Medicaid - Lawyers With Purpose

Know What Trust & LWP-CCS Options To Choose

August 16, 2013

by Lawyers With Purpose with No Comment Estate Planning Drafting Software Medicaid SNT VA

During Day 2 of the LWP Retreat Attorneys Track – members will be learning fact patterns, designing plans for results and the CCS features & functions in a way that they can understand the science, the art and the legal technical. Dave Zumpano, Victoria Collier and resident SNT expert Kristen Lewis will lead you through an extensive legal technical day. Our goal during this time together is for you to know with certainty the LWP-CCS software confidently, competency and consciously to get the results for meeting your clients’ wants and needs.

You'll gain knowledge of all the trusts available in the CCS as an LWP Member. RLT, MIT, FIT, KIT, CGT, TAB, ENT & SNT trusts will be covered so you'll walk away knowing what they are – and how to charge clients, ultimately increasing your revenue.

What will you be missing if you don't attend? What the software is capable of:

Powers of Appointment
Formula Funding
Retirement Plan Choices
Lifetime Beneficiaries Choices
Family Trust Beneficiaries
Residual Trust Options
Trustee Formula Selection
Trust Protector & Powers
Remarriage Choices

Day 2 will methodically teach you all this and how to compensate yourself for the value you bring to your clients and referral sources. Register today, the hotel is almost SOLD OUT and sells out every year. Invest in your future today and secure your spot. The price will increase tomorrow click here to register now. We can't wait to be in the room with you!

Next up…..what’s our team doing all of Day 2?

Sheraton Syracuse University Hotel & Conference Center
Room Rate: $132.00/Single – $142.00/Double – $152.00/Triple & Quad
Group Rate Cut Off Date: 5:00 pm October 7, 2013

Is Medicaid For Millionaires?

July 25, 2013

by Lawyers With Purpose with No Comment Medicaid

There is a misunderstanding in the industry as to whether millionaires should protect their assets to qualify for Medicaid so they can pay for their long-term care should the need arise. While it makes good headlines, the question is not the determining factor of Medicaid eligibility. Obviously, those who have the means are able to provide for themselves to a much greater extent than those who are required to rely on Medicaid. An annual premium for LTC insurance is far less than one month’s nursing home care and would pay for care in the home to ensure the client never needs to reside in a health care facility apart from the family. There are however, other issues to consider.

The type of assets one owns and where they come from can have a tremendous impact on the decision to qualify for Medicaid. I recently had a client who inherited a $1 million piece of land that has been in the family for four generations. The land was non‑income producing but something the family treasures. Had my client’s parents planned properly, they could have ensured the property was not at risk to a lawsuit, nursing home or other creditors of my client. Now my client wanted to ensure that the property stayed in the family and continued to derive benefit for the family and the other members of the community who used it. Other than this piece of property, the client would have been a typical American with assets less than $300,000 and insufficient means to pay for long-term care should the need arise.

So the question becomes whether a client with non-liquid assets that do not produce income should plan to qualify for Medicaid or should they be forced to liquidate their assets to pay for their long-term care? Irrespective of your answer, the law provides for the latter and it highlights that Medicaid planning is not just about qualifying for Medicaid, but is a series of counseling issues to address each client’s situation and needs. One tradeoff: Millionaires who want to qualify for Medicaid must give up access to their assets for the rest of their lives as if they had given them away. So is it worth that loss? A good estate planning attorney can find alternative planning strategies for millionaires that get a better result than giving away their assets to qualify for Medicaid. Ultimately, however, our job as counselors is to advise the clients of their options and let them choose the path that best meets their goals and objectives.

THE THREE MOST CONFUSED MEDICAID TERMS

The three most confused terms in Medicaid planning are the look back date, the look back period and the penalty period. If you go to any beauty shop or coffee shop and ask the people what would happen if they transfer assets, the common answer will be that they are ineligible for Medicaid for sixty months. Medicaid practitioners know sixty months is merely the period of time Medicaid can look back at the financial records of a Medicaid applicant, a.k.a. the “look back period.” The period of the look back (sixty months) has no impact on qualifications. The look back period begins on the look back date. The look back date is the date a Medicaid applicant resides in a care facility and applies for benefits. It is critical that a practitioner understands this distinction. If a client resides in a nursing home and you apply for medical before continuing the client’s eligibility, you can disqualify a client from medical and create a penalty period that is far greater than sixty months. This occurs when there is a large uncompensated transfer within the look back period.

