Estate Planning Blog Articles

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When do Medicaid Recipients have to Cash Stimulus Checks before Government Collects?

Medicaid enrollees are generally allowed to have only a limited amount of assets, outside of their primary residence, car and other essentials.

For singles, it’s typically about $2,000. Those who exceed that threshold could be deemed ineligible for the health insurance program for low-income Americans.

CNN’s recent article entitled “Nursing home residents have a little more time to spend stimulus checks before losing Medicaid” notes that the $1,200 stimulus payments that many people received last spring didn’t count as income under Medicaid rules.

As a result, nursing home residents didn’t have to give the money over to the facilities where they live and could save it for their own use.

However, the funds are considered an asset after one year. That is a deadline that is rapidly drawing near for the first of the three relief payments Congress has authorized since the pandemic began.

Even so, another coronavirus provision that lawmakers approved last March prevents states from disenrolling residents from Medicaid during the public health emergency, which is currently set to end next month. However, it’s expected to be extended again.

This means that Medicaid recipients, including nursing home residents, don’t have to worry about spending the funds until the pandemic is over.

The same is true for the $600 checks many received from the December relief bill and the $1,400 payment that is being distributed from President Biden’s $1.9 trillion recovery package, but the time on those funds started more recently.

Just the same, people shouldn’t wait until the last minute to spend their stimulus funds. They can buy things they need and can also give the money to family or friends or make a charitable contribution. They just need to prove that the gift isn’t part of a strategy to give away assets to qualify for Medicaid.

“People should just be conscious of Medicaid asset limits and deal with it without trying to wait until the last month of the public health emergency,” said Eric Carlson, a directing attorney with Justice in Aging, a non-profit legal advocacy group. “There’s no particular benefit to cutting it close.”

Reference: CNN (March 30, 2021) “Nursing home residents have a little more time to spend stimulus checks before losing Medicaid”

Should I Worry about Medicaid Estate Recovery?

What is It? The Medicaid Estate Recovery Program (MERP) may be used to recoup costs paid toward long-term care. It’s designed to help make the program affordable for the government, but it can financially affect the beneficiaries of Medicaid recipients.

AOL’s article entitled “What Is Medicaid Estate Recovery?” explains that’s where Medicaid can help fill the void. Medicaid can assist with paying the costs of long-term care for aging seniors. It can be used when someone doesn’t have long-term care insurance coverage, or they don’t have the assets to pay for long-term care out of pocket. It can also be used to pay for nursing home care, if you’ve taken steps to protect assets using a trust or other estate planning tools.

However, the benefits you (or an aging parent) receive from Medicaid are not necessarily free. The Medicaid Recovery Program lets Medicaid recoup or get back the money spent on behalf of an aging senior to cover long-term care costs. Federal law requires states to attempt to seek reimbursement from a Medicaid beneficiary’s estate when they die.

How It Works. The Medicaid Estate Recovery Program lets Medicaid seek recompense for a variety of costs, including:

  • Nursing home-related expenses or other long-term care facility stays
  • Home- and community-based services
  • Medical services from a hospital (when the recipient is a long-term care patient); and
  • Prescription drug services for long-term care recipients.

If you (or an aging parent) die after receiving long-term care or other benefits through Medicaid, the recovery program allows Medicaid to pursue any eligible assets held by your estate. Exactly what that includes depends on your state, but generally any assets that would be subject to the probate process after you pass away are fair game.

That may include bank accounts you own, your home or other real estate and vehicles or other real property. Each state makes its own rules. Medicaid can’t take someone’s home or assets before they pass away, but it’s possible for a lien to be placed upon the property.

What Medicaid Estate Recovery Means for Heirs. The biggest thing about the Medicaid estate recovery for heirs of Medicaid recipients is that they might inherit a reduced estate. Medicaid estate recovery rules also exclude you personally from paying for your parents’ long-term care costs. However, filial responsibility laws don’t. It is rare, but the laws of some states let healthcare providers sue the children of long-term care recipients to recover nursing care costs.

How to Avoid Medicaid Estate Recovery. Strategic planning with the help of an elder law attorney can help you or your family avoid financial impacts from Medicaid estate recovery. You should think about buying long-term care insurance for yourself. A long-term care insurance policy can pay for the costs of nursing home care, so you can avoid the need for Medicaid altogether.

Another way to avoid Medicaid estate recovery is to remove assets from the probate process. For example, married couples can do this by making certain that assets are jointly owned with right of survivorship or using assets to purchase an annuity to transfer benefits to the surviving spouse when the other spouse passes away. You should know which assets are and are not subject to probate in your state and whether your state allows for an expanded definition of recoverable assets for Medicaid. Speak with an experienced elder law lawyer for assistance.

Medicaid estate recovery may not be something you have to concern yourself with, if your aging parents leave little or no assets in their estate. However, you should still be aware of it, if you expect to inherit assets from your parents when they die.

Reference: AOL (Feb. 5, 2021) “What Is Medicaid Estate Recovery?”

