Massachusetts Estate Planning & Asset Protection Blog

Is your Planning Stuck in Limbo? (part 2)

Posted by Dennis Sullivan & Associates on Tue, Aug 01, 2017

How does the debate over health care reform affect you and your estate plan?

35274856603_c2af85ca10_b.jpg In our last post we discussed the importance of keeping up with the constant changes happening in health care reform. We will continue to examine how the on-going deliberations in Washington may affect you, your future health care and your estate.  We at Dennis Sullivan & Associates are keeping up to date on all the changes, and making sure you stay informed on all the important details.  For more information on the current law of the land, you can download our Report: Senior & Boomers Guide to Health Care Reform.   

The Senate has dealt a devastating setback to Republican efforts to repeal and replace Obamacare, defeating a GOP "skinny repeal" bill early Friday morning. With the "skinny repeal" bill off the table, lawmakers are unsure of where the health care debate is headed. 

Senate Majority Leader McConnell and his staff are trying to find a balance between conservative Republicans, who want a full repeal of ObamaCare and a replacement that has lower health care costs, and more moderate Republicans who want to preserve its more popular benefits.

The deal-making process is in full swing, with the additions of opioid funding and allowing health savings accounts to be used to pay for insurance premiums. Some Senators are for potentially leaving in some taxes to pay for more generous benefits, after weeks of being criticized by Democrats for offering “tax cuts for the rich and Medicaid cuts for the poor.” Conservatives want to cut more from the regulations and many from Medicaid expansion states are uneasy about future cuts to Medicaid.

Senator Ted Cruz of Texas has offered an amendment called the “Consumer Freedom Option” that would allow insurance companies to sell any health coverage plan they wish as long as they provide one plan that satisfies the “essential benefits” mandates of Obamacare. While the Cruz amendment appeals to conservatives who want to provide consumers with lower cost options, moderates are concerned it could negatively impact those with pre-existing conditions. Supporters have suggested that federal subsidies could help ensure that premiums don’t increase for those who are seriously ill. The CBO is currently scoring this amendment.  

President Trump, along with Senator Rand Paul of Kentucky and Senator Ben Sasse of Nebraska, has even offered to repeal ObamaCare for now and replace it later.

Of course, no one is going to get everything they want so there must be compromises. Majority Leader McConnell has said that if the Senate is not able to pass a bill soon, Congress will have to pass a bipartisan measure to shore up the imploding health insurance markets.

And so, the Civics lesson continues. The process is at work.  As we see here the process can be long, unstable and worrisome.  Luckily for you your estate planning doesn’t have be. We at Dennis Sullivan and Associates make your estate planning and asset protection worry and stress free.  Once you have a plan in place you will feel confident knowing it will protect you, your family and your life savings.  You can enjoy life to the fullest knowing you and your family are protected no matter what unknowns lay ahead. 

 

At the Estate Planning & Asset Protection Law Center, we help people and their families protect their home, spouse, life-savings, and legacy for their loved ones.  We provide clients with a unique educational and counseling so they understand where opportunities exist to eliminate problems now as they implement plans for a protected future.

We encourage you to attend one of our free educational workshops, call 800-964-4295 and register to learn more about what you can do to enhance the security of your spouse, home, life savings and legacy.

Click Here to Register For Our Trust, Estate & Asset  Protection Workshop

Tags: Affordable Health Care, Affordable Health Care Act, Announcements, Elder Law, Estate Planning, Financial Planning, Health Care, Health Care Ruling, Medicaid, Medicare, Obamacare, Retirement, applying for medicare, Medicaid penalties, care costs, care, coverage, coverages, disenrollment, elder care, enrollment, elder care journey, federal, health, health Care act, life-care plan, long term care, medicaid qualification, medical expenses, proposed changes, senior, unreimbured medical expenses, seniors

Is your Planning Stuck in Limbo?

Posted by Dennis Sullivan & Associates on Thu, Jul 27, 2017

How does the debate over Health Care Reform affect you and your estate plan?

Everyone is talking about health care reform: whether it’s the House bill, Repeal & Replace, Skinny Repeal, it can make your head spin.  One question on everyone’s mind is how changes to health care will affect them.  We at Dennis Sullivan & Associates are keeping up to date on all the changes, and will cover the process through a series of blogs to explain where health care reform is now, how it affects you and what the future may hold.  For more information on the current law of the land, you can download our Report: Senior & Boomers Guide to Health Care Reform

 


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Eventually, both the House and Senate must vote on the same bill.

The battle continues in Washington over the repeal or replacement of the Affordable Care Act (ObamaCare) and as we are witnessing; this can be a messy process. 

Why Republicans are trying so hard to repeal and replace ObamaCare and how they are going about it:

ObamaCare, you may remember, was passed by the Democrats in 2010 with no Republican support. Ever since, Republicans have campaigned on repealing the program, which was unpopular with many Americans. “Repeal and Replace” was their rallying cry to voters to help them win back control of the House in 2012, then the Senate in 2014, and finally the Presidency in 2016. If the Republicans are not able to fulfill this major promise, some may be in danger of losing their seats in the next election, as they would likely be blamed for the problems with ObamaCare if they don’t fix them. These are the political reasons.

