April 8, 2010 

 
Law Offices of D. Victor Pellegrino
Attorney at Law
2627 Genesee Street
Utica, New York 13501
Phone (315) 733-0417
Fax (315) 792-8075
Email: Dick@estateandelderlaw.com

"Protecting The Assets of Seniors and Their Families for Over Thirty Years"

HOW TO PLAN YOUR ESTATE

To Avoid Your Assets Being Wiped Out To Pay
for
 Nursing Home Costs
and Uncovered Medical Expenses



 

I have spent over 34 years helping seniors and their families protect their home and life savings by showing them how they can plan to qualify for Medicaid and actually qualifying them for Medicaid in the event of a medical emergency.

This document is intended to answer thirteen of the most frequently asked questions I am asked when I meet with families who are interested in protecting their life savings and home from being wiped out to pay for nursing home costs and uncovered medical expenses. I hope you find them helpful in protecting your assets.
 
  1. Q. WILL MEDICARE PAY FOR ALL OF MY NURSING HOME COSTS? A. No. Medicare might provide payment for the first 20 days and part of the next 80 days of care in a nursing home, which usually results in a contribution by you of about $134 per day for the 80 days in central New York. There are strict Medicare conditions you must meet or private pay 100% of your own nursing home costs from day one:

              1. You must be hospitalized for medically necessary inpatient hospital care for at least three consecutive calendar days, not counting the day of discharge.

              2. You must be admitted to a nursing home within 30 days of being discharged from the hospital.

              3. The skilled nursing and/or skilled rehabilitative services are those furnished pursuant to physician's orders which: (a) require the skills of professional personnel such as a nurse or therapist; and (b) are provided either directly or under the supervision of such personnel. Please note that if you are receiving physical therapy and not showing an improvement, Medicare can cut you off and stop paying the nursing home, leaving you to pay all costs privately.

    "Skilled" nursing care is really like extended hospital care, which is very different from "custodial care". Custodial care is that level of care which is merely assistance with what are known as the Activities of Daily Living (ADL's). This type of personal care, such as assistance with eating, bathing, dressing, toileting, transferring in and out of bed and supervision of medications usually do not require the assistance of professionally trained and licensed personnel. The Medicare program does not cover custodial care. Medicare does not provide protection for expenses of long-term health care such as:

  2. Q. WHAT GOVERNMENT PROGRAM WILL PAY FOR MY NURSING HOME COST?

    A. The only government program that will pay for long-term care is Medicaid which is a jointly financed federal and state medical welfare program for the poor.  If you qualify, Medicaid can cover nursing home costs, hospital care, home care, doctor bills and drug prescriptions. Medicaid can also cover Medicare deductibles and certain services that Medicare won't pay for.

  3. Q. HOW CAN I PROTECT MY ASSETS FROM BEING WIPED OUT TO PAY FOR NURSING HOME COSTS?

    A. The strategy most frequently used to protect and save the senior's assets is called the "impoverishment" strategy. Over a period of time, the senior gradually transfers (either outright or in Trust) and protects all or nearly all of his or her assets for the purpose of qualifying for the Medicaid Program. The "impoverishment" strategy or what is sometimes called "planned poverty" aims to:

    1. reduce the senior's assets below the minimum amount for Medicaid and
    2. qualify him or her for Medicaid, thus
    3. prevent the senior's assets from being used up to pay for uninsured health care expenses or nursing home costs, to
    4. allow assets to be transferred to the children or other family members either during the senior's life or on the senior's death.
    5. allow a healthy spouse to support themselves from assets that would otherwise be used to pay for their spouses nursing home costs.

  4. Q. IF MY SPOUSE IS GOING INTO A NURSING HOME, CAN HE OR SHE TRANSFER ALL OF HIS OR HER ASSETS TO ME AND QUALIFY FOR MEDICAID?

    A. No. To determine the eligibility of the spouse who is going into the nursing home to receive Medicaid, all of the non-exempt assets held by the husband or wife are added together and then the total divided equally between the spouses. To the extent the healthy spouse's half exceeds $74,820, in New York State, the Community Spouse Resource Allowance,  (CSRA), the excess is attributed to the spouse going into the nursing home, thereby disqualifying the spouse going into the nursing home from receiving Medicaid.

    The spouse outside of the nursing home can retain $74,820 in New York State, the CSRA, in otherwise non-exclude able assets, plus homestead, plus personal property, plus a burial reserve, plus an automobile. 

    While the Community Spouse Resource Allowance (CSRA) can be as high as $109,560 for seniors with a large amount of assets, this higher CSRA results in  the payment of more of your assets for nursing home costs.

