Planning for Medicaid with an Elder Law Attorney

May 8, 2023Filed Under: Elder Law, Medicaid Planning

People with low incomes are eligible for Medicaid health insurance. However, because of the steep costs associated with long-term care, Medicaid planning is a growing trend for individuals with higher net worth as an alternative to spending down assets to qualify for benefits. Individuals can plan to meet eligibility requirements by legally restructuring their financial resources and maximizing their likelihood of being accepted into the Medicaid program.

Common Reasons to Engage in Medicaid Planning

There are many reasons to participate in Medicaid planning, including:

· Long-term Care Costs

Medicaid can help cover expensive long-term care costs. Medicaid planning can help prepare for the possibility that you or a loved one will need to qualify for benefits to offset costs for long-term care.

· Protecting Assets

Medicaid has strict eligibility requirements, including limits on the number of assets you possess. Medicaid planning helps restructure these assets to ensure you qualify for health benefits when needed.

· Estate Planning

Medicaid planning is often a key component of estate planning. By arranging your finances in a way that allows you to qualify for Medicaid, you ensure you have the resources you need to cover long-term healthcare costs while protecting assets for your heirs.

How Prevalent is the Need for Long-term Care?

According to the National Center for Health Statistics, approximately 65,600 regulated long-term care facilities in the US serve more than 8.3 million residents in various long-term care facilities, assisted living facilities, and nursing homes.

The percentage of individuals who will need long-term care is growing rapidly. According to the Administration on Aging (AoA), a division of the US Department of Health and Human Services (HHS), at least 70 percent of people aged 65 today will require some long-term care. This percentage continues to increase with age.

With an average stay of 3.2 years, Americans spend $475.1 billion annually to cover long-term care costs, and projections continue to climb. Medicaid benefits will cover approximately 42 percent of these costs making Medicaid planning crucial for financial solvency in retirement and legacy planning.

A Place for Mom

How to Begin Medicaid Planning

Taking the appropriate steps to legally and ethically protect assets while qualifying for Medicaid benefits is best handled by an elder law attorney in your state. Medicaid is a federal and state partnership program, and following your state’s rules and regulations is crucial to success. However, before engaging with an elder law attorney, you can gather some information to help them with your Medicaid planning strategy:

Becoming familiar with your state laws and eligibility requirements regarding income and assets can streamline your consultation. Your attorney will answer all of your questions.
Compiling a list of all assets, including savings, investments, property, insurance policies, and retirement accounts, can help your attorney determine which assets are exempt from Medicaid’s asset limits.
Gathering information regarding all income sources will help your attorney figure out how much you can earn while still qualifying for benefits.
Researching long-term care insurance policies helps decide whether you can afford to add it to your Medicaid strategy.

How an Elder Law Attorney can Help

After gathering the necessary financial information and any existing estate planning documents, it’s time to meet with your Medicaid planning or elder law attorney.

They will review your financial situation to determine what income and assets count toward Medicaid eligibility and identify any potential issues or challenges. Knowing your unique situation, your attorney can begin developing a custom strategy to comply with Medicaid rules and regulations.

Your Medicaid strategy must complement your estate planning documents and goals. An elder law attorney may amend existing will or trust documents to maximize Medicaid benefits and ensure a healthy spouse living at home has the financial resources they need.

An elder law attorney may recommend transferring assets into a Medicaid asset protection trust. The Medicaid lookback rules make it necessary to start this process at least five years before the need for care. When it’s time to apply for benefits, your elder law attorney helps prepare and submit your Medicaid application.

You or a Loved One are Likely to Need Long-Term Care

Medicaid planning ensures you can afford the care you need. Because Medicaid eligibility is as important as it is complicated, an elder law attorney can ensure you qualify and avoid simple mistakes that result in a denial or delay of benefits. When planning for potential long-term care, the sooner you begin, the more options you have.

We hope you found this article helpful. If you’d like to discuss your particular situation, please don’t hesitate to reach out. Please contact our Cincinnati office by calling us at 513-771-2444 and schedule a consultation. We look forward to the opportunity to work with you.

Plan Medicaid and Inheritances Carefully

October 17, 2022Filed Under: Elder Law, Medicaid Planning

It is possible to make mistakes when it comes to inheritances and Medicaid. It can be very costly to make those mistakes. When a person is drawing Medicaid benefits and inherits money or property, that inheritance jeopardizes the benefits. The inheritance must be handled carefully to minimize expensive penalties. What “careful” means, though, can be misunderstood without the necessary expertise.

