The customized plan you need— with the lawyers you trust.
Rusty Fracassa and the staff at Paths Law Firm serving Kansas City are the most compassionate, attentive, and experienced elder law planners and advocates in the KC metro area.
We offer multiple office locations for your convenience. We can also meet at your home, the hospital, or a nursing home for those less able to visit our office. Meeting with clients on Saturdays to accommodate their schedule is just one of the perks of working with us.
The Issue and Planning for Medicaid
Medicaid is a joint federal and state program that provides financing for medical treatment for those unable to afford to pay. Medicaid covers physicians’ services, hospital care, supplies and other required services once a person has been made eligible for the program. It also covers the costs of nursing home care for the elderly.
Each state administers its own Medicaid program independently. While the basic eligibility requirements are the similar across the United States, there are substantial variances between the Medicaid programs of each state. In spite of these variations, eligibility is often determined by a combination of a person’s assets and income. State Medicaid offices decide eligibility, and in the case of married applicants, both spouses’ assets and income are considered.
It is essential to differentiate Medicare and Medicaid. Medicare is an insurance program that pays for the medical expenses of those aged 65 and older and some individuals with disabilities. All adults 65 and older, regardless of financial means or income, are eligible for Medicare. Medicare and Medicare supplementary insurance, however, give extremely little reimbursement for the expense of nursing home long-term care. Unless the individual has coverage under a long-term care insurance policy, these non-covered services must be paid privately by the individual. Medicaid, on the other hand, covers for medical requirements for persons of any age that have been proven to be qualified. In reality, a Medicare recipient with little income and assets may also qualify for Medicaid benefits.
Medicaid is regarded as one of the most complex laws in the United States, and the situation is further complicated by the fact that each state has its own version of Medicaid. Numerous Elder Law Attorneys are able to assist clients because they have researched the Medicaid statutes and regulations thoroughly.
Medicare does not cover the costs of long-term care for conditions such as Alzheimer’s disease or paralysis resulting from a stroke, thus Medicaid is frequently important to middle-income Americans. The majority of people who require long-term care will eventually exhaust their assets and be unable to pay for their care.
Medicaid is then available to pay the difference between their income and the actual costs of nursing home care, including room and board, medical treatment, hospital care, and all other reasonable and necessary medical expenses. Medicaid supports the costs of such care in nursing homes, adult care homes, hospices, and, where necessary, the individual’s own home.
If you anticipate incurring such long-term care bills, you should be aware of the following rules:
In assessing eligibility for Medicaid payment of long-term care expenses, the eligibility team will evaluate the individual’s actual need for care, the individual’s available resources (including life insurance and retirement plans), and the individual’s total income. In some places, if an individual’s monthly income exceeds a specific threshold, he or she is ineligible for Medicaid, even if long-term care expenses outweigh income.
In evaluating eligibility, a person’s recent charitable contributions will disqualify them from Medicaid.
The assets and income of both spouses are evaluated when evaluating eligibility for one spouse, regardless of premarital agreements, community property rules, or the nature of asset ownership.
However, married couples’ assets are treated differently so that the spouse who remains at home is not unjustly impoverished. Such a community spouse is entitled to retain one-half of the couple’s accessible assets (up to a federally-established maximum) and a minimum amount of the couple’s income in order to cover domestic support expenses (See below for details on Division of Assets).
In addition, there are resources that are not considered when determining eligibility; they include the family home, household goods, a vehicle, a pre-paid funeral fund, and other necessities.
Before applying for Medicaid, it is essential to understand the state-specific eligibility requirements and exemptions so that assets are not excessively depleted.
Lastly, it is essential to understand that appeals systems are integrated into the Medicaid system. If you disagree with Medicaid eligibility determinations, care decisions, or placements, there is a procedure for an administrative hearing and even legal action to vindicate your rights.
Source: National Academy of Elder Law Attorneys NAELA.org
Frequently Asked Questions
The Spousal Impoverishment Law, often known as the Division of Assets, modifies the Medicaid eligibility requirements for couples where just one spouse requires nursing facility care. It permits the spouse remaining at home to safeguard a portion of income and assets. The spouse in need of care can acquire Medicaid sooner without the other spouse falling into poverty.
