Bigstock-Two-Women-Pondering-Over-Docum-44621401

Medicaid Planning: Who Should Consider It, Part 2

February 18, 2014

by David Zumpano with No Comment Medicaid

As you saw in my prior post titled “Medicaid Planning: Who Should Consider It,” it can be a shock to clients when they realize how much it can cost to provide for their care. So what did this piece inspire you to think?

The purpose of the analysis in the previous post was to identify whether people have properly planned for the long-term care they may incur. Our job as counselors is to advise people on the impact of their decisions. Fact by fact case analysis.

The conclusion was that, if you have anything short of $3.5 million, you aren't going to be able to pay for that care; the payment is going to come out of your assets. Most people want to protect their assets, and they hire us to help them with that. So the question is, are you having this conversation with people? Finding our what they want? If not, you need to.

Medicaid has a set of rules that determines whether someone qualifies. It’s the client's choice, not ours to decide for them. Our job to advise them and let them decide. We help them identify the long-term impact their decisions would have, and whether they will be able to protect their legacy.

Long-term care insurance is another option, and it can be a great solution. But it doesn't mean you have to give up on qualifying for Medicaid – find the “and” by figuring out how the client can qualify for both. If you've helped your client meet the legal guidelines for that, you've done something that will make a lasting impact.

David J. Zumpano, Esq, CPA, Co-founder Lawyers With Purpose, Founder of MPS, Founder and Senior Partner of Estate Planning Law Center

Medicaid Planning: Who Should Consider It.

February 11, 2014

by David Zumpano with One Comment Medicaid

The first question you'll run into in Medicaid planning is, who needs it? Attorneys will bump up against a variety of scenarios, from those clearly in need to others who are convinced they're "all set." So which ones truly need your help?

The safe answer is, more people need this than you might think. Let's run through a typical case, and you'll see what we mean.

Most of our Medicaid clients here have income of around $2,500 and live on $2,000, so we'll use those numbers for our typical case. The difference between those two means there's $500 in disposable income every month.

Now let's see how far that gets us. In this area, typical long-term care costs are about $6,000. Subtract the $500 in disposable income from that and you've got a shortfall of $5,500 per month in paying for the client's care. That's $66,000 per year, and that will have to come from the client's principal.

So the next question is, how much investment do we need to cover that shortfall? To figure that out, choose an expected rate of return. Let's say 5%; if we went any lower, you might freak out. You'll see why in a minute.

The $66,000 divided by your .05 rate of return tells you how much money you would need in investable assets to generate the funds to cover the shortfall. In this case, that amount would be $1.32 million. If you can only manage a 3% return instead of 5%, which is more likely, then you would need $2.2 million in investable assets. So, as you can see, someone who thinks he is set because he has $1 million is in for a shock, because he's not even close to covering his costs of care.

For the attorney, this is a powerful way to explain who should be scheduling a Medicaid conversation with you. Because a client who does not have the total net worth to pay his own way has to understand that it’s going to be eating up his principal, and it becomes a planning issue for you as the attorney to be able to solve. And that’s really a powerful tool to help you identify whom in your community this would apply to.

A word of warning: You're probably better off presenting the above math to a referral source, not directly to a client. If you drop this on your clients, our experience is that it can seem too technical, and you really want to keep it simple for them. Do the math for your client, then just ask the big question: "Did you know that you don't have sufficient assets to pay your way if needed?"

Factoring in the numbers that are relevant to your region and your practice. If in you area, for instance, the cost of nursing homes is more like $9,000 per month, the client would need $3.4 million sitting in a brokerage account generating 3% to cover that. So being a multimillionaire might be just enough.

David J. Zumpano, Esq, CPA, Co-founder Lawyers With Purpose, Founder of MPS, Founder and Senior Partner of Estate Planning Law Center.

Medicaid Terms of Art Glossary

January 22, 2014

by David Zumpano with No Comment Asset Protection Medicaid

Dave Zumpano used the below Terms of Art Glossary for the Your Legal Hour series on Medicaid Planning: Who Should Consider It. We've put them in a user friendly format for you to print and use as needed!

CS: Community Spouse: The Spouse of an institutionalized individual and does not reside in an institution.

IS: Institutionalized Spouse: The spouse that resides in an institution and is receiving chronic care (not custodial).

MA: Medicaid Applicant: Individual applying for Medicaid.

MR: Medicaid Recipient: Individual qualified for and who is receiving Medicaid benefits.

INDIVIDUAL RESOURCE ALLOWANCE: The amount of resources (assets) the Medicaid Applicant can retain and still be eligible for Medicaid benefits.

CSRA: Community Spouse Resource Allowance: Minimum and Maximum amount of resources (assets) the community spouse is entitled to retain and have the institutionalized spouse be eligible for Medicaid benefits.

MMMNA: Minimum Monthly Maintenance Needs Allowance: (“Triple M N A”): The minimum amount of income per month a “community spouse” is entitled to retain prior to being required to contribute toward the “institutional spouse’s” cost of care.

SNAP SHOT DATE: The date used to calculate the CSRA. The first day the Medicaid applicant is admitted to a health care facility for at least 30 continuous days and then applies for Medicaid benefits.

LOOK-BACK DATE: The first day of the month in which a MA resides in a health-care facility and applies for Medicaid benefits. (Can apply for benefits retroactively 3 months.)

LOOK-BACK PERIOD: The period of time Medicaid will look at all financial records of a MA. The Look Back Period begins on the Look Back Date.

SPEND DOWN: The method or process of transferring (or spending) MA’s income or assets to get applicant and/or community spouse to Medicaid qualifying levels.

COMPENSATED TRANSFER: A transfer or spending of MA or CS’s income or assets and MA or CS receives something of equal value in return.

UNCOMPENSATED TRANSFER: A transfer or spending of MA or CS income or assets and MA receives no value, or less than the value transferred in return.

MONTHLY DIVISOR: The average cost of one month of private pay nursing home costs in your region. (Must be revised annually by the state)

PENALTY PERIOD: The number of months an MA is ineligible for Medicaid Benefits because of an uncompensated transfer.