The Right Steps for Handling Inheritance

The first and best idea is to call experienced elder law attorneys like us. (An even better idea is to call us well before any inheritance becomes a “problem.” The sooner you call us, the more money we can likely protect for you.)

An Ohio attorney was recently suspended partly because he mishandled this Medicaid-inheritance issue. The mistaken advice was that to protect the benefits, the person who stood to inherit should “disclaim” or “renounce” the inheritance – in other words, give it away to someone else.

Medicaid Rules and Inheritance Context

That advice would have been OK in the tax context. It was not OK in the Medicaid context. The Medicaid rules count inheritances regardless of whether the recipient keeps them or passes them on to someone else. The bad result, in such cases, is that the person receiving Medicaid would be charged just as if he or she had taken the money, even if he or she gave it away, and the person’s benefits would be docked accordingly. This can be a very expensive misstep.

The better result would be to consult us immediately. We can advise you on the necessary techniques to split the inheritance between the recipient and somebody else, like a child. If the right strategies are used, Medicaid would count the inheritance to an extent, but not as much as it would have if the recipient had simply given away the whole sum.

An even better result would be if the person leaving the inheritance had consulted us first. We know how to structure that person’s financial arrangements, to protect the people to whom the person wants to leave his or her legacy.

Elder law is a law unto itself. We know that complicated area of the law well and we have helped many people successfully meet the challenges it poses. If you have questions or would like to discuss your personal situation, please don’t hesitate to contact us at 513-771-2444.

Managing Long-Term Care Costs

July 18, 2022Filed Under: Long Term Care, Medicaid Planning

Almost seventy percent of retirees in the United States will need some kind of long-term care (LTC), according to figures released by the US Department of Health and Human Services (HHS). According to research by Genworth, the median annual cost for these services will range from $53,768 to $105,850. HHS also reports that those who receive Medicaid-financed nursing home care will spend more time in residence than those who self-finance their care or have private long-term care insurance. These long-term care services and supports (LTSS) are becoming more critical as retirees live longer lives and worry about outspending their assets.

The Dilemma of Affording Long-term Care

Paying for long-term care planning remains a significant challenge for most older Americans and preparing for service payments can be tricky. LTC insurance may cover a portion of services or all of them, and premiums depend on a person’s age, gender, health, location, and other criteria. The American Association of Long-Term Care Insurance lists 2021 average premiums for initial benefits of $165,000 (with a 1 to 5 percent annual growth rate) for a healthy fifty-five-year-old male to be between $1,375 to $3,685 per year. For the same coverage type, a healthy fifty-five-year-old woman can expect to pay between $2,150 to $6,400. Premium hikes tend to be costly because metrics used years ago in the insurance industry were faulty and did not accurately project the real LTSS costs.

What is Hybrid Long-term Care Coverage?

A different payment option is hybrid long-term care coverage. These policies are part annuity or life insurance and part long-term care coverage. You may purchase a policy upfront eliminating any future risk of premium increases, and your heirs may receive a death benefit if you do not need long-term care. This option is an arbitrage approach hoping that you will not require LTSS and that your heirs may benefit. Hybrid policy price comparisons are more difficult to ascertain than a standalone long-term care coverage policy.

How to Utilize Health Savings Account to Pay for Long-term Care

A third option is for those retirees with sizable health savings accounts to use pre-tax funds to cover long-term care expenses or premiums. Currently, those itemizing deductions can write off long-term care expenses above 7.5 percent of their adjusted gross income on their taxes. Finally, those low-income retirees with assets below a certain threshold may qualify for Medicaid LTSS. Applicants must pass a five-year “look back” period to assure they did not gift or spend down assets to qualify.

Typically, family members play an important caregiver role for their loved ones who need help regarding activities of daily living. This statement is particularly true in the earlier stages of requiring care, where someone may need help with just one activity of daily living. In-home assistance, community programs, and residential facilities can help your loved one stay as active as possible, accomplishing everyday tasks. The family-style approach constitutes most living arrangements for those who receive long-term care.

HHS

Many available resources help older adults continue to reside in-home and participate in their communities. The stay-at-home option in the earlier stages of a significant long-term need, or if projected care requirements may be a matter of two to three months, may be the most viable and cost-effective solution. Pivoting to in-home service provision is the most likely scenario for most American retirees. Nursing home residential space is expensive, and Medicaid can only supply so much aid. While most LTSS stays remain paid care and have relatively short durations, the lifetime risk for expensive out-of-pocket costs runs high.