Yes, but only if your spouse can demonstrate a medical requirement for nursing home placement and meets federal and state eligibility requirements.
You must satisfy the following conditions:
You must contact KanCare to receive the necessary forms. You will be required to submit an application for Medicaid. You will be required to list every asset you and your spouse hold. The KanCare worker will decide how much of the community spouse’s resources can be protected. If there is a need to shift resources to the at-home spouse, the KanCare worker will notify you and provide you with the necessary documents.
Based on the information provided on the evaluation form, you will split the available resources. It may be necessary to transfer certain assets from the institutionalized spouse to the at-home spouse. You will be informed if any resources require transfer. You may also contact an attorney for assistance with the legal paperwork involved in the transfers. Do not add other people’s names to any assets during the transfer process without first consulting with KanCarefirst, since doing so could result in a delay or cancellation of Medicaid coverage for nursing facility payments. Medicaid benefits might be paid for up to ninety days while the real property transfer takes place. In some situations, extensions may be granted if you have been actively transferring ownership but have not yet completed the process.
Certain items are excluded from the Medicaid determination. These are exempt resources, which you may retain.
You may retain the larger of the first $25,284 of total non-exempt assets or half of the total non-exempt assets owned at the time your spouse joined a nursing facility. The maximum amount of retained stock is $137,400. These amounts are subject to vary on a yearly basis, so contact Kancare for the most up-to-date information. The remainder of the total assets is believed to be available to the institutionalized spouse.
The amount of assets that can be preserved is based on the entire amount of non-exempt assets owned by the marriage at the time the spouse initially entered an institution. This number is derived from the data you give and confirm on the Resource Assessment form. Alternatively known as the Community Spouse Resource Allowance.
After Medicaid approval, the LTC spouse may be responsible for a percentage of his or her medical expenses. The cost of care is determined by the institutionalized spouse’s monthly income. A $62 allowance for personal necessities is removed from the gross monthly income, along with any medical expenses not covered by Medicaid or any third party, such as health insurance premiums. This amount is also subtracted if the stay-at-home spouse is qualified for an income allowance as indicated above. The remaining funds, if any, are paid to the nursing home towards the cost of care. This amount is referred to as the patient or client duty.
No transfers should be made until all documentation has been completed and the amount of income and assets that the at-home spouse is permitted to retain has been decided. Transfers made prior to enrolling in KanCare might often affect Medicaid eligibility. Always seek KanCare’s prior consent before moving any funds or income.
Legally, the State Medicaid agency has a first-class claim against the Medicaid recipient’s estate or surviving spouse for benefits provided to the Medicaid beneficiary. The Medicaid beneficiary must have been at least 55 years old or resided in a nursing home while receiving benefits. This claim only arises after the demise of both the beneficiary and the surviving spouse. There would be no recovery if a minor or crippled child survived.
No. The couple has the option of seeking a distribution of resources, income, or both. If you do not, some assets and income will be considered available to the nursing home resident’s spouse, and he or she may not qualify as quickly.
Prior to receiving benefits, the spouse requesting for help must meet Medicaid eligibility conditions. This means that the spouse requiring care must deplete his or her part of the divided assets to the Medicaid qualifying threshold (now $2,000).
If new resources are acquired prior to the LTC spouse acquiring Medicaid coverage, they are often considered part of his or her share of assets and must be drained prior to eligibility. Due to the fact that the Community Spouse Resource Allowance is calculated as of the month of the spouse’s entry into long-term care, resources that neither spouse owned in that month cannot be included for division reasons. The spouse of a Medicaid client who is institutionalized will have their assets counted against the $2,000 limit. The receipt of resources exceeding this threshold may result in the loss of Medicaid coverage. The at-home spouse’s receipt of additional resources typically does not alter the eligibility of the other spouse for Medicaid.
Inflation adjustments will be based on changes in the Consumer Price Index. KanCare will calculate any increase automatically and adapt your case accordingly. The quantity of resources a stay-at-home spouse is permitted to retain will be determined at the time of application and will not be modified.
The statute solely applies to Medicaid eligibility for covered long-term care (nursing home), Home and Community-Based Services (HCBS), and Program of All-Inclusive Care for the Elderly (PACE).
