Legacy Planning Law Group
Weekly Blog

Estate & Elder Law

Protect Your Family. Preserve Your Legacy

If you’re interested in learning more about our process and the solution for you and your family, please book your free 15-minute call with us today!

apply for medicaid

How to apply for Medicaid

Below is a general guide to the Medicaid application process. Be sure to contact your local Medicaid office for state-specific rules.

Note: Your Medicaid office may be called the Department of Health, the Department of Social Services, the Department of Insurance, or by another name.

  • Contact your local Medicaid office to ask how you need to submit your application. Some states require you apply in person, while others may allow you to apply by mail, online, by telephone, or at locations in the community, such as health centers and community organizations.
  • Find out which documents and forms of identification you may need in order to apply. Your Medicaid office may ask you to show the following:
    • Proof of date of birth (e.g., birth certificate)
    • Proof U.S. citizenship or lawful residence (e.g., passport, drivers license, birth certificate, green card, employment authorization card)
    • Proof of all types of income, earned and unearned (e.g., paycheck stubs, retirement benefits, Supplemental Security Income)
    • Proof of resources (e.g., bank or stock statements, life insurance policies, property)
    • Proof of residence (e.g., rent receipt, landlord statement, deed)
    • Medicare card and any other insurance cards (you can also provide a copy of the insurance policy)

Note: Medicaid coverage is available, regardless of citizenship status, if you are pregnant or require treatment for an emergency medical condition. A doctor must certify that you are pregnant or had an emergency, and you must meet all other eligibility requirements.


  • If you have any problems applying at a Medicaid office, ask to speak with a supervisor.
  • If you do not receive a timely decision on your Medicaid application or are turned down for Medicaid, you can appeal by asking for a state fair hearing (not a city or local one). Check with your Medicaid office to learn more about requesting a fair hearing.
  • Once you have Medicaid, you must recertify (show that you remain eligible for Medicaid) to continue to get Medicaid coverage. When you submit your Medicaid application, be sure to ask when and how you will need to recertify. In many states, recertification is an annual process.

Read more related articles here:

Florida Medicaid

New to Medicaid? How It Works

Also, read one of our previous Blogs here:

What It Means to Need ‘Nursing Home Level of Care’ for Medicaid Eligibility

Click here to check out our On Demand Video about Estate Planning.

Click here for a short informative video from our own Attorney Bill O’Leary.

Medicaid POA

Importance of Having the Right Power of Attorney When Applying for Medicaid

Importance of Having the Right Power of Attorney When Applying for Medicaid

A Power of Attorney is one of the most important documents for an older person to have, especially when they plan on applying for Medicaid Long Term Care and receiving its benefits. Without it, the application process could stall or benefits might be denied.


Power of Attorney (POA) basics are fairly straightforward. It’s a document where a “principal” or “grantor” (usually an elder) legally names an “agent” or “attorney-in-fact” (typically an adult child) to act on their behalf in medical and/or financial dealings if they are not capable of doing so themselves. POAs can be canceled or changed at any time for any reason, as long as the principal is competent enough to make those types of decisions. In all POAs, the agent’s powers end upon death of the principal.

Without a POA, anyone who loses the capacity to make decisions for themselves will have their financial holdings and health care choices managed by the state. In order to reclaim those powers, a family member would have to go to court and establish legal guardianship, which can be a lengthy and expensive process. In the context of applying for Medicaid Long Term Care, the state could choose not to apply, instead they could choose to sell the individual’s home and pay for care with those proceeds or make other financial decisions family members would likely not make.

Creating a POA is critical for potential Medicaid Long Term Care applicants. If the applicant’s health happens to fail rapidly and they are not capable of completing the Medicaid application on their own, having a POA will allow the agent (usually an adult child) to collect the necessary financial and medical documentations and complete the application. A POA will also prove valuable after the application has been approved so the agent can make further financial and medical decisions for the principal/elder/Medicaid beneficiary while they are receiving long term care.


The most common type of POA for those considering Medicaid Long Term Care is a Durable Power of Attorney (DPOA). A DPOA is effective immediately and gives the agent (usually an adult child) decision-making power after the principal (typically an elder parent) has become mentally or physically incapacitated and is no longer able to make decisions on their own.

A springing POA can also be helpful for those seeking Medicaid Long Term Care benefits. Instead of being effective immediately, a springing POA is “sprung” into effect by a predetermined event like an incapacitating trauma such as a stroke or major accident, or a change in a preexisting illness or condition like Alzheimer’s disease or dementia.

A POA that will not be entirely helpful when it comes to Medicaid is a general or non-durable power of attorney. This type of POA is also effective immediately, but the powers of the agent/adult child end when the principal/elder is incapacitated, and therefore won’t allow the agent to perform the tasks needed for Medicaid application.


POAs do not give the agent (typically an adult child) full control of the life and possessions of the principal (usually an elder parent). Instead, the agent’s powers must be specifically detailed in the wording of the POA document. For Medicaid Long Term Care purposes, the principal should grant the agent control in two key areas – health care and finances.

With a DPOA for health care, the agent can decide if the principal needs to live in an assisted residential setting like a nursing home facility or Alzheimer’s care unit; the agent can make decisions regarding the principal’s health care options such as surgery, in-home health care and hospitalization; and the agent can choose the principal’s healthcare professionals and types of medications.

Even though the agent for the health care DPOA can make all of these choices, they can not use the principal’s funds to pay for the health care without approval from the agent for the financial DPOA. The health care and financial DPOA agent can be the same person, but they do not have to be.

The financial DPOA allows the agent to manage the principal’s finances – access bank and retirement accounts, write checks, pay bills, file taxes, manage real estate, file insurance claims, etc. The financial DPOA also allows the agent to apply for benefits like Medicaid for the principal, and just as importantly, access all the documentation needed in the Medicaid Long Term Care application process. Required documents for the application include year-end statements from all bank accounts, investments, IRAs, 401Ks and annuities for the last five years to satisfy Medicaid’s “look back” rules (except in California, where the look back period is 2.5 years instead of 5) as well as proof of all income streams (pensions, interest, royalties, wages) from the payer, and copies of all life insurance policies and trusts.

A Certified Medicaid Planner can help navigate all the DPOA permutations and options for your particular case. To schedule a free consultation with a Certified Medicaid Planner, start here.