Can Mom Live in the Backyard?

When one Georgia senior thought about moving closer to her daughter in an Atlanta suburb, she realized she couldn’t afford to buy a home.

Therefore, her daughter researched building a cottage in her own backyard. This fall, they made a deposit on a Craftsman-style design by a local architect who will manage the project from permits to completion. The 429-square-foot home will have one bedroom and bathroom, a galley kitchen and living area and a covered porch.

Kiplinger’s recent article entitled “A Retirement Home Is a Tiny House in the Kids’ Backyard” reports that driven by an aging population and a scarcity of affordable housing, accessory dwelling units (ADUs) are a new trend in multigenerational living. These units are also known as in-law suites, garage apartments, carriage houses, casitas and “granny flats.” Freddie Mac found the share of for-sale listings with an ADU rose 8.6% year-over-year since 2009.

Homes such as these can be created by finishing a basement or attic, converting a garage, reconfiguring unused space, adding on, custom-building a detached unit, or installing a prefab. This unit can also be a source of rental income. A homeowner could also use it to house a parent, child or caregiver; downsize into it themselves to rent the main house; or make it into an office or guest quarters.

Converting existing space is less expensive than building a detached unit. A prefab ADU is cheaper and quicker to install than one built on site. However, a custom project allows you to include aging-in-place features, like a step-free entry, wider doorways and a handicapped accessible shower.

An ADU also allows seniors some privacy, so they’ll feel at home, rather than a visitor or intruder. You might add a private entrance and soundproofing to the shared walls of an in-law suite. Sitting areas indoors and outdoors will let you or a parent enjoy solitude, entertain friends without asking for permission and avoid feeling locked in.

Prior to using your nest egg to create an ADU on a child’s property, think about the way in which you’ll pay for the care you will inevitably need someday. You can’t sell the ADU to raise funds and renting it out after you’ve moved elsewhere is unlikely to cover the cost of your care.

In addition, note that if a parent gives a child money to build an ADU within the look-back period when applying for Medicaid, they may be penalized with delayed coverage.

Reference: Kiplinger (Dec. 31, 2020) “A Retirement Home Is a Tiny House in the Kids’ Backyard”

States with Most Affordable Long-Term Care?

Seven in 10 people 65 and older will require some type of long-term care during their lifetime. This expense will vary based on the patient’s required level of care, care setting and geographic location, says Think Advisor’s recent article entitled “15 Cheapest States for Long-Term Care: 2020.”

A recent study by Genworth found that the cost for facility and in-home care services increased on average from 1.9% to 3.8% per year from 2004 to 2020. That amounts to $797 annually for home care and as much as $2,542 annually for a private room in a nursing home.

At the current rate, some care costs are more than the 1.8% U.S. inflation rate, Genworth said.

These findings were taken from 14,326 surveys completed this summer by long-term care providers at nursing homes, assisted living facilities, adult day health facilities and home care providers. The survey encompassed 435 regions based on the 384 U.S. Metropolitan Statistical Areas, as defined by the U.S. Office of Management and Budget.

In a follow-up study, Genworth also found that these factors are contributing to rate increases for long-term care:

  • Labor shortages
  • Personal protective equipment (PPE) costs
  • Regulatory changes, such as updated CDC guidelines
  • Employee recruitment and retention issues
  • Wages demands; and
  • Supply and demand.

Here are the 15 cheapest states for long-term care, according to Genworth with their average annual cost:

15. Utah: $59,704

14. Kansas: $57,766

13. Iowa: $57,735

12. Kentucky: $57,540

11. South Carolina: $57,413

10. Tennessee: $56,664

9. North Carolina: $56,512

8. Georgia: $53,708

7. Mississippi: $52,461

6. Arkansas: $50,835

5. Oklahoma: $50,641

4. Texas: $48,987

3. Missouri: $48,753

2. Alabama: $48,240

1. Louisiana: $44,811

Reference: Think Advisor (Dec. 14, 2020) “15 Cheapest States for Long-Term Care: 2020”

What Did the Supreme Court Say about Medicaid Work Requirements?

The Trump administration had asked the Supreme Court in July to reinstate its historic approvals of state work requirements waivers. It contends that these rules may assist certain beneficiaries in transitioning to private policies and may result in improved health and to help states conserve financial resources to provide coverage to others in need.

MSN’s article entitled “Supreme Court agrees to consider Medicaid work requirements” reports that lower courts have struck down the Department of Health and Human Services’ approvals, holding that Medicaid’s primary purpose is to provide health care coverage.

The National Health Law Program, one of the consumer advocacy groups that brought the original lawsuits, said it thinks it will win at the Supreme Court.

“HHS’s action was properly vacated because Secretary [Alex] Azar failed to account for the significant loss in health coverage that these approvals would produce,” said Jane Perkins, legal director at the National Health Law Program. “Tens of thousands of people would lose their Medicaid coverage and become uninsured.”