Once Medicaid looks back at the financial records from the look back period it examines whether any uncompensated transfers occurred. An uncompensated transfer is the transfer of assets made by an applicant to someone else with no compensation in return. Gifts are typically the most common uncompensated transfer. If there is an uncompensated transfer, Medicaid will deem the applicant ineligible for a certain number of months based upon two factors: the amount of money transferred and the monthly divisor in the region where the applicant lives. Each state must publish, at least annually, the average cost of one month’s private pay nursing home cost for the region. If the average monthly private cost of a nursing home was $5,000 and the uncompensated transfer was $100,000, the applicable penalty for the transfer is 20 months. So the 60‑month look back period has nothing to do with how long an applicant may be ineligible, it’s merely a period of time Medicaid can look back at financial records to determine if an uncompensated transfer occurred, and if so, then calculate the penalty period based on the amount of the uncompensated transfer and the regional divisor.

It’s that simple.

If you are at all interested in joining Lawyers With Purpose and would like to know what we have to offer your estate planning or elder law practice, join us in Phoenix, AZ, September 12-13th for our Asset Protection, Medicaid and VA Summit September 12-13 in Phoenix, AZ. We are filling up seats quickly and only have limited space. Register today!

Estate Planning Conversion to Asset Protection Planning

June 25, 2013

by Lawyers With Purpose with No Comment Medicaid VA

I met with Roger 8 days ago. He is 89 years old, a veteran of WWII, and married to Sylvia. Roger has end stage lung cancer and a prognosis of less than two months to live. He is receiving in-home hospice. His wife, Sylvia, is 83 years old and has early to mid-stage Alzheimer’s Disease. She also lives at home. They each have 24/7 home health care, which costs approximately $13,000 per month. When Roger dies, Sylvia’s home health care expense will be reduced to $9,000 per month, but she will still have the expense of maintaining the home and other daily living expenses.

In 2001, Roger and Sylvia, engaged in sophisticated estate planning to minimize estate taxes and to take advantage of the marital deduction rules. Their plan consisted of a qualified personal residence trust (QPRT) and an irrevocable life insurance trust (ILIT), with basic wills and powers of attorney. Due to the rise in the estate tax exemption, these sophisticated tools are no longer necessary because their taxable estate is under the $10,000,000+ limit for a married couple, and even under the $5,000,000+ limit for a single person. However, they do have assets of about $600,000 that are not in either of the trusts, and which are not protected from long-term care costs.

Since Roger is a wartime veteran, his widowed spouse, which will be Sylvia, may be eligible for a widow’s death pension, commonly referred to as Aid and Attendance. But, their assets must be below certain limits. Moreover, should Sylvia’s physical needs exceed that which can be provided at home and she later moves to a nursing home, she may benefit from qualifying for Medicaid.

When we know with reasonable certainty that one spouse may die sooner than the other, and the death is relatively imminent, we have the perfect situation for asset protection planning for the survivor. In Roger and Sylvia’s situation, we want to protect the extra $600,000 upon Roger’s death so that Sylvia can immediately qualify for VA benefits or Medicaid benefits without unnecessary spend down or penalty from making lifetime gifts.

To do so, we must put all of the assets into Roger’s name. Then, Roger can create living trusts that will pass the property upon his death into special needs trusts for Sylvia, and also trusts for his child and grandchildren. Transfers upon death do not trigger a look-back penalty for Medicaid. And, assets maintained in a third party special needs trust are protected as well.

We do not intend for Roger to gain access to any government assistance programs while he is alive. Instead, the benefit of the planning is for his wife, Sylvia. The VA widow’s pension will pay Sylvia up to $1,113 per month to offset the cost of her home health care. That will allow the other assets to stretch out further. Then, if Sylvia moves to a nursing home, not only can she qualify for Medicaid, but the assets that were preserved can be used to pay the differential in price for a private room, as well as continue to pay for home health care at the nursing home so that Sylvia does not have to wait 30 minutes to answer a call button, or be sitting in front of a tray of food she no longer knows how to eat without assistance.

Estate planning, asset protection planning, and long-term care planning are all distinct planning strategies, each used for a specific purpose. As our lives and circumstances change, often our planning needs to change too. Lawyers with Purpose has the training, software, systems, and support necessary to assist lawyers who have clients that are healthy and then progress through the need for assistance from others. By using these systems, I was able to convert Roger’s outdated estate plan to an asset protection plan in seven days, fully executed. When a person is receiving hospice care, you don’t know how much time you have to execute a plan. Therefore, you must have the systems in place to act swiftly.