The truth is it’s never too early to get a DPOA because the creation of a DPOA does not mean the principal (usually an elder parent) is incompetent, nor does it take away the principal’s rights to make financial, health care or any other kind of decision on their own. It simply means that if the principal is incapacitated and can no longer make their own decisions, the agent (typically an adult child) will do so on their behalf.

An elder can also grant an adult child, or another family member, power of attorney in a living will, as long as the elder was mentally capable while creating that living will.

POAs for Persons with Dementia / Alzheimer’s

If an elder is the early stages of Alzheimer’s or some other form dementia and still has the capacity to understand what the power of attorney documents mean and what powers they transfer, they can still create a DPOA. In cases like this, consulting with a Certified Medicaid Planner is strongly recommended.

Understanding how state Medicaid offices evaluate Alzheimer’s / dementia cases is critical because Medicaid applications could be ruled invalid if POA documents were created by someone the state considers incapacitated by those conditions. If that happens, the elder could become a ward of the state and family members would have to go to court to gain guardianship (also known as conservatorship) of the elder.

Read more related articles at:

Importance of Durable Powers of Attorney for Finance and Health Care to Medicaid

FloridaMedicaid.com/Durable Power Of Attorney

Also, read one of our previous Blogs here:

How Medicaid And Medicare Fit Into Planning For Long-Term Care

Click here to check out our On Demand Video about Estate Planning.

Click here for a short informative video from our own Attorney Bill O’Leary.


No One Knows The Time Or Hour…Incapacity Planning

No One Knows The Time Or Hour…Incapacity Planning

No One Knows The Time Or Hour…Incapacity Planning.

“However, no one knows the day or hour when these things will happen, not even the angels in heaven” Matthew 24:36

The first thing to discuss is how to prepare for even a temporary incapacity, like creating documents to allow another to care for children and pets if you have a long stay in the hospital. You may also want someone to take over paying bills and have someone secure firearms and other tangible property in your home that might be stolen. You may even need to have someone clean out perishable food in the refrigerator.

Further, in this digital age, you will need to set up who can access your data if you are incapacitated, and provide passwords and usernames. The document to give someone the authority to act on your behalf is a durable power of attorney. This appointment of an agent to act on your behalf can be a general power or a limited power.

The second thing to do is to tell people what you would like to have done. This can be in the form of a letter, but to make your wishes legally binding it will need to be in the form of a will or a trust. Some things you can decide for yourself, such as funeral arrangements with a prepaid funeral contract. Make sure that these and other documents are held in a secure place and where someone can access them in an emergency. Here is a quick Estate Planning Document Checklist:

‡        Durable Power of Attorney

‡       Health Care Proxy

‡       Revocable Trusts

‡       Irrevocable Trusts

‡       Declaration of Homestead

‡       Beneficiary Designation Forms

‡       Retirement accounts

‡       Life insurance

‡       Annuities

In addition, you should discuss how decisions are too be made, and by whom, if you are incapacitated – even going as far as a written procedure for friends and family. Also, make a detailed outline of your wealth trasnfer wishes and then review your documents – do your documents match you estate planning desires? If so, are your assets are titled correctly and have you set up the appropriate beneficiary designation forms? If not, then consider revision of those documents. Finally, make sure current copies of those documents go to the correct people. No One Knows The Time Or Hour…Incapacity Planning.

Read more related articles here:

5 Legal Facts You Need to Know About Incapacity Planning

Legal Planning for Incapacity

Also, read one of our previous Blogs here:

How Can I Plan For Incapacity?

Click here to check out our On Demand Video about Estate Planning.

Click here for a short informative video from our own Attorney Bill O’Leary.


worlds oldest woman

The world’s oldest person, Japan’s Kane Tanaka, dies at age 119

The world’s oldest person, Japan’s Kane Tanaka, dies at age 119

April 25, 20225:42 PM ET


The world’s oldest person, Japan’s Kane Tanaka, dies at age 119. Kane Tanaka, born in 1903, smiles as a nursing home celebrates three days after her 117th birthday in Fukuoka, Japan, on Jan. 5, 2020.

Although she didn’t quite make it to her goal of 120 years old, Kane Tanaka still lived long enough to become the world’s oldest person — a title she held for the past three years, and attributed to family, sleep, hope and faith.

Tanaka died last week at 119, Japanese authorities announced. Tanaka, who had been living at nursing home in Fukuoka, died on Tuesday at a hospital.

According to Guinness World Records, Tanaka was born prematurely on Jan. 2, 1903 — the same year the Wright brothers brought powered flight to the world. She was the seventh child in her family.

She had four children and adopted a fifth.

Tanaka loved chocolate and soda. During a 2019 presentation ceremony to celebrate her being the oldest person alive, she was given a box of chocolates — which she immediately opened and began devouring.

Tanaka was tapped to carry the Olympic torch during as part of the torch relay leading up to the Olympic Games in Tokyo, but her relatives deemed it too risky given COVID-19.

Earlier this month, Tanaka surpassed Sarah Knauss of the U.S. to become the second-longest lived person in recorded history. Jeanne Louise Calment, a French woman who died in 1997, remains the longest-lived person at 122 years and 164 days.

The oldest currently living person is now said to be Lucile Randon, a 118-year-old French nun. Randon is also the oldest known survivor of COVID-19.

Read more related articles at:

World’s oldest person, Kane Tanaka, dies at age 119

Life Expectancy by State 2022

Also, read one of our previous Blogs at:

What Is Elder Law?

Click here to check out our On Demand Video about Estate Planning.

Click here for a short informative video from our own Attorney Bill O’Leary.

long term care

Do I Need To Think About Long Term Care?


Do I Need To Think About Long Term Care?


Many older adults and caregivers worry about the cost of medical care. These expenses can use up a significant part of monthly income, even for families who thought they had saved enough.

How people pay for long-term care—whether delivered at home or in a hospital, assisted living facility, or nursing home—depends on their financial situation and the kinds of services they use. Often, they rely on a variety of payment sources, including personal funds, government programs, and private financing options.

Personal Funds (Out-of-Pocket Expenses)

At first, many older adults pay for care in part with their own money. They may use personal savings, a pension or other retirement fund, income from stocks and bonds, or proceeds from the sale of a home.

Much home-based care is paid for using personal funds (“out of pocket”). Initially, family and friends often provide personal care and other services, such as transportation, for free. But as a person’s needs increase, paid services may be needed.