The Supreme Court’s decision to take up the cases follows a panel of federal appellate judges that struck down the Trump administration’s approval of work requirements in Arkansas in February. The unanimous decision, written by Judge David Sentelle, a Reagan appointee, affirmed a district court ruling that found the administration had failed to analyze whether these programs would “promote the primary objective of Medicaid — to furnish medical assistance.”

New Hampshire stopped its roll-out of work requirements last year after the same district judge, James Boasberg in DC, set aside the administration’s approval in that state.

In an unprecedented step two years ago, the Trump administration started granting state requests to mandate that certain Medicaid beneficiaries work to receive benefits. Republicans have long wanted to have that requirement with Medicaid, which insures more than 75 million low-income Americans.

There were 12 states that received waivers, although four were set aside in court, according to the Kaiser Family Foundation. Another seven state requests are awaiting federal approval. Work requirements are not in effect anywhere, after states stopped their efforts because of the legal rulings and the pandemic.

In Arkansas, more than 18,000 people lost coverage in 2018, before the court intervened. Judge Boasberg had also canceled Kentucky’s approval. That move blocked work requirements from being implemented in the state. However, Kentucky withdrew its waiver request after a Democratic governor won election in 2019 and dismissed its appeal.

The judge blocked work requirements in Michigan earlier this year.

Reference: MSN (Dec. 5, 2020) “Supreme Court agrees to consider Medicaid work requirements”

transfer a house

Is Transferring House to Children a Good Idea?

Transferring your house to your children while you’re alive may avoid probate. However, gifting a home also can mean a rather large and unnecessary tax bill. It also may place your house at risk, if your children get sued or file for bankruptcy.

You also could be making a mistake, if you hope it will help keep the house from being consumed by nursing home bills.

There are better ways to transfer a house to your children, as well as a little-known potential fix that may help even if the giver has since died, says Considerable’s recent article entitled “Should you transfer your house to your adult kids?”

If a parent signs a quitclaim to give her son the house and then dies, it can potentially mean a tax bill of thousands of dollars for the son.

Families who see this error in time can undo the damage, by gifting the house back to the parent.

People will also transfer a home to try to qualify for Medicaid, but any gifts or transfers made within five years of applying for Medicaid can result in a penalty period when seniors are disqualified from receiving benefits.

In addition, transferring your home to another person can expose you to their financial problems because their creditors could file liens on your home and, depending on state law, take some or most of its value. If the child divorces, the house could become an asset that must be divided as part of the marital estate.

Section 2036 of the Internal Revenue Code says that if the parent were to retain a “life interest” in the property, which includes the right to continue living there, the home would remain in her estate rather than be considered a completed gift. However, there are rules for what constitutes a life interest, including the power to determine what happens to the property and liability for its bills.

There are other ways to avoid probate. Many states and DC permit “transfer on death” deeds that let homeowners transfer their homes at death without probate.

Another option is a living trust, which can ensure that all assets avoid probate.

Many states also have simplified probate procedures for smaller estates.

Reference: Considerable (Sep. 18) “Should you transfer your house to your adult kids?”

keep assets

How Do I Keep My Assets from the Nursing Home?

If you don’t have a plan for your assets when it comes time for nursing home care, they can be at risk. Begin planning now for the expenses of senior living. The first step is to consider the role of Medicaid in paying for nursing home services.

WRCB’s recent article entitled “How to Protect Your Assets from Nursing Homes” describes the way in which Medicaid helps pay for nursing homes and what you can do to shield your assets.

One issue is confusing nursing homes and skilled nursing facilities. Medicare does cover a stay in a skilled nursing facility for convalescence. However, it doesn’t pay for full-time residence in a nursing home. For people who can’t afford to pay and don’t have long-term care insurance, they can apply for Medicaid. That’s a government program that can pay nursing home costs for those with a low income. People who don’t have the savings to pay for nursing home care and then require that level of care, may be able to use Medicaid.

For those who don’t qualify for Medicaid when they need nursing home care, they may become eligible when their savings are depleted. With less money in the bank and minimal income, Medicaid can pay for nursing home care. It is also important to remember that when a Medicaid recipient dies, the government may recoup the benefits provided for nursing home care from the estate. Family members may discover that this will impact their inheritance. To avoid this, look at these ways to protect assets from nursing home expenses.

Give Away Assets. Giving loved ones your assets as gifts can help keep them from being taken by the government when you die. However, there may be tax consequences and could render you Medicaid ineligible.

Create an Irrevocable Trust. When assets are placed in an irrevocable trust, they can no longer belong to you because you name an independent trustee. The only exception is that Medicaid can take assets that were yours five years before you died. Therefore, you need to do this as soon as you know you’re going into a nursing home.

Contact an experienced estate planning, elder law, or Medicaid planning attorney to help you protect your assets. The more you delay, the less likely you’ll be able to protect them.

Reference: WRCB (Dayton) (Sep. 4, 2020) “How to Protect Your Assets from Nursing Homes”