When you and your spouse meet the following conditions.
A spouse currently resides in a nursing facility.
The income of the at-home spouse is less than $1,992.
Any property handed to a spouse is part of that spouse’s estate and will pass to heirs unless the recipient’s at-home spouse lives. According to state inheritance regulations, the receiving spouse should get at least half of the estate as an heir. If this does not occur, the recipient’s eligibility may be affected by a transfer of assets issue. If the at-home spouse survives the recipient, the State Medicaid Agency may file an Estate Recovery claim against the at-home spouse’s estate following his or her death.
No. Your heirs can only inherit your actual assets on the day you pass away. In addition, keep in mind that the estate of the spouse who stays at home will be subject to estate recovery, as stated previously.
The law only pertains to Medicaid eligibility.
Source: Kansas Department for Aging and Disability Services www.kdads.ks.gov
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Jeane Fracassa – a dedicated and accomplished professional who retired with an impressive 38-year service record from the Kansas City Missouri Police Department. Throughout her illustrious career, Jeane served as a Civian Supervisor in the Communications Unit, where she played a pivotal role in ensuring efficient and effective communication within the department.
Even in retirement, Jeane’s commitment to community service remains unwavering. Currently, she serves in various capacities within Community Relations at Paths Law Firm. Actively engaged in the Lee’s Summit and Overland Park communities, she proudly represents the law firm.
In all aspects of her life, Jeane Fracassa exemplifies the values of community, compassion, and family. Her commitment to making a difference and her love for exploration make her a remarkable individual, whose presence brightens the lives of those she encounters. Whether at work, with family, or during her travels, Jeane’s genuine care for others and her zest for life make her a truly remarkable and inspiring person.
Laura is the Law Firm’s marketing assistant, supporting all marketing tasks, including managing calendars, researching upcoming events, updating marketing software and spreadsheets, and partnering with organizations to maintain relationships that benefit Paths Law Firm’s clients. Laura is also the law firm’s professional photographer as she provides the professional photographs for the headshots, organizations, events, and networking.
Laura has over 10 years of experience as a professional photographer. She is also Adobe and Microsoft Certified. She graduated from Columbia College, Columbia, Missouri with her Bachelor of Arts degree, Magna Cum Laude, in Behavioral Psychology (minors in Social Work and Criminal Justice), and her Photographic Craftsman degree from Professional Photographers of America. She is certified as a Qualified Mental Health Professional, Certified Gentle Teacher, Medicaid Billing Certified, Crisis Intervention Counselor, and a Missouri Notary.
Laura has been married more than 26 years and has a daughter and a son. She has four brothers, a niece, and a nephew. Her four spoiled pets that love her attention. A lot of Laura’s off time is spent taking photos and she is an internationally published photographer. Laura owns a studio on the historic Independence Square.
Holly is our newest member of the administrative team. She is hardworking, has proven organizational skills and excellent communication skills. Holly has transitioned to the Estate Planning field from healthcare administration where she gained valuable knowledge that has contributed to her success here at Paths.
Holly enjoys spending time with loved ones, cheering for the Chiefs, and relaxing on the beach.
Tressa has the important role of being a client’s initial point of contact as the law firm’s receptionist for all locations. She also welcomes, assists, and cares for clients at the Lee’s Summit office. Additionally, she provides support in an administrative capacity for the attorneys, staff, and clients. When you meet Tressa, the first quality many note is her readiness to be of assistance.
Tressa is a graduate of Park Hill High School with extensive administrative experience and executive level management. Tressa brings a stability and comfort to the law firm experience having worked in a variety of industries and having lived in six different major metropolitan cities.
Tressa has a daughter, two sons, and one grandchild. In her free time, she enjoys her family and friends, loves being outdoors, gardening, bike riding and bird watching. Indoor hobbies include scrapbooking, painting cookies, and cheering on Chiefs football. She is a Kansas City native but enjoys traveling but is always happy to be back in her hometown.
Kathleen Overton is an attorney and owner at Paths Law Firm. She has more than 17 years of experience advocating for those with special needs and navigating the state and federal agencies formed to help the disabled and elderly. At Paths Law Firm, Kathleen’s practice focuses on helping the elderly qualify for nursing home Medicaid, creating estate plans to protect beneficiaries, as well as a lot of time planning and forming businesses. Kathleen also enjoys helping clients form non-profit organizations and obtain 501(c)(3) tax exempt status.
