Ralph Robbins
Certified Financial Planner
Ralph S. Robbins, CFP©, is a licensed Certified Financial Planning Practitioner and an Accredited VA Claims Agent specializing in Eldercare Financial Planning. He works everyday helping families in crisis find creative ways to fund long-term care expenses and deal with family financial issues.
Show:
Articles Question
Question
Can my mom sell her house right now, knowing my Dad will eventually go into a nursing home?
CarrieLockhart... Selling the present homestead residence and purchasing another should not be an issue with respect to future Medicaid... CarrieLockhart...
Selling the present homestead residence and purchasing another should not be an issue with respect to future Medicaid eligibility.
When budgeting keep in mind that even if your father were to enter a nursing home, a portion of his income may be "diverted" to your mother to help support her housing needs. The amount she may keep of their combined gross income will be between $2,057.50 and $3,160.50 (the Minimum Monthly Maintenance Needs Allowance or MMMNA).
To amplify on and correct some of the answers posted...
With respect to assets and Medicaid eligibility, at the time of eligibility determination Tennessee will allow the Medicaid applicant spouse (aka Community Spouse) to retain all combined "countable" assets up to $25,284 (amounts are adjusted annually).
Above this asset level the state will require that countable assets be split 50/50 between the couple. The Medicaid applicant spouse may retain only $2,000. The Community Spouse may retain up to $126,420 of the 50%. This compels the Medicaid applicant spouse to "spend down" their 50% to meet the asset eligibility requirement of $2,000 or pursue some other legal way to devise (transfer) the assets without incurring an eligibility penalty. Sometimes as was suggested, a Medicaid Qualified Annuity will be helpful in this process (converting an asset to income) however the higher income generated by the annuity may affect the MMMNA as described above.
This planning can become quite complex and Tennessee requires that an licensed attorney provide advice regarding the transfer or assets of income to obtain Medicaid eligibility.
On other issues...
Tennessee does have a Medicaid Home and Community Based long-term care Waiver program that provides benefits for home care and assisted living. https://www.tn.gov/tenncare/long-term-services-supports/choices/what-home-care-services-are-covered-in-choices.html
Medicaid home based benefits typically require no co-pay and the couple will be able to keep all income for housing and medical needs.
Also mentioned was the potential for VA benefits. Service connected benefits known as Compensation or "Disability" may be an option if your father was a veteran who has injuries or disabilities resulting from active duty service. If circumstances are such, it may be possible for an award to be granted but it may literally take years.
If, however, your father is a war-time veteran (he did not have to have served in combat) he may be eligible for and may qualify for a NON-Service Connected benefit called Improved Pension. This award may provide a monthly benefit to the couple of up to $2,230 per month to assist with home care or provide some assistance with assisted living expenses.
Medicaid home care services and, if applicable, the VA benefit mentioned above may permit your parent's to age in place for quite some time.
I wish you and your family well... see more
Selling the present homestead residence and purchasing another should not be an issue with respect to future Medicaid eligibility.
When budgeting keep in mind that even if your father were to enter a nursing home, a portion of his income may be "diverted" to your mother to help support her housing needs. The amount she may keep of their combined gross income will be between $2,057.50 and $3,160.50 (the Minimum Monthly Maintenance Needs Allowance or MMMNA).
To amplify on and correct some of the answers posted...
With respect to assets and Medicaid eligibility, at the time of eligibility determination Tennessee will allow the Medicaid applicant spouse (aka Community Spouse) to retain all combined "countable" assets up to $25,284 (amounts are adjusted annually).
Above this asset level the state will require that countable assets be split 50/50 between the couple. The Medicaid applicant spouse may retain only $2,000. The Community Spouse may retain up to $126,420 of the 50%. This compels the Medicaid applicant spouse to "spend down" their 50% to meet the asset eligibility requirement of $2,000 or pursue some other legal way to devise (transfer) the assets without incurring an eligibility penalty. Sometimes as was suggested, a Medicaid Qualified Annuity will be helpful in this process (converting an asset to income) however the higher income generated by the annuity may affect the MMMNA as described above.
This planning can become quite complex and Tennessee requires that an licensed attorney provide advice regarding the transfer or assets of income to obtain Medicaid eligibility.
On other issues...
Tennessee does have a Medicaid Home and Community Based long-term care Waiver program that provides benefits for home care and assisted living. https://www.tn.gov/tenncare/long-term-services-supports/choices/what-home-care-services-are-covered-in-choices.html
Medicaid home based benefits typically require no co-pay and the couple will be able to keep all income for housing and medical needs.
Also mentioned was the potential for VA benefits. Service connected benefits known as Compensation or "Disability" may be an option if your father was a veteran who has injuries or disabilities resulting from active duty service. If circumstances are such, it may be possible for an award to be granted but it may literally take years.
If, however, your father is a war-time veteran (he did not have to have served in combat) he may be eligible for and may qualify for a NON-Service Connected benefit called Improved Pension. This award may provide a monthly benefit to the couple of up to $2,230 per month to assist with home care or provide some assistance with assisted living expenses.
