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How Trusts Affect Medicaid Eligibility and Estate Recovery

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Web-Seminar Presentation Materials – Medicaid Eligibility

On March 20, 2019 I participated in a national webinar entitled How Trusts Affect Medicaid Eligibility and Estate Recovery.  The goal was to review the basic tenants of estate planning and specifically around Medicaid qualification. We reviewed the rules to Medicaid eligibility, discussed the difference between countable and non-countable assets, discussed income and what spousal protections are in place. It was a top-line comprehensive review.

The materials were focused around the difference between revocable trusts and irrevocable trusts and reviewed the tenants that revocable trusts do not work for Medicaid eligibility and qualification while properly drafted Irrevocable Trust could accomplish the goal of protection and qualification for Medicaid benefits.

Attached below is a link to a Power Point Presentation of the slides shared with the attendees of the webinar:

How Trusts Affect Medicaid Eligibility and Estate Recovery Slides

If you wish to review and discuss the rules of Medicaid eligibility, how trusts can be used in your estate plan with regard to your specific facts, please contact us for a no-cost no-obligation consultation.

How Can I reduce Capital Gains Taxes?

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Consider Transferring Highly Appreciated Assets to a Parent

If property is held by someone at their death, the “basis” in the property used by the seller to determine taxable gain on its sale is re-set to the fair market value at the date of death.

Income and capital gains tax rates have increased over the last 10 years, and during that time the exemption to avoid estate tax has increased dramatically. This combination (which did not generally exist before now) creates a tremendous opportunity to reduce income tax on property sales. There are many ways to do this. One simple technique is to transfer a highly appreciated asset to a parent. When Mom or Dad passes away, the basis in the asset is increased to its fair market value at the date of death (even though there is no estate tax), which can eliminate income tax on the gain on a sale thereafter, or permit much greater depreciation deductions when re-acquired by the owner.

So for example, if basis is stepped up by $1,000,000, then the tax on sale of the asset will be reduced, which tax savings could easily be $300,000. Note this is an after-tax savings!

There are related issues that should be addressed to protect the asset, account for timing and further enhance the tax benefits.

Medicaid Eligibility Update

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Rhode Island has updated its rules to become Medicaid eligible.

If you are a Rhode Island resident and you are seeking Medicaid benefits, you should be aware of some recent changes approved by the Rhode Island Department of Human Services as to your eligibility under the program. Final rules are expected to be published and release shortly but here is a recap of the expected changes:

  1. Income cap of $9,581 meaning that if the applicant has more than $9,581 in income, then they can never become eligible for Medicaid, nor can they start the penalty period.  If they have income under $9,581 but greater than $6,700 and they want to start a penalty period, they can do so but cannot get community Medicaid benefits, like Rx copays and doctor bills.   If their income is under $6,700, then nothing changes.    This went into effect in September and is effective for applications for eligibility delivered after 10/1/18.   50-00-2.4

    Changes Are Coming

  2. Long term care insurance is not considered countable income for purposes of the above income cap.   However, once on Medicaid, it would need to be spent as part of the patient share.    50-00-6.5.2(B)
  3. Burial Funds & Irrevocable Funeral Contracts have new limits which are helpful and could affect clients.  The new cap on Irrevocable funeral contracts is $15,000 and anything over that would be considered a countable asset.   40-00-3.5.5 A(1)(f)
  4. Life insurance is now exempt up to $4,000 of cash surrender value, with anything over being countable.  40-00-3.5.5 A(1)(h)
  5. Retirement Funds now have a new definition, but as long as they are income producing and the client gets at least the RMD, then they should still be fine. 40-00-3.5.5 A(2)(g)
  6. Penalty Divisor is $9,581 since mid September.

Like any social program, the figures and rules for eligibility are constantly revisited and updated based on changes in federal law, budgets, and program changes and advances. Staying current on the latest rules is the challenge.

If you or a loved one is facing serous medical issues requiring skilled nursing care, the Medicaid program will help pay for those costs for applicants who have assets and income within program limits. Contact us to discuss your estate plan and if your estate plan should be revised so as to become eligible for these valuable benefits.

Can I Deduct Nursing Home Expenses?

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My mother is in a nursing home. Can she still deduct this expense?

Yes. For 2018, in certain instances nursing home expenses are allowable as medical expenses.