Democrats admit that ObamaCare has problems and needs a major fix to survive. But they are not on board with repeal and replace of such a signature piece of legislation, while Republicans try to find a way to pass new legislation.

The Legislative process:

The normal legislative process is that a bill begins in the House, where it is written, discussed and approved by a committee before the House votes on it. If it passes the House, it is then sent to the Senate. The Senate can vote on the same bill, make amendments to the House bill, or create its own bill. Eventually, both the House and Senate must vote on the same bill, so if there are differences, members of both the House and Senate meet in committee to resolve them. Once a bill passes both the House and Senate, it is then sent to the President who can sign it into law or veto it.

Right now, there is a House bill on health care that has passed the House, and a Senate bill that has not passed the Senate. Discussions and amendments are still occurring with the Senate bill in hopes it will pass soon. The public posture is that this messy legislative process is making the bill better.

Further complicating this process is that while the Republicans have a majority in both the House and the Senate, they only have 52 Republican Senators. 60 votes are required to overcome the filibusters and pass new legislation, so they are attempting to pass health care legislation through the Budget Reconciliation process. It only requires 51 votes, but it limits the legislation to budget-related items only. They would not be able to include provisions some Republicans want in a full repeal and replace bill—for example, letting insurance companies sell across state lines to increase competition, lower prices and create better plans; and allowing the government to negotiate lower drug prices. Issues like these would have to be voted on later.

For the Senate bill to pass in Reconciliation, 50 Republicans must vote for the bill, since no Democrat or Independent is expected to vote for the bill. Vice-President Pence would break the tie if needed.

So far:

The Senate rejected a proposal from Republican lawmakers to repeal Obamacare on Wednesday July 26, 2017, marking a significant milestone in the Republican Party's years-long political crusade to gut former President Barack Obama's legacy health care law.

 

What does the future hold?

We aren’t sure what the future American Health Care Act is going to look like, not sure anyone does, but luckily protecting yourself and your loved ones from expensive long term care doesn’t have to be so uncertain.  With asset based long term care products, there are ways to insure your control over your future long term care and insure you have something left over for your spouse, children and loved ones. Don’t let your long term care plan sit in limbo. Stay tuned we will discuss more about what the future looks like in our next blog post.

 Click here for more information on  Estate Planning and Asset Protection

At the Estate Planning & Asset Protection Law Center, we help people and their families protect their home, spouse, life-savings, and legacy for their loved ones.  We provide clients with a unique educational and counseling so they understand where opportunities exist to eliminate problems now as they implement plans for a protected future.

If you would like more information on Medicaid, the Affordable Care, or the impact of new health care laws on your planning, request your free preview of our guide, the Senior & Boomers’ Guide to Health Care Reform & Avoiding Nursing Home Poverty. 

We encourage you to attend one of our free educational workshops, call 800-964-4295 and register to learn more about what you can do to enhance the security of your spouse, home, life savings and legacy.Click Here to Register For Our Trust, Estate & Asset  Protection Workshop

Tags: Affordable Health Care Act, Announcements, Dennis Sullivan, Elder Law, Estate Planning, Estate Planning Recommendations, Estate Planning Tip, Financial Planning, Health Care, Health Care Ruling, Medicaid, Medicaid penalties, Medicare, Obama, Obamacare, Retirement, care costs, coverage, unreimbured medical expenses, surviving spouse, senior, coverages, applying for medicare, elder care

What will 2017 bring to Seniors and Persons with Disabilities? - Part II

Posted by Dennis Sullivan & Associates on Tue, Jan 24, 2017

What will 2017 bring to Seniors and Persons with Disabilities? - Part II

In last week's blog 'What will 2017 Bring to Seniors and Persons with Disabilities? - Part I' we discussed some of the key issues to watch out for in 2017 including Medicare and Medicaid reform. In Part II of the blog we continue our review of potential impacts on legislation that affects seniors and persons with disabilities.

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Affordable Care Act

Republicans are already moving to repeal and replace Obamacare. The question is: How much will be repealed? There are several programs included in the ACA, not related to traditional health insurance, that are important to elder law attorneys and their clients. For example, Medicaid expansion, a kind of Medicaid reform, is part of the ACA.

The ACA also includes programs that work toward ending the institutional bias in Medicaid. One is Community First Choice, a state plan that provides home- and community-based services. Currently it has an extremely low-income threshold so it’s a limited population, but it’s a start.

Another is Money Follows the Person, which pays for transition services. For example, it could provide extra funds to help someone leave a nursing home, by paying for a housing coordinator to find an apartment, a roommate, buy basic furniture and so on.

We are moving toward home- and community-based service, which many people favor. How will that interact with Medicaid reforms? Because they are optional, some fear that with per capita caps, these services will be among the first to go. There may be more opportunities to expand these services through block grants because they allow more flexibility in what is offered. Along this line, Senator Chuck Schumer (D-NY) has introduced a bill called the Disability Integration Act, which would make home- and community-based services a civil right.

Other Medicaid-Related Issues to Watch

Limiting home equity: This proposal, H.R. 1361, would take away the state option to expand the cap for single individual home owners. It would not impact people who have a community spouse living in the home or if you have a disabled child or a dependent under 21. 

Medical liability reform: This could impact whether individuals get adequate access to personal injury settlements and funds that can be put into a special needs trust.