Medicaid home care services and, if applicable, the VA benefit mentioned above may permit your parent's to age in place for quite some time.
I wish you and your family well... see more
Question
Can I get help with gas costs going to visit my mother? Will Medicaid frown upon that if I use her funds to pa...
Sancheza.... It appears you have had your question answered. Now I have a question for you. Have you considered investigating legal ways... Sancheza....
It appears you have had your question answered.
Now I have a question for you. Have you considered investigating legal ways to transfer funds away from your mother prior to application for Medicaid so there will be funds to support her while receiving benefits?
The particular methods available will vary by state. In Florida there are several methods available to my clients including transferring funds to a Supplemental Needs Pooled Trust, establishing and funding a Personal Care Agreement, purchasing an interest in a pooled income producing real estate arrangement.
All of these methods DO NOT result in the incursion of a Medicaid eligibility penalty (aka "5 year look back").
Please seriously consider this as you will certainly need funds for mom's support while she is on Medicaid. The above arrangements will provide for that. see more
It appears you have had your question answered.
Now I have a question for you. Have you considered investigating legal ways to transfer funds away from your mother prior to application for Medicaid so there will be funds to support her while receiving benefits?
The particular methods available will vary by state. In Florida there are several methods available to my clients including transferring funds to a Supplemental Needs Pooled Trust, establishing and funding a Personal Care Agreement, purchasing an interest in a pooled income producing real estate arrangement.
All of these methods DO NOT result in the incursion of a Medicaid eligibility penalty (aka "5 year look back").
Please seriously consider this as you will certainly need funds for mom's support while she is on Medicaid. The above arrangements will provide for that. see more
Question
During Medicaid spenddown how should I purchase items for Mom? I need to buy her a new mattress and bedding, c...
Use your mother's funds for all purchases. Do NOT transfer money to yourself and then pay for items. Using a debit card is fine, just... Use your mother's funds for all purchases.
Do NOT transfer money to yourself and then pay for items.
Using a debit card is fine, just make sure you save receipts.
May I ask if you are taking any steps to avoid spend down of all of your mother's funds?
I suggest that you investigate methods of transferring assets away from her prior to Medicaid application so funds will be available for her use while receiving Medicaid benefits.
As you are discovering, care is expensive and I can promise you Medicaid will not adequately cover all needs. see more
Do NOT transfer money to yourself and then pay for items.
Using a debit card is fine, just make sure you save receipts.
May I ask if you are taking any steps to avoid spend down of all of your mother's funds?
I suggest that you investigate methods of transferring assets away from her prior to Medicaid application so funds will be available for her use while receiving Medicaid benefits.
As you are discovering, care is expensive and I can promise you Medicaid will not adequately cover all needs. see more
Question
Does 5 year look back allow for family members to pay themselves $1,000/ month for gas reimb and time if no ca...
TryHarder1... I am sorry to hear of your dilemma. It is one that often surprises families when not aware of the consequences of financial... TryHarder1...
I am sorry to hear of your dilemma. It is one that often surprises families when not aware of the consequences of financial decisions made prior to applying for public benefits.
As you consider the below please know that only a licensed attorney can provide legal advice or draft legal documents with respect to the transfer of assets or income to achieve Medicaid eligibility. The following is NOT to be considered legal advice and is provided for educational and informational purposes only.
That said, the answer to your question depends on several factors including the state in which your mother lives. I only serve those living in Florida and I share my experience in the hope that it may benefit you and, if not, perhaps others.
In addition to the state your mother lives in, my experience in Florida is that the outcome of this situation may also vary depending on the District in which the case is processed as well as upon the Specialist actually processing the case.
In Florida, the policy is that asset transfers of over $500 per month are considered "assets transferred for less than fair market value"; in other words, a gift. Unless it can be proven otherwise, the state will then asses an "eligibility penalty" based on the sum of the assets transferred over the 5 years prior to application for Medicaid. The penalty levied is expressed in a number of months the applicant will deemed ineligible to receive Medicaid benefits and is determined as follows:
$ amount of assets transferred divided by the "Medicaid Pay Rate" (in Florida presently $9,485) = number of months of penalty. From what you stated above your mother's penalty would look like this: $96,000 divided by $9,485 equals 10.12 months of ineligibility. Ouch.
From my view, those facing this situation have two options. I'll give you the more complicated first.
If you do not have receipts evidencing that the transferred funds were used for your mother's benefit you might consider submitting an affidavit detailing the circumstances and how the funds were spent. Include any additional information you can including, perhaps, testimony from others familiar with the situation. You want to essentially bombard them with evidence. As stated above, the outcome is uncertain...even if you did have proper evidence.
Another, perhaps less complicated approach with a more certain outcome, would be to claim a "Hardship Exemption". Blessed be this provision in policy which states: "When application of the transfer of assets or income provisions discussed in this chapter would cause an undue hardship on the applicant/recipient, the transfer provisions do not apply." Say what? Yes indeed. If it can be demonstrated that, to paraphrase, the applicant's life, health, or welfare would be at risk if determined ineligible for Medicaid long-term care services the transfer penalty will not be imposed.
