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Medicaid Planning.

Today's Q&A on ElderCareMatters.com is about Medicaid-Funded Home Care

Question:  I am caring for my mother in my home in California.  It is a full time job.  Will the state provide any kind of assistance to pay for this elder care?

Answer:  The state of California offers a program called In-Home Supportive Services (IHSS), which is paid for by Medicaid funds (MediCal, in California).  The program, administered by each county, does provide a certain number of home care hours, based upon an assessment by a county social worker.   

The care may be provided by a family member, who is paid by IHSS, if the recipient qualifies for MediCal and the caregiver is acceptable to IHSS.   

There is a Website with links to each of the counties’ offices: http://www.cdss.ca.gov/agedblinddisabled/pg1785.htm 

If your mother does not qualify for MediCal, you can talk to a reputable employer-based home care agency about the possibility of working for that company.  The care will not be free to your mother, of course, and you would have to pass the agency’s background screening, but you would be legally employed.

Bert Cave, President
Support For Home
Sacramento, California
916-482-8484
Member of the national ElderCare Matters Alliance, California chapter

Today's Q&A on ElderCareMatters.com discusses our role in linking families across America to competent elder care experts

Every day, more and more families from across America are relying on ElderCareMatters.com to help them find competent "Elder Care Experts" who are located near them and who can help them with a wide range of elder care matters, such as legal services, financial planning, home care, senior housing, adult day care, geriatric care management, money management, insurance services, aging in place services, etc. 

Below are just a few of the many emails that ElderCareMatters.com receives daily from families across America requesting help with their elder care matters:

  • I am looking for help for my 77 year sister who lives in Louisiana and has been abandoned by her children.  Can you help me? 
  • I need to locate someone to provide home care for my wife.  We live in New Jersey.  Can you help us? 
  • We need to find senior transportation services in the Miami area.  Can you help us? 
  • My mother has been injured in an Assisted Living Home in Arizona and we need an attorney with whom to discuss this legal matter.  Can you help us? 
  • Can you help me locate elder care experts in the Jacksonville, Florida area?

If you are a competent, caring professional who helps families plan for and/or deal with elder care matters, then you should definitely become a professional member of the national Elder Care Matters Alliance and you should be listed on ElderCareMatters.com – America's #1 source for Elder Care Experts, Information & Answers about Elder Care Matters.  Professional membership is just $15/month.

To request an Application for Membership to the national ElderCare Matters Alliance, send us an email at:  info@ElderCareMatters.com

Phillip G. Sanders, MBA, MSHA, CPA
Founder & CEO, ElderCare Matters, LLC
ElderCareMatters.com

Today's Q&A on ElderCareMatters.com is about gifting and VA planning for Aid & Attendance

Question:  Would you please provide me with some information re: gifting as it relates to VA planning for Aid & Attendance.  It is my understanding that there are no penalties involved for gifting assets in order to reduce resources to approved levels.  Mom’s income is less than the medical expenses that she will pay in the assisted living facility, but her assets are a bit too high.

