C O V E R S T O R Y

Helping Grandma make ends meet

Consider the following hypothetical: Granddad and Grandma are Tennessee residents and have been married for 50 years. About a month ago, Granddad, who is 76, suffered a stroke that has left him completely paralyzed on his left side. After being hospitalized for a week, he was discharged to a skilled nursing facility, where Medicare has been paying for his care.₁ The 21st day, when 100 percent Medicare coverage will end, is approaching.₂ Grandma, who is 72 and suffers from arthritis, hypertension and glaucoma (all controlled by prescription medication) has just met with the nursing home social worker, who has advised her that Granddad's condition has improved to the point where he no longer requires skilled care. Unfortunately, he does need intermediate nursing home care.₃ The cost of such care will be around $3,394 per month.₄ Grandma's and Granddad's total income from Social Security only equals $1,850 per month. The social worker encourages Grandma to apply for Medicaid₅ to help cover the cost, but explains that Granddad cannot have more than $2,000 worth of countable assets.₆ Grandma and Granddad have been frugal and have managed to accumulate total countable assets of $100,000, which they were counting on as a "rainy day" fund in their old age. Grandma, beside herself, comes to you with a lengthy Medicaid application form, seeking assistance. What will you tell her to do?

Before answering that question, it may be helpful to review the development of Medicaid eligibility criteria as they have been applied to married couples when one spouse enters a nursing home. In Tennessee, as in most states, spouses are normally expected to provide for the necessary expenses that each incurs, including necessary medical expenses.₇ Thus, when Medicaid was first enacted, Congress contemplated spousal contribution and states did consider the income the community spouse had remaining over and above that required for his or her basic needs to be available to help defray the cost of care of the institutionalized spouse.₈ Thus couples were expected to exhaust virtually all income and assets owned jointly or separately before Medicaid would pay for nursing home care. The husband or wife left living home alone was effectively "pauperized," being allowed a maximum annual income of $6,600 in 1988, with the couple allowed to have no more than $3,000 assets total.₉ In 1988, pursuant to the "spousal impoverishment" provisions of the federal Medicare Catastrophic Coverage Act (MCCA),₁₀ Congress amended the Medicaid Act₁₁ in an attempt to enable the non-institutionalized spouse of a nursing home resident to continue to live independently in the community without being reduced to poverty as a consequence of the stringent financial eligibility criteria imposed by Medicaid.₁₂ The MCCA enacted the following protections: 1) eliminated consideration of income received solely in the name of the community spouse as being available for the support of the institutionalized spouse once a married person enters a nursing home;₁₃ 2) required establishment by the states of a "minimum monthly maintenance needs allowance" (MMMNA) for the community spouse;₁₄ 3) allowed for transfer of a sufficient amount from the institutionalized spouse's income to eliminate any shortage between the community spouse's "post-eligibility income" and the MMMNA;₁₅ 4) required establishment by the states of a "community spouse resource allowance" (CSRA);₁₆ and 5) allowed transfer from the assets of the institutionalized spouse (and consequent increase in the CSRA) in an amount sufficient to generate additional income needed to eliminate any shortage should the standard CSRA be insufficient to generate income needed to bring the spouse's income up to the MMMNA.₁₇ It should be noted that the statute appears to contemplate that this last increased allowance is contingent upon the requisite showing being made by the applicant at a fair hearing on the issue.₁₈ It is the method used at the fair hearing to calculate the community spouse's initial income that was at issue before U.S. Supreme Court in Wisconsin v. Blumer.₁₉ The choice of method is important, because it is largely determinative of the likelihood of whether an increase in the CSRA will be allowed or not, which in turn may be determinative of the applicant's immediate eligibility for Medicaid coverage of the cost of nursing home care.

At the time of her application for Medicaid, Irene Blumer and her husband, Burnett Blumer, had $89,335 worth of assets between them. Under the CSRA in effect at the time, Mr. Blumer was allowed to retain $72,822 of these assets. Mrs. Blumer could only have $2,000. The Blumers therefore had $14,513 in excess assets. Mrs. Blumer's monthly income consisted of $927 in Social Security and a $336 private pension for a total of $1,263. Mr. Blumer's monthly income consisted of $1,015 in Social Security and a $309 annuity payment for a total of $1,324. In addition, Mr. Blumer's $72,822 worth of assets was generating income in the amount of $315 per month, for a grand total monthly income of $1,639. This left him $88 short of the $1,727 MMMNA in effect in Wisconsin at the time. The Blumers therefore argued that the CSRA should be increased by the amount necessary to generate $88 worth of additional income for Mr. Blumer. As it turned out, under the existing rate of return, allocation of the entire $14,000 to Mr. Blumer would only yield an additional $63 per month, which would still leave Mr. Blumer short $25 and require transfer from Mrs. Blumer's income to make up the shortfall. The operative effect, however, of applying this "resources first" method to eliminate the shortfall would be to achieve immediate eligibility for Mrs. Blumer and preservation of all the assets for use by Mr. Blumer if need be.