This exemption can be requested at the time of application or after denial via a "Fair Hearing". The request must be properly evidenced and documented.
Please note that care agreements can only be drafted on a prospective basis, not perspective basis. In other words, the agreement will not cover transfers made before the date of the agreement; only those made after the date of the agreement.
If your mother still has funds left, establishing a care agreement now may make a lot of sense in that while receiving Medicaid benefits funds will still be required to support her. Florida permits lump-sum transfers in full advance satisfaction of the contract which can be extremely helpful in making sure such funds are available to her.
Internecine conflict between siblings also occurs more often than one would think. If your brother does not wish to follow financial recommendations may I kindly suggest that you concentrate on your mother's care, wash your hands of the financial matters, and let him deal with the fallout. see more
I am sorry to hear of your dilemma. It is one that often surprises families when not aware of the consequences of financial decisions made prior to applying for public benefits.
As you consider the below please know that only a licensed attorney can provide legal advice or draft legal documents with respect to the transfer of assets or income to achieve Medicaid eligibility. The following is NOT to be considered legal advice and is provided for educational and informational purposes only.
That said, the answer to your question depends on several factors including the state in which your mother lives. I only serve those living in Florida and I share my experience in the hope that it may benefit you and, if not, perhaps others.
In addition to the state your mother lives in, my experience in Florida is that the outcome of this situation may also vary depending on the District in which the case is processed as well as upon the Specialist actually processing the case.
In Florida, the policy is that asset transfers of over $500 per month are considered "assets transferred for less than fair market value"; in other words, a gift. Unless it can be proven otherwise, the state will then asses an "eligibility penalty" based on the sum of the assets transferred over the 5 years prior to application for Medicaid. The penalty levied is expressed in a number of months the applicant will deemed ineligible to receive Medicaid benefits and is determined as follows:
$ amount of assets transferred divided by the "Medicaid Pay Rate" (in Florida presently $9,485) = number of months of penalty. From what you stated above your mother's penalty would look like this: $96,000 divided by $9,485 equals 10.12 months of ineligibility. Ouch.
From my view, those facing this situation have two options. I'll give you the more complicated first.
If you do not have receipts evidencing that the transferred funds were used for your mother's benefit you might consider submitting an affidavit detailing the circumstances and how the funds were spent. Include any additional information you can including, perhaps, testimony from others familiar with the situation. You want to essentially bombard them with evidence. As stated above, the outcome is uncertain...even if you did have proper evidence.
Another, perhaps less complicated approach with a more certain outcome, would be to claim a "Hardship Exemption". Blessed be this provision in policy which states: "When application of the transfer of assets or income provisions discussed in this chapter would cause an undue hardship on the applicant/recipient, the transfer provisions do not apply." Say what? Yes indeed. If it can be demonstrated that, to paraphrase, the applicant's life, health, or welfare would be at risk if determined ineligible for Medicaid long-term care services the transfer penalty will not be imposed.
This exemption can be requested at the time of application or after denial via a "Fair Hearing". The request must be properly evidenced and documented.
Please note that care agreements can only be drafted on a prospective basis, not perspective basis. In other words, the agreement will not cover transfers made before the date of the agreement; only those made after the date of the agreement.
If your mother still has funds left, establishing a care agreement now may make a lot of sense in that while receiving Medicaid benefits funds will still be required to support her. Florida permits lump-sum transfers in full advance satisfaction of the contract which can be extremely helpful in making sure such funds are available to her.
Internecine conflict between siblings also occurs more often than one would think. If your brother does not wish to follow financial recommendations may I kindly suggest that you concentrate on your mother's care, wash your hands of the financial matters, and let him deal with the fallout. see more
Question
Question
Will Medicaid pay for a private personal care aide?
Hi cetude... FYI: In Florida the Medicaid Home and Community Based Services waiver program will provide personal home care services in the... Hi cetude...
FYI: In Florida the Medicaid Home and Community Based Services waiver program will provide personal home care services in the home as well as a stipend towards the cost of care in an assisted living facility. Adult Day Care would also fall under this program. There is a wait list for this waiver program.
Nursing home benefits do not fall under Home and Community Based Services and are available to a qualified Medicaid recipient at any time. see more
FYI: In Florida the Medicaid Home and Community Based Services waiver program will provide personal home care services in the home as well as a stipend towards the cost of care in an assisted living facility. Adult Day Care would also fall under this program. There is a wait list for this waiver program.
Nursing home benefits do not fall under Home and Community Based Services and are available to a qualified Medicaid recipient at any time. see more
Question
Will Medicaid pay for a private personal care aide?
As is often the case, and has been previously mentioned, the answer will depend, in part, on the state in which you live and its specific... As is often the case, and has been previously mentioned, the answer will depend, in part, on the state in which you live and its specific policies.
If your loved one is not in a nursing home she is participating in what is known as a "Medicaid Waiver Program". In Virginia, the program she is most likely participating in is called "Commonwealth Coordinated Care Plus".