Answer:  At this time, gifting does not create penalties (or periods of ineligibility) for the purposes of VA pension benefits.  That being said, gifting for VA purposes may create penalties (periods of ineligibility) for the purposes of future applications for Medi-Cal for skilled nursing facilities.  Any time you do gifts for VA purposes, you should be structuring a plan that ensures that you will not be creating periods of ineligibility for future Medi-Cal applications.  Often a stroke, hip fracture, heart attack, or some other unexpected medical hospitalization and subsequent discharge to a skilled nursing facility will create a need for Medi-Cal benefits within the look-back period (currently 30 months after the gift was made, or 60 months in the case of gifts to irrevocable trusts, and 60 months for all gifts in the future when the Deficit Reduction Act is implemented with filing of final regulations with the Secretary of the State of CA).  If you have not structured the gifts to create either no period of ineligibility or very minimal period of ineligibility, then you will have shot yourself in the Medi-Cal foot when you do your VA pension gifts.  Because the gifting rules for Medi-Cal are complicated, see an experienced California attorney who knows the current rules about gifting.  Be sure to ask the attorney if they are experienced in the laws governing gifting under Medi-Cal and if they can structure a gifting program that will not create a period of ineligibility, or that will greatly minimize any gifting period of ineligibility.  Also, if you are thinking of gifting real estate, the rules are even more complicated for purposes of VA pension or Medi-Cal, and you will need an attorney with experience in both areas of law.  Any time you gift an asset that has appreciated in value since purchase, there will be tax issues to evaluation, discuss, and account for—income tax issues, capital gains step-up issues, 121 exclusions, property tax reassessment issues, so do not try to do this on your own.  Lastly, when someone needs VA pension now, it is not unlikely that they will need Medi-Cal within a matter of months or a few years, so always consider that VA gifts may create Medi-Cal penalties if not structured properly.   The area of gifts for VA and Medi-Cal is not a do-it-yourself proposition.  Get good legal advice and guidance. 

Dallas Leigh Atkins, Esq.
Law Offices of Dallas Atkins
Santa Barbara, CA  93101
805-687-8782
www.AtkinsElderCareLaw.com
Member of the national ElderCare Matters Alliance, California chapter

Question of the Day on ElderCareMatters.com: "I am an Elder Care Professional with 15 years experience in helping families with their elder care matters. Should I be listed on ElderCareMatters.com?"

Answer:  If you are a professional who helps families plan for or deal with ANY of their elder care matters, then you owe it to yourself to be listed on America's #1 online source for "Elder Care Experts"….

ElderCareMatters.com

ElderCareMatters.com is where you will find more than 2,000 competent, caring elder care experts located across America, including:

  • Elder Law Attorneys
  • Estate Planning Advisors
  • Financial Planners
  • Investment Advisors
  • Geriatric Care Managers
  • Insurance Professionals
  • Life Care Planners
  • Professional Organizers
  • Reverse Mortgage Lenders
  • Senior Move Managers
  • Senior Real Estate Professionals
  •  Tax Advisors
  • Aging in Place Professionals
  • Daily Money Managers
  • And other elder care experts with long and successful careers working with seniors and their families

This is also where you will find some of America's best:

  • Assisted Living Communities
  • Alzheimer's / Memory Care Communities
  • Continuing Care Retirement Communities
  • Home Care Agencies

Together, we provide families across America with:

  • Unparalleled professional expertise
  • Up-to-date elder care information & answers to your elder care questions
  • Competent, caring assistance with a wide range of elder care services

So if you are a competent, caring elder care professional who helps families with ANY of their elder care matters, then request today an Application for Membership in the national ElderCare Matters Alliance and get listed on ElderCareMatters.com - America's #1 source for "Elder Care Experts" plus information and answers about a wide range of elder care matters.

Phillip G. Sanders, MBA, MSHA, CPA
Founder & CEO
ElderCare Matters, LLC
ElderCareMatters.com

 

 

 

Question of the Day on ElderCareMatters.com: "Should I transfer my home to my kids to protect it if I should need nursing home care?"

Answer:  The correct answer is "It depends". It depends on your unique family, health, and financial situation. Tax consequences also have to be considered. In the event you need long-term care, there is a five year look-back period that applies to gifts (transfers of assets without consideration). Thus, if you are faced with a chronic or catastrophic illness within five years after you transfer the home to your children; such transfer may impact your ability to obtain Medicaid (Title 19) benefits. This is a very complicated area of the law and requires careful consideration.

If it makes sense to transfer the home to your children, there are several ways to structure the transfer. The first is an outright gift to your children. This is generally not advisable for tax reasons and asset protection purposes. The second is by completing the transfer but retaining a life estate. While generally superior to an outright gift, this is also not without problems. However, the retained life estate does give you some legal control over the property and also preserves some tax benefits associated with inherited property versus gifted property. The third is a transfer of your home to an irrevocable trust. This is usually the preferred method of protecting the home as it balances tax benefits with asset protection issues and also protects the home from your children's creditors or in the event they should predecease you.