Many older adults also pay out-of-pocket to participate in adult day service programs, meals, and other community-based services provided by local governments and nonprofit groups. These services help them remain in their homes.

Professional care given in assisted living facilities and continuing care retirement communities is almost always paid for out of pocket, though, in some states, Medicaid (see below) may pay some costs for people who meet financial and health requirements.

Look up what long-term care costs in your area.

Government Programs

Older adults may be eligible for some government healthcare benefits. Caregivers can help by learning more about possible sources of financial help and assisting older adults in applying for aid as appropriate. The Internet can be a helpful tool in this search.

Several federal and state programs provide help with healthcare-related costs.

Centers for Medicare & Medicaid Services

The Centers for Medicare & Medicaid Services (CMS) offers several programs. Over time, the benefits and eligibility requirements of these programs can change, and some benefits differ from State to State. Check with CMS or the individual programs directly for the most recent information.


Medicare is a Federal Government health insurance program that pays some medical costs for people age 65 and older, and for all people with late-stage kidney failure. It also pays some medical costs for those who have gotten Social Security Disability Income (discussed later) for 24 months. It does not cover ongoing personal care at home, assisted living, or long-term care. Here are brief descriptions of what Medicare will pay for:

Medicare Part A:

  • Hospital costs after you pay a certain amount, called the “deductible”
  • Short stays in a nursing home to get care for a hospital-related medical condition
  • Hospice care in the last 6 months of life

Medicare Part B:

  • Part of the costs for doctor’s services, outpatient care, and other medical services that Part A does not cover
  • Some preventive services, such as flu shots and diabetes screening

Medicare Part D:

Call Medicare at 1-800-633-4227TTY: 1-877-486-2048 to find out what costs Medicare will cover for your situation, or visit the Medicare website for more information.


Some people may qualify for Medicaid, a combined Federal and State program for low-income people and families. This program covers the costs of medical care and some types of long-term care for people who have limited income and meet other eligibility requirements. Who is eligible and what services are covered vary from State to State.

To learn more about Medicaid, call 1-877-267-2323, TTY: 1-866-226-1819, or visit the Medicaid website. Or, contact your State health department. For a State-by-State list, visit Medicaid’s State Overviews page.

Program of All-Inclusive Care for the Elderly (PACE)

Some States have PACE, Program of All-Inclusive Care for the Elderly, a Medicare program that provides care and services to people who otherwise would need care in a nursing home. PACE covers medical, social service, and long-term care costs for frail people. It may pay for some or all of the long-term care needs of a person with Alzheimer’s disease. PACE permits most people who qualify to continue living at home instead of moving to a long-term care facility. You will need to find out if the person who needs care qualifies for PACE. There may be a monthly charge. PACE is available only in certain States and locations within those States.

To find out more about PACE, call 1-877-267-2323, or visit the PACE website or Medicare’s PACE page.

State Health Insurance Assistance Program (SHIP)

SHIP, the State Health Insurance Assistance Program is a national program offered in each State that provides counseling and assistance to people and their families on Medicare, Medicaid, and Medicare supplemental insurance (Medigap) matters.

To contact a SHIP counselor in your State, visit the SHIP National Technical Assistance Center website.

Department of Veterans Affairs

The U.S. Department of Veterans Affairs (VA) may provide long-term care or at-home care for some veterans. If your family member or relative is eligible for veterans’ benefits, check with the VA or get in touch with the VA medical center nearest you. There could be a waiting list for VA nursing homes.

To learn more about VA healthcare benefits, call 1-877-222-8387, or visit the Veterans Health Administration or the Veterans Affairs Caregiver Support page. You can also find more information at Geriatrics and Extended Care: Paying for Long-Term Care.

Social Security Administration Programs

Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) programs provide financial assistance to people with disabilities.

SSDI is for people younger than age 65 who are disabled according to the Social Security Administration’s definition. To qualify, you must be able to show that:

  • You are unable to work because of your medical condition
  • Your medical condition will last at least a year or is expected to result in death

Processing an SSDI application can take three to five months. However, Social Security has “compassionate allowances” to help people with Alzheimer’s diseaseother forms of dementia, and certain other serious medical conditions get disability benefits more quickly.

SSI is another program that provides monthly payments to adults age 65 and older who have a disability. To qualify, your income and resources must be under certain limits.

To find out more about these programs, call 1-800-772-1213TTY: 1-800-325-0778, or visit the Social Security Administration.

National Council on Aging (NCOA)

The National Council on Aging, a private group, has a free service called BenefitsCheckUp®. This service can help you find Federal and State benefit programs that may help your family. After providing some general information about the person who needs care, you can see a list of possible benefit programs to explore. These programs can help pay for prescription drugs, heating bills, housing, meal programs, and legal services. You don’t have to give a name, address, or Social Security number to use this service.

To learn more about BenefitsCheckUp®, call 1-571-527-3900, or visit BenefitsCheckUp®.


For more information about Federal, State, and local government benefits, go to Benefits.gov or call 1-800-FED-INFO (1-800-333-4636).

Private Financing Options for Long-Term Care

In addition to personal and government funds, there are several private payment options, including long-term care insurance, reverse mortgages, certain life insurance policies, annuities, and trusts. Which option is best for a person depends on many factors, including the person’s age, health status, personal finances, and risk of needing care.

Long-Term Care Insurance

Long-term care insurance covers many types of long-term care and benefits, including palliative and hospice care. The exact coverage depends on the type of policy you buy and what services are covered. You can purchase nursing home-only coverage or a comprehensive policy that includes both home care and facility care.

Many companies sell long-term care insurance. It is a good idea to shop around and compare policies. The cost of a policy is based on the type and amount of services, how old you are when you buy the policy, and any optional benefits you choose.

Buying long-term care insurance can be a good choice for younger, relatively healthy people at low risk of needing long-term care. Costs go up for people who are older, have health problems, or want more benefits. Someone who is in poor health or already receiving end-of-life care services may not qualify for long-term care insurance.

Reverse Mortgages for Seniors

A reverse mortgage is a special type of home loan that lets a homeowner convert part of the ownership value in his or her home into cash. Unlike a traditional home loan, no repayment is required until the borrower sells the home, no longer uses it as a main residence, or dies.

There are no income or medical requirements to get a reverse mortgage, but you must be age 62 or older. The loan amount is tax-free and can be used for any expense, including long-term care. However, if you have an existing mortgage or other debt against your home, you must use the funds to pay off those debts first.

