Health Care Surrogate Designation
Portia B. Scott, J.D., L.L.M. • June 1, 2021

A common tool for planning for disaster.

No one likes to consider the possibility that she ever may not be able to make informed health care decisions for herself. Yet, there are times when that may be exactly what happens. The inability to make health care decisions may only be temporary, but they also may be permanent.


This is not the same as just making poor decisions for yourself. It is when you actually cannot make a decision.


For instances, you are driving along, obeying the laws of the road and are, nonetheless, involved in an accident which leaves you unconscious and injured. When the paramedics arrive, they do not need anybody’s permission to provide life-saving services. This is an emergency and that is exactly for which these professionals are trained and valued so much in our society.


However, after been taken into life-saving surgery, the physician notices another problem in its infancy. Very easily, the physician could stop this problem from further developing and becoming a much bigger issue in a few weeks. You, obviously, cannot give consent to the physician to deal with it now and, without someone appointed by you to make this decision, the physician may not do anything but the emergency surgery.


Another example is the patient, not involved in an accident this time, has had a series of strokes which renders him incapable of making the decision. A healthcare provider notices a slow growing skin cancer. The preferred treatment is immediate removal of the offensive cancer for it will continue to grow and will, eventually result is significant danger. However, right now, it is not an emergency under any definition.


If you have executed a Health Care Surrogate Designation (a “health power of attorney”) your designated choice can make these decisions for you, following what they believe would be your wishes. So, if the patient is going to recover from the strokes and is getting proper medications, the Surrogate would probably decide the skin cancer should and may be removed. 


Merely executing the document is not enough. The Surrogate must be informed of your choice and be given a copy. A copy should be provided to your primary health care provider as well as the hospital where you are most likely to be taken. 


The paper, though, should not be considered as a replace for a face-to-face conversation with your Surrogate about your wishes or you primary health care provider about who you have chosen. 


The Surrogate will also be authorized, according to the Statutes, to sign for your admission or transfer from one health care center to another.


The Surrogate takes on NO financial responsibility for you though.

 

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Odd Laws - Iceland

By Portia B. Scott, J.D., L.L.M. • January 31, 2025
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MEDICAID IN FLORIDA Part I

By Portia B. Scott, J.D., L.L.M. • June 11, 2024
Medicaid planning is a complicated concept with many moving parts, all of which need to work in tandem and cohesively together to achieve the goal of providing quality long term care and/or nursing services to a Floridian in need. People often merely state that Medicaid is always a payor of last resort, but that expression needs to be defined and discussed as part of an over-all plan. The first issue addressed, then, is what is meant by “The payor of last resort?” Medicaid is, indeed, the payor of “last resort.” Briefly, this means, when all other medical assistance care is gone, Medicaid may step up and help pay for some uncovered medical expenses. Although Medicaid is a Federal program, it is administered on a State-by-State basis. When Medicaid was first being created, each state in the Union submitted their own plan on how the funds available to their own State’s Medicaid applicants. Florida submitted its plan which continues (with some tweaks) as to be used by Florida’s Medicaid system. If the applicant (the “patient”) otherwise qualifies for Medicaid in Florida, the State’s Medicaid program will help pay the expenses of Long Term Care, including Nursing Home Care. So, if the patient has a privately purchased policy for Long Term Care Insurance, those benefits will have to be fully depleted before Medicaid will provide any financial help. If the patient has more than $2,000.00 in “countable assets,” those will need to be spent before Medicaid will help. (We do mean “spent,” too; not gifted away!) If the patient is on Medicare, Medicare will step back and no longer pay once Medicaid has taken over. This means that the patient’s Medicare premium will no longer be deducted from any Social Security payment, increasing the net income of the patient. Further, there will no longer be a need for supplemental health insurance since the policy (Medicare) which was being supplemented, no longer is paying. When good planning has been implemented, including, at times, some of the countable assets of the patient having been legally and permissibly transformed into uncountable assets, Medicaid will step in to help pay for the Long Term Care Nursing Home expenses. This is what is meant when the term “payor of last resort” is used.
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