Under this program, as it is in more and more states, Virginia contracts with managed care companies to coordinate and pay for long-term care services delivered in a venue outside of a nursing home (at home or in an assisted living facility.
The managed care companies then contract with private providers, such as home care agencies, to deliver services to the Medicaid recipient.
By clicking the following link you will find that there are 6 such entities in your county.
https://www.cccplusva.com/choose/compare-plans?location=27
In the case of home care, these entities contract with private companies to deliver care to the Medicaid recipient and they, in turn, pay the home care companies.
Importantly, with your respect your question, most states require that these plans offer a "Patient Directed Option" where the Medicaid recipient can hire virtually anyone they choose, including a family member, who then gets paid by the managed care plan.
Unfortunately, in my experience, the reimbursement rate under Patient Directed Options is very low; like $7-$10 dollars per hour. which is generally wholly inadequate.
Another option which I suggest to my clients is to consider having the caregiver they prefer get hired by one of the aforementioned contracted home care agencies.
Now comes the really technical part in terms of meeting your goal:
There is a difference between a "home care agency" and "home care registry".
When a care provider works for a home care agency they are a direct employee of the agency. The agency pays for all related bonding and insurances and withholds taxes, etc. The employee may not have freedom of choice with respect to assignments, hours worked, etc.
A home care registry, however, differs in that the care provider simply "registers" with the company which acts as a middle man of sorts. The care provider is typically responsible for paying their own insurances, taxes, etc. and is generally free to work with more than one registry at a time. Essentially, they are an independent contractor.
The caveat under both scenarios is that the care provider will have to be certified as a Home Health Aide or Certified Nursing Assistant. These certifications, however are relatively simple to obtain.
By having the care provider work through a nurse registry that is contracted with a Medicaid managed care plan, my clients have been able to get the maximum benefits available from a care giver they prefer.
I hope this helps in achieving your care giving goal. see more
If your loved one is not in a nursing home she is participating in what is known as a "Medicaid Waiver Program". In Virginia, the program she is most likely participating in is called "Commonwealth Coordinated Care Plus".
Under this program, as it is in more and more states, Virginia contracts with managed care companies to coordinate and pay for long-term care services delivered in a venue outside of a nursing home (at home or in an assisted living facility.
The managed care companies then contract with private providers, such as home care agencies, to deliver services to the Medicaid recipient.
By clicking the following link you will find that there are 6 such entities in your county.
https://www.cccplusva.com/choose/compare-plans?location=27
In the case of home care, these entities contract with private companies to deliver care to the Medicaid recipient and they, in turn, pay the home care companies.
Importantly, with your respect your question, most states require that these plans offer a "Patient Directed Option" where the Medicaid recipient can hire virtually anyone they choose, including a family member, who then gets paid by the managed care plan.
Unfortunately, in my experience, the reimbursement rate under Patient Directed Options is very low; like $7-$10 dollars per hour. which is generally wholly inadequate.
Another option which I suggest to my clients is to consider having the caregiver they prefer get hired by one of the aforementioned contracted home care agencies.
Now comes the really technical part in terms of meeting your goal:
There is a difference between a "home care agency" and "home care registry".
When a care provider works for a home care agency they are a direct employee of the agency. The agency pays for all related bonding and insurances and withholds taxes, etc. The employee may not have freedom of choice with respect to assignments, hours worked, etc.
A home care registry, however, differs in that the care provider simply "registers" with the company which acts as a middle man of sorts. The care provider is typically responsible for paying their own insurances, taxes, etc. and is generally free to work with more than one registry at a time. Essentially, they are an independent contractor.
The caveat under both scenarios is that the care provider will have to be certified as a Home Health Aide or Certified Nursing Assistant. These certifications, however are relatively simple to obtain.
By having the care provider work through a nurse registry that is contracted with a Medicaid managed care plan, my clients have been able to get the maximum benefits available from a care giver they prefer.
I hope this helps in achieving your care giving goal. see more
Question
When should I use Mom’s long-term care benefit and when should I pay for assistance out of pocket?
My experience has been that most long-term care insurance policies were purchased 10 to 15 years ago with benefits of $100/day with no... My experience has been that most long-term care insurance policies were purchased 10 to 15 years ago with benefits of $100/day with no inflation rider. Most are limited in duration by either the bucket of money approach or by a stipulated benefit period.
What most don't know or recognize is that it is possible to receive public benefits (Medicaid and/or VA) while simultaneously making claim on an LTC insurance policy (depending on expenses and assets).
For instance, I presently have a Florida client living with her spouse in Independent Living. She has a policy that pays $150/day for Home Health Care; not enough to cover the 24 hour cares she requires. The family does NOT want to place her in Assisted Living or a Nursing Home. The policy and the couple's income are not enough to provide the needed care and cover room and board.
She has less than $2,000 and her spouse has less than $123,600 in countable assets. Her income is under the $2,250 per month Medicaid eligibility limit (her spouse's income is higher but in Florida there is no income limit for the Community Spouse).