Life Insurance Policies for Long-Term Care

Some life insurance policies can help pay for long-term care. Some policies offer a combination product of both life insurance and long-term care insurance.

Policies with an “accelerated death benefit” provide tax-free cash advances while you are still alive. The advance is subtracted from the amount your beneficiaries (the people who get the insurance proceeds) will receive when you die.

You can get an accelerated death benefit if you live permanently in a nursing home, need long-term care for an extended time, are terminally ill, or have a life-threatening diagnosis such as AIDS. Check your life insurance policy to see exactly what it covers.

You may be able to raise cash by selling your life insurance policy for its current value. This option, known as a “life settlement,” is usually available only to people age 70 and older. The proceeds are taxable and can be used for any reason, including paying for long-term care.

A similar arrangement, called a “viatical settlement,” allows a terminally ill person to sell his or her life insurance policy to an insurance company for a percentage of the death benefit on the policy. This option is typically used by people who are expected to live 2 years or less. A viatical settlement provides immediate cash, but it can be hard to get.

Using Annuities to Pay for Long-Term Care

You may choose to enter into an annuity contract with an insurance company to help pay for long-term care services. In exchange for a single payment or a series of payments, the insurance company will send you an annuity, which is a series of regular payments over a specified period of time. There are two types of annuities: immediate annuities and deferred long-term care annuities.


A trust is a legal entity that allows a person to transfer assets to another person, called the trustee. Once the trust is established, the trustee manages and controls the assets for the person or another beneficiary. You may choose to use a trust to provide flexible control of assets for an older adult or a person with a disability, which could include yourself or your spouse. Two types of trusts can help pay for long-term care services: charitable remainder trusts and Medicaid disability trusts.

Read more related articles at:

What Is Long-Term Care?

How long-term care planning can help your loved ones

Planning for Long-Term Care Your Resource Guide

Also, read one of our previous Blogs at:

How Do I Protect Property If I Need Long-Term Care?

Click here to check out our On Demand Video about Estate Planning.

Click here for a short informative video from our own Attorney Bill O’Leary.


end of life planning

What to know about end-of-life planning

What to know about end-of-life planning.

What to know about end-of-life planning. End-of-life planning refers to the steps a person takes to get their affairs in order and determine how they want to spend their last days. Also known as advance care planning, it typically involves a person completing a living will, a healthcare proxy, and a last will and testament.

Whether a person is well or facing a terminal illness, end-of-life planning helps ensure that those who care for them can carry out their last wishes. While it may be a difficult subject to consider and discuss, it is important for a person to have their affairs in order to help facilitate a smooth process after their passing.

In this article, we will discuss what people can expect with end-of-life planning.

End-of-life planningTrusted Source provides people with tools to control their financial and healthcare decisions while they can still take part in the decision-making process. A person usually starts advance care planningTrusted Source steps with a healthcare professional. They can involve conversations with caregivers about what they would want in the event of a life threatening illness or injury.

This type of planning may helpTrusted Source alleviate unnecessary pain and discomfort, improve quality of life, and provide a better understanding of decision-making challenges for a person and their caregivers.

Individuals do not need a lawyer for an advance directive, living will, or healthcare proxy. But a person may need legal help for special circumstances and power of attorney. The National Institute on Aging has an easy-to-follow checklistTrusted Source to help a person make legal and financial plans now for their healthcare in the future.

End-of-life planning involves forethought to ensure that a person receives healthcare treatment consistent with their wishes and preferences, should they be unable to make their own decisions or speak for themselves. It can require people to answer specific and difficult questions about death and dying. Questions a person may want to consider include:

  • Do I need or have a will?
  • Does my family know where I keep my important papers?
  • Do I have life insurance or money set aside for burial, cremation, or funeral expenses?
  • How and where do I wish to die if I have a choice?
  • Do I want lifesaving measuresTrusted Source if or when they become necessary?
  • Is palliative care right for me?
  • How do I want my body handled after my death?
  • Do I have social media accounts that need closure?
  • Do I want to donate my organs or my body?
  • Do I want a death announcement or an obituary? What do I want in it?
  • What sort of memorial do I want, if any?
Read more relkated articles at:

One Woman Helps Others Make Sure End-Of-Life Planning Is ‘Good To Go’

Getting Your Affairs in Order

Also, read one of our previous Blogs here:

End-Of-Life Planning Is A ‘Lifetime Gift’ To Your Loved Ones

Click here to check out our On Demand Video about Estate Planning.

Click here for a short informative video from our own Attorney Bill O’Leary.



chronic care

Planning For Chronic Illness Is Not Just For The Elderly

Planning For Chronic Illness Is Not Just For The Elderly

Planning For Chronic Illness Is Not Just For The Elderly. A common misconception is that estate and financial planning for chronic illness is an elder law or elder abuse issue. This myth is not true. Martin Shenkman explained in an e-mail, “Sixty percent of those living with chronic illness are age 18-64. The characterization of all this planning as elder law or elder abuse makes it harder for those who are young and have chronic health issues to find help. Our society doesn’t focus on this situation.”

While some elderly experience chronic illness, it is not exclusive to them. Chronic illness can happen to any one of any age and proper estate planning just makes sense to protect you or a loved one now and in the future. With chronic illness somestimes comes incapacity, the inability to make decsions on ones own. In the case of becoming incapacitated, one will need a trusted representative to handle their financial and healthcare affairs. Proper estate planning can ensure that a persons wishes are met provided they become incapacitated and unable to decide for themselves.

Whether a person with a chronic illness is young, middle aged, or elderly, there is a need for proper estate planning at least at the simplest of levels. Powers of attorney can help one establish trusted personal representatives to help administer their affairs in case of incapacity. Because laws vary from state to state and upon different circumstances, it is wise to seek legal counsel when trying to establish powers of attorney and other estate planning documents.

Read more related articles at:

Estate Planning Musts When You Or A Or A Loved One Has A Chronic Illness

Supporting Older Patients with Chronic Conditions

Also, read one of our previous Blogs at:


Click here to check out our On Demand Video about Estate Planning.