Long-Term Care Reform

There has been a lot of discussion on Capitol Hill about picking up the pieces on long-term care. After a decade, the market has completely collapsed. John Hancock just withdrew, and Genworth was bought out by a Chinese private equity firm. Republicans and Democrats agree on the problem, but there doesn’t seem to be common ground yet on a solution. The Senate Aging Committee is starting the process, which is a positive step. There are calls for catastrophic coverage, at least on the back end, and probably some sort of front-end coverage for two or three years. There may be some long-term care reform as part of Medicaid reform.

VA Benefit Rules

The new rules have been delayed again until at least April, 2017. Fixing the VA is a Trump priority. An important piece to what will happen with the VA is who Trump names to head the VA and Veterans Benefit Administration (VBA). 

Nursing home binding arbitration rules

Nursing homes must comply with binding arbitration rules to have access to Medicare or Medicaid funds. NAELA has been working with others to push CMS to ban pre-dispute binding arbitration. The for-profit nursing home industry association is fighting it and recently won a preliminary injunction in a Mississippi district court (American Health Care Association et al v. Burwell). We do not yet know if the Trump Administration will appeal this ruling and continue with banning binding arbitration for nursing home contracts. 

In Kindred Nursing Centers Limited Partnership v. Clark in Kentucky, the issue is whether federal arbitration acts overrule the state’s arbitration acts. The state of Kentucky has a law that says in order to waive the principal’s constitutional right to a jury trial, the agent must be given that specific authority within the power of attorney. Whether this is overturned is likely to hinge on President Trump’s pick to fill Justice Scalia’s vacancy on the Supreme Court.

 Conclusion

There are a number of issues that will be addressed in 2017 that can have significant impact on seniors and their loved ones, Veterans, and persons with disabilities. If you have questions or would like to discuss any of the issues raised here, please don’t hesitate to contact us.

At the Estate Planning & Asset Protection Law Center, we help people and their families learn how to protect their home, spouse, life-savings, and legacy for their loved ones.  We provide clients with a unique educational and counseling approach so they understand where opportunities exist to eliminate problems now as they implement plans for a protected future.

We encourage you to attend one of our free educational workshops. Call 800-964-4295 and register to learn more about what you can do to enhance the security of your spouse, home, life savings and legacy.

Click Here to Register For Our Trust, Estate & Asset  Protection Workshop

 

Tags: disabled, seniors, Affordable Health Care Act, Veteran, VA benefits, VA, Medicaid, Nursing Home, Estate Planning, Elder Law, elder care, New estate tax law, new regulations, trusts, Nursing Home Costs, social security

What will 2017 bring to Seniors and Persons with Disabilities? - Part I

Posted by Dennis Sullivan & Associates on Thu, Jan 19, 2017

What will 2017 bring to Seniors and Persons with Disabilities? - Part I

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Donald Trump’s election and Republican majorities in both houses of Congress surprised much of the nation. With control of legislative and executive branches of government, the expectation is Republicans will finally be able to push through long-awaited legislation, as well as follow through on promises made by candidate Trump. And they are expected to move quickly.

We will summarize some key issues to watch out for in 2017 that affect seniors and persons with disabilities and continue to provide updates throughout the year.

What the Election Outcome Means in Congress

The House has remained in Republican control—about 45% Democrat and 55% Republican. The majority rules, so while the Democrats may have loud opposition, they don’t have a lot of power. Currently, Republicans are mostly united, but those in the Freedom Caucus (Tea Party Republicans) are deciding how they will interact with the Republican establishment. If they split, votes may be needed from Democrats to pass legislation.

The Senate is 48 Democrats and 52 Republicans. 60 votes are needed to prevent a filibuster (where senators can talk for hours and delay votes). But with budget reconciliation, only a simple majority (51) is needed to pass legislation in the Senate. Because they are all budget-related programs, the Republicans will try to reform Medicaid, Medicare and the Affordable Care Act (Obamacare) through budget reconciliation. Individual Republican senators will have a lot of power, as some may insist on additions or deletions to secure their vote. If the Republicans do not stick together for the majority, votes may be needed from Democrats. (Note: Budget reconciliation was used to pass the Deficit Reduction Act of 2005 and OBRA 93, which enacted big cuts that changed elder law—the lengthening of the transfer penalty, the change in the time of when that penalty applies, the move from trust.)

One thing to watch is who is going to run Health and Human Services (HHS), Centers for Medicare and Medicaid Services (CMS) and the Social Security Administration, especially considering how much is related to Supplemental Security Income (SSI). The people now in charge of staffing these agencies are conservative. For example, the person in charge of staffing the political positions at the Social Security Administration has called for privatizing Social Security in the past. Donald Trump has repeatedly said he doesn’t want to change Medicare and Social Security, but that may be changing. (See below.)

Tax Policy

Tax changes are expected as part of the budget reconciliation process. We are not sure yet if 2017 will bring major tax reform or just tax cuts, but tax rates are expected to decrease for both individuals and businesses. Candidate Trump called for elder care and child care tax deductions and/or credits. He has also stated his plan to eliminate the federal estate tax, then charge capital gains tax on everything over $10 million, with exemptions for family farms and small businesses.

