‘Tis the season to give and receive, but did you know that this can have significant consequences if you need to apply for Medicaid in the next three to five years? Can gifts impact Medicaid eligibility? Yes, this can have impacts for both the giver and receiver.
Regarding the gift giver, it should be noted that the IRS allows a tax-free annual gift of fifteen thousand dollars per person with an unlimited amount of donees. In other words, a wealthy donor could gift away over a million tax free dollars per year by gifting a hundred different people the maximum fifteen thousand dollars.
It can be vital, however, to understand these are tax laws and Medicaid takes a different stance on gifting in terms of Medicaid eligibility. When a person’s assets are reviewed for Medicaid eligibility, this includes a “Look-Back” period of thirty to sixty months, depending upon the state. If it is discovered that the Medicaid applicant has gifted money in order to be eligible for Medicaid, the penalty is Medicaid ineligibility. The length of time of ineligibility is determined by the amount of the gift and the average cost of a private pay nursing home in the area.
A person deemed ineligible for Medicaid due to gift giving has some options. It is possible for the gifter to collect the gift back, or reimbursement, in order to “un-do” the penalty. Even if possession of the money makes them ineligible for Medicaid, they can spend it down by temporarily paying for long-term care or making a home modification related to their disability until they reach eligibility status. There may also be a possibility of an undue hardship waiver, if Medicaid ineligibility will cause the person to go without medical care, food or shelter.
There may also be important impacts on the gift receiver. All states have an asset limit to be Medicaid eligible and it is not very high. In fact, many states have limits falling in the range of fifteen hundred to two thousand dollars. Even a small gift can push a Medicaid recipient over the eligibility limit. Any gift received must be spent within a month in order to avoid affecting Medicaid eligibility. A Medicaid recipient has options if they receive a gift. They can pay off debt, purchase a funeral trust or a Medicaid eligible annuity. If money is received before applying for Medicaid, the money can also be spent down in a similar fashion.
If you will be giving or receiving money or other assets this holiday season and anticipate this may impact your Medicaid eligibility or someone else’s, contact our office to discuss your options.
A positive Alzheimer’s Diagnosis is a life-changing event both for the person receiving it and for those who care about him or her. Did you know that understanding the diagnosis and early stages of the disease are critical for identifying effective medical treatments, caregiving options, and future planning items aimed at providing long-term care?
June is Alzheimer’s and Brain Awareness Month. Alzheimer’s is a brain disease and the most common form of dementia, which is a general term for memory loss and degenerative mental capability. Toxic changes in the brain occur long before any Alzheimer’s symptoms are exhibited. Abnormal protein deposits form plaques throughout the brain and cause healthy neurons to cease functioning. To diagnose Alzheimer’s, doctors conduct tests to assess memory impairment, cognitive reasoning skills, functional abilities, and behavioral changes. They also perform a series of tests to rule out other possible causes of impairment.
While there is no known cure for Alzheimer’s Disease, family caregivers and adult children can better understand a senior loved one’s diagnosis by asking the evaluating physician important questions, such as:
What tests or tools were used to determine the diagnosis?
What were you measuring when the tests were performed?
How will the disease progress?
What treatment options are available?
What care planning services do you provide?
What support services or resources are available to help with the disease?
Early detection usually provides the best opportunities for long-term care and access to clinical trials. Traditional and experimental drug and non-drug interventions can ease the burden of the disease, and slow memory loss and other symptoms. If diagnosed during more developed stages, specializing physicians can still impart caregiving strategies to enhance safety and maximize quality of life for as long as possible.
Understanding an Alzheimer’s Diagnosis also helps families plan for the future. For example, a trusted family member can obtain a durable power of attorney document that would allow him or her to make binding decisions on the elder adult’s behalf when the elder adult is no longer competent. Advance health care directives, medical privacy releases, and updates to estate plans are also important planning items for long-term care needs and inheritance wishes.
If you or someone you know would like more information or guidance on related legal issues, we are here to help. As an elder law firm, we are committed to providing legal counsel on matters relating to degenerative diseases such as Alzheimer’s. Contact us today to schedule a meeting.
The holidays are a time for all of us to come together and celebrate. It may also be the only time during the year that families who live far apart from each other can visit, face-to-face. We find this to hold especially true for our Florida seniors who have either moved away from their adult children or whose children have moved out of state.