  • If you or someone who was your spouse or your dependent, either when the service was provided or when you paid them, is in a nursing home primarily for medical care, then the entire Long Term Carecost including meals and lodging is deductible as a medical expense.
  • If the individual is in the home mainly for personal reasons, then only the cost of the actual medical care is deductible as a medical expense, not the cost of the meals and lodging.

To determine if your mother qualifies as your dependent for this purpose, refer to Whose Medical Expenses Can You Include and Nursing Home in Publication 502Medical and Dental Expenses.

  • Deduct medical expenses on Schedule A (Form 1040)Itemized Deductions.
  • The total of all allowable medical expenses must be reduced by 7.5% of your adjusted gross income.

This write-off is only available to filers who itemize. People who qualify for it can deduct insurance premiums paid with after-tax dollars, plus many costs not always covered by health insurance—such as for long-term care, prostheses, a wig after chemotherapy and more.

Reaction to R.I.’s $9.6B budget proposal: Bad for nursing homes; some good news for kids

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PROVIDENCE, R.I. — The proposed $9.6 billion state budget headed for a House vote later this week has elicited both sighs of relief – and groans – since its piece-by-piece unveiling late Friday night.

A blog dedicated to the challenges facing people with developmental disabilities carried this headline: “Crisis appears averted in RI DD Services.”

But nursing homes cried foul over a “devastating” 8.5 percent cut in their state Medicaid reimbursements to offset the millions they won in a court case, that is currently in limbo, because a state lawyer, who has since resigned, missed the appeal deadline. The Raimondo administration is currently begging the Supreme Court for a reprieve.

Here’s what the bill says: “Beginning July 1, 2018, the rates paid to nursing facilities will be reduced by eight and one-half percent (8.5%) from the rates approved by the Centers for Medicare and Medicaid Services and in effect on October 1, 2017 for nine (9) months until March 2019, at which time the rates will revert to the October 1, 2017 level and be increased by one percent (1%).”

Mattiello told reporters the wording is aimed at reinforcing the funding level lawmakers intended all along, in the face of winning arguments by the nursing homes that the state had improperly shortchanged $8 million a year – and a potential $24 million overall – in its calculations.

James Nyberg, the director of one of the two nursing home advocacy groups – LeadingAge RI – issued a statement over the weekend that said the proposed new budget “will have immediate and devastating consequences for nursing homes and their residents.”

“Tucked into the budget is a cut of 8.5 percent for nursing homes that will go into effect July 1st, in just 21 days. How can we, as an industry, be prepared to react responsibly when we are already significantly underfunded?” he asked.

 

Source: Reaction to R.I.’s $9.6B budget proposal: Bad for nursing homes; some good news for kids

MassHealth Denial Trust Case Overturned

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Denial of Medicaid Benefits based on Income-Only Trust Overturned

A Massachusetts Superior Court has overturned a MassHealth denial of coverage for a nursing home resident who MassHealth found had countable assets available from a trust she had created.

MassHealth who administers the Medicaid program for Massachusetts residents has been aggressively challenging and contesting applications where the applicant was the beneficiary of an Income-Only trust. MassHealth would take the position that assets held in an Income-Only trust are considered available to the applicant to be used on their own care and thus would disqualify them from Medicaid eligibility.

MassHealth will need to be more welcoming of Income-Only trusts

An Income-Only Trust used for Medicaid purposes states that the grantor of the trust shall, as the name indicates, only be entitled to receive income from the trust. If the terms of the trust also state that the grantor shall never be able to receive principal from the trust, the assets in the trust will not be deemed an available resource for the Medicaid applicant. Massachusetts has not followed this rule and denied Medicaid benefits to applicants despite these terms in the trust. With this new decision, MassHealth has been told that it was improper to deny applicants Medicaid benefits of the the basis of Income-Only Trusts.

This decision is welcome news for many estate planners seeking to clarify the role Income-Only trusts play in the estate planning process.

CLICK HERE TO READ THE ARTICLE

The usage of Trusts in Estate Planning is a critical component. The rules and terms contained in the trust dictate how various governmental agencies will view the trust. Having a clear understanding as to interpretation of language as to important benefits such as tax treatment, control issues or Medicaid qualification is required. This decision with MassHealth brings clarity to language that prior was in flux.