We may also see some changes to the ABLE Act (Achieving a Better Life Experience), which passed in December 2014 and amended Section 529 Plans. Currently, ABLE allows people with disabilities developed before the age of 26 and their families to set up tax-exempt savings accounts, which can be used to cover qualified disability expenses such as, but not limited to, education, housing and transportation. Revisions in 2017 may raise the age to 46, allow those working to put in more money, and allow rollovers of these accounts. 

Medicare Reform

President-elect Trump started by saying he was going to protect Medicare and Social Security. After meeting with House Speaker Paul Ryan, he said he will modernize Medicare. Reince Priebus, incoming chief of staff, recently insisted that Mr. Trump won’t meddle with Medicare or Social Security. Instead, he has said he will focus on 1) improving the economy, which will reduce the debt and ease entitlement concerns and 2) save Medicaid, Medicare and Social Security without cuts while eliminating fraud, waste and abuse. 

But he is already encountering resistance from Republicans, who for years have claimed that a major overhaul to Medicare and other entitlements are needed to ensure they don’t go bankrupt; that entitlement reform is critical to reducing debt; and the longer they wait, the harder it becomes to solve the problems. Obama administration officials warned just last year that a central Medicare trust fund is projected to run out of money by 2028.

Yet Republicans are also encouraged by what some of the President-Elect’s Cabinet picks could mean for future entitlement reform. Representative Tom Price (R-GA), who replaced Paul Ryan as Budget chairman and sought to overhaul entitlement programs, is Trump’s pick for Health and Human Services secretary. Representative Mick Mulvaney (R-SC), a fiscal hawk and Freedom Caucus co-founder, will lead his White House budget office.

So, we will have to wait and see if President-elect Trump, his Cabinet members and leading Republicans will find a way to agree. Some reforming of Medicare may be part of the 2017 budget reconciliation, but with ObamaCare repeal and replace, tax reform and infrastructure as the immediate priorities, solving the decades-long problem of deficits in Medicare and Social Security will likely have to wait until after 2017.

In the meantime, we are seeing a tilt toward Medicare Advantage plans. These managed care plans (offered through HMOs) often have lower costs and provide benefits not covered by traditional Medicare and Medicare Supplement Plans, such as health club memberships and preventative educational programs for those with diabetes and other chronic diseases. 

A long-term goal for Medicare, which has been around since its founding in 1964, is premium support. Basically, the consumer would choose a plan from those offered through an exchange. The government would provide subsidies to companies, they would lower the premiums and then people would choose their plans. It’s not likely that this will replace Medicare as we know it, but it is an idea being discussed.

Medicaid Reform

President-elect Trump has called for block granting Medicaid. House Speaker Paul Ryan has called for it, too, and Republicans are looking at whether they can reform Medicaid through budget reconciliation.

Those who want to reform Medicaid are focusing on the FMAP, the federal percentage match that states receive through federal funding. This is based on per capita income of the state. For example, a rich state like New Jersey is a 1:1 ratio, while a poor state like Mississippi is about a 3:1 ratio. This means for every one dollar that Mississippi spends on Medicaid, they will receive three free extra dollars from the federal government. This can impact states’ budget decisions. For example, if the governor of Mississippi needs to cut costs, he will more likely cut education or infrastructure by one dollar, rather than cut Medicaid spending by one dollar and lose the three free extra dollars.

The idea of block grants has been around for about 30 years. They are attractive because there are fewer federal rules to comply with and the states can use the money however they wish. But block grants shift more costs onto the states, and governors tend to oppose that.

Another idea floating around is a per capita cap, which would give the states a fixed dollar amount per individual, based on Medicaid standard lines (the blind, aged, and disabled children and adults). It was first proposed by President Clinton, who also wanted block grants. A per capita cap may force the states to control Medicaid costs over time, but there is also a demographic shift to consider—the medical needs and costs for an 85-year-old are much greater than for a 65-year-old. Nursing homes and aging disability provider groups have a huge stake in this and would likely oppose it, as would some governors.

The cost changes may not be felt right away, but they will be noticeable ten years from now and that’s what Congress must plan for. There may be increased waiver flexibility for the states and provider taxes to offset states’ losses. We may also see reforms to make it easier to manage care.

We will be following changes in legislation very closely and will keep you informed as to how these changes affect seniors and persons with disabilities. Check back next week for Part 2 of this blog where we will discuss more anticipated changes in the law including the Affordable Care Act and VA Benefit Rules!

At the Estate Planning & Asset Protection Law Center, we help people and their families learn how to protect their home, spouse, life-savings, and legacy for their loved ones.  We provide clients with a unique educational and counseling approach so they understand where opportunities exist to eliminate problems now as they implement plans for a protected future.

To learn more about elder care and how changes in the law may affect you,attend one of our free educational workshops, call 800-964-4295 and register to learn more about what you can do to enhance the security of your spouse, home, life savings and legacy.