As you can see, the transfer of your home is something that requires careful consideration and sound legal counsel.

Paul T. Czepiga, Esq., CELA
Czepiga Daly Dillman, LLC
Newington, CT  06111
860-597-7995
www.CtSeniorLaw.com
Member of the national ElderCare Matters Alliance, Connecticut chapter

Question of the Day on ElderCareMatters.com: “My mother just moved into an assisted living community in Illinois. We were told that once all her assets have been depleted that they will start taking her social security. They said that she would never be kicked out and that Medicaid will kick in. How do we know if Medicaid will approve her? And what if they don't? They are really pushing for us to sell her house ASAP! I'm just so scared that once they've sucked up all her assets that somehow she might have to leave. Is there a way Medicaid will pay without selling her house?”

Answer:  Wow, I would be worried also, without any assurances in writing.  Please understand that there are a number of issues in your question, all rolled into one.  First, when your mother entered the assisted living facility, she or, perhaps a family member acting on her behalf, probably signed a contract.  It is important to know what provisions are contained in the contract to see if, in fact, what you have been told verbally is in the written agreement.  Second, you said your mother moved into assisted living.  However, unless it is a continung care community or one of the few supportive living facilities in Illinois that take Medicaid, most assisted living facilities do not accept Medicaid, so more information is needed. Third, you don't mention how your mother is paying for the assisted living facility and what other assets she may have, so it's difficult to asses how soon she may need assistance paying for care.  The house presents a trickier issue.  Is there a possibility your mother intends to return to her home?  If so, the home may not be considered an available asset for purposes of qualifying for Medicaid.  The home may also be exempt if a "qualifying family member" is living in the home.  She may be allowed to transfer the home to a qualifying family member.  However, if she does not intend to return home, if there is no qualifying family member living in the home, and the home is sold, there may be planning strategies that could preserve some of the funds for her use, rather than to spend them all down before qualifying.  Bottom, line, it is not a simple question, and you would be well served by seeking the advice of an experienced elder law attorney in your area who could sort out all the issues and recommend planning strategies rather than rely on verbal assurances of the facility representative.

Teresa Nuccio, Esq.
Teresa Nuccio & Associates, P.C.
Park Ridge, Illinois  60068
847-823-9576
www.teresanuccio.com
Member of the national ElderCare Matters Alliance, Illinois chapter

Question of the Day on ElderCareMatters.com: “We are applying for Georgia Medicaid benefits for my mother who is 81 years old and has Alzheimer’s disease. Mom has very few assets but does have an IRA account that the Medicaid case worker says has to be annuitized so that monthly payments are received. Why is this necessary, who receives the monthly payments, and upon Mom’s death, will we the family – rather than the state – receive the remainder of Mom’s IRA?”

Answer:  Georgia Medicaid policy, found at Section 2332 et seq. of VOLUME II/MA, MT 39-08/10 titled “Retirement Funds”, expressly exempt retirement funds, including, Individual Retirement Accounts (IRAs) Keogh plans, and some retirement profit sharing plans are “exempt” or non-countable resources for Aged, Blind, or Disabled classes of Medicaid, including Long-Term Care (Nursing Home) Medicaid if owned by the applicant/recipient if the applicant/recipient applies for “periodic” distributions.  To be eligible for ABD Medicaid, the individual must apply for periodic benefits.  If s/he has the choice between periodic payments and a lump sum, the individual must apply for periodic payments. 

A “lump” sum is a liquidation of the retirement fund.  There’s no requirement in the Medicaid plan that payments be taken monthly; payments can be made annually.  The Medicaid policy states “[p]eriodic retirement benefits are payments made to an individual at some regular interval (e.g. monthly).  The signal, “e.g.” means “for example”.  As a result, the use of “monthly” in the policy is intended only as an example of what “periodic payments” means.  

