Medicaid Planning - How to Pay for the Nursing Home Without Going Broke

Protecting Your Parents Assets From Nursing Home CostsNursing home care costs have been rising over time, with many older Americans who require long-term care unable to afford it.With proper planning, seniors may be able to rely on Medicaid to pay for this care and still retain some of their assets by exploring several different strategies.The aging U.S. population means that more people will likely need nursing home care in the coming decades. Meanwhile, the cost of nursing home care is increasing and expected to keep increasing.With the exorbitant cost of nursing home care, many families worry about depleting their loved ones life savings to pay for the care they need. Private health insurance does not cover nursing home care, and while long-term care insurance is available to cover nursing home costs, these plans are also expensive and may come up short for long-term stays.This leaves millions of Americans reliant on Medicaid to pay for nursing home care a far from perfect solution that usually involves spending down assets to qualify. With proactive Medicaid planning, though, it is possible for someone to qualify for Medicaid and still retain some of their assets. The sooner you start planning, the more options youll have for protecting your parents assets from nursing home costs. Odds of Needing Long-Term Care Are HighThe lifetime likelihood of needing nursing home care is relatively high. About 70 percent of people who turn 65 today will eventually need some type of long-term care, including nursing home care.About 1.3 million Americans aged 65 and older currently live in nursing homes, and about 40 percent of todays 65-year-olds will spend some time in a nursing home before the end of their lives.Women are more likely than men to need long-term care, and the older a person gets, the more likely they are to need it. At the same time, there has been a growing trend of younger adults (those under the age of 65) living in nursing homes, in part due to Medicaid eligibility expansion under the Affordable Care Act. Research shows that this group increased from 10.6 percent of total nursing home residents in 2000 to 16.2 percent in 2017.Medicaid expansion has led to more people of all ages qualifying for the joint federal and state health insurance program. Intended as the payer of last resort when it comes to long-term care, Medicaid has become the primary nursing home insurance for millions of Americans due to the absence of any other public program covering long-term care.In 2020, around 6 million Medicaid enrollees used the program to pay for long-term support and services. Around one in five enrollees received institutional care, such as care provided at a nursing facility.After age 65, more than a quarter of adults receive at least 90 days of nursing home care. Thirteen percent of them receive long-term Medicaid-financed nursing home care.Medicaid typically pays for 100 percent of nursing home costs and may be the only insurance option available for long-term stays. Long-term care insurance can be purchased, but most policies have limits on the maximum daily or monthly benefit amount and the total lifetime benefit, as well as terms and health requirements that may exclude coverage.A nursing home stay isnt necessarily permanent. About 15 percent to 20 percent of admissions are for short-term rehabilitation. Among current residents, the average stay is one year and four months. More than half of residents stay for at least 100 days, while 15 percent of older adults spend over two years in a nursing home.With nursing home costs running $250 to $300 per day in some states, costs can add up quickly. The average nursing home stay of little over a year, or about 485 days, could end up costing upwards of $150,000.Extrapolate these costs over multiple years, and they are unsustainable for many families. Medicaid Planning StrategiesWhether a nursing home stay lasts months, years, or is permanent, you may have crunched the numbers and determined that Medicaid is the only feasible payment option for a parents nursing home care.This is a good news, bad news scenario. The good news is that its possible for somebody who doesnt currently meet Medicaids income and asset limits to spend down their excess assets to meet limits. The bad news is that these limits are generally only $2,000, which requires significant planning, since the average net worth of Americans is more than $1 million, including nearly $1.8 million for those 65 to 74.Another upside is that not all a persons assets count against the limit. A home, for example, is typically exempt. Someone can also own one car without exceeding Medicaids asset limits.Many Medicaid spend down strategies take advantage of workarounds that allow nonexempt assets to be converted to exempt assets, thereby excluding them from Medicaid calculations. But these strategies often involve navigating a tricky five-year lookback period where past asset transfers are scrutinized to ensure applicants dont give away assets to qualify for Medicaid.Keeping these considerations in mind, there are financial planning strategies that can help to protect a parents assets from nursing home costs and a Medicaid spend down. Medicaid-Compliant Annuities (MCAs)MCAs, a type of single premium immediate annuity, allow countable assets (like cash or investments) to be