Unfortunately, receiving paid LTSS care is not equally distributed among the US population. Generally, people with limited education and less financial resources are the most likely to experience severe LTSS needs. Over a lifetime, however, the more well-educated population with different socioeconomic advantages tend to live longer and can outlive their assets. Family is an integral part of the solution for long-term care while the federal government responds to the growing need to make this care more available and affordable. For your best outcome, be proactive in your planning. Most Americans will need LTSS, but few will have taken steps to plan for it. We hope you found this article helpful. If you’d like to discuss your particular situation, please don’t hesitate to reach out. Please contact our Cincinnati office by calling us at 513-771-2444 with any questions.

Medicaid: Five Years of Looking Back Without Penalties

June 6, 2022Filed Under: Elder Law, Long Term Care, Medicaid Planning

Planning for long-term care is important because nearly everyone will require it at some point in their lives. While we cannot predict the timing or level of care, we can take steps to prepare for an unexpected medical and financial crisis to help reduce the stress on ourselves and our family members. The cost of care continues to rise, but Medicaid planning can protect your assets, such as your home, hard-earned savings, retirement fund, or anything you wish to pass on to your loved ones.

Medicare is a federal and state program that helps seniors with limited assets and income afford long-term healthcare. Many seniors believe their only option to qualify for the program is to “spend down” their assets. However, proactive Medicaid planning can protect a substantial portion of your estate if done correctly. That means preparing at least five years before the potential need for benefits. The program’s eligibility rules are complicated, as is the application process. That’s why many people choose to hire an elder law attorney who specializes in Medicaid planning to evaluate their estate and reorganize assets over time.

Medicaid qualification requires a five-year look-back period at financial transactions in most states. The program verifies income and makes sure you haven’t gifted property to others under fair market value to reduce countable assets. Gifting assets is subject to a penalty that results in a period of ineligibility for benefits. The rules for gifting change state by state, and it’s important to know the rules where you live. If you begin early, you can ensure qualification for benefits when you really need them.

Qualifying for Medicaid Without a Penalty

A combination of options gives you the best outcome when applying for Medicaid benefits. An elder law attorney can customize a Medicaid planning strategy that works for your specific needs and goals. When you find yourself in need of long-term care services, you can receive Medicaid benefits to offset costs ranging anywhere from $60,000 to $100,000 a year.

The rising costs of long-term care can be overwhelming and unaffordable, depending on an individual’s needs. Your Medicare policy doesn’t cover long-term in-home or nursing facility services, and long-term care insurance premiums are very high. To discover more options, you’ll need a list of countable assets to determine ways to spend down that comply with Medicaid rules. It makes sense to spend down if it offers advantages:

Make home modifications like stairlifts, wheelchair ramps, walk-in showers, and other convenient amenities
Purchase a funeral benefits plan to cover final expenses
Pay off debt
Gift assets at fair market value with legal documentation
Create caregiver agreements to compensate for care

Caregiver Agreements are formal agreements to compensate caregivers who can be relatives or friends, but they need to be carefully drafted by a professional.

Qualified Income Trust

You may still have too many assets to qualify for Medicaid benefits, but those assets can be protected from Medicaid’s Estate Recovery Program. Your elder law attorney may recommend transferring them to a trust called a Qualified Income Trust (QIT) or Miller Trust. It is an irrevocable trust managed by a trustee who has legal control of the funds. Once they are transferred, they are no longer countable assets.

Medicaid Exempt Annuities

This life insurance annuity type is common to avoid Medicaid penalties during the look-back period. An annuity is a lump sum investment by an individual in return for a monthly payment for the duration of that person’s life or a set number of years. These annuities turn assets into income, lowering the countable assets of the Medicaid candidate below the eligibility limit. However, not all annuities qualify, and your attorney will help you choose the right product.

The surest way to avoid violating a look-back period when qualifying for Medicaid is to consult a qualified Medicaid planning and elder law attorney before you gift or transfer any assets. If a violation has already occurred, they can also offer assistance to correct a problem.

Always seek professional legal advice when creating your long-term care strategy using Medicaid. Applications are rarely successful due to mistakes when filling out forms, and it can have devastating long-term consequences on a family and their finances. Begin well before you anticipate needing long-term care. Become well-informed about all your options as you go through the application process. Proactive planning and expert legal strategies can help protect your assets and offer considerable help for your long-term care costs. We hope you found this article helpful. If you’d like to discuss your particular situation, please don’t hesitate to reach out. Please contact our Cincinnati office by calling us at 513-771-2444 with any questions.