We applied for and she is receiving Medicaid Home and Community based services which is providing 40 hours of personal home care per week.
The husband is a wartime veteran who does not require care. Still, because of the couple's high unreimbursed medical expenses, He will qualify for a VA Improved Pension Basic award of $1,097 per month.
This combination of all three benefits, plus the couple's income and a small amount from savings is supporting the couple's needs. see more
What most don't know or recognize is that it is possible to receive public benefits (Medicaid and/or VA) while simultaneously making claim on an LTC insurance policy (depending on expenses and assets).
For instance, I presently have a Florida client living with her spouse in Independent Living. She has a policy that pays $150/day for Home Health Care; not enough to cover the 24 hour cares she requires. The family does NOT want to place her in Assisted Living or a Nursing Home. The policy and the couple's income are not enough to provide the needed care and cover room and board.
She has less than $2,000 and her spouse has less than $123,600 in countable assets. Her income is under the $2,250 per month Medicaid eligibility limit (her spouse's income is higher but in Florida there is no income limit for the Community Spouse).
We applied for and she is receiving Medicaid Home and Community based services which is providing 40 hours of personal home care per week.
The husband is a wartime veteran who does not require care. Still, because of the couple's high unreimbursed medical expenses, He will qualify for a VA Improved Pension Basic award of $1,097 per month.
This combination of all three benefits, plus the couple's income and a small amount from savings is supporting the couple's needs. see more
Question
If Mom goes on hospice will we still pay privately or will Medicare pick it back up due to hospice care?
It is true that Medicare will only pay for Hospice services in a nursing home; not room and board. If, however, Hospice services are being... It is true that Medicare will only pay for Hospice services in a nursing home; not room and board.
If, however, Hospice services are being delivered in a free-standing Hospice facility or in a dedicated portion of a hospital, Medicare will pay the full cost of care including room and board. see more
If, however, Hospice services are being delivered in a free-standing Hospice facility or in a dedicated portion of a hospital, Medicare will pay the full cost of care including room and board. see more
Question
A caregiver stole from my home and the agency said that it is between me and the worker. Isn't the agency liab...
Countrymouse...
As you discovered, often difficult to discern. Usually disclosed somewhere, just have to look for it...or ask.
As you discovered, often difficult to discern. Usually disclosed somewhere, just have to look for it...or ask.
Question
A caregiver stole from my home and the agency said that it is between me and the worker. Isn't the agency liab...
Of critical importance when selecting an organization that is "providing" home care is determining whether the organization is a... Of critical importance when selecting an organization that is "providing" home care is determining whether the organization is a "licensed home health care agency" or a "nurse registry". Most seeking such services do not understand the importance of the difference.
In the case of the former, the home health aide is an employee of the company and is (hopefully) insured and bonded through the agency. Still, the contract entered into rules.
In the case of the latter, the home health aide is an independent contractor and is responsible for their own liability insurance and bonding. Typically, a nurse registry is just that and does not provide any liability protection.
Caveat emptor. see more
In the case of the former, the home health aide is an employee of the company and is (hopefully) insured and bonded through the agency. Still, the contract entered into rules.
In the case of the latter, the home health aide is an independent contractor and is responsible for their own liability insurance and bonding. Typically, a nurse registry is just that and does not provide any liability protection.
Caveat emptor. see more
Question
Non-family member caregiver has been written into will; she will receive 25%. Is this legal?
Most don't fully understand how and when a Will operates and under what circumstances. A Will only governs those assets subject to... Most don't fully understand how and when a Will operates and under what circumstances.
A Will only governs those assets subject to probate.
If assets pass to another by Operation of Law (such as jointly held) or by Beneficiary (such as life insurance or IRA's where the beneficiary is not the estate of the deceased) THEY ARE NOT SUBJECT TO THE PROBATE PROCESS AND THEREFORE NOT SUBJECT TO THE TERMS OF A WILL.
The administration of a Will upon one's death is conducted by the Probate Court that has jurisdiction. The process is time consuming and usually relatively expensive.
As a result, most chose to do some form of Estate Planning that avoids the probate process.
This planning is accomplished, as suggested above, by holding assets jointly with the intended beneficiary, naming Payable on Death (POD) or Transfer on Death (TOD) beneficiaries on financial accounts, naming individuals as beneficiaries on life insurance/annuity policies and IRA's, or by creating a Revocable Trust and titling assets in the name of the trust (upon death of the grantor the trust becomes "irrevocable" and assets are devised according to the terms of the trust by the trustee named in the document).
There are, however, instances where one might actually prefer that their estate be subject to probate as then the administration of the estate will be supervised by a Probate Court thereby assuring assets subject to a Will are properly devised.
Proper estate planning and proper titling of assets to accomplish same is a crucial if one wishes their assets to be distributed as intended.
Seek proper legal advice. see more
A Will only governs those assets subject to probate.
If assets pass to another by Operation of Law (such as jointly held) or by Beneficiary (such as life insurance or IRA's where the beneficiary is not the estate of the deceased) THEY ARE NOT SUBJECT TO THE PROBATE PROCESS AND THEREFORE NOT SUBJECT TO THE TERMS OF A WILL.