converted into a stream of income that doesnt count toward the Medicaid asset limit. The payout structure must be based on life expectancy, and once purchased, the annuity cannot be cashed out or changed; funds in the annuity are no longer accessible as assets.Annuity income may affect your parents eligibility for other needs-based government programs, such as Supplemental Security Income (SSI). In addition, the state Medicaid agency must be the primary beneficiary in case of the annuitants death during the annuity period. Medicaid Asset Protection Trusts (MAPTs)Medicaid-compliant trusts, like MAPTs, hold assets for a set period, after which they transfer to beneficiaries (usually children or other family members).Assets in the MAPT are no longer considered part of your parents estate for Medicaid purposes. They are legally owned by the trust, not your parents, although they may be able to benefit from these assets, such as remaining in a home transferred to a MAPT.Creating a MAPT triggers a penalty period of Medicaid ineligibility under the lookback period thats based on the value of assets transferred. A MAPT is therefore most effective when implemented well in advance of potential Medicaid need, often in conjunction with a parents estate plan. Promissory NotesA promissory note is a legal agreement that allows your parents to lend money to someone (e.g., a family member) who agrees to repay the money with interest over time. This converts a lump-sum asset into a stream of income.Not all states recognize promissory notes for Medicaid planning. In states that do allow them, they may be subject to scrutiny by state Medicaid agencies. The note must clearly outline the repayment terms and the interest rate must be at or above the applicable federal rate (the minimum interest rate the IRS allows for private loans).Interest income from the loan may be taxed at a lower rate, and the terms can be customized to meet individual needs. For the Medicaid applicant, however, the effectiveness of a promissory note is largely dependent on the borrowers ability and willingness to repay the loan. Life EstatesA life estate lets your parents transfer ownership of their home to a child or other family member while retaining the right to live there for the rest of their lives. It removes the homes value from their countable assets for Medicaid purposes and may protect the family home from Medicaid estate recovery, a program that empowers states to recoup Medicaid expenses from the deceased beneficiarys estate.Medicaids lookback policy applies to life estates, so the transfer must be done well in advance of needing care. Your parents may also lose some control over the property, and there could be tax implications. Other Spend Down StrategiesA spend down strategy might additionally include a parent spending on needs or wants that can both enhance their quality of life and help them qualify for Medicaid.Paying off debts, making necessary home repairs, purchasing a new car, prepaying funeral expenses, or taking a family vacation are ways to spend down assets and derive an instant benefit.Gifting assets to loved ones outside of the lookback period can reduce countable assets and fit into a gifting while living strategy, but annual and lifetime gift tax exemptions apply.If only one spouse needs nursing home care, Medicaid allows the other spouse (the community spouse) to retain a certain amount of income and assets.Because state Medicaid laws and individual nursing home care needs vary, there is no one-size-fits-all strategy for protecting a parents assets from nursing home costs and a Medicaid spend down. To develop a personalized plan that avoids penalties or disqualification from Medicaid in your state and also maximizes asset protection, consult with Ashley Day.  Phone: 251-277-3377.

Each fall, the Centers for Medicare & Medicaid Services (CMS) renews the federal guidelines that seek to protect individuals whose spouses are applying for or receiving Medicaid long-term care benefits.These protections, known as the Spousal Impoverishment Standards, help to support the financial well-being of seniors who continue residing at home while their spouse on Medicaid lives in a long-term care facility, such as a nursing home.Qualifying for Medicaid Long-Term Care BenefitsLong-term care is prohibitively expensive for many, so a large share of adults aged 65 and older rely on Medicaid to help cover the costs.To qualify for Medicaid long-term care benefits, however, one must generally have very limited resources. In most states, the asset limit is set at $2,000. (Certain assets, such as personal belongings and the applicants primary residence, do not count toward this limit.) The applicants income typically goes to the nursing home as well, with some exceptions.So, what happens if a person who qualifies for Medicaid long-term care is married? How can their healthy spouse afford to remain on their own at home? This is where the Spousal Impoverishment guidelines help.2024 Spousal Impoverishment FiguresCommunity Spouse Resource Allowance (CSRA)A spouse who continues living at home while their partner receives long-term care coverage through Medicaid can keep up to $154,140 in assets starting in 2024.The healthy spouse, or so-called community spouse then has a minimum amount of assets to live on without rendering their Medicaid spouse ineligible for benefits. This special protection