Click here for a short informative video from our own Attorney Bill O’Leary.


disabled voting

7 Ways New Voting Laws Can Affect People With Disabilities.

7 Ways New Voting Laws Can Affect People With Disabilities.

7 Ways New Voting Laws Can Affect People With Disabilities. A July 13, 2021, Opinion piece in the Washington Post, by Katrina vanden Heuvel, offered a rare look at a comparatively neglected aspect of the current fight to preserve voting rights: safe, flexible, and accessible voting for people with disabilities. It’s a perspective well known in the disability community, but seldom covered as strongly in the “mainstream” press.

As states take action to more tightly regulate and restrict voting methods, many within the disability community and outside it are taking notice, and see significant risks ahead to disabled people’s right and access to the vote.

“There are hundreds of anti-voter bills in states across the country that would present barriers to disabled people voting privately and independently,” says Dom Kelly, founder and leader of Fair Fight Action’s Disability Council. He adds, “Most of the new anti-voter laws we have seen enacted in a number of states will make voting more difficult for disabled folks.”

These threats are not solely or even primarily targeted against voters with disabilities, though the new and proposed measures themselves would significantly hamper disabled people’s actual access to voting. The more familiar focus has been on two intersecting and overlapping trends:


  1. Making voting more difficult and cumbersome in ways that disproportionately affect Black voters, other voters of color, and low income voters.

Measures prompted by a conviction, repeatedly shown to be unfounded, that voter fraud is a significant problem –– an idea vastly intensified by the mostly partisan belief that the 2020 Presidential election was “stolen” from Donald Trump through voter fraud.

These are not separate problems from voting accessibility for disabled people. Many disabled voters are also people of color, low income, and have other marginalized identities that make their voting status additionally fragile. And disabled voters are no less invested in secure and honest vote-counting than anyone else.

But some of the specific ways that disabled people in particular may see their access to a free and independent vote damaged aren’t widely recognized or understood right now, except by the disability community itself and some of its advocacy organizations.

toolkit on voting rights and access from the American Association of People with Disabilities and the #RevUp disabled voter registration campaign identifies several types of measures that directly affect disbaled voters’ access to an unfettered and independent vote, including:


  • “Restricting access to mail-in voting
  • Increasing voter ID requirements
  • Reducing opportunities to vote
  • Reducing voter registration opportunities
  • Limiting the availability of ballot drop boxes
  • Purging registered voters”


Dom Kelly of Fair Fight Action, who has Cerebral Palsy himself, notes that these threats are not remote or speculative. He cites already passed and pending measures in Florida, Georgia, and Texas that would add layers of repeated bureaucracy to vote by mail requests, and in some cases narrow the criteria and raise the bar for disabled people to even qualify to vote by mail. A Texas proposal would even permit poll watchers to go so far as to enter a disabled person’s vehicle to watch them fill in their ballot in curbside voting. This takes vigilance to extreme and intrusive lengths that are hard to imagine any voter tolerating, even if it was the only practical way they could cast their vote.

Here are 7 types of policies, considered in some states, already passed in others, that hinder disabled people’s ability to vote freely, independently, and safely. Again, 7 Ways New Voting Laws Can Affect People With Disabilities.

1. Voter ID requirements

The most frequently used form of photo identification is a driver’s license. And a higher proportion of disabled people than average don’t drive, and don’t have a driver’s license. This creates another bureaucratic task for many disabled people, the need to acquire an acceptable form of ID.

While this may seem like a small task to most observers, it’s important t0 remember that bureaucratic tasks themselves are often harder for disabled people, who may encounter barriers in finding transportation to government offices, difficulty completing forms, and even complications sending and receiving postal mail.

For many people with disabilities, additional voter ID requirements simply add another layer of logistical difficulty in the voting process –– another choke point where a disabled person’s drive to vote can be disrupted.

2. Eliminating or reducing early voting

As already noted, many disabled people can’t simply hop in the car and drive to their local polling place when the moment is convenient for them. Many must rely on public transportation, long treks over streets and sidewalks of unreliable accessibility, and help from friends, relatives, or neighbors.

That is why it is often even more difficult for disabled people to complete multi-step logistical tasks, like getting to and from a polling place, when it can only be done on a particular day in a limited time. Early voting over a span of days makes it easier to schedule or reschedule transportation, and any assistance that a disbaled person might need.

And if logistical problems crop up, or a disabled person doesn’t feel well on the day they originally planned, early voting means they are more likely to be able to try again on another day. A single day of voting offers little or no margin for error or mishap –– another way disabled people’s path to a vote can be narrowed or even closed off.

3. Narrowing options for mail-in and absentee voting

While many disabled people feel strongly about voting in person, others have always used absentee voting, rather than risk potential problems at inconsistently accessible and poorly staffed polling places. In fact, one of the long-standing implicit arguments against making polling place accessibility a priority is the idea that a disabled person can simply vote by absentee.

In their report on disabled voter participation in the 2020 election Lisa Schur and Douglas Kruse of Rutgers University found that the expansion of available mail-in voting in some states helped increase disabled voter turnout.

While absentee voting shouldn’t be offered instead of accessible polling places, it should always be as free and simple an option as possible, as it reduces many of the logistical and scheduling problems with on-site, Election Day voting. Scaling back the expansion of mail-in voting, or making it even harder than before the pandemic, would close off yet another more accessible method of voting for people with disabilities. It’s a step that seems even less necessary considering the fact that absentee ballots has been a part of the voting process for many decades. It is a time-tested method, not a radical new idea.

4. Eliminating ballot drop-boxes

While mailing an envelope is in some ways easy and low-cost, few people these days use postal mail, and many don’t have stamps on hand, or have easy access to a mailbox or post office. Drop boxes are another option for disabled people to deliver absentee ballots, and may be more reliable than postal delivery.

Using a drop box can be easier than mailing in certain circumstances. And again, more options is always better for disabled people than fewer.

5. Prohibiting on-site aide for people waiting at the polls

Disabled people who do go to properly accessible polls with fully trained poll workers usually find it a relatively easy, in-and-out process. But some districts in some areas are chronically overrun with voters, resulting in long waits in line.

Almost any kind of disability makes waiting for a long time to vote exponentially harder, and for some outright impossible. A disabled person with every intention to vote may well simply go home if they literally cannot face a 2 hour wait in line. And once you give up on Election Day, there may be no other way to vote. The small window of opportunity is closed.

Being able to get a drink of water or a snack from a volunteer can make a big difference, or all the difference. From this perspective, prohibiting this kind of basic, non-political aide to people at the polls seems not just petty, but a real deterrent to voters with disabilities.