The administration of a Will upon one's death is conducted by the Probate Court that has jurisdiction. The process is time consuming and usually relatively expensive.
As a result, most chose to do some form of Estate Planning that avoids the probate process.
This planning is accomplished, as suggested above, by holding assets jointly with the intended beneficiary, naming Payable on Death (POD) or Transfer on Death (TOD) beneficiaries on financial accounts, naming individuals as beneficiaries on life insurance/annuity policies and IRA's, or by creating a Revocable Trust and titling assets in the name of the trust (upon death of the grantor the trust becomes "irrevocable" and assets are devised according to the terms of the trust by the trustee named in the document).
There are, however, instances where one might actually prefer that their estate be subject to probate as then the administration of the estate will be supervised by a Probate Court thereby assuring assets subject to a Will are properly devised.
Proper estate planning and proper titling of assets to accomplish same is a crucial if one wishes their assets to be distributed as intended.
Seek proper legal advice. see more
Question
Any hints on dealing with the VA for aid and attendance?
Qualifying financially for VA Improved Pension with Aid and Attendance requires that asset and income tests be met. Unfortunately, the VA... Qualifying financially for VA Improved Pension with Aid and Attendance requires that asset and income tests be met. Unfortunately, the VA does not provide "red line" asset and income limits and instead uses formulas.
Income:
To qualify for the maximum award, GROSS household income from all sources (including that of the spouse if married) must be totally consumed by Unreimbursed Medical Expenses ("UME") which may include payments made to a family caregiver (other than the spouse). Payments to a caregiver must be evidenced (copies of cashed checks) and an affidavit signed by both the caregiver and the care recipient indicating the type of care being provided, the frequency of the care, and the amount of compensation must be submitted. As a previous poster suggested, payments for care to a family member may cause an issue with Medicaid eligibility and a properly drafted agreement between the family caregiver and the person providing care is recommended.
Assets:
There is no stipulated asset limit although many will incorrectly state that there is a limit of $50,000 for an individual and $80,000 for a couple. These numbers only apply to VA internal processing and have nothing to do with qualification. In determining an "asset limit" the VA looks at the family's "gross estate" (essentially everything except the homestead residence, automobile and personal effects) and asks the following question: "If the gross estate is divided by life expectancy, will the result cover reported unreimbursed medical expenses for the life of the claimant?". If the answer is "yes", no award. If the answer is "no" an award may be granted.
Other matters:
A partial award may be granted which seems to be the case here.
Awards can be increased upon new evidence.
Do not file an "appeal". The first step in adjusting or contesting a claim is to submit new evidence based on the original application. The next step would be the filing of a "Notice of Disagreement". The final step would be filing a formal Appeal. The last two take forever and you are better off filing a new claim. Once the new claim is filed and approved the claimant can seek benefits they may be entitled to for the previous 12 months.
Getting help with claims:
No-cost help with VA applications can be obtained at the federal, state and local level. It has been my experience that as well intentioned as those who staff these institutions and organizations may be, they cannot (or will not due to their mission) be able to help those who have but the simplest claims. Moreover, virtually none of them have expertise with respect to coordinating VA benefits with Medicaid. There can be tremendous value in seeking professional help when appropriate. see more
Income:
To qualify for the maximum award, GROSS household income from all sources (including that of the spouse if married) must be totally consumed by Unreimbursed Medical Expenses ("UME") which may include payments made to a family caregiver (other than the spouse). Payments to a caregiver must be evidenced (copies of cashed checks) and an affidavit signed by both the caregiver and the care recipient indicating the type of care being provided, the frequency of the care, and the amount of compensation must be submitted. As a previous poster suggested, payments for care to a family member may cause an issue with Medicaid eligibility and a properly drafted agreement between the family caregiver and the person providing care is recommended.
Assets:
There is no stipulated asset limit although many will incorrectly state that there is a limit of $50,000 for an individual and $80,000 for a couple. These numbers only apply to VA internal processing and have nothing to do with qualification. In determining an "asset limit" the VA looks at the family's "gross estate" (essentially everything except the homestead residence, automobile and personal effects) and asks the following question: "If the gross estate is divided by life expectancy, will the result cover reported unreimbursed medical expenses for the life of the claimant?". If the answer is "yes", no award. If the answer is "no" an award may be granted.
Other matters:
A partial award may be granted which seems to be the case here.
Awards can be increased upon new evidence.
Do not file an "appeal". The first step in adjusting or contesting a claim is to submit new evidence based on the original application. The next step would be the filing of a "Notice of Disagreement". The final step would be filing a formal Appeal. The last two take forever and you are better off filing a new claim. Once the new claim is filed and approved the claimant can seek benefits they may be entitled to for the previous 12 months.