The Wisconsin Department of Health and Family Services, however, applied the "income first" method, and pursuant to that, allocated $88 of Mrs. Blumer's income to Mr. Blumer, thus eliminating the income shortfall and eliminating any need for an increased allocation of the CSRA. Without the increased allocation, Mrs. Blumer was determined to be ineligible for Medicaid coverage, based on excess resources.

The Blumers argued that Wisconsin's use of the 'income first' method violated the MCCA by assuming in its eligibility calculations that a portion of the institutionalized spouse's income would be available to the community spouse through post-eligibility transfer. Since the language of the statute refers to the "community spouse's income,"₂₀ the Blumers' position was Congress intended the calculation to include only that income actually belonging to and possessed by the community spouse at the time of application and prior to the eligibility decision and not income that they might potentially receive once eligibility had been determined.

Although not definitively ruling on the issue, as it had not been raised, the Supreme Court in dicta agreed that the "resources first" interpretation of the statute advocated by the Blumers seemed to constitute a permissible reading. However, the court refused to find that it constituted the only permissible reading, and found that the statutory scheme created by MCCA, by permitting post-eligibility income transfers from the institutionalized spouse to the community spouse up to the MMMNA, "offers affirmative support for the 'income first' method."₂₁

The state of Tennessee joined with the Medicaid agencies of 13 other states in support of Wisconsin's position₂₂ and it has been the Department of Human Services' policy to apply the "income first" method when determining eligibility. However, prior to the ruling in Blumer, advocates could always argue for, and were sometimes successful, in obtaining application of the "resources first" rule.₂₃ Since Tennessee's choice of "income first" has been upheld, use of that argument is now clearly precluded.

So, how does application of the "income first" rule as opposed to the "resources first" rule affect Granddad's eligibility for Medicaid? Going back to the hypothetical, Granddad receives $1,200 in Social Security, while Grandma receives $600 in spousal benefits.₂₄ After all applicable exemptions, they have $100,000 worth of countable assets in the form of a $20,000 joint savings account balance, $50,000 certificate of deposit in Granddad's name and $30,000 worth of stock in Grandma's name. This excludes the value of their home, which they own outright and which is appraised at $120,000. In determining eligibility, DHS will consider all resources as belonging to both spouses, regardless of the name in which the resource may be titled. The total will then be divided in half, with $50,000 allotted to Grandma and $50,000 to Granddad. Since $50,000 is less than the current CSRA of $89,280, Grandma is entitled to an additional transfer of $39,280 from Granddad's half of the assets, leaving him with a total asset allocation of $10,720 or $8,720 over the asset limit of $2,000.

But Grandma's monthly income is only $600 or $852 less than the MMMNA of $1,452₂₅. Assuming a 5 percent return on the assets already allotted to her, her monthly income would rise to $972,25 or $480 less than the MMMNA, Application of the "resources first" rule would have resulted in transfer of the remaining $10,720 worth of assets to Grandma, because, at 5 percent return, this transfer would still only raise her income by $45 per month,₂₆ thus leaving her $435 short of the MMMNA. This shortfall would be remedied by a post-eligibility transfer of $435 from Granddad's $1,200, leaving him with $765 of income per month, out of which he could retain $30 as a personal needs allowance, with the remaining $735 going toward the cost of his care. Application of the "resources first" method would thus leave Granddad with no assets and make him immediately eligible for Medicaid.

Application of the "income first" method, however, yields a different result. Rather than transferring the resources to address the shortfall in Grandma's income, the "income first" rule would transfer $480 out of Granddad's income, leaving him with $720 worth of post-eligibility income, out of which he could retain $30 personal needs allowance, while the remaining $690 would go to partially defray the cost of his care. Although this second option will leave the state with a larger monthly bill to pay on behalf of Granddad when and if he does become eligible for Medicaid, the immediate result is that he is not eligible and will not be eligible until he has spent down the remaining $8,720 of excess assets that have been allocated to him.

