Long Term Care
All too often, the need for long-term care, whether it be in-home, assisted living, or a nursing home, arises before a family has adequately protected their home or savings. Worse, few people know that they still have options to protect some, if not all, of their assets, even at the last minute. Specialized transfer techniques, based on Federal and state law, allow families to keep at least some, and sometimes most, of their assets, while still qualifying for Medicaid.
Simply put, you do not need to “spend down” all your assets before receiving Medicaid coverage. The team at DuBois Law Group, PLLC are the Hudson Valley’s most dedicated and focused providers of estate planning assistance in this area. Our approach involves a thorough discussion and understanding of the family’s care situation, and then a custom plan designed to ensure that whatever care is needed is paid for, at least in part, by Medicaid, to preserve the maximum amount of the family’s assets.
If you or a loved one requires long-term care or elder care, contact us to find out how we can help. The initial inquiry is always free of charge.
Estate Planning is Common, the Answers are Not
Planning for Long-Term Care
Our society, government, financial institutions, and even our families, are not set up to bear the burden of long-term care and estate planning. The industry is segmented, and the information available to people is often piecemeal and confusing, hard to find, or full of technical jargon.
DuBois Law Group, PLLC has worked in this field since 2007, has watched the trends and dealt with the changing laws, regulations, policies, and agencies on a daily basis. We are able to talk about the issues and explain the rules to our clients in plain English–providing detail where asked, but bottom-line facts and advice when needed.
Nursing home finance offices are loyal to the nursing homeowners; Department of Social Services case workers do (mostly) care but cannot give legal advice. They are often under resourced and overworked, and do not have the time to devote to helping individuals. Hospitals are not long-term care facilities and therefore their focus is to ensure someone in need of long-term care is expedited to an appropriate facility. The professionals at DuBois Law Group, PLLC know the players, know the game, and are committed to taking as much time as is necessary with you and your family to ensure that the results you want happen.
Faq about Immediate Long Term Care
Who qualifies for Medicaid?
Medicaid coverage is available for long term care, both at home, some assisted living facilities, and nursing homes, assuming you medically need such care, and financially you have less than $15,450 (as of 2019) in “countable resources”. Generally, that means bank accounts, retirement accounts*, cash value of life insurance, investment accounts, and any real estate that’s not a primary residence*. There are also limits on income. As of 2019, the monthly limits are $50 if the applicant is in a nursing home, $867 if they are in the community, and $1,444 if they are in an assisted living facility that accepts Medicaid. If an applicant has more income than this, it does not mean that they are not eligible for Medicaid. They are eligible, but their excess income must be spent on their care, and then they can keep the income below the limit. In community and assisted living settings, a special type of trust (a pooled income trust) can be established to preserve most of a person’s income, and still qualify for Medicaid.
*Primary residence and retirement accounts are NOT entirely exempt--there are special rules, covered in the FAQs related to each.
Can they take my home?
No, Medicaid (more accurately, the county administering the Medicaid) cannot take your home away from you--you will always be allowed to live there or return to live there, assuming it is safe. However, the county can take all the equity in your home. Unless you or your spouse are living in the home, Medicaid can put a lien on the house to recoup any benefits it has paid out for you. So, if you are in a nursing home, the lien will grow at the rate of many thousands of dollars per month*. So while you may at some point be able to go back and live in the house, if you or your family ever sells it, Medicaid gets their money back before you or your family do. That is why the rumor that your house is “protected” is dangerously incorrect.
*Medicaid pays the nursing home approximately 60-70% of the nursing home’s private pay rate, which averages $12,426 per month for the Hudson Valley in 2019. So, the lien will grow at whatever amount Medicaid pays the nursing home where the applicant resides.
Aren’t retirement accounts “protected”?
No! This is another dangerous rumor, perpetuated, sadly, by some attorneys that purport to be knowledgeable in this area. Retirement accounts are not protected. They are treated differently--but they are still a countable resource for Medicaid purposes. Retirement accounts are counted one of two ways, either (1) the entire balance of the account counts against the applicable Medicaid resource limit ($15,450 as of 2019), or (2) if they are in “pay out” status, the balance does not count (which is what most people confuse with being “protected”), however, the amounts that are taken out of the account are counted toward Medicaid’s income limits. This would not necessarily be a terrible result, if an applicant could only take out the RMDs required by the IRS. Unfortunately, Medicaid requires that the applicant take withdrawals out on a monthly basis, at a much higher rate than the IRS requires. Those withdrawals are included in the income calculation, and may need to be spent down on nursing home or other long term care costs.
There is no quick fix for protecting retirement accounts in a Medicaid context. It requires a detailed and focused calculation involving other income, cost of care, tax rates, and other assets. At DuBois Law Group, PLLC, we have created our own in-house customized calculators to help our clients make the most informed decision about what course of action is best, to save the most money possible.