Medicaid Planning

Home Care with Community Medicaid

Published on: October 30, 2024 | by Ettinger Law Firm

To qualify for community based Medicaid, meaning receiving medical care in the home, an individual cannot make more than $1,752 per month and a married couple cannot make more than $3,853.50 per month. Obviously, these minimal income standards make it very difficult to qualify for community Medicaid. However, applicants can “spend down” excess income to meet the Medicaid income requirement.

Also, an individual cannot own more than $31,175 in assets and a married couple cannot own more than $74,820 in assets. There are two ways to spend down income. First, the applicant can reduce the income by paying for caregiving and other medical expenses. Second, the income can be reduced through the use of a “pooled income trust” where participants deposit their funds in a general trust, each with their own sub-account within the pooled trust.

A pooled trust, which is available in all states, must be run by a non-profit organization, and exists for elderly and disabled individuals for the purpose of supplementing the participants’ needs beyond government benefits. In the case of people who may not qualify for community Medicaid because of excess income, the pooled trust can allow them to stay at home, also known as “aging in place.”

Elder Law Estate Planning Misconceptions

Published on: September 27, 2024 | by Ettinger Law Firm

One of the most common and devastating misconceptions about elder law estate planning is that it is too late to save money from nursing home costs. On the contrary, there are crisis planning tools that may save substantial assets from being spent on nursing home costs, even after the client has already entered the nursing home. Almost always, if there are assets left, much can be saved.

There are only three ways to pay for nursing home costs – your own assets, long-term care insurance (owned by less than five percent of the population), or Medicaid provided by the government.

Many people know about the “five-year look-back period” and assume nothing can be done without advance planning. The five-year look-back rule means that if you gave any gifts away within the last five years, when asking for Medicaid to pay for nursing home costs, the gift amount creates a penalty period, which results in a period of ineligibility for Medicaid coverage.

Spousal Refusal – Just Say No

Published on: April 12, 2024 | by Ettinger Law Firm

Spousal refusal is a legally valid Medicaid planning option in New York. By way of background, certain income and assets are exempt from Medicaid if there is a spouse. Generally, the spouse at home, known as the “community spouse” may keep about $3,850 per month of the couple’s combined income and up to about $150,000 of the assets or “resources”. Not included in those figures are any other exempt assets, such as a home (up to about $1,000,000 of the equity only) and one automobile. The spouse who is being cared for in a facility is known as the “institutionalized spouse”.

Many a spouse has advised us that they simply cannot afford to live on the allowances that Medicaid provides. This is where spousal refusal comes in. We start by shifting excess assets into the name of the “community spouse”. He or she then signs a document which the elder law attorney prepares and files with the county indicating that they refuse to contribute their income and assets to the care of the ill spouse since they need those income and assets for their own care and well-being. Note that you may not refuse your spouse’s own income over the $3,850 per month exemption as it is not coming to you.

Once the “community spouse” invokes their right to refuse, and all of the other myriad requirements of the Medicaid application are met, the state Medicaid program must pay for the care of the institutionalized spouse.

Tax and Medicaid Law Changes for 2024

Published on: January 18, 2024 | by Ettinger Law Firm

For 2024, the exemptions for estate taxes rise to 6.94 million for New York estate taxes, and to 13.61 million for Federal estate taxes. The annual gift tax exclusion rises to $18,000. If your estate is, or may become, greater than the New York threshold, early intervention can avoid the hefty New York estate taxes, which start at over $500,000. Some of the techniques are (1) setting up two trusts, one for husband and one for wife, and using them to double the New York exemption, (2) gifting out so much of the estate so as to reduce it below the New York exemption, at least three years before the death of the donor, and (3) using the “Santa Clause” providing that the amount over the threshold be donated to a charity or charities of your choosing so as to reduce the estate to no more than the exemption.

For Medicaid, the house is an exempt asset so long as a spouse is residing there, up to $1,071,000 of equity for 2024. Seeing as over 80% of nursing home residents do not have a spouse, it is better to plan ahead with a Medicaid Asset Protection Trust (MAPT) to get the five year look-back for nursing facility care. In that case, the house would be protected by the trust rather than the unreliable spousal exemption. Unless your other assets have been protected by the MAPT, an individual may keep only $30,182 and a spouse can keep up to $154,140.