Nursing home care is more than $180,000 per year! Attend this FREE educational seminar to learn:

  • How to protect your home and assets from the costs of long-term care
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  • How to access Veterans benefits to pay for long-term care

Click Here to Register For Our Trust, Estate & Asset  Protection Workshop 

 

Tags: Medicare, Medicaid, seniors, disabled, Elder Law, Affordable Health Care Act, social security, trusts, Estate Planning, New estate tax law, new regulations, retirement plans, Nursing Home, Nursing Home Costs

Why Retitling Assets to Your Spouse to Qualify for Medicaid May Not Work Part 2

Posted by Dennis Sullivan & Associates on Fri, Feb 20, 2015

Why Retitling Assets to Your Spouse to Qualify for Medicaid May Not Work Part 2 | Massachusetts Elder Law Attorney

 

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A few weeks ago we were discussing Angela’s dilemma.  Her husband, Peter, has Alzheimer’s disease and is going to need some care at home.  Angela is concerned that he will need nursing home level care sooner rather than later and she wants to preserve their primary home as well as their vacation home.

The problem is that Peter does not have long term care insurance so they will have to privately pay for care until he qualifies as eligible for Medicaid.  Angela can keep the primary home and $119,220 in assets and still be eligible. Unfortunately, all their other assets, including their vacation home, will need to be spent down before Medicaid will cover his care.  She can’t simply take Peter’s name off the deed to their vacation home like she had hoped she could.

So, what are their options?  It may still be possible to transfer the second home to a trust and try to get through the 5 year look back.  Peter doesn’t need nursing home level care yet, and if his decline in health is slow enough, it may be possible to continue paying for the care he needs for the next 5 years.  This option would mean that they would have to spend their other savings during that time frame and if they can’t quite make it, maybe their children or another family member can help to pay for Peter’s care.  If not, Angela can always sell the vacation home if there is no other option.

Another approach for Angela to consider, she could also sell both homes and then buy one primary residence with the proceeds from both sales.  While this option doesn’t accomplish what Angela really wants, keeping their vacation home in the family, it does help preserve their assets for any future needs she may have as well as increase the amount that she will be able to be passed on to her family when she is gone.  If a family member can purchase the property from her, or take a mortgage to do so, then it can stay in the family like she wanted.

So where does Angela go from here?  We told her that a transfer to trust is definitely worth considering since we don’t know how Peter’s illness will progress.  The lesson here is an important one:  Angela should have called us much earlier, when both Peter and Angela were still healthy, not after Peter’s diagnosis.  It would have made it much easier to get through Medicaid’s 5 year look back and Angela would have been able to rest easy knowing she had secured their vacation home that she and her family have enjoyed for years.

As it stands now, she could set up the trust that meets Medicaid requirements, make the transfer and hope for the best to make it through the current five year look back period. If the ten year look back period ever passed, it would not make sense given Peter’s illness.

 

For additional guidance, please see The Seniors and Boomer's Guide to Health Care Reform and Avoiding Nursing Home Poverty the book provides important information for families on resources for quality care and protection for loved ones.

At the Estate Planning & Asset Protection Law Center, we provide a unique education and counseling process which includes our unique 19 Point Trust, Estate and Asset Protection Review to help people and their families learn how to protect their home, spouse, life-savings, and legacy for their loved ones, click here for more information. We provide clients with a unique approach so they understand where opportunities exist to eliminate problems now as they implement plans for a protected future.

We encourage you to attend one of our free educational workshops, call 800-964-4295 and register to learn more about what you can do to enhance the security of your spouse, home, life savings and legacy.

 Click Here to Register For Our Trust, Estate & Asset  Protection Workshop

Tags: Nursing Home Costs, asset protection, Medicaid, Nursing Homes, transfer of assets, retitling assets, 2015

The Pit Falls of Do-It-Yourself Medicaid Planning

Posted by Dennis Sullivan & Associates on Fri, Nov 07, 2014

The Pit Falls of Do-It-Yourself Medicaid Planning | Massachusetts Elderlaw Attorney

 

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Off To A Good Start

We got a call the other day from Ben.  He had prepared and filed his mother’s Medicaid application himself.  From what he told us, it sounded like he did a great job.

He had hit a bit of a snag because Ben and his brother had been helping Mom out with her expenses.  At first, the Medicaid caseworker treated the transfers into Mom’s account as additional income to her.  However, Ben was successfully able to prove that the money was given to Mom to help pay some of her medical expenses.  It wasn’t support and shouldn’t affect her Medicaid eligibility.  He was successful and Medicaid was approved.

So Why Was He Calling?

Ben was calling us because his mother had inherited $75,000 from a family member. The first thing he wanted to know was whether there was any way they could keep the money.  His thinking was that the inheritance would act as a reimbursement by Mom to Ben and his brother.

I told him that unfortunately I didn’t think it would work that way.  The lesson here is that if Ben had consulted with us before he applied for Medicaid we would have taken steps to make sure that he could recoup some of the funds in the event that something like this happened. The reason his plan wouldn’t work is because he didn’t document that the money he gave to his mom was a loan.  He said that he never could have foreseen that his mother could ever pay back the money and that at the time; he didn’t see the need to write up a contract. Unfortunately, from a Medicaid perspective, the Commonwealth of Massachusetts presumes that the money given to Mom is either income to support her, or a gift.

This Is Why You Should Consult A Professional

Remember, I told you that when Ben applied for Medicaid, the caseworker tried to peg it as income.  Ben successfully fought that.  However, he didn’t see the gift vs. loan issue coming.    Not knowing the Medicaid rules as I do, how could he have?  Without a written agreement at the time he gave Mom the money, the presumption is that there was never an intention for Mom to pay her sons back, making any attempt now to do so a transfer subject to a Medicaid penalty.