Getting help with claims:
No-cost help with VA applications can be obtained at the federal, state and local level. It has been my experience that as well intentioned as those who staff these institutions and organizations may be, they cannot (or will not due to their mission) be able to help those who have but the simplest claims. Moreover, virtually none of them have expertise with respect to coordinating VA benefits with Medicaid. There can be tremendous value in seeking professional help when appropriate. see more
Question
Mother-in-law came back from hospital unable to stand or walk on her own. How do we get her into rehab quickl...
Quick review of Medicare Skilled Nursing Facility qualification requirements (the last item has not been mentioned in previous posts): 1.... Quick review of Medicare Skilled Nursing Facility qualification requirements (the last item has not been mentioned in previous posts):
1. The patient must be an admitted hospital patient with at least three overnights of in patient hospital care.
2. The patient must require skilled nursing services ordered by a physician.
3. The patient must enter a Medicare participating facility.
4. The patient may qualify for Medicare coverage if admitted to the nursing facility within 30 days of hospital discharge for the same condition for which they were hospitalized. see more
1. The patient must be an admitted hospital patient with at least three overnights of in patient hospital care.
2. The patient must require skilled nursing services ordered by a physician.
3. The patient must enter a Medicare participating facility.
4. The patient may qualify for Medicare coverage if admitted to the nursing facility within 30 days of hospital discharge for the same condition for which they were hospitalized. see more
Question
I'm on Medicare A and B and Medicaid and I'm getting billed high copays to see doctors etc. Why is that?
The answer to your question depends, in part, on the type of Medicaid assistance you are receiving and the state in which you reside. Are... The answer to your question depends, in part, on the type of Medicaid assistance you are receiving and the state in which you reside.
Are you receiving "Community Medicaid" or are you participating in a "Medicare Savings Program".
If, for instance, you are participating in the Qualified Medicare Beneficiary ("QMB") Medicare Savings Program, then Medicare providers are prohibited by Federal Law to charge the patient anything above Medicare's reimbursement and the state's Medicaid payment (if any) irrespective as to whether or not the provider participates in a given state's Medicaid program.
Background can be found here: www.ssa.gov/OP_Home/ssact/title19/1902.htm
But you may be better off calling Medicare (1-800-MEDICARE) to discuss your particular circumstances or search the Medicare.gov website for more information. see more
Are you receiving "Community Medicaid" or are you participating in a "Medicare Savings Program".
If, for instance, you are participating in the Qualified Medicare Beneficiary ("QMB") Medicare Savings Program, then Medicare providers are prohibited by Federal Law to charge the patient anything above Medicare's reimbursement and the state's Medicaid payment (if any) irrespective as to whether or not the provider participates in a given state's Medicaid program.
Background can be found here: www.ssa.gov/OP_Home/ssact/title19/1902.htm
But you may be better off calling Medicare (1-800-MEDICARE) to discuss your particular circumstances or search the Medicare.gov website for more information. see more
Question
If you have a POA but do not agree with the POA and you are competent, alert and oriented who has decision mak...
There are two issues: 1. The construction of the document. 2. The powers provided for in the document. With respect to #1 above, Powers of... There are two issues:
1. The construction of the document.
2. The powers provided for in the document.
With respect to #1 above, Powers of Attorney are typically drafted in one of two ways: as a "Durable Power of Attorney" or "Springing Power of Attorney". Some states, like Florida, no longer permit Springing Powers of Attorney.
A Durable Power of Attorney grants the Agent immediate powers upon execution of the document irrespective of the Principal's capacity.
A Springing Power of attorney grants the Agent powers only upon an event(s) specified in the document (usually incapacity).
With respect to #2 above, an agent can only exercise those powers specified in the document. Typically, a POA is drafted to address only financial and contractual matters and a separate document (Health Care Surrogate) is drafted to cover health care decision making and HIPPA authorization.
Some POA's whether Durable or Springing, include health care decision making and HIPPA powers.
The delineated powers in the document rule; there are rarely "implied" powers (although state statute may have clarifying language).
If the Principal has capacity they retain the ability to revoke the POA at anytime. Usually the Agent(s) must be notified in writing of such revocation.
The above is not to be considered legal advice. Consult competent counsel in your state regarding your particular circumstances. see more
1. The construction of the document.
2. The powers provided for in the document.
With respect to #1 above, Powers of Attorney are typically drafted in one of two ways: as a "Durable Power of Attorney" or "Springing Power of Attorney". Some states, like Florida, no longer permit Springing Powers of Attorney.
A Durable Power of Attorney grants the Agent immediate powers upon execution of the document irrespective of the Principal's capacity.
A Springing Power of attorney grants the Agent powers only upon an event(s) specified in the document (usually incapacity).
With respect to #2 above, an agent can only exercise those powers specified in the document. Typically, a POA is drafted to address only financial and contractual matters and a separate document (Health Care Surrogate) is drafted to cover health care decision making and HIPPA authorization.
Some POA's whether Durable or Springing, include health care decision making and HIPPA powers.
The delineated powers in the document rule; there are rarely "implied" powers (although state statute may have clarifying language).
If the Principal has capacity they retain the ability to revoke the POA at anytime. Usually the Agent(s) must be notified in writing of such revocation.