After attending law school at the University of Oklahoma, Kathleen began representing clients before the Social Security Administration. Eventually her practice switched to federal court appeals and Kathleen spent years representing clients before the Eastern and Western District of Missouri, the District of Kansas, and the Eighth Circuit Court of Appeals. Kathleen has since focused her practice on estate planning and elder law after watching clients struggle to find ways to financially care for loved ones with special needs or aging parents.
Kathleen lives in the Northland with her husband and four children. She spends her free time attending soccer matches and ballet performances with her children and starting endless home improvement projects with her husband.
Tena is a Medicaid Paralegal. She is very meticulous and organized. She works closely with the attorneys, clients, and State representatives.
Tena has an associate in applied science and has over 20 years of office management experience. She has two daughters and one grandson.
Tena enjoys spending time with her family. She enjoys everything outdoors and her hobbies include fishing and gardening.
Sydney is the law firm’s internal accountant and one of their experienced paralegals having been with Paths Law Firm since 2017. She is a primary point of contact for estate planning and business planning.
Sydney graduated with honors from the University of Missouri Kansas City in 2022 with her Bachelor of Science Degree in Accounting. She is a Bloch Launchpad, Phi Theta Kappa, and National Honor Society alumni.
In her free time, Sydney enjoys spending time with her husband, reading, baking and going on long walks.
Christy has three years of experience in elder law working for seniors and their families. She is currently the Senior Administrative Assistant and organizes the day to day functions of the office and makes sure everything runs smoothly. When asked why she loved what she does, Christy said at Paths Law Firm, she gets the opportunity to help clients in more ways than one. Her favorite parts of the job are getting to know the clients and helping them get their questions answered.
Christy’s experience in the finance industry has been extremely beneficial to her role as the Senior Administrative Assistant. Christy has a special place in her heart for the elderly and attributes this to the relationship she had with her grandparents.
Christy was raised in Ogden, Utah and moved to Independence, MO, when she was ten years old. She has been with her high school sweetheart for 25 years and they have two beautiful children together. Her daughter works in the medical industry, and her son currently attends High School and plays Baseball. When Christy is not working, she enjoys crafting and spending time with her family and friends.
Christy’s experience in the finance industry has been extremely beneficial to her role as Benefits Coordinator. There have been many influences that went into her decision to select the field of Elder Law. Christy has a special place in her heart for the elderly and attributes this to her relationship with her grandparents.
When asked why she loves what she does, Christy said that at Paths Elder law, she gets the opportunity to help clients in more ways than one. Her favorite part of her job is getting clients approved for Medicaid or VA benefits as it is a huge relief for them and their loved ones.
Christy was raised in Ogden, Utah, and moved to Independence, MO, when she was ten years old. She has two children that keep her busy and fill her life with joy! Christy’s daughter cheers for Avila University, and her son plays competitive baseball for the Bucks and races BMX locally for the Motorcycle Closeout Team.
When Christy is not working, she enjoys crafting and making homemade gifts for her loved ones and raising her kids to be healthy, happy, and positive humans.
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René is the Financial Manager at Paths Law Firm overseeing all aspects of revenue, expenses, and financial planning. She is also responsible for general office management, including assisting in many of the administrative matters that periodically arise.
René earned her Bachelor of Science in Hotel and Restaurant Management from Central Missouri State University in Warrensburg, Missouri and soon thereafter worked her way through management at The American Restaurant where she worked almost 17 years before relocating to the country of China.
René is the Financial Manager at Paths Law Firm overseeing all aspects of revenue, expenses, and financial planning. She is also responsible for general office management, including assisting in many of the administrative matters that periodically arise.
René earned her Bachelor of Science in Hotel and Restaurant Management from Central Missouri State University in Warrensburg, Missouri and soon thereafter worked her way through management at The American Restaurant where she worked almost 17 years before relocating to the country of China.
René is the Financial Manager at Paths Law Firm overseeing all aspects of revenue, expenses, and financial planning. She is also responsible for general office management, including assisting in many of the administrative matters that periodically arise.