Ben didn’t like my answer and tried to find a way around the system.  “What about if Mom refuses to accept the inheritance,” he asked.  “It would then pass to my brother and me.”

Disclaimers May Not Apply

Ben is referring to what is known as a disclaimer.    A disclaimer is a legal statement filed by the heir who says, “I am supposed to receive this gift but I don’t want it”.  Mom would be treated as having predeceased (died) before the relative leaving her the $75,000.  Under his will, that money would have passed to Ben and his brother.

Sounds great so far doesn’t it, but it won’t work.  By refusing to accept the money, Medicaid treats it as if Mom took the inheritance and gave it away.  It is no different than if she accepts it and then turns around and gives it to her children.  It causes a Medicaid penalty either way.

So where does that leave Ben?  He and Mom have two very unappealing choices.  She can accept the money, come off of Medicaid and spend the money down and then reapply.  Or, she can stay on Medicaid and give all the money to the State of Massachusetts.   Tough choices, I know.  But, that’s what makes Medicaid so tricky when you are trying to navigate it alone, and why we always recommend professional guidance on your Medicaid journey.

 

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At the Estate Planning & Asset Protection Law Center, we provide a unique education and counseling process which includes our unique 19 Point Trust, Estate and Asset Protection Review to help people and their families learn how to protect their home, spouse, life-savings, and legacy for their loved ones, click here for more information. We provide clients with a unique approach so they understand where opportunities exist to eliminate problems now as they implement plans for a protected future.

We encourage you to attend one of our free educational workshops, call 800-964-4295 and register to learn more about what you can do to enhance the security of your spouse, home, life savings and legacy.

 

Click Here to Register For Our Trust, Estate & Asset  Protection Workshop

Tags: Medicaid, family, Medicaid penalties, medicaid qualification, Inheritance

The High Cost of Seniors Living Longer

Posted by Massachusetts Estate Planning & Elder Law Attorney, Dennis B. Sullivan, Esq., CPA, LLM on Fri, Sep 05, 2014

 

The Cost of Living Longer | Massachusetts Eldercare Attorney

 

 planning, estate, eldercare

 

A Pachyderm of Problems

Every day, we see clients for whom long-term care is the elephant in the room. They feel they can’t afford the costs, but they also feel they can’t afford not to have it either. So their solution is to pretend they don’t see the elephant and try to ignore the problem until it goes away on its own. This unfortunately often leads to our metaphorical elephant trampling their life savings and any future inheritance they are trying to leave behind. The older you are, the more expensive a long-term care policy gets and if you get sick before you have long-term care protection in place, it’s too late. Insurance companies are looking out for their bottom line, and an already ill senior will scare them off.

The costs for these policies are rising faster than inflation too. Therein lies the conundrum for Boomers and seniors: They’re living longer than their parents did but that means they need more money to make it through “old age”. Finding long-term care is a tough and complicated process. You’ll need to find a place that cares for people with your (or your loved one’s) circumstances. You need to find a place with the right facilities and staff, a place that leaves you with a good, safe feeling. And you have to be able to afford it too. This is not any sort of one-size-fits-all situation. Everyone has their own specific services and conditions that they or their loved ones will need met. Remember, what we call “long-term care” is a broad category, with options ranging from live-in facilities to your own home.

Lurking Complications With Long Term Care

The greatest threat to the financial security of Boomers and seniors is the cost of long-term care (and Obamacare will not assist with this). Assisted-living facilities are now climbing toward the $7,500-a-month mark. Many have started bundling more services together, rather than charging for each individually. Bundling might be a good idea from the nursing home’s perspective, but just like pre-packaged cable TV you will wind up paying for a lot of services you don’t need and don’t want. A private room at a nursing home will range from $500 - $600 a day.

The cost of home healthcare is rising, too. Some people choose independent-living apartments. These facilities typically don’t require lump-sum payments, and residents can contract with home health-services independently. Medicaid may be there for those who qualify but if you ever want to learn the true meaning of “jumping through hoops” just try qualifying! The best thing, of course, is long-term care insurance, but that’s getting more expensive too as companies raise their rates while cutting back on their coverage. In addition, this insurance is getting more complicated, now encompassing aspects such as protection of the surviving spouse, caregiver issues, scams/ID theft, and making sure you have an advocate to fight for your rights in a system that’s slanted against you.

In short, we’re living longer, and unlike previous generations, people are generally not living with or even near their children. Seniors are going to need more money for this longer life and for any unforeseen medical problems that may arise.

A Magic Trick No One Wants to See

Do you know the fastest way for a Boomer or senior couple to become an impoverished Boomer or senior couple is? Simple, one of them just needs to become ill before they get long-term care insurance. We see it every day, people who’ve worked hard and saved money all their lives are forced to see it wash away in a flood of medical bills as they age. It is truly heart-breaking, because, if you’ve managed to squirrel some money away, you could probably have afforded long-term care. 

