Ethan R. Okura
Hawai‘i Herald Columnist
In 1965, President Lyndon B. Johnson signed the Social Security Act into law, which included two programs we often hear about in the news: Medicaid (Title XIX) and Medicare (Title XVIII). Medicaid is a joint federal-state program that pays the medical costs of those with limited resources. It also provides some health care benefits not covered by Medicare, such as long-term care services in nursing homes.
Medicaid laws are very complicated and difficult to research thoroughly. They are a combination of federal statutes and regulations, Hawai‘i statutes and Hawai‘i administrative rules, the Hawaii State Plan (an agreement between Hawai‘i and the federal government that describes how Hawai‘i implements Medicaid), federal guidance from the Centers for Medicare and Medicaid Services and policies established by the Hawaii Department of Human Services. Some of these policies are published in a policy manual that Medicaid eligibility employees can access, while some, on the other hand, are not published anywhere: They are simply decisions made and changed from time-to-time by state employees on how to interpret the various Medicaid laws.
Unfortunately, these policies change often, even if the written law has not changed at all — and sometimes the policy is in direct conflict with the written law. Thus, the only way to know exactly what will work and what will not work is to have recent and continuous experience in applying for Medicaid and communicating regularly with policymakers to get an accurate sense of their current thinking on all of the issues that can come up in the process of applying for Medicaid.
Most of Hawai‘i’s Medicaid workers are good, decent people who do their best to help Medicaid applicants get the health care they need. However, most of them are not lawyers, and yet, they are expected to comprehend vast amounts of information and many rules without having adequate resources or the training to understand all of the complex and complicated details.
Ethan R. Okura received his doctor of jurisprudence degree from Columbia University in 2002. He specializes in estate planning to protect assets from nursing home costs, probate, estate taxes and creditors.
This written advice was not intended or written to be used, and it cannot be used by any taxpayer, for the purpose of avoiding penalties that may be imposed on the taxpayer. (The foregoing legend has been affixed pursuant to U.S. Treasury Regulations governing tax practice.)
This column is for general information only. The facts of your case may change the advice given. Do not rely on the information in this column without consulting an estate planning specialist.