Victoria L. Collier, Certified Elder Law Attorney, Fellow of the National Academy of Elder Law Attorneys, Co-Founder, Lawyers with Purpose, LLC, Veteran of the U.S.A.F. and author of 47 Secret Veterans’ Benefits for Seniors…Benefits You Have Earned but Don’t Know About.

Boom Town Talk Radio with Victoria Collier & Retired NFL Player Jamie Dukes

May 22, 2013

by Lawyers With Purpose with No Comment Medicaid VA

On Saturday I had the privilege of being interviewed on Boom Town Talk, hosted by retired NFL Player, Jamie Dukes, Lee Lambert, and Melinda Davis.

BTT’s purpose is to provide relevant information to Seniors (the 50 plus population) as part of the Put Up Your Dukes Foundation’s health and wellness strategy. My portion of the interview discussing the relevance of Elder Care Attorneys, begins at 7:15 minutes into the interview and ends at 16:50. As part of the interview, we discuss when a person should begin planning for long-term care and estate planning, plus the top three things to remember when planning.

Click the link below now and play to learn.

02-boomtown 5-18-13

We’re Providing 25+ Hours of Education This Week in Atlanta!

April 30, 2013

by Lawyers With Purpose with No Comment Medicaid VA

Technology is absolutely fascinating. As I typed this I was on a Delta flight loaded with WIFI and headed to Atlanta for an action filled transformative week in the Estate Planning and Elder Law World. Tuesday and Wednesday our very own National Experts, Dave Zumpano and Victoria Collier will be leading a Two Day Summit on Asset Protection, Medicaid and VA planning (to a SOLD OUT crowd so if you do not have a reserved seat but would like a recorded copy of the event, email motts@lawyerswithpurpose.com ). We are honored to have the opportunity to provide solutions for Asset Protection, Medicaid, and VA Benefits to some of the nation’s top estate planning & elder law attorneys.

After over 25+ hours of phenomenal education, software & marketing, we'll be heading on over to the Annual NAELA Conference where Lawyers with Purpose will be one of the Featured Exhibitors of the 2013 Spring Event, celebrating their 25 year Anniversary!

Make certain you stop by The Lawyers with Purpose booth to register to WIN one of two $100 VISA Gift cards. We look forward to seeing many familiar friends and meeting many new as well.

Molly L. Hall, Co-Founder, Lawyers with Purpose, LLC, and author of Don’t Be a Yes Chick: How to Stop Babysitting Your Boss, Transform Your Job and Work with a Dream Team Without Losing Your Sanity or Your Spirit in the Process.

What To Do With “Excess” SSI Benefits

March 6, 2013

by Lawyers With Purpose with No Comment Medicaid SNT

Every once in awhile, a client who receives monthly Supplemental Security Income (“SSI”) cash benefits (in 2013, a maximum of $710/month) may find that he cannot spend the full amount on his needs (and wants). This failure to fully expend the SSI benefits may, in due time, result in the client accumulating more than $2,000 in his bank account, thus jeopardizing his ongoing eligibility for SSI and, in a majority of states, Medicaid as well.

We all know that SSI benefits are not assignable in advance of receipt to a first-party Special Needs Trust. See POMS Section GN 02410.001 and Sections SI 01120.200G.1.c and 01120.201J.1.c. However, is it permissible for an SSI recipient or his Representative Payee to transfer unused SSI benefits to a first-party SNT? The answer is “yes.”

POMS Section GN 00602.075 (“Transfer of Benefits to a Trust”) provides that a Representative Payee (or, presumably, the benefits recipient himself) is permitted to transfer Title XVI benefits (i.e. SSI) to establish and fund a trust, or to fund an existing trust, if the following prerequisites are met:

(i) establishing the trust is in the beneficiary’s best interest;
(ii) the trust is established exclusively for the use and benefit of the beneficiary to meet the beneficiary’s current and reasonably foreseeable needs; and
(iii) the SSI recipient is the sole trust beneficiary during his lifetime. See POMS Section GN 00602.075C.1. The POMS then incorporate by reference the familiar SNT requirements set forth in POMS Sections SI 01120.201, 01120.202 and 01120.203 for “guidance on trusts and how trusts established with an individual’s assets affect SSI eligibility.” See POMS GN 00602.075C.4.