6. Paper-only ballots

One idea that enjoys wide bipartisan support is a “return” to paper-only ballots. This is seen as more secure than voting involving machines or electronics. And paper ballots are understood to be less prone to tampering, especially for those who have an instinctive distrust of digitial and internet technology.

But paper ballots pose a specific problem for some disabled voters.

As the National Council on Independent Living notes:

“A paper ballot mandate would not allow for complete privacy and independence for voters with disabilities. It prohibits fully digital voting which allows voters to read, mark, verify, and return their ballot completely electronically.“

Paper ballots are not reliably accessible to blind and visually impaired voters, or those who physically can’t make a paper ballot with a pen. And current paper ballot proposals don’t adequately address this problem, including the paper ballot provisions in the For The People Act, which in other ways would protect the right to vote and voting accessibility. The fact than this otherwise very promising and progressive bill still fails to ensure accessibility for all disabled voters is unfortunate but not uncommon. Disability activists have to remain vigilant at all times in the legislation process, no matter which party or ideology they are working with.

7. Making Election Day a holiday

It’s not only more “restrictive” measures that would harm disabled people’s access to voting. Even measures fully intended to make voting easier for everyone could have perverse effects on disabled voters.

Many disabled people have no other way to get to the polls than to use public transportation. Many others rely on personal care staff and other government workers in the community to be able to complete multi-step tasks outside the home.

That’s why making Election Day a holiday could actually make getting to the polls and back harder for disabled people who depend on workers who will themselves have the day off to vote. It’s another example of a well-intended idea that has the right goal, but lacks key input from the disability community.

Almost any changes in voting laws and regulations that add steps and requirements, or narrow options for how and when to vote, will discourage disabled people from voting. Even when these changes don’t actually prevent a disabled person from voting, they make voting harder.

When you tell a disabled person that there’s only one acceptable way to do a thing, at a very specific time and place, that poses a very real accessibility problem. It’s the same when you add more steps to any task. Disabled people in particular need to be able to do typical things in different ways, with fewer intermediate steps. It’s different for every disabled person of course, but more options, fewer steps is fundamental to just about every aspect of disabled life, including the fundamental right and indispensable civic function of voting.

Like most other disabled activists, Dom Kelly wants voting systems that ensure disabled people’s right to vote “privately, independently, and fairly.”

His vision for voting that is truly accessible to people with disabilities includes:


  • Being able to choose how to cast their votes from among several options of location, timing, and method;
  • Proper training for poll workers so they treat disabled voters with due respect and ensure a smooth and independent voting experience;
  • Disabled people involved in designing truly accessible and independent voting systems that encourage voting rather than just meet “the bare minimum” of technical accessibility.


None of this is incompatible with secure voting free from undue influence. And all of it is essential to making sure eligible disabled people have both the right and practical access to vote. Now you know the 7 Ways New Voting Laws Can Affect People With Disabilities.

Read more related articles at:

New restrictions causing roadblocks for voters with disabilities

New Voting Laws May Impact Those Who are Disabled

Also, read more one of our previous Blogs here:

New Data Shows Support For The Equality Act Including Those With Special Needs.

Click here to check out our On Demand Video about Estate Planning.

Click here for a short informative video from our own Attorney Bill O’Leary.


nursing care

Getting Paid to Care for Mom or Dad. Are You Eligible?


Many adult children wonder if they can be compensated for the countless hours that they spend caregiving for their aging parents. This is especially true with those family members who are caring for a loved one with Alzheimer’s or another form of dementia. The short answer to this question is yes, it is possible. Unfortunately, the short answer is insufficient, as the subject is complex. Many variables impact whether a loved one who requires care is eligible for such assistance, and what many people fail to ask, is if they, themselves as caregivers, are eligible.

The article that follows comprehensively explores the many different options and programs that can be used to pay family members as caregivers. However, this in-depth exploration makes for heavy reading and many of the programs won’t be relevant to the reader based on varying eligibility criteria, such as veteran’s status, income, or state of residence. An alternative approach is to use our Paid Caregiver Program Locator. This interactive tool asks a series of questions and provides the reader with a list of programs that are relevant to their family’s situation.

Medicaid Options

Of all the programs that pay family members as caregivers, Medicaid is the most common source of payment. Medicaid has eligibility requirements that apply to the program participant and it has rules that dictate who is allowed to provide them with care. While Medicaid is historically thought of as paying for nursing home care, modern Medicaid programs offer assistance options outside of nursing homes, in the beneficiary’s home or primary place of residence. We have identified four types of Medicaid programs / options that allow family members to be paid as caregivers. The bad news is that not all four are available in every state, but the good news is at least one of the four is available in every state.

HCBS Waivers and 1915(c) Waivers

The first and most common Medicaid option is Medicaid Waivers. These are often called HCBS Waivers, short for Home and Community Based Services, or 1915(c) Waivers or occasionally Section 1115 Waivers. Waivers allow states to pay for care and support services for individuals residing outside of nursing homes. Commonly, they pay for personal care (assistance with activities of daily living, such as eating, dressing, and mobility) and chore services provided for elderly or disabled persons who live in their homes or the homes of family members.

Most states’ Medicaid Waivers have an option called “Consumer Direction”. Consumer direction allows the beneficiary (the ”consumer” or the “care recipient”) to direct or choose from whom they receive care services. With this option, the care recipient can choose to receive care from a family member, such as an adult child, and Medicaid will compensate the adult child  for providing care for the elderly parent. In most cases, the adult child / caregiver is paid the Medicaid approved hourly rate for home care, which is specific to their state. In very approximate terms, caregivers can expect to be paid between $9.00 – $19.25 per hour.

It is important to note that the phrase “consumer direction” is not used in all states. However, the concept of consumer direction is available in all states. A variety of other terms or phrases are employed to describe this same concept. Depending on one’s state, alternative language may include Participant Directed Services, Self-Directed Care, Cash and Counseling, Choice Programs, and Self-Administered Services.

Waivers are offered as an alternative to nursing home care. Waiver names, eligibility requirements, and benefits are different in each state. While nursing home Medicaid is an entitlement, Waivers are not entitlements. They are enrollment capped, meaning there is a select number of people who can be enrolled in the program, and waiting lists are fairly common. A complete list of Waivers that allow family members to be paid as caregivers is available here.

