PART A: REPRESENTING SENIORS

CHAPTER 1
Ethical Considerations in Representing Seniors
Introduction; Who Is the Client?; Representing Clients With Diminished Capacity; Maintaining Confidentiality; Lawyer as Fiduciary; Dishonesty
– Karin Ciano

CHAPTER 2
Organizing Information
Introduction to the Planning Notebook; Contents of a Planning Notebook
– Laurie Hanson

CHAPTER 3
The Planning Process: Surrogate, Substitute, and Supported Decision-Making and Basic Estate Planning
Introduction; Financial Management; Health Care Management; Supported Decision-Making; Planning for Death; Appendix A – Minnesota Statutory Short Form Power of Attorney; Appendix B – Minnesota Bankers Association Legal Compliance Bulletin LC-7-2006
– Megan Kelly & Laura Zdychnec

CHAPTER 4
Taxes 
Introduction; General Rules Regarding the Sale of Capital Assets; Other Miscellaneous Income Tax Issues; Gift and Estate Tax Provisions; Qualified Retirement Accounts; Appendix A – Life Estates Mortality Table – EPM Appendix G; Appendix B – Information on IRS Applicable Federal Rates and Actuarial Tables; Appendix C – Chronically Ill Certification; Appendix D – Tax Return Samples; Appendix E – Important Rules and Deadlines Summary
– Scott Ruhsam

CHAPTER 5
Vulnerable Adults and the Vulnerable Adults Act
Introduction and Background; The Vulnerable Adults Act; Vulnerable Adults Act – Reporting Suspected Maltreatment; Vulnerable Adults Act – Processing a Maltreatment Report; Application of the Act; Limitations of the Act; Other Minnesota Vulnerable Adult Legislation; Federal Vulnerable Adults Legislation; Summary of Legislative Changes to the Act and Related Provisions
– Marit A. Peterson

CHAPTER 6
Resources for Serving Older People in Economic Need  
Introduction; Fee-Generating Cases; Legal Aid; Other Nonprofit Organizations; Government Agencies; Appendix A – Map of Minnesota Legal Services Coalition (MLSC) Programs by Region; Appendix B – Legal Services Coalition Programs Listed by County; Appendix C – Listing of Other (Non-MLSC) Civil Legal Services Providers; Appendix D – Listing of Non-Legal Advocacy Services
– Benjamin Kaufman

PART B: PAYING FOR LONG-TERM CARE WITHOUT MEDICAL ASSISTANCE

CHAPTER 1
Medicare for Nursing Home or Community Care 
Overview and Regulatory Reference; Organizations within the Medicare System; Who May Receive Medicare; Hospital Stays; Skilled Nursing  Facilities; Home Health Care; Hospice Care; Ambulance Service; Modifications to the Temporary Changes Effective During COVID-19 Pandemic; End-Stage Renal Disease and Medicare Coverage; Appendix A – Medicare Monthly Premiums; Appendix B – What Services Are Covered; Appendix C – Abbreviations
– Kelli Jo Greiner

CHAPTER 2
Long-Term Care Insurance
Introduction; Qualified Long-Term Care Insurance Policy; Partnership Long-Term Care Insurance Policies; Regulation of Insurance Companies, Agents, and Agencies; Consumer Information and Enforcement Action Websites; Claim Disputes, Premium Increases, and Litigation; Appendix A – Glossary of Long-Term Care Insurance Terminology
– Jody A. Cohen-Press & Elizabeth I. Wrobel

CHAPTER 3
Veterans Benefits
Introduction; Minnesota Veterans Benefits; Federal Veterans Benefits; VA Health Care Benefits; Veterans with Service-Connected Disabilities; Pension; Burial and Memorial; Dependents and Survivors Benefits
– Mary Frances M. Price

CHAPTER 4
Alternative Care and Essential Community Supports
Introduction; Eligibility for Alternative Care; Changes Affecting Lower Need Individuals (Case Mix “L”); Essential Community Supports for those Ineligibility for Alternative Care; Services Covered Under Alternative Care; Alternative Care Program Administration and Case Management; Care Providers; Alternative Care Program Funding, Allocation of Funding, and Fees; Estate Recovery; The Future of Alternative Care;  COVID-19 and Alternative Care; Conclusion
– Allison J. Frasier

CHAPTER 5
Reverse Mortgages: A Financing Tool for Seniors
Introduction; The Home Equity Conversion Mortgage Program; The Home Equity Conversion Mortgage Application Process; Borrower, Property, and Disclosure Requirements; Reverse Mortgage Options; Maximum Loan Amount; Costs; Other Charges and Fees; Reverse Mortgage Myths; Deaths of Homeowners; Use of Powers of Attorney; Transfers into Trust; Appendix A – Sample HECM Amortization Schedules; Appendix B – HUD Single Family Housing Policy Handbook 4001.1 (May 20, 2024); Appendix C – Third-Party Authorization Form; Appendix D – Sample Trust Agreement Language – Compliance with Home Equity Conversion Mortgage; Appendix E – Sample Trust Agreement Language – Trustee Compliance with Home Equity Conversion Mortgage; Appendix F – Sample Attorney Opinion Letter – Trust Not Yet Executed/Deed Not Yet Recorded; Appendix G – Sample Attorney Opinion Letter – Trust Executed/Deed Recorded
– Jody A. Cohen-Press

PART C: MEDICAL ASSISTANCE

CHAPTER 1
Medical Assistance Programs and Eligibility for Nursing Home Care 
Introduction; General Eligibility Requirements for Medical Assistance in Minnesota; Eligibility Requirements for Medical Assistance for Nursing Home Care (MA-LTC); MA-LTC – Spousal Impoverishment Rules for a Married Couple; Appendix A – Prior Asset Rules
– Amber M. Hildebrandt