With such a small amount of assets at stake, it will only take a little more than two months of paying for private care to exhaust these funds, but from Grandma's standpoint, even if she receives $1,492 per month once Medicaid eligibility is obtained, restoration of these assets will be virtually impossible. So, before she completes the application, she should review her circumstances to see whether or not there are any possible permissible exempt uses to which the assets can be applied that may have been overlooked. For example, does the house need any repairs? A new roof, siding, plumbing? Grandma can contract for these immediately and thus eliminate the excess assets prior to application. Do she and Granddad have burial insurance and burial spaces? What about a car? If Grandma needs transportation to and from the doctor, she may purchase a new car and exclude the entire value of it from consideration as an asset.₂₇

Grandma may also need to be prepared to question asset determinations made by DHS once Granddad does apply for Medicaid. Suppose Grandma and Granddad both have life insurance policies with face values in excess of $1,500 that DHS believes should be included in the couple's countable resources.₂₈ In a recent unreported case, a husband had four life insurance policies: one with initial face value of $2,500, two of $5,000 and one of $6,000.₂₉ Although none of the policies had any cash surrender value and two of the policies had declining "ultimate" values of $1,200 and $1,500 respectively, DHS assigned all of the policies a value of 60 percent of the initial face value, based on a formula found in the State Medicaid Manual, for a total of $11,100. In reversing this valuation, the Court of Appeals noted that asset determinations are to be made with reference to the same standards set out in the federal regulations for determining eligibility for SSI.₃₀ The court found that the operative concept is that of "conversion to cash" - the regulations specifically exempt term life insurance from consideration, regardless of face value₃₁ and if the policies in question are payable only upon death, have no cash surrender value, and, for two of them, at least, have a decreasing ultimate value, no justification exists "to support ... inclusion of the life insurance policies in ... [the applicant's] resource assessment."₃₂

In addition, given Grandma's medical condition, it may be that she should be entitled to an increase in the MMMNA because of the cost of her prescription medications, which are not covered by Medicare.₃₃ Similarly, the spousal income allocation can be further raised by assertion of excess shelter costs. The current shelter standard for Tennessee is $435; if Grandma has shelter costs in excess of this amount, she may be entitled to an increase of her spousal income. Grandma has no mortgage obligation, but she may have a maintenance fee if she lives in a planned community, certainly she has a property tax obligation, needs homeowner's insurance, and may have utility costs in excess of the standard amount. If so, she should receive an "excess shelter allowance" in addition to her basic MMMNA.₃₄ These sorts of arguments can be raised at a fair hearing before an administrative law judge₃₅ or could be established by a court of proper jurisdiction by means of an order of support.₃₆

Another unreported case₃₇ is illustrative concerning establishment of an increase in the spousal MMMNA by obtaining a court order of support. Frederic Blumberg's wife required nursing home care, so he filed a petition against her in Circuit Court asking the court to award him an increase in his spousal MMMNA. The court did so, ordering Mrs. Blumberg to pay her entire Social Security check to Mr. Blumberg to help defray his living costs.₃₈ Mr. Blumberg then filed Mrs. Blumberg's application for Medicaid, which was approved, and requested DHS to honor the court order by increasing his MMMNA in the amount decreed by the court. DHS refused to acknowledge the court order as binding, and challenged it on the grounds that the plaintiff Blumberg had failed to give notice to DHS when he filed his petition for support. The Blumbergs requested a fair hearing to resolve the issue, which again resulted in denial of the requested increase in Mr. Blumberg's MMMNA. The Blumbergs sought review in chancery court, which upheld the administrative decision.

In reversing the court below, the Court of Appeals found that the Medicaid statute set up two equally valid alternative paths to establishing an increased MMMNA. The court noted that although it might be "good policy" to notify DHS of spousal support petitions to increase the MMMNA, the statute did not require that such notice be given.₃₉ Under the plain language of the statute, DHS had no choice but to honor the Circuit Court's order increasing the MMMNA without any further proof or showing relating to the issue.₄₀ Therefore, whenever grounds exist for raising the MMMNA, counsel may want to consider pursuit of a judicial decree first; if the court grants the requested relief, DHS must honor the court's finding and should the court refuse to grant the requested relief, the clients can then raise the issue in the fair hearing without reference to the court's determination.