The major change to Medicaid is the often-delayed imposition of the new two and a half year look-back for home care, commencing April 1, 2024. Previously, there was no look-back for home care. This resulted in people not having to worry about getting home care until they actually needed it. With the law change, the MAPT now becomes far more important as a tool to qualify you for home care than to simply protect your assets from a nursing home. Assets will have to be moved into the MAPT years ahead of time if you want to be able to afford to stay in your own home and get home health aides for assistance with the activities of daily living, should the need arise.

Home Care with Community Medicaid

Published on: June 8, 2023 | by Ettinger Law Firm

Home care paid for by New York State is known as “Community Medicaid”. Paying your own living expenses, plus the cost of caregiving services, is beyond the means of many.

Since 2020, there have been numerous attempts to create a new thirty month look-back period for Community Medicaid eligibility. So far, none of these attempts have been successful and now 2024 is the earliest expected date for implementation. There is no current look-back period for Community Medicaid in New York. This means that you may move assets out of your name this month and obtain Medicaid home care benefits next month, provided you need the care.

Currently, an individual may keep about $1,700 per month plus the amount of any health care insurance premiums. Any excess income must be used towards their care. What if your living expenses exceed $1,700 per month? Enter the “pooled income trust”.

2023 Elder Law Estate Planning Changes

Published on: January 6, 2023 | by Ettinger Law Firm

Happy New Year to all!

There have been significant changes in the law in a number of areas as of January 1, 2023.

The gift tax exclusion, which many people still think is $15,000, is now $17,000, up from $16,000 in 2022. Each person may give up to $17,000 to as many people as they want to without incurring any Federal gift tax liability and without using any of their Federal estate tax exemption at death.

Audits Could Leave Many People Without Health Insurance

Published on: June 22, 2022 | by Ettinger Law Firm

State audits have the potential to impact 15 million individuals including 6 million children losing their health insurance. Some state workers are concerned that they might lack the resources to aid people in finding new insurance coverage.

The existing federal public health emergency will expire this year, which will subsequently trigger a requirement that state workers must examine Medicaid to determine who qualifies as eligible. Over the last two years, these audits have been suspended. With the resumption of these adults, up to 15 million individuals are losing their medical insurance.

The Role of the Biden Administration

Postal Service Switches Retirement Benefits to Medicare

Published on: June 22, 2022 | by Ettinger Law Firm

Congressional efforts to revise the country’s mail service might come at the cost of an even more nuanced issue involving Medicare.

The Postal Service Reform Act of 2022 would help to free post office costs by resolving the unusual and challenging legal requirement to fund 75 years of retirement health benefits in advance. In return, this Act would require future Postal Service retirees to participate in Medicare.

The Congressional Budget Office reports that the movie would save postal retirement as well as healthcare programs more than $5 billion and add more than $5 billion in costs to Medicare from now until 2031.

The Impact Covid Has on Long-Term Care Insurance

Published on: June 16, 2022 | by Ettinger Law Firm

Over the last few years, Covid-19 has caused many people to think deeply about health issues. Now that the height of the pandemic has passed, many people are left wondering how this has impacted long-term care insurance.

A noticeable increase in long-term care insurance has occurred following the summer of 2020 as reported by many medical experts. Many people who previously rejected long-term care coverage have since changed their opinions.

What Is Long-Term Care Insurance?

The Role of the Stop Unfair Medicaid Recoveries Act

Published on: April 18, 2022 | by Ettinger Law Firm

Current federal regulations require Medicaid programs run by states to try to recoup the cost from estates of recipients who have since passed away even if the state would rather not pursue such recovery.

Medicaid programs must pursue compensation for the cost of nursing home services as well as home and community-situated services in addition to other associated services if a person who receives Medicaid was at least 55 at the time the services were provided. States have the choice to pursue recovery for other services due. The recovery is restricted by the size of the deceased individual’s estate. No other public benefit program requires that correctly paid benefits be received from a deceased Medicaid recipient’s family members. The minimum revenue created by estate recovery is surpassed by the burden it places on low-income individuals. The burden unfairly falls on families whose loved one’s experience

The Stop Unfair Medicaid Recoveries Act was introduced by an Illinois representative and if passed into law would revise the Social Security Act’s Title XIX to repeal requirements that states create a Medicaid Estate Recovery Program and restrict the circumstances when a state can institute a lien on property owned by a Medicaid beneficiary.