We encourage you to carve out time during your holiday celebrations to discuss the future with your aging parents. While none of us want to consider a future that includes long-term care it does not mean the conversation should be avoided. Difficult conversations are, for the most part, better to have in person.
It may not seem necessary to have this conversation, especially if your parents are only recently leaving their middle-age years and in relatively good health. We would counter, however, that there is never a wrong time to begin to plan for your aging parent’s potential need for long-term care and their nursing home eligibility. A sudden, incapacitating stroke could leave them with diminished capacity or Alzheimer’s Disease at any time, and we all need planning in place that contemplates these issues. In fact, right now the cost of long-term care in Florida presently exceeds $8,000 per month. Without a plan in place to qualify for nursing home Medicaid in the future, your parents’ assets could be substantially depleted due to long-term nursing home care.
In addition, the community spouse may only retain his or her income plus the portion of the institutionalized spouse’s income necessary to allow the community spouse $2,058.00 in income per month with a maximum to include an excess shelter and a standard utility allowance of no more than $3,161.
It is important to understand that Medicaid is a means-based program. For example, a parent in a nursing home can only own $2,000 of countable assets and be eligible for Medicaid nursing home assistance. The non-institutionalized parent can only own $126,420 in countable assets. This means that your parents will not receive Medicaid assistance if they have too many assets. This is why it is important to begin far in advance of applying for Medicaid eligibility to divert their assets from the countable assets that will disqualify them for Medicaid eligibility to non-countable assets. Presently, examples of non-countable assets can include, but are not limited to, a residence, improvements made to their residence, Individual Retirement Accounts, a prepaid burial account or an automobile regardless of its value.
If your parents wait too long to make gifts of their assets to someone other than a spouse they may be penalized for making the gift too close to the time that they need to apply for Medicaid assistance. Assets given to another person, such as a son or a daughter, at least five years in advance of applying for Medicaid assistance, however, may not give rise to their disqualification for assistance. Further, a good elder care planning tool can be to transfer their countable assets to an irrevocable trust at least five years in advance of applying for Medicaid nursing home assistance.
We know this article may raise more questions than it answers. Planning for elder care issues, at any time, can feel as if you are navigating a long-term care maze. We encourage you not to wait to get the advice you need. Do not wait to schedule a meeting with our office with your parents while you are visiting, or any time throughout the year.
For most of us, the idea of moving to a nursing home can be a difficult subject to discuss. Whether you are a Florida senior who needs to consider moving out of the home or an adult child looking to help your aging parent, you may be confused as to where to start. Where do you find the information you need? How do you know how to choose the right facility for you? How will you be able to afford it?
We deal with each of these questions on a daily basis when we work with our clients and their loved ones. We know the challenges you face and want to be able to help you navigate these issues.
As you complete your research on finding the right nursing home for you or a loved one, you need to have the right tools to review and compare the places you are considering. Medicare does have a resource for you. Medicare has created the Nursing Home Compare Tool. According to Medicare, when using this tool, you may find “detailed information about every Medicare nursing home in the country.” You can perform a search using city, state, and zip code features.
Recently, The Center for Medicare and Medicaid Services (CMS) has made an effort to give consumers even more critical information. We have been watching these chances that were announced to be put into play this year. CMS reported that updates were coming “to Nursing Home Compare and the Five-Star Quality Rating System to strengthen this tool for consumers to compare quality between nursing homes.”
How does this work? According to The Center for Medicare and Medicaid Services:
“Nursing Home Compare has a quality rating system that gives each nursing home a rating between 1 and 5 stars. Nursing homes with 5 stars are considered to have above average quality and nursing homes with 1 star are considered to have quality below average. There is one Overall 5-star rating for each nursing home, and a separate rating for each of the following three factors:
Health Inspections: Inspections include the findings on compliance to Medicare and Medicaid health and safety requirements from onsite surveys conducted by state survey agencies at nursing homes.
Staffing Levels: The staffing levels are the numbers of nurses available to care for patients in a nursing home at any given time.
Quality Measures: The quality of resident care measures are based on resident assessment and Medicare claims data.”
