medical transportation among other things.
Utilizes the same eligibility requirements as the institutional Medicaid programs and transfer of assets rules apply.
NO AL or PCH coverage
Options Program – cost share

9. Medicaid – Primary Residence
New Jersey
Pennsylvania
Exempt if a community spouse, a child under the age of 21 or disabled child resides in the primary residence.
Countable and must be listed for sale for a single applicant unless occupied by a child under age 21 or disabled children.
MLTSS (ALF):
Countable and must be listed for sale if the applicant does not intend to return to the home within 6 months.
MLTSS (Community Medicaid):
Exempt, if the equity value is less than $750,000. The property will be subject to the estate recovery rules set forth below upon the applicant’s death unless a spouse, a child under age 21 or disabled child resides in the property.
Exempt if used as principal reside applicant, applicant’s spouse, or dependent relative or blind or disabled child, if the institutionalized applicant states, in writing, his/her intent to return home, even if it is not practically possible.
Home equity limited to $525,000, unless applicant’s spouse, child under 21, or disabled child is residing in home.

10. Medicaid – Retirement Accounts
New Jersey
Pennsylvania
Accounts of applicant and spouse are countable towards the asset limits set forth above.
Accounts of applicant are countable towards the asset limits.
Accounts of community spouse are exempt as a resource.
Required minimum distributions are factored into MMMNA calculations.

11. Medicaid – Qualified Income Trust
New Jersey
Pennsylvania
Used in NJ
$2,250 income cap
Not valid in PA
$2,250 income cap

12. Powers of Attorney New Jersey Pennsylvania
Must be executed by a competent adult that is signed and dated by the principal in the presence of two witnesses or a notary, attorney or other person authorized to administer oaths.
Must be executed by a competent adult or can direct someone else to sign at his behest that is signed and dated by the principal.
If signed by someone else at the principal’s behest, the signature must also be witnessed by two people who are at least 18 years old.
Additional notice requirement and acknowledgment by agent.
Also, must be witnessed by two witnesses, among other changes.

13. Advance Directive for Healthcare
New Jersey
Pennsylvania
An advance directive for healthcare can be executed as a one or two part document: a proxy directive and an instruction directive.
Proxy directive appoints a surrogate decision maker, “health care representative.”
Instruction directive states the declarant’s general treatment philosophy and objectives, or the declarant’s specific wishes regarding withholding or withdrawal of any form of health care, including life sustaining treatment.
A valid advance directive for healthcare must be executed by a competent adult and signed and dated in the presence of two witnesses or in front of a notary public, attorney or another person authorized to administer oaths.
Health Care Power of Attorney
Living Will
Physician’s Order for Life Sustaining Treatment (POLST) – effective October 24, 2010
PA Advance Health Care Directives and Health Care Decision Making for Incapacitated Patients (2006) – created statutory framework to govern advance health care directives and health care decisions by an health care agent. Law provides flexibility and a hierarchy of decision-makers if the principal fails to execute an advance directive prior to end-of- life. “Terminal” qualification is broadened to include “end-stage” conditions, and “certification” requirement is reduced to one doctor.

14. Case Study - #1 H needs NH care, W at home living in marital home
H & W live in NJ, 2 children live in Bucks Co., PA
Assets – $300K plus home, with W’s 401K worth $150K
What state makes sense for H’s NH care?

15. Case Study - #2 Single Veteran lives in PA, 2 children live in NJ
Vet needs an AL level of care
Assets are $75k plus home to sell for $150K
Income is $1,500/month
What state should Vet receive AL care?

16. Wrap-Up
Questions?
Use Rothkoff Law Group as a resource.
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