René earned her Bachelor of Science in Hotel and Restaurant Management from Central Missouri State University in Warrensburg, Missouri and soon thereafter worked her way through management at The American Restaurant where she worked almost 17 years before relocating to the country of China.
René is the Financial Manager at Paths Law Firm overseeing all aspects of revenue, expenses, and financial planning. She is also responsible for general office management, including assisting in many of the administrative matters that periodically arise.
René earned her Bachelor of Science in Hotel and Restaurant Management from Central Missouri State University in Warrensburg, Missouri and soon thereafter worked her way through management at The American Restaurant where she worked almost 17 years before relocating to the country of China.
In her spare time, René is currently quite active managing multiple generations of her family, including parents and grandkids. René has had great impact on the lives of many women teaching discipling and teaching and abundance of Bible Studies. Her former career in management and event planning trained her well to juggle all the activity.
Hilary plays a vital role in managing the Marketing Department at Paths Law Firm. She is excellent at bringing new ideas and sharing valuable resources with the law firm and our community. Hilary has been with the law firm since the beginning, working in nearly every role which is invaluable in her marketing endeavors as she brings a unique set of skills into the Marketing Department.
Hilary is nearly complete in her Bachelor’s of Arts Degree in Marketing at Park University. She has earned the honor of being listed in National Honors Society, Phi Theta Kappa, and the Dean’s List. Hilary is always looking for new and innovative ways to share the law firm’s message.
While not working, Hilary spends her time with her family at their rural home. They tend to their chickens and honeybees and enjoy the solitude of country living.
Jennifer is the Sr. Paralegal and Operations Manager at Paths Law Firm. She oversees the firm’s probate department as well developing, implementing, and managing all the firm’s administrative processes having been with the law firm almost from the beginning. She enjoys client contact as well as behind-the-scenes operations.
Jennifer began her legal career in 1990 as a legal secretary. She has worked in small and medium sized firms, as well as court operations. She has her Paralegal Certificate from Boston University, Law Office Management Certificate from University of Central Missouri, and she is a Master Financial Coach.
Jennifer has two daughters, twin sons, and twin grandsons. She spends as much time as she can with them. She enjoys reading, listening to podcasts, and tending her yard.
When asked what he wants to do, his reply was “I just want to sit at the kitchen table and work directly with people.” Rusty enjoys working with clients providing experienced advocacy and supporting them through their unfamiliar and overwhelming situations. Due to all the challenges faced by seniors, it is essential to work with an experienced elder law attorney who has expertise in the law, issues, and concerns affecting seniors and their families.
Rusty brings more than 30 years legal experience and expertise working for seniors and their families as an elder law attorney in Kansas City and surrounding. Prior to law school, Rusty was an accountant and his first couple years practicing law was as a tax attorney. This provides invaluable experience in his current practice of law. Rusty’s focus is helping protect seniors’ assets from taxes and long-term care costs, benefit qualification, and navigating more complex family scenarios in their estate planning.
Rusty has personally experienced the loss every parent fears, caring for a spouse suffering with cancer and the treatment, and working with aging parents through all stages of their lives. He intimately understands the challenges faced by individuals and their caretakers when capacity or health declines, how to prepare for it, and the legal matters while in the midst of it. He may not be able to eliminate his client’s grief, but he strives to provide clients with peace of mind.
In 2010, Rusty’s faith and love led him and part of his family to China as Christian missionaries. He and his wife, went permanently, but ended up dedicating 3 years to that ministry. They returned to Missouri to help with grandchildren after a family tragedy and later began anew with Paths Elder Law. The goal is providing compassionate care through legal advocacy.
Rusty has multiple degrees and advanced study spanning his Bachelor’s of Arts in Business Administration – Accounting at Rockhurst College (now Rockhurst University), Masters of Arts in Accounting and in Intercultural Studies, as well as his Juris Doctorate from the University of Missouri at Kansas City School of Law.
When Rusty is not practicing law, he enjoys spending time with his family, grandchildren, and excessive eating at local restaurants.
Practice Areas
BSBA and Master’s in Accounting, Master’s in Inter-Cultural Studies, and Doctorate in Juris Prudence
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