Medicaid Personal Care Services

State Medicaid programs often cover personal care under their regular Medicaid program, sometimes referred to as their “Medicaid State Plan”. Unlike Waivers, regular Medicaid is an entitlement program; if an applicant meets the eligibility requirements, then they can receive benefits. Waiting lists do not exist. Please note that some states elect to offer personal care services in the home and community through their state plan via an option called Community First Choice (CFC).

Similar to how Waivers offer consumer direction of services, State Plan Personal Care often allows the beneficiary to choose their care provider. Family members, including adult children can be chosen to provide care for their mothers and fathers. Again, like Waivers, the adult children caregivers are paid the Medicaid approved hourly rate for their efforts. During the initial enrollment process, the elderly individual is assessed, and it is determined how many hours per week they require care services. A list of state Medicaid programs that offer the choice of provider in their personal care benefit is available here. Readers should be aware of the various names these programs use, which include Personal Assistance Services (PAS), Personal Care Assistance (PCA), Attendare Care, and Personal Attendants. Sometimes, states don’t make a point to distinguish this option as a separate program, they just call it the personal care benefit under their regular Medicaid program.

Medicaid Caregiver Exemption

The Caregiver Exemption is also referred to as the Child Caregiver Exception. This option does not directly pay the adult child for their caregiving efforts on an hourly basis, but instead compensates them indirectly. To better understand this option, some background information on Medicaid eligibility is required. Eligibility for elderly persons is based largely on their income and their assets. One’s home, provided it is lived in by the Medicaid participant, is considered an exempt asset. However, if one moves from their home (into a nursing home, for example), then their home is no longer considered an exempt asset (unless their spouse lives there or the Medicaid recipient expresses an intent to return home). When the elderly person passes away, their state may try to take the home or some of the home’s value as reimbursement for the elderly person’s care. This is known as Medicaid Estate Recovery.

The Caregiver Exemption allows the adult child who provides care for their elderly parent in their parent’s home to inherit the home, instead of the state taking the home under Estate Recovery rules. There are additional requirements. The adult child must live in the home with their parent and provide care for at least two years. The level of care they provide must prevent their parent from being placed in a nursing home and they must have the medical documentation to validate this fact.

How much the adult child receives in compensation depends on the value of the home and their parent’s equity in the home.

The Caregiver Exemption is complicated. Therefore, it is strongly advised that families plan in advance for this option to avoid both Medicaid and family conflicts. One can read more about the Caregiver Exemption here or connect with a Medicaid planning expert to discuss if, and how this option, would work for your family.

Adult Foster Care

In a limited number of states, Medicaid allows the adult children to become adult foster care providers for their aging parent(s). In this situation, the aging parent moves into their adult child’s home. The caregiver / child is responsible for providing personal care, assistance with the activities of daily living, meals, transportation to medical appointments, and other supports. Medicaid will continue to fund the elderly parent’s medical care, prescriptions, etc. In return, the adult children are compensated by Medicaid for their care services, but not for room and board. Medicaid, by law, cannot pay for room and board. However, many states offer supplemental financial assistance from state funds to Medicaid beneficiaries who live in an adult foster home situation. This additional financial assistance is intended for room and board expenses. To summarize, the adult children caregivers will be compensated from two sources, Medicaid and the state’s supplemental program. It is estimated that the caregiving child will be compensated between $1,550 – $2,550 per month, dependent on the level of care required by their aging parent and, of course, their state of residence. State Medicaid programs offering adult foster care.

Programs for Veterans

Veterans Directed Home and Community Based Services

This program is often abbreviated as VD-HCBS or referred to informally as Veterans Directed Care. The program is open to any veteran who is currently enrolled in the VA health care system whose care requirements are such that “nursing home level care” is required. Under Veterans Directed Care, veterans are able to select from whom they receive care services. Veterans with a certain level of care needs, require personal care or personal care attendants. This program gives veterans the option to hire whoever they choose, including family members, such as their adult children to provide them with personal care services.

Adult children caregivers are paid an hourly rate. This rate is determined annually by Veterans Health Administration and modified for regional differences in home care costs. It is difficult to accurately project what caregivers will receive, as each veteran is assessed for a different amount of home care assistance. That said, caregivers might expect to be compensated between $8.44 – $20.00 per hour for their efforts.

The program is run at the local level through participating VA Medical Centers. See a list of participating VAMCs here.

Veteran’s Aid & Attendance and Housebound Pensions

The veterans’ pensions, which are called the Aid & Attendance and Housebound benefits, are programs specifically designed for wartime veterans and their spouses. How they can be used to pay individuals to provide care for their aging parents is a little complicated. It is important to understand that the dollar amount of pension that a veteran or their spouse receives depends on their current, non-pension related income. The second important factor is when calculating income, the Department of Veterans Affairs allows the beneficiary to deduct all care related expenses from their income. This can include the cost of personal care assistance provided by an individual or home care agency. Therefore, an aging parent can hire their adult child as a private caregiver. The adult child invoices their parent for their caregiving services, the parent deducts those invoices from their income, and the VA increases their pension check by the amount of the invoices. While confusing and seemingly roundabout, this approach is well documented, legal, and encouraged by many VA benefits experts. Learn more about the Aid & Attendance and Housebound Pensions or connect with a VA Pension planning expert to determine if your family is eligible and to discuss if either of these approaches can work for you.

Other Options

State Based, Non-Medicaid Programs

The concept of Consumer Direction (discussed under Medicaid) is not limited to Medicaid programs. Most states offer what are loosely categorized as nursing home diversion programs. These are state funded programs that provide assistance to elderly individuals who live at home with the objective of preventing unnecessary placement of these persons in Medicaid-funded nursing homes. Some of these state programs allow for consumer direction of care services. Phrased another way, program participants are given the flexibility to choose their own caregivers. This allows participants to choose their adult children to provide them with care services and assistance, instead of working with a state-chosen caregiver or home care agency. Caregivers are paid a rate comparable with the average hourly rate for home care in their geographic area.

Unfortunately, these programs are not available in every state. Further limiting this option is the fact that some programs allow for consumer direction, but do not allow family members to be hired. Finally, many of these programs are means-tested (this means eligibility is based on the financial resources of the participant). See a list of state programs that allow consumer direction here.