The above is not to be considered legal advice. Consult competent counsel in your state regarding your particular circumstances. see more
Question
Mother is in the final stages of life with 2 policies that have no beneficiary. What to do?
If you are agent under her Power of Attorney and it gives you the ability to change beneficiaries you are in luck. Immediately submit her... If you are agent under her Power of Attorney and it gives you the ability to change beneficiaries you are in luck. Immediately submit her POA to the insurance company and request a change of beneficiary form. Most large companies will accept a fax of the form and have the change done with 48 hours.
If her POA does not permit this then the policy proceeds will be paid to her estate. The next question will be: does she have a living trust (becomes irrevocable at death) and a "pour over" Will that instructs assets not titled in the name of the trust to be "poured into" the trust for administration purposes?
If not, then the proceeds of the policies will be subject to the terms of her Will and probate administration. see more
If her POA does not permit this then the policy proceeds will be paid to her estate. The next question will be: does she have a living trust (becomes irrevocable at death) and a "pour over" Will that instructs assets not titled in the name of the trust to be "poured into" the trust for administration purposes?
If not, then the proceeds of the policies will be subject to the terms of her Will and probate administration. see more
Question
Grandma needed surgery. She stayed in the hospital hospital for 35 days, was in a nursing home for 64 days, an...
Under Medicare Part A she still has 36 days of her 100 Medicare Skilled Nursing Facility benefit available during this "Benefit... Under Medicare Part A she still has 36 days of her 100 Medicare Skilled Nursing Facility benefit available during this "Benefit Period". A Benefit Period is defined as any period of care separated by a least 60 days during which care is not received. Part A benefits are not calculated on a calendar year basis as Part B and D are. see more
Question
I've sent Mom's Medicaid application but they never replied after weeks now. What can we do for payment?
Anna... 1. Make certain your mother has less than $2,000 in countable assets before the end of the month. That is why the pre-need... Anna...
1. Make certain your mother has less than $2,000 in countable assets before the end of the month. That is why the pre-need funeral arrangement was suggested...it is not a countable asset and hopefully brought her assets below $2,000. If she is over $2,000 in assets on July 30th she will be out of luck with respect to eligibility in July regardless of when an application is filed.
2. Income requirements vary by state. What state does your mother live in? Are you sure her income is under the limit if there is one in your state?
3. Medicaid benefits are retroactive to the first of the month your mother is financially and otherwise eligible.
4. Medicaid benefits can be retroactive up to three months. For example, an application filed by the last day in July may be approved for benefits beginning April 1
.
5. Given #4 above, in the short run it does not matter when the application is filed.
6. In any event, the nursing home cannot discharge your mother without providing for "safe discharge" to another facility.
7. If they accept her as a long-term patient they must provide a 30 day discharge notice and then must arrange for safe discharge as noted above.
8. Nursing homes take an aggressive stance with respect to payor source and this is certainly understandable. Work with the facility, keep them updated, be nice, and everything should be fine. If you mother's case is not complicated, and it does not sound as though it is, Medicaid approval should come relatively quickly. see more
1. Make certain your mother has less than $2,000 in countable assets before the end of the month. That is why the pre-need funeral arrangement was suggested...it is not a countable asset and hopefully brought her assets below $2,000. If she is over $2,000 in assets on July 30th she will be out of luck with respect to eligibility in July regardless of when an application is filed.
2. Income requirements vary by state. What state does your mother live in? Are you sure her income is under the limit if there is one in your state?
3. Medicaid benefits are retroactive to the first of the month your mother is financially and otherwise eligible.
4. Medicaid benefits can be retroactive up to three months. For example, an application filed by the last day in July may be approved for benefits beginning April 1
.
5. Given #4 above, in the short run it does not matter when the application is filed.
6. In any event, the nursing home cannot discharge your mother without providing for "safe discharge" to another facility.
7. If they accept her as a long-term patient they must provide a 30 day discharge notice and then must arrange for safe discharge as noted above.
8. Nursing homes take an aggressive stance with respect to payor source and this is certainly understandable. Work with the facility, keep them updated, be nice, and everything should be fine. If you mother's case is not complicated, and it does not sound as though it is, Medicaid approval should come relatively quickly. see more
Anyone else in or been this impossible situation? Any suggestions welcome.
Rest assured you will not have lose all of your spouse's income if it happens that he needs to move to a long-term care facility as a Medicaid recipient.
Federal Law provides for Community Spouse protections to prevent the spouse living in the community from becoming impoverished.
The guideline are the same for all states except Alaska and Hawaii and, depending on your shelter expenses (housing and other costs), you will be able to retain $2,739 of you and your spouses combined income and up to $109,560 of otherwise countable assets (the $109,950 does not include the house, automobile and personal effects).
Interestingly, Illinois' standards are quite a bit more restrictive than in other states, e.g., Florida the combined income limit (technically called the "Minimum Monthly Maintenance Needs Allowance or "MMMNA") is up to $3,260 and the Community Spouse asset limit is $130,360 (these are the Federal limits).
I hope these numbers work for you and your financial stress is somewhat relieved. see more