The Downside to Living Longer

Our life expectancies are going up these days and so is the cost of healthcare, the distance seniors are living from their children and families, and the financial pressures on Medicare and Medicaid. The new Affordable Care Act, in fact, stipulates $500 billion in Medicare cuts over the next decade! Where do you turn if you or your spouse gets ill? Home health care? Adult day-care? Assisted-living? A nursing facility? Respite-care services, which allow the caregiver to drop off the senior for a limited period? Who’s going to pay for it? And for how long?  These are the questions to ask now, while you still have time to plan. If you haven’t purchased long-term care before you or your spouse become ill…forget about it. No one will insure you once you’re sick! If this happens to you, you’re going to be out of time, out of options, and very quickly out of money. And if you’ve planned to leave something for your heirs, there may be nothing left to leave to them other than a pile of bills. 

 

It’s an old (but true) cliché: those who fail to plan, are planning to fail. When it comes to healthcare expenses as you age, you fail to plan at the risk of yourself and those you love.  

 

At the Estate Planning & Asset Protection Law Center, we provide a unique education and counseling process which includes our unique 19 Point Trust, Estate and Asset Protection Review to help people and their families learn how to protect their home, spouse, life-savings, and legacy for their loved ones, click here for more information. We provide clients with a unique approach so they understand where opportunities exist to eliminate problems now as they implement plans for a protected future.

We encourage you to attend one of our free educational workshops, call 800-964-4295 and register to learn more about what you can do to enhance the security of your spouse, home, life savings and legacy.

Click Here to Register For Our Trust, Estate & Asset  Protection Workshop 

 

Tags: living will, Estate Planning, Estate Planning, asset protection, Massacusetts Estate Tax, long term care, life insurance, Medicaid, MassHealth, in-home care, marriage, Estate Planning Tip, seniors, assisted living, life-care plan, hospice, Massachusetts, assets, in home, incapacity, asset, home, surviving spouse, Estate Planning Recommendations, in-home care, long term care insurance, Inheritance

Can Your Will Protect You When You Don't Die?

Posted by Massachusetts Estate Planning & Elder Law Attorney, Dennis B. Sullivan, Esq., CPA, LLM on Thu, Aug 07, 2014

 

What Happens When You Don’t Die?

medicare, medicaid, wills, spouse

 

Is your “I love you” will capable of protecting you or your spouse from long-term care costs?

You know the kinds of wills we’re talking about: The husband leaves everything to the wife, the wife leaves everything to the husband and after they both die, everything goes to the kids. This works well in situations where the spouses are healthy one day and are deceased the next. 

However, as most of us know, life usually doesn’t work that way very often. Research indicates that nearly 70% of individuals over 65 will require some kind of long-term care in their lifetimes.

Thus, many spouses worry that if they predecease an ill spouse who is currently in a nursing home or will require long-term care at some point in the near future, there will be insufficient funds available to provide for their institutionalized spouses’ needs. This is an especially relevant concern for expenses that are not covered under Medicaid such as: care managers, private nurses, single rooms, as well as certain therapies and drugs.

Another concern is that the availability of funds from “I love you” wills and trusts will disqualify the surviving ill spouse from eligibility for Medicare benefits. As you know from prior articles, Medicare (MassHealth in Massachusetts) is the only long-term-care governmental program in the United States and does not cover long-term custodial care.

To solve this problem many of our clients rely on a “testamentary trust”. This is a trust built into the will of each spouse. For many estate planners, this is counterintuitive because much of the estate planning occurs within the context of a revocable living trust. In order to preserve access to Medicaid eligibility without requiring that the surviving spouse spend down the assets and lose the chance to maintain a “rainy day fund”, creating a testamentary trust in the will of the pre-deceasing spouse is essential.

What this means is that around age 55, you have to completely revise your wills and trusts to accommodate a different paradigm of thought. The thinking process is no longer “What happens when I die?” Now the question becomes “What happens if I don’t die and live a long time with expensive long-term care?”

The new paradigm requires a new estate plan. If you consider yourself middle-class (meaning that your net worth will be significantly impacted by the cost of long-term care for you and/or your spouse) and are over age 55, we suggest that you revise and update your estate plan to reflect your current and future needs as soon as possible.

At the Estate Planning & Asset Protection Law Center, we help people and their families learn how to protect their home, spouse, life-savings, and legacy for their loved ones.  We provide clients with a unique educational and counseling approach so they understand where opportunities exist to eliminate problems now as they implement plans for a protected future.

We encourage you to attend one of our free educational workshops, call 800-964-4295 and register to learn more about what you can do to enhance the security of your spouse, home, life savings and legacy.

 Click Here to Register For Our Trust, Estate & Asset  Protection Workshop

Tags: will, living will, Estate Planning, Estate Planning, Alzheimer's Disease, Elder Law, asset protection, long term care, Medicaid, in-home care, Health Care, estate reduction, estate, elder care journey, hospice, Alzheimers Disease, medicaid qualification, Wills, assets, Medicaid penalties, alzheimer's activities, in home, incapacity, Elder Law, Attorney, myths, Alzheimer's, alzheimers, financial, Attorney, income, Alzheimer's, federal, health, surviving spouse, in-home care, long term care insurance

What To Do When Medicaid Comes For You Part 2

Posted by Massachusetts Estate Planning & Elder Law Attorney, Dennis B. Sullivan, Esq., CPA, LLM on Wed, Apr 09, 2014

Medicaid, Masshealth, Estate Planning

Last time I was telling you about Noah’s problem with Medicaid.  After his Dad died he received a Medicaid estate recovery letter from the State of Massachusetts looking to recoup $150,000 in benefits.