Further, on October 7, 2019, CMS announced more enhancements where “CMS will display a consumer alert icon next to nursing homes that have been cited for incidents of abuse, neglect, or exploitation. According to CMS, this critical move toward improved transparency is yet another way the Agency is delivering on its five-part approach to ensuring safety and quality in nursing homes.”
We know this article may raise more questions than it answers. We also know the challenges you face when searching for nursing home care for yourself or a loved one. We encourage you not to wait to reach out to us and schedule a meeting to find answers to your questions.
We often find that adult children and their aging parents will come to our office and present to us, their newly recommended estate planning attorney, a last will and testament that is at least twenty years old. This estate planning document nominates a brother or a sister as a guardian for the minor children. It also provides for the assets to be distributed on death to a bank trust company that is to retain the assets in trust until the children have attained age 21.
One of the problems with this estate plan, which needs updating, is that the youngest of the children is now age 25 and the eldest is age 35. In addition, the bank nominated in the last will and testament to serve as the trustee is no longer in business. Further, if there was a trust agreement, it was never funded.
In this scenario, we are fortunate that the parents lived these many years and it was not necessary to use the estate plan, or even fund the trust. In situations like this, one of the ways we can help the parents is by drafting a new estate plan that corrects these issues. For example, the new trust agreement could dispense with the need for a guardian of minor children and name a trust company now in existence to serve as the trustee.
The parents, however, have aged to the point that a new estate plan alone is not sufficient for them. The parents need their own updated advanced directives in the event of a disability. Therefore, the parents will also need to consider signing, at a minimum, durable powers of attorney, health care surrogate designations, and living wills.
Further, they need to consider long-term care planning.
An estate plan alone will not be sufficient to help them be able to afford the high cost of long-term care in an assisted living facility with memory care or a skilled nursing home. Medicare is also not able to help with the cost of the daily custodial care. The parents need an estate plan but also an elder care plan that can help them plan for how they will be able to afford long-term care and not lose their lifetime of savings.
We work with parents and adult children each day to tackle this difficult issue.
The key is to not put off this type of planning as time is of the essence. If you have questions on this or any issue, we encourage you to contact us to schedule a meeting.
As we look to care for our parents and grandparents as they age in Florida, we need to think about their current and potential long-term care needs. How will they be able to find good care should they need it? Where should they look for help? What is available in our community? How will they be able to afford the care they need should the time come?
Unfortunately, many Florida seniors do not begin to plan for the high cost of long-term care until it is too late. For a myriad of reasons, they did not plan forward to think about what they may need both now and for a future that includes an increased need for long-term care assistance. Most of us today simply cannot afford the additional thousands of dollars per month it would cost to have support from home healthcare or a semi-private room in a skilled nursing facility without rethinking our finances and looking for help from public benefits.
While many Florida seniors turn to Medicaid and other local community programs for assistance, for Florida veterans, there are additional benefits available. They range from health care and funeral assistance to disability support and pension assistance. For many veterans the available benefits remain unused and hard to obtain due to the qualification that is required to gain access to them.
Perhaps the most beneficial program for the Florida senior veteran in need of long-term care assistance is the VA Pension program.
The VA Pension program is in no way tied to a service-connected disability.
In fact, the health care disability standard associated at the basic level is met simply by being over age 65. This a monthly, tax-free benefit that can increase based on the health care needs of the veteran.
The rules changed substantially for this program on October 18, 2018. This program is not an automatic benefit for wartime veterans and their dependents. They must prove, first, that the veteran served for at least 90 days of active service with one day during a period of war. Second, he or she must prove that he or she was discharged under conditions other than dishonorable.
Now, to access this program, the new rules created a few more qualifications. For example, there is an asset limit for the veteran’s countable resources. Prior to the rule changes, there was no set amount in place. This year the veteran may have $126,240, excluding exempt assets, and this amount will change each year.
Further, through these rules the Department of Veterans Affairs created a “look-back” period. A “look-back” period is a period of time during which the Department may review assets to determine if the veteran has made gifts of his or her resources. A similar set up currently exists for the Florida Medicaid program. The “look-back” period will be for thirty-six months. If the VA determines this occurred the veteran may face a disqualification period.
These are just a few ways the VA Pension program has changed.
We know this article may raise more questions than it answers and encourage you to schedule a meeting with us to get the answers you need for yourself and your loved ones.