Seventy percent of those who reach age 65 will need long-term care services or expensive in-home nursing care, and 42% of it nationwide is paid for by Medicaid.
With long-term care costing nearly $100,000 a year in Nebraska as of 2022, assets can quickly be wiped out.
Ann Mangiameli, an attorney in Omaha, said states are required to "recover" funds Medicaid spends on in-home or out-of-home nursing care for those 55 and older, but the Spousal Impoverishment program allows the healthy spouse to preserve a portion of their assets. It includes their house, if the spouse continues to live there.
She pointed out if one member of a couple may need nursing home care, they should request a "Spousal Impoverishment" assessment through the Department of Health and Human Services, which involves dividing their total assets in half.
"And then they look at the half of the assets that goes to the spouse that's going to be considered the one needing the nursing care," Mangiameli explained. "That person needs to spend their assets down to $4,000 in Nebraska to qualify for Medicaid."
Mangiameli noted the house is not considered when totaling the couple's assets. She said once the spouse needing care qualifies for Medicaid, the house should be transferred to the name of the spouse living there, referred to as the "community spouse." If it is not done, and the community spouse dies first, the house becomes eligible for Medicaid recovery since it is considered an asset of the spouse who's receiving Medicaid.
As of 2022, the "community spouse" can keep a maximum of roughly $137,000 and a minimum of roughly $27,000. They can also keep their income up to just over $3,400 a month, with amounts adjusted annually based on inflation.
Mangiameli emphasized by delaying the Medicaid assessment until the couples' assets have further dwindled, the community spouse may qualify to keep a lower amount. She also cautioned seniors assets given away within five years of applying for Medicaid -- the current "look-back" period -- will be considered when determining total assets. Although it will not permanently disqualify a person from Medicaid, it will result in a "penalty period."
"So, let's say you gave away $100,000, and the nursing home that you're going into is $10,000, you are ineligible for a period of 10 months," Mangiameli outlined. "It's the actual cost of the facility up to whatever that amount of money is."
Mangiameli added since 2017, the state law said all assets, with or without a probated will, and including those in a trust, may be eligible for Medicaid recovery.
Nebraska's Spousal Impoverishment Program and Medicaid Recovery both include a number of exceptions and special considerations, so Mangiameli urged seniors to consult with an elder law attorney and not delay seeking a Spousal Impoverishment assessment if they anticipate needing Medicaid in the future.
"People need to know that Medicaid Recovery is a thing; that they will get letters," Mangiameli stressed. "Nebraska is required to try to get paid back for any Medicaid payments, specifically once they are in nursing homes. And families usually don't know that until they get those letters in the mail."
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Colorado lawmakers are working to ensure all Coloradans with health coverage for ambulance services are not hit with surprise bills or charged higher out-of-network rates.
Rep. Karen McCormick, D-Longmont, said when patients are in their most vulnerable moments, their focus should be on their health, not navigating coverage loopholes or worrying about affording a bill.
"When people call 911, they don't have a choice on who is going to show up," McCormick pointed out. "They don't have the ability to shop around."
The bill would close a gap in surprise-billing protections passed in 2019 to include the nearly 75% of Colorado ambulance services that are operated by cities, special districts and other political subdivisions. First responders and consumer advocates support House Bill 1088. Some insurance companies are lobbying against the measure and claimed it could lead to higher premiums paid by individuals and their employers.
McCormick underscored the measure would apply to people who already have coverage for ambulance services listed in their insurance plans.
"If indeed these services are covered, if (insurers) are saying it's going to raise premiums, it doesn't make any sense because they should have been covering it all along," McCormick contended. "We do have data that shows that it will not raise premiums."
McCormick noted the bill also provides assurances to ambulance agencies across the state by requiring insurance carriers to pay the full rates set at the local level by cities and other governing bodies. Currently, insurance companies get to decide how much of the rate to pay.
"This is very much a local control issue," McCormick stressed. "It will also create a public-facing website of rates that have been adopted by these political subdivisions."
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States like North Dakota could see unique effects under President Donald Trump's approach to tariffs.
Uncertainty lies ahead, but one expert said consumers should be prepared. Going into this week, prospects were raised about the U.S. imposing tariffs on goods from counties like Canada and Mexico. The plans were paused for a month.
Ernie Tedeschi, director of economics of the Budget Lab at Yale University, said people should expect more of the president's rhetoric and know how to protect their wallets. If tariffs against Canada come back into play, the ripple effect on household budgets could be noticed in certain ways, especially in this part of the United States.
"We import a great deal of crude oil and natural gas from Canada, particularly in the Midwest," Tedeschi pointed out. "There's a heating bill effect. There's also a gasoline bill effect."
A significant percentage of fruits and vegetables come from Mexico but he cautioned against stockpiling them because they will likely expire before they're eaten, wasting your money. Groups like AARP said one way to prepare for possible changes is to find deals on dining out, with restaurants offering more discounts these days.
Lumber imports could become more expensive, with added pressure to rebuild homes lost in the Los Angeles wildfires. Tedeschi recommended if you're considering a home renovation project, it is something to keep in mind. He added if you feel you cannot hold off on a big-ticket purchase, like an appliance, there still could be wiggle room in the short term.
"Electronic stores, for example, get through their nontariff stock before they get to the tariff stock," Tedeschi noted.
Those prices might not escalate as quickly under a rapidly changing trade war if the local company has a big inventory ahead of time.
For durable goods, he emphasized it is all about doing the research to make sure the financial sting is not so bad. Cars are another example.
"Even if you think you're buying an American brand, remember that a lot of American brands are assembled in Mexico and Canada, and would be subject to tariffs," Tedeschi observed. "Or least some parts of them would be subject to tariffs."
While pauses were announced for Canada and Mexico, new tariffs for China were on the table this week.
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As Los Angeles starts to recover, residents across the Pacific Northwest are being reminded of the risks wildfires pose.
Timothy Ingalsbee, executive director of the nonprofit Firefighters United for Safety, Ethics and Ecology, said firefighters are quickly overwhelmed by today's fast-moving wildfires. He noted simple, proactive measures such as sweeping your roof of debris, keeping your gutters clean and installing screens on roof vents are cheap and effective ways of protecting homes.
However, such efforts are not just up to individuals, Ingalsbee emphasized, adding homeowners need to approach the problem as a community.
"Because if you do all these things to protect your home but your neighbor doesn't, it's your neighbor's house that will catch fire and then put yours at risk," Ingalsbee explained.
Ingalsbee urged people to keep lawns mowed and warned not to leave flammable objects close to the house. He stressed keeping up on chores, as well as implementing more prescribed burns outside urban areas, will go a long way to protecting communities from wildfires.
Once a fire starts moving house to house, Ingalsbee acknowledged it is almost impossible to control. He added people living rurally as well as in urban areas need to think about safety because embers from wildfires can travel for miles and ignite homes easily.
"If anything is teaching us a lesson now, in this era of climate change, we're all living in the fire zone," Ingalsbee pointed out.
Ingalsbee encouraged everyone to think about their senior or disabled neighbors who may not be able to tend their own homes, and give support as they can. He said everyone should feel empowered to help protect their communities. If we all do our part, Ingalsbee added, wildland firefighters will not be needed to protect homes from wildfires because they will not ignite in the first place.
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