Thus, despite the "income first" rule, there are strategies that may be successful both in increasing the income available to the community spouse and in reducing the amount of resources that are attributed to the institutionalized spouse, resulting in a speedier determination of eligibility and at least partially ameliorating the "pauperization" effect on the community spouse once eligibility has been determined. It has been suggested that desperation may drive couples such as Grandma and Granddad to elect to divorce in response to the rigid imposition of the "income first" policy.₄₁ Obviously, after a marriage that has endured 50 years, the emotional toll of divorcing, particularly when one of the parties appears to be more in need of the moral support and faithful companionship of the other, makes this a particularly unattractive choice from the standpoint of individual good and social policy. In addition, in order for the divorce to serve the purpose of preserving assets for the community spouse on the one hand and achieving Medicaid eligibility for the institutionalized spouse on the other, the distribution of property between the spouses will have to divest the institutionalized spouse of virtually all marital and separate property. Although the parties could agree to such a division in an irreconcilable differences divorce, query as to whether a voluntary division of this sort would withstand challenge by DHS as constituting a disqualifying transfer of assets for less than fair market value.₄₂ Presumably DHS would have to honor a court finding that such a distribution was "fair and equitable" but query as to whether a court would be willing to so find, since the factors considered by the courts in making such determinations would ordinarily dictate a greater award of assets to the institutionalized, and thus clearly the more needy, spouse, rather than the opposite.₄₃ In any event, the problem of separate assets owned by the institutionalized spouse remains, since the divorce court has no jurisdiction to award these to the community spouse.₄₄ So, it is hoped that frightened couples will not resort to such extreme measures, as the intangible costs in terms of family disruption would seem in most cases to far outweigh the ends to be achieved. Given the MCCA and the Congressional history behind it, it would appear to be a much better practice to aggressively pursue and assert the spousal protection provisions that are provided under the law, and to litigate where necessary to expand and preserve these protections, as already suggested above.

Finally, as the law now exists under Wisconsin v. Blumer, Tennessee could still elect to follow the "resources first" rule. Given the present budgetary constraints facing Tennessee, it seems unlikely that the state will elect to do so, since the clear result will be to grant Medicaid eligibility to more people at an earlier point, which will certainly result in increased costs.₄₅ Still, in assessing the political benefit of whatever cost-savings are afforded by retaining the "income first" method, state taxpayers may want to consider the fact that "43 percent of all persons over the age of 65 will spend some time in a nursing facility,"₄₆ and that 70 percent of that 43 percent "rely on Medicaid to help pay for their nursing home care."₄₇ Although there are certainly no easy answers, the decision to balance the budget at the expense of those who are elderly, frail and seriously ill may one day result in a bitter harvest for a substantial number of Tennesseans.

Notes

1. See 42 U.S.C.S. §1395i-3 (2001). The statute defines skilled care in general terms, but regulations promulgated by the Centers for Medicare and Medicaid Services (CMS) specify that the care provided must be of sufficient complexity to necessitate provision "directly by, or under supervision of," skilled professional personnel, be required on a daily basis, be furnished for a condition that arose while the patient was in the hospital, and be such that, "as a practical matter," can only be implemented on an inpatient basis in a skilled nursing facility. 42 C.F.R. §409.31.

2. 42 U.S.C.S. 1395e(a)(3) (2001). As of January 2002, after the 20th day, the patient is responsible for a daily co-pay of $101.50 up through the 100th day of care; from the 101st day on, the patient is entirely responsible for the cost of care.

3. The state regulations, found in the Rules of the Tennessee Department of Finance and Administration, Bureau of TennCare, Chapter 1200-13-1 et seq., refer to intermediate nursing care as "Level 1" nursing care. Medicaid will only pay for such care if the following criteria are met:

1) The care is medically necessary (as further defined in the regulation) and

2) Inpatient nursing care is needed on a daily basis, due to the patient's inability to "self-perform needed nursing care" (as evidenced by one or more of nine criteria set out in the regulation). See Rule 1200-12-1.10(4)(b), Tenn. Comp. R. & Regs (revised Nov. 2001).

4. David Flaum, "Some 401(K) Plans Allow Hardship Withdrawals," Com. Appeal, Jan. 26, 2002 at C8, available at 2002 WL 3460500.