The caseworker is directed to determine if the applicant for Nursing Home Medicaid is eligible for periodic payments from the IRA.  If not, can the individual make a lump sum withdrawal.  If the individual is eligible and receiving periodic payments, the payments are treated as “income” only; the fund is disregarded as an asset. 

A retirement fund belonging to an applicant/recipient’s spouse is disregarded, regardless as to whether periodic payments are made. 

The income is budgeted with other sources of income the applicant receives.  For example, if she has Social Security retirement and the IRA distributions, these amounts make up her income.  Once Medicaid eligibility is established, Medicaid calculates a “patient liability” or cost-share which is her contribution toward the costs of her long-term care.  Patient liability is paid over to the nursing home each month.  

The IRA does not designate the State as the beneficiary upon death; she can designate whomsoever she wishes. 

It sounds like the Medicaid caseworker communicating with this family is confusing the treatment of an “annuity” with the treatment of “retirement funds” for Nursing Home Medicaid eligibility purposes.

David Paul Pollan, Esq.
The Pollan Law Firm
Atlanta, Georgia  30309
678-510-1358
www.PollanLawFirm.com
Member of the national ElderCare Matters Alliance, Georgia chapter

Question of the Day on ElderCareMatters.com: "Would you please provide me with a list of all the 87 different elder care services that the members of the national ElderCare Matters Alliance provide on ElderCareMatters.com?"

Answer:  It is my pleasure to provide you with the following list of the 87 different elder care services that are currently provided by the members of the national ElderCare Matters Alliance on ElderCareMatters.com:

  1. Accounting Services
  2. Adult Day Care
  3. Advance Medical Directives
  4. Aging in Place Services
  5. Alzheimer's / Memory Care Communities
  6. Annuities
  7. Arbitration
  8. Asset Protection Planning
  9. Assisted Living Communities
  10. Assisted Living Referral Services
  11. Bankruptcy
  12. Bill Paying
  13. Budgeting
  14. Caregiving Education
  15. Companion Care
  16. Conservatorship
  17. Consumer Law
  18. Continuing Care Retirement Communities
  19. Cremation Services
  20. Crisis Intervention
  21. Daily Money Management
  22. Dementia Care
  23. Disability Income Insurance
  24. Disability Planning
  25. Elder Abuse Litigation Services
  26. Elder Law
  27. ElderCare Planning
  28. Estate Administration
  29. Estate Liquidation
  30. Estate Planning
  31. Family Law
  32. Financial Planning
  33. Funeral Services
  34. Geriatric Care Management
  35. Guardianship
  36. Health Insurance
  37. Hoarding Clean Up and Coaching Services
  38. Home Care
  39. Home Downsizing Services
  40. Home Health Care
  41. Home Modifications
  42. Hospice Care
  43. Independent Living Communities
  44. Investment Services
  45. Life Care Planning
  46. Life Insurance
  47. Litigation
  48. Long Term Care Insurance
  49. Long Term Care Planning
  50. Medicaid Planning
  51. Medical Services
  52. Medical Alert Systems
  53. Medical Claims Processing
  54. Medical Equipment & Supplies
  55. Medical Malpractice Litigation
  56. Medicare Consulting
  57. Medicare Supplemental Insurance
  58. Medication Management Services
  59. Moving Services
  60. Nursing Homes
  61. Personal Finance
  62. Powers of Attorney
  63. Probate
  64. Professional Organizing
  65. Public / Non-Profit Resources
  66. Real Estate Services
  67. Rehabilitation Services
  68. Residential Psychiatric Care
  69. Respite Care
  70. Retirement Planning
  71. Reverse Mortgages
  72. Securities Arbitration & Litigation Services
  73. Senior Housing
  74. Senior Move Management
  75. Senior Move Planning
  76. Senior Relocation Services
  77. Social Security Disability Services
  78. Special Needs Planning
  79. Tax Law
  80. Tax Planning
  81. Tax Preparation
  82. Transportation Services
  83. Trustee / Fiduciary Services
  84. Trusts
  85. VA Benefits
  86. Wills
  87. Wound Care

The goal of ElderCareMatters.com is to provide families across America with the help they need to plan for and deal with their elder care matters.  Let us know if there are other elder care services that you would like to have us list on ElderCareMatters.com – America's #1 source for Elder Care Experts plus information & answers about a wide range of elder care matters.