CHAPTER 2
Medical Assistance Programs Beyond Nursing Homes 
Introduction; Categorical Basis of Eligibility; Financial Eligibility; Long-Term Care Consultation or MnCHOICES Assessment; Home and Community-Based Waiver Services for Individuals Under 65; Home and Community-Based Waiver Services for Individuals Age 65 and Over; Other Considerations When Applying for Home and Community-Based Waiver Programs; Medical Assistance for Employed Persons with Disabilities; COVID-19 and Home and Community Based Services; Additional Resources; Conclusion: Appendix A – Minnesota Department of Human Services Insurance Affordability Programs Income and Asset Guidelines; Appendix B – Comparison of MnCHOICES, RSC and CAC, CADI, BI Waivers for Persons With Disabilities; Appendix C – Health Care Programs Eligibility Policy Manual Appendix F: Standards and Guidelines
– Brenna Galvin

CHAPTER 3
Assets 
Definition of “Asset”; “Asset” Distinguished from “Income”; Deeming of Income and Assets; Asset Limits; Excluded Assets; Countable Assets; Availability of Assets; Asset Verification; Community Spouse Asset Assessments
– Amber M. Hildebrandt & Julian J. Zweber

CHAPTER 4
Asset Transfers and Reduction of Assets 
Reducing Assets – Introduction; “Spending” the Assets – Purchasing Goods or Services; Making Permissible Transfers Under an Exception to the Transfer Rules; Transfer of Income-Producing Assets – Increased Spousal Share Allowance – MINN. STAT. § 256B.059, subd. 4 and EPM § 2.4.2.1.2 (HCPM § 19.45.15); Making Transfers without Adequate Compensation Subject to Transfer Penalty Rules; Hardship Waivers; Appendix A – Pfoser v. Harpstead, 953 N.W.2d 507 (Minn. 2021)
– Mark Anderson & Patty Dunlop

CHAPTER 5
Medical Assistance and Annuities
Introduction; Requirements for a Medicaid-Compliant Annuity; Annuities and Medical Assistance Planning; Eligibility Policy Manual Guidance Regarding Annuities
– Lauren L. Fink & Julian J. Zweber

CHAPTER  6
Medical Assistance and Trusts 
Introduction; Sources of Law Governing the Use of Trusts in Medical Assistance and Disability Planning; Trusts Created Before August 11, 1993 – Medicaid Qualifying Trust Rules; Third-Party Established and Funded Trusts; Trusts Created on or After August 11, 1993 with the Assets of the Individual; Treatment of Irrevocable Trusts in Minnesota Since Minnesota Statutes section 501C.1206 Has Been Repealed; Supplemental and Special Needs Trusts; Appendix A – Comparison Chart of Supplemental, Special, and Pooled Trusts; Appendix B – Redacted California Decision Regarding Transfers of Assets into the Pooled Trust Subaccount; Appendix C – Redacted Maryland Decision Regarding Transfers of Assets into the Pooled Trust Subaccount
– Laurie Hanson

CHAPTER 7
Marital Issues 
Antenuptial Contracts in the Context of Medical Assistance Planning; Marital Dissolution in the Context of Medical Assistance Planning
– Jason C. Brown

CHAPTER 8
Medical Assistance Application
Introduction; Who Can Apply – EPM § 1.2.2; Where Application Can Be Made; Application Timing; Application Forms; Verifications; Reporting Asset Transfers; Notices of Action by County Agency – EPM § 1.3.1.5; Renewal – EPM § 2.4.1.3; Applicant Rights and Responsibilities – EPM § 1.3; COVID-19 Information
– Patty Dunlop

CHAPTER 9
Appeals of Agency Decisions 
Medical Assistance Appeals – Introduction; Administrative Appeal Prehearing Matters; Administrative Appeal Hearing Procedure; Administrative Appeal Hearing Decisions; District Court Appeal; Court of Appeals; Exhaustion of Administrative Remedies
– Jeffrey W. Schmidt  

CHAPTER 10
Recovery of Medical Assistance Benefits 
Introduction; Determining if (and When) an Estate Is Subject to Recovery; Estate Recovery Claim Process; Medical Assistance Liens; Recovery of Benefits from Special Needs Trusts; Recovery of Annuities
– Sarah Sicheneder

PART D: HOUSING AND THE ELDERLY

CHAPTER 1
Assisted Living and Senior Housing Options 
Introduction; Independent Senior Housing; Assisted Living Facilities and Assisted Living Facilities with Dementia Care; Long-Term Care Options Counseling; Quality Assurance Mechanisms for Services Provided in Senior Housing (Other than Nursing Homes); Other Senior Housing Settings; Public Assistance; Landlord/Tenant Issues; Assisted Living License Legislation and Related Changes
– Barb Blumer & Suzanne Scheller

CHAPTER 2
Eviction from Long-Term Care Facilities
Introduction; Nursing Homes; Assisted Living; Independent Senior Living; Memory Care; Veterans Homes; Other Long-Term Care Facilities; Appendix A – Survey of Nursing Home Transfer/Discharge Decisions; Appendix B – Significant Passages from Decisions Discussed in This Chapter
– Benjamin Kaufman

CHAPTER 3
Nursing Home and Assisted Living Litigation
Introduction; Long-Term Care Settings; Common Injuries as a Result of Negligence; Bringing a Negligence Claim; Laws to Combat Elder Abuse and Neglect; Personal Injury Claim Considerations; Wrongful Death Claim Considerations; Punitive Damages; Settlement; Ethical Considerations; Arbitration Clauses; Conclusion
– Suzanne M. Scheller

Table of Authorities
Subject Index
Glossary of Acronyms

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