Life Insurance

Persons with life insurance policies with a death benefit valued at over $50,000 can use those policies to pay family members to provide care. As with many of the programs described in this article, the process is complicated. The policyholder, while living, engages in what is called a life settlement. A life settlement is the sale of one’s life insurance policy to a 3rd party while the policyholder is alive. The buyer pays the policyholder a lump sum amount, they take over paying the monthly premiums, and when the policyholder passes, they collect the full amount of the death benefit. In taking this approach, the original policyholder receives a lump sum of cash from their policy while they are alive.

This money can be used directly to pay a family member, such as a son or daughter, to provide care. However, a better option exists called a Medicaid Life Settlement. This type of life settlement allows the policyholder to preserve the option to receive Medicaid in the future, should the proceeds from their life settlement run out. A more thorough investigation of this strategy and its pros & cons can be found here.

Long Term Care Insurance

Some elderly individuals that have long-term care insurance may use the benefits from that insurance to pay their children to provide them with care. Each policy is different and some policies may expressly prohibit family members from being compensated. However, such rules are relatively rare. More common is the long-term care insurance policy that requires care providers to be licensed. Fortunately, this should not prevent the family members of the policyholder from being paid to provide care. It does, however, create a minor logistical obstacle in that the son or daughter will have to obtain a business license as a care provider and register with their local authorities. While this process may sound daunting, it is in fact a fairly simple and quick process. The adult children who are now paid caregivers must declare their payment as income and pay taxes as they would with any other income.

Paid Family Leave Laws

Paid Family Leave (PFL) is a type of program that allows working individuals to take time off from their jobs (or take non-consecutive days off) to care for their family member. Paid Family Leave laws are not limited to caring for aging parents, one can also care for their children or spouses. However, caring for aging parents is most relevant to this article. The caregivers continue to receive a large percentage of their salary and they are legally protected from losing their jobs or their health insurance.

Most laws will pay the adult children for periods of between 4 – 12 weeks, so this is not a permanent solution for most families. However, the paid leave does not have to be taken in one consecutive period. Instead, the caregiving child could take one day off each week for many months. Additionally, multiple siblings could take consecutive paid family leave if they live in the same state, which when combined, can make a large impact in helping an elderly parent.

Unfortunately, not all states currently have paid family leave laws. While they are under discussion in many states, at present only California, New Jersey, New York, Rhode Island, Washington, and the District of Columbia have programs. More about each program can be found at the following links: CANJNYRI and DC. At the time of this writing, the paid family leave acts have not yet been implemented in Washington and the District of Columbia. Both are expected to be in effect in 2020.

State specific, paid family leave laws should not be confused with the national Family and Medical Leave Act (FMLA), which allows family members to take time off work to care for a loved one and protects their job and health insurance but does not offer compensation. More about the FMLA.

Tax Deductions and Credits

Tax deductions or tax credits do not pay the adult children directly as caregivers. However, they can considerably decrease the tax burden of those caring for their elderly parents. The net effect is the same, they have more money available to them as a result of their familial caregiving efforts. For persons whose parents are financially dependent on them, the medical and care expenses incurred by the aging parents can be deducted from their own income. Read about medical and care expense deductions here. Another option is the Dependent Care Credit. For persons who must pay for care for their elderly parent so that they are able to continue working, this credit is highly relevant. Expenses such as home care or adult day care, in most instances, are fully deductible under this credit. Read more.

Read more related articles here:

Also, read one of our previous Blogs at:

Should You Get Personal Care Agreement to Care for Mom?

Click here to check out our On Demand Video about Estate Planning.

Click here for a short informative video from our own Attorney Bill O’Leary.

Old lonely woman

Social Interaction Study Highlights Loneliness and Isolation as Heath Risks for Elders

Social Interaction Study Highlights Loneliness and Isolation as Heath Risks for Elders

Bernard A. Krooks

To reduce the stress of uncertainty, elder law addresses the financial, medical and legal concerns that accompany aging. It’s about ensuring that your preferences are respected, preparing for life’s uncertainties and reducing family stress. A study from the University of California, San Francisco, which examined how social interaction can impact quality of life in the elderly found that a sense of loneliness and isolation can lead to a decline in physical health, and in some cases, even early death.

Some 1,604 participants, all age 60 and older, were contacted by gerontologists every two years between 2002 and 2008. More than 43 percent of respondents reported that they were sometimes lonely. Follow-up research found that members of the self-identified “sometimes lonely” segment were 45 percent more likely to die during the six-year period than those who reported that they were satisfied with the sense of connection in  their relationships, and were 59 percent more at risk for physical decline, measured as performing daily living tasks, including bathing, dressing and eating. [1]

Reducing social isolation for elders is critical to improve their quality of life, though it’s not just an issue for the elderly. A large segment of the US population is facing a known health risk – and the fallout from that risk affects family members, communities, care givers and others.

Health professionals have long known that loneliness and social isolation directly affect older people’s physical and mental health. Even in highly populated urban areas, there are elderly-rich communities where members are living alone and suffering from a lack of social interaction.  Some 30 percent of Americans age 65 and above live alone, but the rate is significantly higher, approximately 53 percent, for older New York residents in public housing. [2]

While many seniors are well-versed when it comes to steps to take to prepare financially for retirement and potential long-term care, there is still a pervasive lack of awareness about how social groups and a sense of community can change as people age.

Other research targeting the social effects of loneliness and isolation have also shown dramatic health risks. A 2008 study from the University of Chicago found that chronic loneliness is a health risk factor comparable to smoking, obesity and lack of exercise, and contributes to a suppressed immune system, high blood pressure and increased levels of the stress hormone cortisol. A study out of Cornell in early 2012 concluded that loneliness can increase the risk of heart disease by producing changes in the body which mimic the aging process. [3]

Though more research is needed to clearly define the link that connects social factors and health, more mainstream physicians are beginning to view their elderly patients’ health concerns beyond what can be found in classic lab results. [4]

Elder law is about more than money. When viewed properly, elder law is about two major things. First, ensuring that your personal wishes—financial, medical, and legal—are carried out; and second, understanding that elder law is a family matter affecting an intricate web of individual relationships. Knowing that your potential long-term care needs have already been addressed frees you and your family from needless worry.

Read more related articles at:

Social isolation, loneliness in older people pose health risks

Loneliness and social isolation interventions for older adults: a scoping review of reviews

Also, read one of our previous Blogs here:

When Do I Need an Elder Law Attorney?

Click here to check out our On Demand Video about Estate Planning.

Click here for a short informative video from our own Attorney Bill O’Leary.

Join Our eNews