5. Medicaid, or the Medical Assistance Program, provides federal funding to the states to pay for medical services for eligible indigent persons. See 42 U.S.C.S §1396 et seq. (2001). In Tennessee, much of the program has been operated under a waiver granted by the Center for Medicare and Medicaid Services (formerly HCFA, or the Health Care Financing Administration) and is popularly known as TennCare. See Tenn Code Ann....§71-5-102 and State of Tennessee, "TennCare: A New Direction in Healthcare" (visited Mar. 5, 2002) http://www.state.tn.us/tenncare

6. The definition of available, or countable, assets, for purposes of Medicaid eligibility tracks that of the definition of resources provided for purposes of determining eligibility for Supplement Security Income, or SSI, and is found at 20 C.F.R. 1201(a). In general, resources are "cash or other property that can be converted to cash within 20 days" and used for the applicant's "support and maintenance." Id. Certain assets, such as the home, household goods, life insurance with face value under $1,500, burial spaces and funds (up to limited amounts) and some income-producing property are exempted from consideration. See Timothy L. Takacs, Elder Law Practice in Tennessee 154-159 (1998 & Supp. 2001).

7. See Kilbourne v. Hanzelik, 648 S.W.2d 932, 934 (Tenn. 1983); see also Tenn. Code Ann. §47-18-805 (2001).

8. See S. Rep. No. 404, 89th Cong., 1st Sess., Pt. 1, 78 (1965).

9. See Schweiker v. Gray Panthers, 434 U. S. 34, 45-50, 101 S.Ct. 2633, 2641-2643, 69 L. Ed.2d 460,469-474 (1981); Renee Loth, "Women Seek Relief in Bills for Nursing Care Elderly Spouses Battle Poverty," Boston Globe, 84, May 5, 1988, available at 1988 WL 4607938; H.R. Rep. No. 105(II), 100th Cong., 2nd Sess. Pt.4, reprinted in 1988 U.S.C.C.A.N. 857, 889-90.

10. P.L. 100-360, §303, 102 Stat. 753 (July 1, 1988).

11. 42 U.S.C.S. §1396 et seq. (2001).

12. Supra n. 11. For persons entering a nursing home now, the maximum amount of countable assets allowed to the resident is $2,000 and all of the resident's available income is to go toward defraying the cost of care with the exception of $30, which can be retained monthly by the resident as a "personal needs allowance." 2 Advising the Elderly Client §29:55 (Louis A. Mezzulo & Mark Woolpert eds.) (1993 & Supp. 2000).

13. 42 U.S.C.S. §1396r-5(b)(1) (2001).

14. 42 U.S.C.S. §1396r-5(d)(3) (2001). As of January 2002, the MMMNA is $1,452 per month.

15. 42 U.S.C.S. §§1396r-5(d)(1)(B) & (d)(2) (2001)

16. 42 U.S.C.S. §1396r-5(f)(2) (2001). As of January 2002, the Maximum Community Spouse Resource Allowance was $89,280.

17. 42 U.S.C.S. §§1396 r-5(e)(2)(B) & (C) (2001).

18. Id.

19. 534 U.S. ______, 122 S.Ct. 962, 70 USLW 4139 (Feb. 2, 2002).

20. See 42 U.S.C.S. §1396r-5(2)(C) (2001). The section of the statute in question reads as follows:

(C) Revision of community spouse resource allowance. If either such spouse establishes that the community spouse resource allowance (in relation to the amount of income generated by such an allowance) is inadequate to raise the community spouse's income to the monthly minimum maintenance needs allowance, there shall be substituted, for the community spouse resource allowance under subsection (f)(2), an amount adequate to provide such a minimum maintenance needs allowance.

21. See Wisconsin v. Blumer, 534 U.S. ______, 122 S. Ct. 962, 974 (2002).

22. See "Brief of Amici Curiae State Medicaid Agencies in Support of Petitioner" (No. 00-952), available at 2001 WL 1077916 (Sept. 7, 2001).

23. See Takacs, supra note 7, §5-5(c)(4).

24. See 42 U.S.C.S.402(b)(2). Spouse's benefits are roughly 50 percent of the wage-earner's primary insurance amount.

25. A 5 percent annual return on $89,280 would equal $4,464, or $372 per month.

26. A 5 percent annual return on $10,720 would equal $536 or approximately $45 per month.

27. See Takacs, supra note 7, at 213-289 for a thorough and detailed discussion of permissible Medicaid transfer strategies.