Phillip G. Sanders, MBA, MSHA, CPA
Founder & CEO, ElderCare Matters, LLC
ElderCareMatters.com
1-877-379-4500

Question of the Day on ElderCareMatters.com: "I noticed this morning that ElderCareMatters.com now has a total of 72 different elder care / senior care services that are included on this wonderful website. Can you tell me how these services are selected, and are there a maximum # of services that will be included on ElderCareMatters.com?"

Answer:  ElderCareMatters.com is an elder care resource to help families across America plan for and deal with their elder care matters.  With this goal in mind, we will continue to add more elder care-related services to ElderCareMatters.com in order to make this online elder care resource invaluable for families looking for help in planning for and/or dealing with their elder care matters.

Below are the 72 different elder care services currently listed on ElderCareMatters.com (with more services soon to be added): 

  1. Adult Day Care
  2. Advance Medical Directives
  3. Aging in Place Services
  4. Alzheimer's / Memory Care Communities
  5. Annuities
  6. Arbitration
  7. Asset Protection Planning
  8. Assisted Living Communities
  9. Assisted Living Referral Services
  10. Bankruptcy
  11. Caregiving Education
  12. Consumer Law
  13. Continuing Care Retirement Communities
  14. Crisis Intervention
  15. Daily Money Management / Bill Paying
  16. Dementia Care
  17. Disability Income Insurance
  18. Elder Abuse Litigation Services
  19. Elder Law
  20. ElderCare Planning / Long-Term Care Planning
  21. Estate Administration
  22. Estate Liquidation
  23. Estate Planning
  24. Financial Planning
  25. Funeral Services
  26. Geriatric Care Management
  27. Guardianship / Conservatorship
  28. Health Insurance
  29. Hoarding Clean Up and Coaching Services
  30. Home Care
  31. Home Downsizing Services
  32. Home Health Care
  33. Home Modifications
  34. Hospice Care
  35. Independent Living Communities
  36. Investment Services
  37. Life Care Planning
  38. Life Insurance
  39. Litigation
  40. Long-Term Care Insurance
  41. Medicaid / Disability Planning
  42. Medical / Healthcare
  43. Medical Alert Systems
  44. Medical Claims Processing
  45. Medical Equipment & Supplies
  46. Medicare Consulting
  47. Medicare Supplemental Insurance
  48. Medication Management Services
  49. Moving / Relocation Services
  50. Personal Finance / Accounting / Tax Preparation
  51. Powers of Attorney
  52. Probate
  53. Professional Organizing
  54. Public / Non-Profit Resources
  55. Real Estate Services
  56. Rehabilitation Services
  57. Residential Psychiatric Care
  58. Respite Care
  59. Retirement Planning
  60. Reverse Mortgages
  61. Securities Arbitration & Litigation Services
  62. Senior Move Management
  63. Senior Move Planning
  64. Social Security Disability Services
  65. Special Needs Planning
  66. Tax Law
  67. Tax Planning
  68. Transportation Services
  69. Trustee / Fiduciary Services
  70. Trusts
  71. VA Benefits
  72. Wills

If you need help with your family's elder care matters, you can count on ElderCareMatters.com to provide you with the experts, information & answers you need to plan for and deal with your elder care matters.

Phillip G. Sanders, MBA, MSHA, CPA
Founder & CEO of ElderCareMatters.com
1-877-379-4500