POMS Section GN 00602.075D.3 then enumerates examples of trust provisions that “meet use of benefits policies,” including expenditures for “food, clothing, housing, medical care, recreation and education,” as well as reasonable compensation for trustee and other professional services. Also permissible are trust provisions which limit disbursements to “the beneficiary’s current maintenance needs that are not covered by public assistance.”

An example of impermissible trust provisions include prohibitions on disbursements for “the beneficiary’s current needs for food, clothing, housing and medical care,” while allowing disbursements only “to enhance the quality of life for the trust beneficiary in the broadest sense, including but not limited to vacation travel and transportation expenses.” Caveat: many early versions of first-party SNTs utilize just this type of impermissibly limiting language!

Thus, a first-party SNT that otherwise complies with the relevant provisions of POMS Sections SI 01120.201, 01120.202 and 01120.203 would be a permissible receptacle of excess SSI benefits paid to the (recipient or his Representative Payee) but not currently expended.

Kristen Lewis

Four Basic Principles – Medicaid Made Simple

February 28, 2013

by Lawyers With Purpose with No Comment Asset Protection Medicaid

Many people are confounded by the complexity of Medicaid. The truth is, Medicaid is quite simple. It’s a set of rules, exceptions and exceptions to the exceptions, but all are founded on four basic principles. First, understanding the rules, second, determining if the client meets the eligibility requirements, or if there’s an excess amount to “spend down”, third, determining the spend down method and fourth, implementing the funding plan.

Understanding the rules really comes down to these basic concepts. The difference between the institutional spouse and the community spouse, the income allowances (minimum monthly maintenance needs allowance a/k/a MMMNA), the community spouse resource allowance (CSRA), the look-back period, the monthly divisor, spend down, the penalty period, compensated transfers, uncompensated transfers and all the allowances and exemptions. The exemptions include protections of your principle residence, for a spouse or disabled or minor child, an automobile, a prepaid funeral and life insurance up to $1,500. All Medicaid determinations are based on these concepts. Once you have a clear understanding of the application of the rules regarding these key terms it will determine whether an individual is Medicaid eligible.

The second principle determining whether the client meets qualifying conditions (That is, are they citizens and a resident of the state?), are broken down into three parts; legal, health and financial. Do they need care that is covered by Medicaid, and do they meet the income and asset limitations? If the client does not meet the legal or health criteria they will not qualify. If they exceed the financial limitation, they must “spend down” their income or assets to the qualifying levels.

The third principle, the method of spending down can have two results: One leads to a penalty and ineligibility for Medicaid (“uncompensated transfer”) and the other type of spend down does not (“compensated transfer”). Qualified (“compensated”) spend downs will not penalize the applicant as they are deemed to be exempted transfers under the law. Such an example of a qualified spend down would be the Medicaid applicant making an improvement on their principle residence, or purchasing a car, a prepaid funeral or paying off debts. Uncompensated transfers are when an individual gives assets away and receives nothing, or less than what was given, in return. In these circumstances, the individual will be penalized and made ineligible for Medicaid depending upon the uncompensated amount given away and the monthly divisor in the community in which they live. What’s critically important to understand is a penalty assessed for an uncompensated transfer can far exceed 60 months and doing an uncompensated transfer does not disqualify your for 60 months. Other methodologies to spend down include the use of annuities, Special Needs Trust, Personal Services Contracts, trusts “solely for the benefit of your spouse, or disabled or minor child, or promissory notes. A combination of these spend down methods may be utilized in qualifying a client.

Finally, once you have applied the rules, utilized the exemptions and completed your spend down strategy, none of it is effective without a funding plan. Unlike traditional estate planning where funding could get “cleaned up” after death by a pour over will, in Medicaid planning, none of the penalties or planning is effective until the funding has been completed. It is absolutely critical that you have a complete funding strategy in place once you create the plan to ensure the plan you create is actually going to work.

Did you even think Medicaid could be explained in less than 350 words? You just read it and it’s not as complicated when you have a structure, such as outlined here, to apply to each case. I will be rolling out such a structure with National Veterans Benefits Expert, Victoria Collier, on April 30th and May 1st in Atlanta, Georgia. For information click here. Hope to see you there!

Dave Zumpano