28. See 20 CFR §416.1230 pertaining to exclusion of life insurance.

29. Miller v. State Department of Human Services, 2001 WL 278001 (Tenn. Ct. App., May 5, 2001).

30. See 20 C.F.R. §416.1201(a), which defines "resources" as "cash or other liquid assets or any real or personal property that an individual (or spouse, if any) owns and could convert to cash to be used for his or her support or maintenance."

31. See 20 C.F.R. §416.1230(b)(5).

32. See Miller, supra note 29, at 4.

33. 42 U.S.C. §410.29(a).

34. See Takacs supra note 7, §5-5(c)(5).

35. Pursuant to 42 U.S.C.S. §§1396r-5(b), (d)(2)-(4), (e) & (f); Rule 1240-3-3-.04, Tenn. Comp. Rules & Regs. (revised Jan. 2002).

36. 42 U.S.C.S. §§1396r-5(d)(5), (e) & (f)(3).

37. See Blumberg v. Tennessee Department of Human Services, 2000 WL 1586454 (Tenn. Ct. App. 2000).

38. Id. at 1. Mrs. Blumberg received $405 per month in Social Security.

39. Id. at 3.

40. Advocates may want to consider that the standard that must be met for increase of the MMMNA at the administrative fair hearing is that of "exceptional circumstances resulting in significant financial distress." See 42 U.S.C.A. §1396r-5(e)(B). However, if a support petition is filed in court, the statute allows for application of a more "lenient" state law support standard. See 42 U.S.C.A. §1396r-5(d)(5) and Jenkins v. Fulds, 1996 WL 221614 (S.D.N.Y. 1996). In Tennessee, a petition for "separate maintenance" is derived from the spousal duty to support, and the court may look to equitable principles in determining the requisite amount. Folk v. Folk, 355 S.W. 2d 634, 636 (Tenn. 1962). In addition, Tenn. Code Ann. §36-5-101(d)(1)(A)-(L) sets out the statutory criteria normally used in setting spousal support, whether in the context of divorce or separation. The courts generally look to all the circumstances, with the "real need" of the spouse asking for support being evaluated and balanced against the supporting spouse's ability to pay. Goodman v. Goodman, 8 S.W. 3d 289 (Tenn. Ct. App. 1999).

41. Takacs, Timothy L., "United States Supreme Court Upholds Medicaid Income-First Rule," The Elder Law eBulletin (Feb. 26, 2002) http://www.tn-elderlaw.com/020226.html

42. See Takacs, supra note 7, §8-3(d).

43. Tenn. Code Ann. §36-4-121(c) provides that the court "shall consider" the following, among other, factors in "making equitable division of marital property": length of the marriage, "age, physical and mental health, vocational skills, employability, earning capacity, estate, financial liabilities and financial needs of each of the parties." Although "equitable" does not necessarily mean "equal," departure from equality generally favors the party with greater need. See Janet L. Richards, Richards on Tennessee Family Law §11-2 (1997, Supp. 2001); Watters v. Watters, 959 S.W. 2d 585 (Tenn. Ct. App. 1997).

44. See Richards, supra note 43, §11-4.

45. Although no statistics were readily available for Tennessee concerning the projected cost of such a change, Wisconsin estimated increased annual costs at $10 million. See Brief of Amici Curiae, supra note 22, at 4. It has been estimated that funding for a "liberalized" version of Medicaid that would allow even single individuals to retain as much as $30,000 in assets and would increase the personal needs allowance to $100 per month, would require a 1.93 percent increase in federal payroll taxes by the year 2018. See Joshua M. Wiener, et al., Sharing the Burden 24-27.

46. See Brief of Amici Curiae AARP and NCCNHR [National Citizens' Coalition for Nursing Home Reform] in Support of Respondent, available at 2001 WL 1246474 (Oct. 17, 2001).

47. Id.

Donna S. Harkness is a certified elder law attorney, employed as assistant professor of clinical law at the University of Memphis Cecil C. Humphreys School of Law, where she directs and supervises the Elder Law Clinic. She is currently a member of the Tennessee Association of Legal Services Health Task Force and the Shelby County Elder Financial Fraud and Economic Crimes Team. She received her bachelor's degree from the University of Memphis and her law degree from Vanderbilt University School of Law.