Medicaid Planning

In the event the client requires home care or institutionalized care in a nursing home facility, an application for Medicaid benefits may be required. Due to complex asset and transfer rules, the application should be made with the aid of an experienced elder law attorney. Again, it is useful in this context for a confidential survey of the client’s assets, as well as any transfers of assets, to be filled out prior to the initial consultation. This form of financial survey will be significantly different from the one used for estate planning purposes.  As a combined federal and state program, Medicaid asset and transfer rules vary significantly from state to state. A few techniques, nevertheless, will be widely applicable. First, in the event an adult child takes the parent into their home in order to care for them in their later years, a housing and care agreement should be executed so that assets may be legitimately moved from the parent to the child prior to any nursing home care.  The adult child will be required to report any payments received under the agreement as earned income on their tax returns. Also, since the family home is usually the most significant asset, consideration will need to be given as to whether the home should be deeded to the client’s adult children while retaining a life estate in the parent or whether the irrevocable Medicaid trust should be used to protect the asset.

While the deed with a life estate will be less costly to the client, in most cases it offers significant disadvantages when compare to the trust. First, if the home is sold prior to the death of the Medicaid recipient, the life estate value of the home will be required to be paid towards their care. If the house is rented, the rents are payable to the nursing facility since they belong to the life tenant. Finally, the client loses a significant portion of their capital gains tax exclusion for the sale of their primary residence as they will only be entitled to a pro rata share based on the value of the life estate to the home as a whole. All of the foregoing may lead to a situation where the family finds they must maintain a vacant home for many years. Conversely, a properly drafted irrevocable Medicaid trust preserves the full capital gains tax exclusion on the primary residence and the home may be sold by the trust without obligation to make payment of any of the principal towards the client’s care, assuming we have passed the look back period. It should be noted here that both the life estate and the irrevocable Medicaid trust will preserve the stepped-up basis in the property provided it is only sold after the death of the parent who was the owner or grantor. Upon the death of the parent, the basis for calculating the capital gains tax is stepped up from what the parent paid, plus any improvements, to what it was worth on the parent’s date of death. This effectively eliminates payment of capital gains taxes on the sale of appreciated property, such as the home, after the parent dies.  Both the revocable and irrevocable trusts also preserve any tax exemptions that the client may have on their home, such as senior and veteran’s exemptions.  

Finally, even with a client already in a nursing home, significant assets may be saved through advanced techniques that are beyond the scope of this guide.  Please consult your elder law attorney for further information if you or a family member is in this situation.

New York Elder Law Attorney Blog - Medicaid Planning