Building Legacies that Last Estate Planning and Elder Law

Report Finds Problems with Assisted Living Oversight

Bigstock-Doctor-with-female-patient-21258332[1]One way that Medicaid can save money is by paying for assisted living care for seniors who are eligible for it, instead of paying for nursing home care. A new report found that because of a lack of oversight, that is not happening.

Medicaid was not originally designed to pay for seniors' stays in assisted living facilities. However, as more and more money was being spent on nursing home facilities and the costs at those facilities continued to rise, the federal government granted states waivers to use Medicaid funds for the generally less expensive assisted living facilities.

This should have saved the federal government quite a bit of money.

A group of Senators asked the Government Accountability Office to study how the government's money was being used. The results were not good as The New York Times reported in "U.S. Pays Billions for 'Assisted Living,' but What Does It Get?"

Every year the government spends approximately $10 billion on assisted living facilities. The discouraging news? It is almost impossible to determine how much of the money is well-spent and how much of it is not. The GAO found that a lack of regulations and proper oversight made it impossible to get even basic information about patient outcomes and critical events in many states.

This is disturbing since Medicaid is expected to need even more money in the future to pay for the nursing home care and assisted living care of an aging population. If the oversight problem is not fixed, it will be seniors who are most harmed by the problems.

Reference: New York Times (Feb. 3, 2018) "U.S. Pays Billions for 'Assisted Living,' but What Does It Get?"


Medicaid Proposals

  Bigstock-Elder-Couple-With-Bills-3557267[1]Even though a vote over the Senate’s bill to repeal Obamacare (Affordable Care Act) has been delayed, it is important to know whether or not it affects elders who rely on Medicaid for nursing home care.

At least for the moment, the legislation to cap Medicaid will not proceed. Nor will the full repeal of the Affordable Care Act.  There were several proposals that could have had an impact.

In March, the House legislation included limits to home equity as a countable resource and repeal of three-month retroactive coverage.  By lowering the limits on home equity, recipients could have been forced to chose between home ownership and Medicaid  assistance. Ultimately, the first was removed from the Senate bill and the second was modified to not apply to persons with disabilities and those over 65.

NAELA is also concerned about the misuse of 1115 waivers to limit Medicaid eligibility. Maine has already proposed an 1115 waiver to put limits on annuities and end retroactive coverage. An elder law attorney can help you learn if you or a loved one qualifies for Medicaid and how to do Medicaid planning.

Medicaid Facts

MP900178564[1]Repeal of the Affordable Care Act has been one the biggest news items in recent weeks. Changes to Medicaid in Republican proposals have received a lot of attention, but many people do not know exactly what Medicaid does.

You probably know that Medicaid is the federal government program that provides health care coverage to poor Americans. However, in the debate about the repeal of Obamacare (Affordable Care Act) and possible reductions to Medicaid in various appeal proposals, what often gets lost is exactly what that federal government program for the poor does.

Facts about the program get lost in the media noise.

It is important to know the facts, because only then can you really decide if you are for or against any changes.

NPR recently published a list of some lesser known facts about Medicaid in "From Birth To Death, Medicaid Affects The Lives of Millions," including:

  • It is very expensive. Medicaid currently takes up approximately 10% of the federal budget. State governments contribute even more on top of that to the costs of the program.
  • Half of all births in the U.S. are covered by Medicaid. The program has been expanded multiple times to include more and more pregnant women.
  • Some 62% of nursing home residents have their care through Medicaid.
  • Disabled people and the people who take care of them are often eligible to receive their care through Medicaid.
  • Medicaid is a major source of funding for the fight against opioid addiction.

Reference: NPR (June 27, 2017) "From Birth To Death, Medicaid Affects The Lives of Millions."


Medicaid Can you Rely On It?

Bigstock-Elder-Couple-With-Bills-3557267[1]People who plan to rely on Medicaid, if they ever need long-term care in a nursing home, often make a very big mistake.

Nursing home care is one of the most expensive things facing elderly people. It costs a lot of money to get long-term care in a nursing home.

Many older people do not have the money for it and do not have a realistic way of getting that money. Profit Law Firm provides Medicaid crisis planning.

As a result, they look to the government to pay for that care. The government will step up through Medicaid, but only if the elderly person, who is in need of nursing home care, has no assets.

When seeking to qualify for Medicaid, however, many people make a big, big mistake.

This mistake is discussed in the Pauls Valley Daily Democrat article titled “Misunderstandings create traps in planning.”

The mistake is a simple one to explain, but it is important to make sure you understand it so you will not make it. You cannot give your assets to your children, just before you go into a nursing home, at Medicaid’s expense.

Unfortunately, that is just what many people are planning to do and it will not work.

What is the problem?

Medicaid has a five-year lookback window, which means that the program will look at any asset transfers the applicant (or anyone on his or her behalf) made within five years of needing long-term care.

If those transfers were not made at market value, then Medicaid will not pay for care until the expenses start to exceed the value of the transferred assets. There is a formula to calculate the “penalty period” that will be applied.

This simple mistake is a big source of problems for the elderly. Make sure that you understand it and ask an elder law attorney, if you have any questions about it.

Reference: Pauls Valley Daily Democrat (March 8, 2017) “Misunderstandings create traps in planning.”



Do You Really Need to Sell Your House to Afford a Nursing Home? Not With An Estate Plan

Bigstock-Senior-Couple-8161132[1]All too often when one spouse in a marriage needs nursing home care, the couple assumes that the only way they can pay for that care is to sell their home. That might not be the case.

Overall, Americans do a poor job of planning for their estates and making plans should they need long-term care in a nursing home. This is because so many Americans do not ever make any plans at all.

Of those that do, many choose to make their own plans and that is a mistake. Those who seek out professional planners normally have good plans.

For the many who have no plans or who have bad plans, they often receive a rude awakening when their spouse needs care in a nursing home. Many of these Americans do not think they have any other option but to sell the family home so the government will pay for the care under Medicaid.

However, that is not always the only option.

This issue was taken up recently by the Boston Globe in “Seniors have more options than selling their home.”

Before selling their homes to pay for nursing home care, seniors are advised to seek out the services of an elder law attorney. The attorney can assess the situation to determine what other options, if any, are available.  At Profit Law firm, during crisis planning, we will review the options to see if a trust, deed transfer or another option works.

The even better option is to plan ahead.

Get a professionally crafted estate plan that includes the possibility of long-term care in a nursing home. Doing so will make it far less likely that having a spouse go into a nursing home will necessitate selling the family home.  Call us for a consultation today.

Reference: Boston Globe (Aug. 20, 2016) “Seniors have more options than selling their home.”