The United States Congress created the Medicaid program in 1964. It is funded in part by the federal government but largely administered by each state.
As a means-tested program, it is designed as an entitlement program to offer a broad array of medical care benefits provided by both the federal or state offices in support of the less fortunate, with specified financial income and resource eligibility.
If eligible for Medicaid, the program will cover physicians’ services, hospital care, medications, medical supplies, and care costs. Standards and guidelines to determine eligibility and spend-down requirements vary from state to state. Don’t try to navigate Medicaid alone; let our firm assist you.
THE MEDICAID TRUST
One currently-effective planning technique is to transfer assets into a ‘Medicaid’ trust. In a Medicaid trust, the trust maker retains the right to all of the trust income for life while irrevocably giving up the right to receive or benefit from any of the trust principal. The assets in the trust are not available to pay for the cost of the trust maker’s long term care.
By using a Medicaid trust, a senior can preserve capital and still qualify for Medicaid, but only after the expiration of the look-back period for the transfer to the trust (which can be as much as 60 months/5 years).
The ‘penalty period’ starts from the date the applicant applies for Medicaid and would be eligible but for the disqualifying transfer. Its length is determined by dividing the state’s average daily private pay nursing home cost into the total of the transfers made during the look-back period.
For the Medicaid trust strategy to work, insurance, an income stream, or other assets must be sufficient to pay for long term care if needed during the waiting period before applying for Medicaid.
A Medicaid trust can allow the trustee to distribute principal during the trust maker’s lifetime for the benefit of the trust maker’s spouse, children, or other designated beneficiaries, just not to or for the benefit of the trust maker. Many trust makers choose to maintain the right (called a Special Power of Appointment) to change the current or ultimate beneficiaries of the Medicaid trust by ‘reappointing’ the assets to different family members at a later date.
If a Medicaid trust is not desired, it is still possible to make ‘outright’ gifts of property, wait until the look-back period expires, and then apply for Medicaid or use other planning techniques to qualify for Medicaid at the earliest possible date.
PROTECTING THE HOME
If the home is the only asset to protect, a deed to children or others with a retained life estate for the client will protect both the property and the client’s Medicaid eligibility upon expiration of either 60 months from the date of the conveyance or the applicable ‘penalty period.’ As with other advanced planning strategies, because the penalty period begins only after the applicant has applied for Medicaid and is otherwise eligible, other long term care funding should be available to get past the look-back period.
Even if the need for long term care is imminent or immediate, sophisticated Medicaid planning opportunities can be employed to protect a substantial portion of your assets. Carefully working within the Medicaid transfer rules can allow individuals to provide security for themselves and a legacy to their families while ensuring that they will remain eligible to receive long term care under Medicaid when necessary.
Counseling individuals on their long term care options, including the availability of long term care insurance, is an integral part of comprehensive wealth planning.