He was not happy when I explained to him that under Medicaid rules they are owed that money.  When Noah purchased Dad’s house, he did not pay fair market value for it.  That’s because he reduced the purchase price by $300,000 to pay for repairs and upgrades that benefitted Noah, not Dad.  In essence, Dad made a transfer for less than fair value which is subject to a Medicaid penalty.

So, why then did Medicaid approve the application and pay for Dad’s care for 3 years?  Because the state never came back to check on whether the home was sold.  Remember I told you that Noah first put the home on the market to try to sell it so the State processed Dad’s application and approved it.  They just never checked backed to see the status of the sale until after Dad died.

It’s never easy telling someone they have a $150,000 bill to pay but Noah was actually financially much better off than had he sold the home for fair market value before applying for Medicaid.  If he sold the home and netted $300,000 for Dad before he applied for Medicaid, then that money would have been spent on Dad’s nursing home care at a rate more than double what the State was paying.  In approximately 2.5 years the money would have run out, at which time Noah would then have filed a Medicaid application.

Instead, he applied for Medicaid before the house sold.  Once Dad died Massachusetts came looking to be reimbursed but for only half of what Dad should have netted from the house sale, which means Noah can keep the rest.  He also received what is the equivalent of an interest free loan, since the State is not charging him interest on the money it paid out in benefits.

With all the improvements he made, Noah told me the home is now worth probably $600,000 or more.  If he doesn’t have the cash to pay the State, he can take a mortgage on the home.  And again, he is still $150,000 ahead.

I knew it would take time for it to sink in but I told Noah he was lucky.  What it did end up to be the best move from a Medicaid standpoint.  He just didn’t know it at the time.  Noah’s story is a cautionary tale.  He went through the Medicaid system blindly and, albeit, with a repayment of $150,000 to Medicaid, it turned out OK.  It certainly could have been a lot worse.

Keep in mind that each situation is different.   What was the right move for Noah and his Dad may not be the right one for the next person.  Each situation has its unique set of facts and circumstances and is why I always tell people there is too much at stake to try this on your own.

At the Estate Planning & Asset Protection Law Center, we help people and their families learn how to protect their home, spouse, life-savings, and legacy for their loved ones.  We provide clients with a unique educational and counseling approach so they understand where opportunities exist to eliminate problems now as they implement plans for a protected future.

We encourage you to attend one of our free educational workshops, call 800-964-4295 and register to learn more about what you can do to enhance the security of your spouse, home, life savings and legacy.

Click Here to Register For Our Trust, Estate & Asset  Protection Workshop

Tags: Medicaid, MassHealth, Massachusetts, Medicaid penalties, 2014

What To Do When Medicaid Comes For You

Posted by Massachusetts Estate Planning & Elder Law Attorney, Dennis B. Sullivan, Esq., CPA, LLM on Fri, Apr 04, 2014

Medicaid, estate planning

Noah called us because he received a letter from Medicaid looking for money.  Dad had been on Medicaid for 3 years before he passed away.  Massachusetts was looking to recoup benefits it paid out on Dad’s behalf to the tune of approximately $150,000.

                Noah received what is called an estate recovery letter.  The State of Massachusetts looks to recover as much of its money as it can from the estates of Medicaid recipients when they die.  “But, why would there be anything left when Dad died,” you might ask, since he had to spend down to less than $2000 in assets before qualifying in the first place.  Good question.

Well, you see, the problem goes back about 4 years.  Noah told me that his dad was living in his home until his health declined to the point where he needed to be placed in a nursing home.  Since Dad had only the house to his name and no other assets, Noah paid some of Dad’s care costs before and after he moved to the nursing home, about $100,000 total.  He then put the house up for sale and applied for Medicaid.

                Massachusetts Medicaid will approve the application while you are trying to sell the home – as long as all the other Medicaid requirements are met.  And that is just what happened in the case of Noah’s dad.  But then the story takes a bit of a twist.

                After some time on the market without an offer, Noah decided to buy the home himself.   It needed a lot of work and upgrades so he and his wife and kids could move in.  He purchased the home for $400,000 and spent $300,000 in repairs and upgrades.  At the closing he reimbursed to himself the $100,000 he spent on Dad’s care from his own funds.  But, he also reduced the purchase price by $300,000.  In other words, Dad actually paid the costs of the repairs and upgrades and received no cash in the transaction.

                That was the root of the problem with Medicaid.  Dad actually made a gift of equity in the home to Noah, which would of course be subject to a Medicaid penalty.  But, why did Dad remain on Medicaid for 3 years?  Didn’t that mean everything was still OK? And how much does Noah actually have to pay back?  We will cover that next time.

 

At the Estate Planning & Asset Protection Law Center, we help people and their families learn how to protect their home, spouse, life-savings, and legacy for their loved ones.  We provide clients with a unique educational and counseling approach so they understand where opportunities exist to eliminate problems now as they implement plans for a protected future.

We encourage you to attend one of our free educational workshops, call 800-964-4295 and register to learn more about what you can do to enhance the security of your spouse, home, life savings and legacy.

Click Here to Register For Our Trust, Estate & Asset  Protection Workshop

Tags: Estate Planning, Medicaid, MassHealth, Medicaid penalties, 2014

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