Medicaid Trusts

New York Writer Releases New Book Explaining Complexity of Elder Care System

Published on: May 24, 2011 | by Ettinger Law Firm

Many New Yorkers will one day be called to help care for their elderly parents. The majority of those caregivers report that the complexities and challenges of the process cannot be fully grasped until one experiences them firsthand. There is often no easy way to handle the emotional and financial toll incurred while helping an elderly loved one when they need it most. Our New York elder law lawyers know well the challenges so that many local families face as they work through this experience.

A new book released last week by New York Times reporter Jane Gross offers a first-hand look at how her own New York family struggled through the process of helping their elderly mother. In “A Bittersweet Season” the writer shares the tumultuous way in which she tried to navigate the eldercare system. She reports on her family’s confusion with Medicare and Medicaid programs and other problematic parts of the American health-care system as it relates to the elderly. The book also shares the impact that the time had on her mother’s finances. An itemized ledger is revealed which imparts the true monetary cost incurred by her loved one throughout this time in her life.

In the new volume the author explains how her family was unprepared for the experience. In some aspects the main take-away from book is summarized by Ms. Gross when she writes that “being clueless–utterly clueless–is the central and unavoidable part of this experience.” As difficult as the process is on many families, there are resources available to ease that uncertainty. In fact, a main lesson from the book is the need for families to do what they can to prepare for the process ahead of time.
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Veterans Benefits Assistance Scams

Published on: March 25, 2011 | by Ettinger Law Firm

by Michael Ettinger, Esq.

I am unsure how many of you have run into this scam. I have seen it off and on for the last few years and think all should know about it. These companies that flog Medicaid annuities have a deal going with assisted living facilities that essentially says this. We will advertise and promote VA benefits to seniors. When they call us we will refer them to your facility provided you recommend our services, for people who come to you, in assisting them in the VA application (free of charge) and for financial planning. The company is actually in the business of selling Medicaid annuities and they give out Medicaid advice consistent only with the one product they have to sell.

Here is what happened in an actual case in my office recently. Client was told by the assisted living facility to contact the VA assistance company to help “expedite” the process. Company told the client it would take three months to get benefits. It is now nine months and nothing has been received by the family. Client was also told that they did not have to do anything now to protect assets because they could purchase a Medicaid annuity if and when she had to go into a nursing home. Turns out that client has rallied nicely and will be staying in assisted living for the foreseeable future. Family is now setting up a Medicaid Asset Protection Trust (MAPT) but nine months later than they should have but for the poor advice received by the annuity floggers. But also consider this: had the client needed nursing home care, it turned out that the HCFA life expectancy was only 5.5 years which the client, in this case, might have well outlived. The client was never told about the requirement that the annuity be actuarially sound (i.e. all the money had to be paid back to her within the 5.5 years) and what that meant or what the alternatives were. Client, in this latter case, would have been better off with a gift and loan strategy.

How Gifts of Money Can Affect 2011 Medicaid Eligibility for Nursing Home Care in New York State

Published on: February 14, 2011 | by Ettinger Law Firm

Medicaid Supervisor for Ettinger Law Firm, Elizabeth Schalk, has been reviewing Medicaid applications for over fifteen years. Having worked in this capacity for a nursing home and an elder law estate planning law firm, Schalk has gained valuable insight and experience from counseling New York State residents in various counties about receiving Medicaid assistance.

“The most frequent thing I see is when someone’s mom or dad is sick and s/he knows it will be a short time before his/her parent will have to go into a nursing home. All of a sudden, money gets transferred out of the sick parent’s resources. The thinking behind this is that that this will make his or her parent eligible for Medicaid to pay for nursing home costs. Nothing can be further from the truth. In fact, these kinds of “gifts” can cause a delay in Medicaid benefits.”

When a person transfers assets and then receives or applies for Medicaid-covered nursing home services, the local New York Department of Social Services ”looks back” at financial transactions made within 60 months or five years from the first date on which the person was subsequently institutionalized and applied for Medicaid coverage.

Local Home Health Care Services

Published on: September 1, 2010 | by Ettinger Law Firm

by Bonnie Kraham, Esq.

Most of us don’t want to end our days in a nursing home, and would rather “age in place,” so it’s important to become familiar with available home health care services.

There are three major ways to pay for home health care: self-pay, long-term care insurance, or Medicaid, which is government provided health insurance for those whose assets have been depleted. Medicare, which is government provided health insurance for the elderly, only has limited community home health care. A New York elder law attorney can help to decide which one is the best option.

Long-Term Care Insurance v. Medicaid Asset Protection Trust – Which Should You Choose?

Published on: June 22, 2010 | by Ettinger Law Firm

by Michael Ettinger, Esq.

Long-term care insurance (LTCI) and the Medicaid Asset Protection Trust (MAPT) are often thought of an alternatives to each other. They are not. While LTCI is both a shield and a sword, the MAPT is a shield only.

LTCI protects your assets and income from the costs of care. But it has a positive effect (the sword) in that it actually pays for someone to come into your home and care for you there. The MAPT protects assets, like your home and your life savings, but it does not protect your income (pensions, social security, interest, dividends, etc.). The MAPT has no positive effect in terms of providing care. It is solely a defensive tactic. That being said, in the event LTCI is unavailable to the client for medical or financial reasons, the MAPT is a wonderful tool. And there is truth in the saying that a good defense is the best offense. With the MAPT in place five years ahead of time, the client’s assets are protected and Medicaid will pay for the cost of care, over and above what your income provides. If you have a spouse at home, they may keep about $3,000 per month of the couple’s combined income and sometimes more.

Protecting Assets on the Nursing Home Doorstep: “Half-a-Loaf” Planning or the “Gift and Loan” Strategy

Published on: May 17, 2010 | by Ettinger Law Firm

by Michael Ettinger, Esq.

What do you do when a client comes in to see you and says that his mother is going into a nursing home and she has $300,000 in assets. In fact, mom scrimped and saved all of her life to have this nest egg and now she desperately wants to see her children get an inheritance.

Although you may protect all of your assets by planning five years ahead of time with a Medicaid Asset Protection Trust, all is not lost if nothing has been done and the client finds herself on the nursing home doorstep.

The Medicaid Asset Protection Trust (MAPT) – Do’s and Don’ts

Published on: April 13, 2010 | by Ettinger Law Firm

by Michael Ettinger, Attorney at Law The Medicaid Asset Protection Trust (MAPT) is a technique commonly used by elder law attorneys. It consists of an irrevocable trust, usually set up by a parent of parents sixty-five and older. One or more of the adult children are named as “trustees” to manage the trust for the benefit of the “beneficiaries” who remain the parents during their lifetimes. For example, the parents retain the right to the exclusive use and enjoyment of the home and the income from all of the trust assets. The establishment and “funding” of the trust, i.e. retitling the home and the investments in the name of the trust, starts the five year look-back period running. After five years, those assets become exempt and are protected from the costs of long-term care.

Once the MAPT is established, there are certain things the parties can and cannot do. Below are a list of the “Do’s and Don’ts” concerning the MAPT.

Do’s

Spousal Refusal in New York – “Just Say No”

Published on: March 15, 2010 | by Ettinger Law Firm

by Michael Ettinger, Esq.

“Spousal refusal” is a legally valid Medicaid planning option in just three states: New York, Florida and Connecticut. 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 $3,000 per month of the couple’s combined income and about $100,000 of the assets or “resources”. Not included in those figures are any other exempt assets, such as a home 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 Department of Social Services (DSS) indicating that they refuse to contributed 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 $3,000 per month exemption as it is not coming to you.