    It is important to understand that under New York law:

              1. A spouse is charged with legal responsibility for the other spouse's nursing home costs. This means that the income and resources of the healthy spouse are considered as available to the Medicaid applicant spouse who is going into a nursing home and will be considered in determining if that spouse qualifies for Medicaid, and

              2. If the healthy spouse has assets in excess of $74,820, those excess assets must be spent on medical care until the healthy spouse's assets are down to $74,820, and

              3. If the healthy spouse's monthly income is more than $2,739 per month, the local Social Services Department will normally require 25% of the excess income to be spent on the nursing home costs of the spouse in the nursing home.

               4. If the total income of both spouses does not exceed $2,739 per month, all of the total income can go to the healthy spouse, even if their spouse is in a nursing home. 

    5. Q. HOW MUCH INCOME CAN I MAKE AND QUALIFY FOR MEDICAID

         A. Any person over 64 whose net income is less than $767 per month, plus an unearned income credit of $20 ($1,117 for a couple) per month, plus an unearned income credit of $20 for some couples) has satisfied the income means test for SSI related Medicaid. A single individual residing in a nursing home is permitted only $50 per month as a personal needs allowance, plus assets of $13,800 ($20,100 for a couple) plus a burial reserve. You can set up a trust with a funeral director to prepay funeral expenses and the money in the trust will not be counted as a resource for Medicaid as long as any money not spent on the funeral is turned over to the Medicaid upon the senior's death. Caution, at the current time, only the cost of the vault, opening and closing of the grave, plot, stone and casket are treated as exempt for the community spouse, as opposed to the Medicaid applicant. (Car and personal residence may be exempt.) The law provides that the spouse of an individual who has established his or her eligibility for Medicaid is entitled to a monthly income not to exceed $2,739 per month. You  can also pay for certain burial space expenses for your children and their spouses to protect a substantial amount of your assets. Interest on burial accounts is exempt for Medicaid purposes.

    6.Q. CAN I TRANSFER MY ASSETS TO MY CHILDREN OR OTHER FAMILY MEMBERS JUST BEFORE I GO INTO A NURSING HOME?

          A. L    AW IN EFFECT AFTER FEBRUARY 8, 2006. There is a new law in effect after February 8th, 2006 that will change previous law drastically. The bottom line is that under the new law there is a five year look back period and any assets transferred within 5 years of you going into a nursing home and making a Medicaid application will disqualify you from receiving Medicaid until that penalty period has run. Under the law before February 8th, 2006, there was a Thirty Six Month Rule (applicable to outright transfers) and a Sixty Month Rule (applicable to certain transfers in trust). Eligibility for medical benefits is denied for a period of time if the person going into the nursing home transferred assets for less than fair market value within thirty six or sixty months before his or her application for Medicaid benefits. Under the old law which applies to transfers made before February 8, 2006, the period of ineligibility begins the first day of the month following the month in which the resources were transferred and lasts for a number of months equal to the total value of the transferred property divided by the average cost of nursing home care to a private patient in that region of the state. (Currently $7,262 per month in central New York State and higher in other areas of New York). Under the new law, the penalty period doesn't start to run the first day of the month after the month of the transfer, it starts to run much later, in essence, the penalty period starts to run the date you end up going into the nursing home and would otherwise qualify for Medicaid, if you hadn't made the transfers. So any transfers within 5 years of applying for Medicaid result in a penalty period preventing you from qualifying for Medicaid, calculated by taking the amount you transferred within 5 years and dividing it by $7,264 (in central NY). ********* UNDER THE NEW LAW ASSETS YOU TRANSFER 5 YEARS BEFORE YOU GET SICK CAN RESULT IN DISQUALIFICATION FOR MEDICAID!!! 

    Under the Medicaid transfer rules, certain resources and transfers are exempt. A home is exempt if transferred to one of the following:

                        1. a spouse,
                        2. a minor (under 21 child), or a blind or disabled child of the Medicaid applicant,
                        3. a brother or sister with an equity interest in the home who resided in the home one year before institutionalization,
                        4. a son or daughter who resided in the home two years and provided care that kept the Medicaid applicant from being institutionalized,
                        
    Certain other transfers of any resource are also exempt. For example: a transfer is exempt if the resource was transferred to a spouse or to another for the sole benefit of the spouse, or to a disabled child, or to a trust established solely for the benefit of the disabled child.

    7. Q. DOES IT MAKE A DIFFERENCE WHEN I APPLY FOR MEDICAID?
     
        A. Extreme caution  must be used is deciding when to file the Medicaid application, because there is no longer a "cap" on the waiting period equal to the look back period. If you apply for Medicaid too soon after a transfer, you may create a penalty period or period of ineligibility for Medicaid longer than 60 months. This means that if you apply one day too early, you could be prevented from qualifying for Medicaid for 5 or 10 years or more. If you applied at the appropriate time, which could be one day later, you could qualify immediately for Medicaid! What a difference a day can make?  