is known as the Community Spouse Resource Allowance (CSRA). The maximum CSRA generally rises each year; in 2023, it was $148,630.Meanwhile, according to federal law, no state can set the minimum CSRA below $30,828 as of 2024.Monthly Maintenance Needs Allowance (MMNA)In addition to CSRA, the federal government offers another level of protection for the community spouse: the Monthly Maintenance Needs Allowance (MMNA).The MMNA ensures that the healthy spouse who continues to live in the couples home maintains a certain amount of monthly income while their partner receives their Medicaid long-term care coverage. (Learn more about the ins and outs of MMNA.)In 2024, the maximum MMNA will be $3,853.50 (up from $3,715.50 in 2023). Again, this is the most in monthly income that the community spouse can keep while their spouse lives in a long-term care institution. If the healthy spouse does not make enough income to live on, this allowance comes from the income of the spouse on Medicaid.Note that the minimum MMNA for 2024 can vary depending on your state. Alaska and Hawaii typically have slightly higher minimums. The federal government updates the minimum MMNA each July.A Note on Income Cap StatesCertain states have in place a Medicaid income cap. If you reside in one of these income cap states, you will not qualify for Medicaid if your income equals more than $2,829 (in 2024) unless you have a certain type of trust in place. This trust, known to many as a Miller Trust, must hold any income you receive that is above that cap.As of 2023, the 23 income cap states were Alabama, Alaska, Arizona, Arkansas, Colorado, Delaware, Florida, Georgia, Idaho, Iowa, Kentucky, Louisiana, Mississippi, Nevada, New Mexico, New Jersey, Oklahoma, Oregon, South Carolina, South Dakota, Tennessee, Texas, and Wyoming.Home Equity LimitsAs mentioned above, Medicaid does not consider the primary home of an applicant as a countable asset, unless the applicants equity interest in their home is above a certain amount.Your home equity equals your homes value minus the sum of any loans you owe on the home. In 2024, the home equity limit is set to $713,000. (Some states choose to raise this limit to $1,071,000.)Contact Entrusted Legacy Law at 412-547-9855 to schedule a complimentary 15-Minute call.

As your loved one ages, you may grapple with the challenging task of finding long-term care. It's a difficult and stressful time for all involved, and navigating the complexities of Medicaid benefits can add confusion and frustration to an already overwhelming situation.That's where a Florida Long Term Care Financing Solutions Company such as Platinum Benefit Services can help. With over 26 years of experience helping over 14,000 clients obtain Medicaid benefits, their team of professionals can help you understand and navigate the intricacies of Medicaid benefits for long-term care.Understanding the Differences in Medicaid Benefits:It's important to note that the Medicaid benefits for home health care or assisted living are different from the Medicaid benefits for a loved one in a skilled nursing facility. Medicaid will cover up to 40 hours of in-home care per week for the Medicaid recipient. If  the patient is either in an assisted living facility (ALF) or wishes to transition to one. Medicaid will pay part of the monthly assisted living bill, and the patient is responsible for paying the remainder.Not all ALFs are contracted with Medicaid, but for the ones that are, each Medicaid-contracted facility has a separate agreement for the amount that Medicaid will cover. This can make it difficult to understand exactly how much you'll be responsible for paying. A Florida long term care financing solutions company can help you navigate these complexities and understand exactly what you'll be responsible for paying.On the other hand, when a patient is in a skilled nursing facility (SNF), the patient must pay the facility all their monthly income minus a personal needs allowance (PNA) of $130, as well as being able to deduct any monthly premiums for health insurance from the patient's responsibility. Medicaid will pay the remainder of the bill owed to the SNF. Navigating Complex Scenarios:There are also more complex scenarios that a Florida long term care financing solutions company can help you with. For example, having a community spouse to which you can divert income can reduce or eliminate the amount you owe to the skilled nursing facility. These nuances can be difficult to understand and navigate, which is why it's so important to seek the help of a professional.Seek Help from a Florida Long-Term Care Financing Solutions Company:When you're already under immense stress and pressure to help your loved one that is needing care, the complexities of Medicaid benefits can be overwhelming. That's why it's important to seek the help of a Florida long term care financing solutions company such as Platinum Benefit Services. Their team of professionals can help you understand the nuances of Medicaid benefits, navigate complex scenarios, and make informed decisions about your loved one's long-term care.Conclusion:Platinum Benefit Services is a trusted Florida long term care financing solutions company with extensive experience helping clients obtain long-term care Medicaid benefits. If you or a loved one need assistance navigating the complexities of Medicaid, contact us for expert guidance and support.