Home Based Medicaid – A Deceiving Benefit #HomeBasedMedicaid
Jim called because his dad was running out of money. Dad is living at home with two aides that provide him with round the clock care. He owns the home he lives in but only has approximately $30,000 of liquid assets left. Jim figured home based Medicaid would be his solution. Dad has $3500 a month of income. If Medicaid picks up his home health aide bills, Jim told me that the $3500 would be enough to cover his other expenses including taxes and insurance on the home with maybe a little bit of a supplement every month from Jim. It was all well thought out. Jim just wanted some confirmation from me. "Unfortunately", I said to Jim, " it sounds great but Medicaid just doesn't work that way." What Jim is trying to do can't work for several reasons. New Jersey's home based Medicaid program is not as comprehensive as its institutional Medicaid program. Jim was puzzled by my answer. "Don't you have to spend down to $2000 in assets, show you you need long term care and then you'll be approved," he asked. "Not true," I told him. Next week I'll share with you the details of
College and Long Term Care – ??? (Part 3) #LongTermCare
The last two weeks I have been telling you about an increasing trend that we are seeing in cases that come through our office- grandparents who are paying for college, daycare, camp expenses etc. for their grandchildren. While a big help to the children of our clients who can’t afford the rising educational costs it can be financial ruin for the clients themselves should they need long term care. If they don’t have sufficient funds to pay for care and no long term care insurance either, the payments could disqualify them for Medicaid because of the lookback and penalty period. As I mentioned last week, there is a way to accomplish both goals of helping family members and preserving Medicaid eligibility. It does require some forethought and planning ahead. By setting aside funds in a trust, the senior can assist children and grandchildren financially. When that need arises the funds come from the trust and not directly from the senior so do not fall within Medicaid’s lookback and won’t trigger a Medicaid penalty. There are a couple of important points to be aware of. First, is that the trust must be established and funded by the senior at least
College and Long Term Care – ??? (Part 2) #LongTermCare
Last week I was talking about an increasing trend that we are seeing in cases that come through our office- grandparents who are paying for college, daycare and camp expenses for their grandchildren. I told you that there is a danger for some who could be headed for financial ruin. How so? The cost of long term care for the grandparent must be considered. Do the grandparents have a plan in place to pay for their own long term care should the need arise? Or could they run out of money? At a cost of $150,000 or more for 24/7 round the clock care an extended period of years spending that kind of money could, for some, cause them to run out of money. If they don’t have long term care insurance then the Medicaid program that covers nursing home level care would be in the picture. So what’s the problem? Well, if you are paying for the needs of child or grandchild – such as college, daycare or camp – that is considered a transfer for less than fair value. The money is being spent but the payer is not receiving something of equal fair market value back
College and Long Term Care – ??? #LongTermCare
I was reading the most recent Consumer Reports magazine cover story on the cost of college and how it is impoverishing young people who are borrowing huge amounts to pay exorbitant tuition bills and graduating with debt into six figures that they can’t pay on the salaries they are earning in their new careers. The rising cost of college has certainly affected the types of cases that we see in our office. You might think that’s strange because our clients’ college years are simply a fond memory at this point. We’re focused on how to help them pay for long term care if they need it. Actually, the rising cost of higher education is having an increasing impact on the planning and guidance we provide to our clients. When I discuss with a prospective client his/her estate and long term care plan, we review that person’s income and asset balance sheet. We also talk about expenses. If the client is in declining health we expect to see some long term care expenses. If the client is healthy we should see a financial picture in which income from Social Security, pension and investments is more than enough to meet the
Medicaid Estate Recovery – The Facts (Part 2) #MedicaidEstateRecovery
Last week I was telling you about a common topic of confusion when it comes to Medicaid – the potential for estate recovery – that process by which the State attempts to recoup money from the estates of Medicaid recipients to offset the amount of Medicaid benefits it paid out. The son our client called with concern over the possible lien on the home that his mom owns and lives in now that his dad has died. I told him not to worry. That’s because the State will not place a lien on the home so long as the deceased Medicaid recipient left a surviving spouse, child under age 21 or a child who is blind or permanently and totally disabled. The State will wait until none of these exceptions exist before pursuing estate recovery. New Jersey will also not seek estate recovery if the property in the estate is the sole source of income for one or more of the survivors and pursuing recovery would likely result in any of those survivors becoming eligible for public assistance or Medicaid benefits themselves. Finally, if a family member (other than the spouse) has been continuously living in the home prior
Medicaid Estate Recovery – The Facts (Part 1) #MedicaidEstateRecovery
I got a call the other day from the son of a client. We had obtained Medicaid for his father, preserving the home and just under $120,000 under Medicaid’s Community Spouse Resource Allowance (CSRA) for his mother. He called to tell us that Dad just died but he also needed me to ease his concerns after he spoke with the attorney who had prepared his Dad’s will. The attorney told him to expect an estate recovery letter from Medicaid and to be prepared that there is the potential for a lien to be placed on the home. It prompted him to call me for clarification. In my 20+ years concentrating my practice in the area of elder law, there has always been much misunderstanding and misinformation about Medicaid. The estate recovery lien is towards the top of that list. Let’s first be clear on what estate recovery is. Under federal and New Jersey law, New Jersey’s Division of Medical Assistance and Health Services (DMAHS) is required to recover funds from the estates of certain deceased medical assistance clients for payments provided on their behalf through the Medicaid program. The State does this to attempt to recoup moneys paid out