Want to learn more about Irrevocable Income-Only trusts? Contact our office for a no-cost consultation to see if they fit into your estate plan.

New drug to treat Alzheimer’s disease under study at Butler Hospital

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Alzheimer’s disease and estate planning

When caring for and planning for an individual, we address the financial and legal aspects of caring for a loved elderly one. These planning considerations do not happen in a vacuum. The decisions we make rely on the medical issues, complications and opportunities available to us. Knowing about treatment options and emerging science is critical in planning for future needs. Alzheimer’s disease robs cognitive ability and causes those who are afflicted to need long-term skilled nursing care.

When medical breakthroughs are occurring on diseases the are often require long term nursing care, we must share and learn as to their success and progress. Such studies and advancements are occurring at Butler Hospital in Providence, Rhode Island as evidenced by the attached link to an article published by the Providence Journal.

Source: New drug to treat Alzheimer’s disease under study at Butler Hospital

 

Co-pays proposed as part of $166M in Medicaid cuts

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Co-Pays and Not Changes to Eligibility Proposed

Gov. Gina Raimondo has proposed balancing next year’s $9.38-billion budget with nearly $166 million in cuts to Medicaid. None of the changes will affect eligibility or benefits, officials said. Co-Pays and other cost reducing strategies will be implemented.

A plan to “rebalance” long-term care and nursing home services would account for another $18.2 million in savings. That includes “modernizing” the eligibility process for long-term care. The budget also calls for a 1-percent increase to nursing home reimbursement rates. In recent years, those rates have seen as much as a 3-percent increase.

Asked if he expected backlash from the nursing homes, Beane said, “I think, frankly, the nursing homes will be pleased to see that some part of the COLA is going to be included here. That’s the first time the governor’s proposed budget has included an increase. She has said in her cover letter to this budget that if revenues are up, this is an area she’d like to see more investment.”

Source: Co-pays proposed as part of $166M in Medicaid cuts

As the long term care insurance market continues to struggle with its future, knowledge as to the rules of Medicaid eligibility that will pay for long term skilled nursing is critical. Individuals can only have $4,000 of countable resources to qualify for Medicaid. Your home, car and personal property is not a countable resource and is protected. Under the proposed budget, those rules appear to remain unchanged. However, what are you to do with savings, investment accounts, a second home or investment property? Will you be forced to liquidate those assets and spend them down on my long term nursing care below $4,000 before I qualify for Medicaid? Without  a plan and proper advice, the answer is likely yes for most. However, with a proper plan, these assets can be protected for yourself, your spouse and your heirs. Contact us to discuss how.

Healthcare Costs Consuming SSI Benefits

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Health Costs May Gobble Up Social Security Benefits

Healthcare for the average woman means they could spend an estimated 70 percent of her retirement check on health care costs, according to a recent study by the Nationwide Retirement Institute. The average man fares better, but still uses nearly half of his benefits to cover medical expenses.

Here’s how the Nationwide analysis reached its disturbing healthcare estimates: It assumed a woman with a life expectancy of 88 married a man who would live to 85 and they both claimed Social Security at 62, which is the earliest and most popular age to file for retirement benefits, regardless of gender. More than half of elderly married couples and nearly 75 percent single retirees depend on Social Security for the majority of their income in retirement. “Women disproportionately rely on Social Security in retirement,” said Nancy Altman, co-director of Social Security Works, which advocates for the expansion of the program. In fact, roughly two-thirds of Social Security beneficiaries age 85 and older are women. In the Nationwide’s bleak scenario, the man collects a monthly benefit of $1,543 and the woman collects $1,171 per month. (The average monthly benefit for a retired worker is $1,350, according to the Social Security Administration.)healthcare-costs

Nationwide projects hefty health costs for the hypothetical couple. The man would pay $214,278 in medical costs in retirement and the woman would pay more than $289,682, because of her longer lifespan. The forecast includes what the couple would have to spend on long-term care at a nursing home or in an assisted living center.

Source/more: CNBC.com

Want to protect your life savings from possible long term care costs?

We have advised hundreds of people on the steps they must take today to protect their assets from the possible catastrophic costs associated with long term care and nursing home care. Contact our office today for a no-cost consultation to discuss your estate planning options.

Matt Leonard