    8.  Q. WHAT CAN BE DONE IF THE SENIOR IS ALREADY IN A NURSING HOME?

         A.     If the senior is already in a nursing home or about to go into one, he or she can retain enough assets to pay for sixty months care, transfer the balance and not apply for Medicaid until sixty months after the date on which the last asset transfers are completed. If the assets total less than the cost of 60 months of care, no transfers will help you. However use of a "Service Contract" or a gift and promissory note between a senior and a family member, usually a child, can avoid the harsh new 5 year rule as discussed below under question 9.

    9.  Q. HOW CAN I AVOID THE NEW FIVE YEAR RULE ON GIFT TRANSFERS AFTER FEBRUARY 8, 2006?

         A.     One technique to avoid the new harsh 5 year rule on gift transfers after February 8th, 2006 is the use of a "Service Contract" between the senior and a child or other family member.

    Most children help their mom and dad in numerous ways as they age by performing the services of a Geriatric Care Manager. It is very common for a child to handle their parents' finances if the parents become unable to handler their own finances by becoming their parents' Power of Attorney. These duties often include paying bills, dealing with the parents' banker, lawyer, tax return preparer and financial planner. In addition, most children manage their parents' health care as their Health Care Proxy by taking their parents to the doctors, communicating with the doctors, hospitals, nursing homes, social workers and home health care aides. Many times the children arrange for supervision of the parents by home health care aides and visit their parents on a regular basis whether at home, during hospital visits or stays in a nursing home.

    These valuable services are usually provided free of charge because of the love and affection we have for our parents. That presumption can be over come under certain court decisions, seniors can actually hire their children to provide these services on a contractual basis and pay the children substantial amounts of money to perform these Geriatric Care services. If the "Service Agreement" is properly drawn and substantiated, money paid to children for documented services pursuant to a binding written agreement entered into at the time of the rendition of the services can completely avoid the new harsh 5 year rule and those payments can be protected immediately upon payment to the children without any penalty period imposed. Extreme caution should be used when employing this technique because DSS is currently challenging the use of service agreements when parents are in a nursing home. DSS's position has been successfully challenged in many court cases (Florida, Louisiana and Missouri) and there is even a New York Fair Hearing Decision that has ruled in favor of the use of this technique and I strongly suggest its consideration.

           Please note that in September, New York State Department of Health issued a ruling that it will give credit for amounts paid to children for certain services rendered under a  service agreement entered into prior to entry into a nursing home, which means these payments will be allowed and not treated as a gift transfer, thus escaping the 5 year rule. I have won 3 favorable fair hearing decisions using this technique, which has protected a substantial amount of money and avoided the 5 year rule for compensation for services rendered to parents prior to entry into a nursing home. It makes sense because the children are in fact providing valuable services to the parents anyway. This is an excellent planing tool that I recommend if used properly.    

Another technique used in an emergency, where little or no planning has been done, is the use of a promissory note, where a parent makes a gift transfer of money to a child and then loans the child money that will be repaid to the parent over a short period of time. Without going into detail, the bottom line is that if done properly, about 1/2 of the parents assets can be protected in this type of emergency planning, sometimes much more. There have been three Fair Hearing Decisions out of Albany County that have allowed this planning technique and I have used it several times in Oneida County.

The use of a private annuity and/ or a Grantor Retained Annuity Trust can also be employed. 

The key is planning and with proper planning there are avenues to use that can avoid the imposition of the new 5 year rule. Of course that depends on the facts of your situation, but without proper planning, assets transferred by gift within 5 years of entering a nursing home will result in disqualification from receiving Medicaid.



10. Q. WHY SHOULD I USE A TRUST TO PROTECT MY ASSETS?
 
       A. Assets are usually transferred to children or other family members either outright or in trusts. A trust is more desirable than an outright transfer to a child in many situations because:

         a) You may have a bad relationship now or in the future with: 

               1.  your child or

               2.  your son-in-law or daughter-in-law
     
         b) Your child may:

 

Please feel free to give me a call at (315) 733-0417

Warmest personal regards

Dick
D. Victor Pellegrino
Email:

PLEASE NOTE THAT THIS DOCUMENT IS NOT MEANT TO GIVE LEGAL ADVICE, BUT ONLY TO ANSWER CERTAIN FREQUENTLY ASKED QUESTIONS CONCERNING HOW TO PROTECT ASSETS FROM BEING WIPED OUT TO PAY FOR NURSING HOME COSTS. YOU ARE STRONGLY URGED TO CONSULT WITH AN ATTORNEY WHO IS COMPETENT IN THE AREA OF ELDER LAW, TAX AND ESTATE PLANNING PRIOR TO TAKING ANY STEPS TO PROTECT ASSETS SO THAT YOU WILL UNDERSTAND ALL OF THE RAMIFICATIONS OF YOUR ACTIONS, INCLUDING BUT NOT LIMITED TO ESTATE TAX, GIFT TAX, INCOME TAX, FINANCIAL AND ESTATE PLANNING CONSIDERATIONS.


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Last Updated: April 8, 2010

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