elder law

[q-school]

how do we feel about elder law?

my mom had a meeting with an elder lawyer and basically what she remembers is that there are strategic options to avoid nursing homes taking your assets if you have to go to a nursing home.  I'm digesting what she is saying but basically it sounds like there is a field devoted to trying to take people who have resources and not use them to pay for services that are then paid by medicaid?  it seems like then they basically pre-death inherit the assets to the kids, leaving creditors in the lurch.  this is through mom, who's half deaf and half crazy, so I could be misunderstanding

is that kosher?  is that screwing over everyone around you?  just being smart?

mom is very motivated to leave whatever she has to us, so if it's legal, she's probably going to do it.   I'm not sure how I feel about it.

[CordMcNally]

I'd speak to the attorney to get the information from him. I suspect it's very similar to what we tell patients and what patients tell other physicians. Usually, it's no where close to what was originally said.

I believe they do a 5 year look back so anything done over 5 years prior to them looking is off the table. I have several feelings on it but I haven't thought about it a whole lot.

[Antares]

I think it’s kosher if it’s done right. I thought any draw down wasn’t ok unless it occurred five years or more earlier. Usually they have to spend down using the money for care, and then become Medicaid eligible.

However, don’t blame the elder lawyers. They are just helping their clients within the law.

[VagabondMD]

I think that there is much more to the field of "elder law" than shielding assets from the government to allow people to get on Medicaid.

I have a good friend who specializes in this area. I will ask her.

[ENT Doc]

Listen to Jimmy. He may not be the straightest shooter, but he ain't wrong.

Before my father's uncle died a few years ago he was in one of those places.  The first question they asked was about his assets, specifically his home. So yes, Medicaid pays a little that runs out soon and then they start diving into your assets. Some of these places maybe owned by REITs so you know the underlying motivations aren't pure. I don't know much more than that, but it's worth hearing out the situation and exploring it further.

[Kamban]

q-school wrote:

it seems like then they basically pre-death inherit the assets to the kids, leaving creditors in the lurch. this is through mom, who’s half deaf and half crazy, so I could be misunderstanding is that kosher? is that screwing over everyone around you? just being smart?

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You may be able to screw that physician and not pay his bills but it is unlikely that you can avoid paying Medicaid unless you have given away your assets > 5 years earlier.

And therein lies the crunch. Many parents do not want to give up their home, retirement savings and other cash investments earlier than 5 years ( who can predict their death just above the 5 year frame) and hope that the children take care of them till they go into that nursing home. The more likely scenario for many is that the children will spend away the money and not take care of them and kick them out of the house. So the parents hang on to the money till the last moment, which may be too late under the current regulations.

For the record, I do not think surreptitious transfer is kosher and if we defraud the government this way, what moral standing do we have to complain about them when they cut our reimbursements.

[spiritrider]

They are probably referring to what are known as a Medicaid Asset Protection Trust (MAPT) and other AKAs. It is an irrevocable trust with very specific provisions that meet Medicaid requirements.

Mom needs to be comfortable with total and irrevocable loss of control and totally trusts the trustee(s).

As pointed out there is a five (5) year look back period from Medicaid application.

My view on this, Backdoor Roths, ACA subsidies, etc... is simple. If congress didn't want to allow it, they can change the law. Otherwise, it is your patriotic duty to take legitimate advantage of any government benefits and/or tax advantages. If you commit fraud or tax evasion they should throw away the key.

 

[Craigy]

IMO morality has no part in this equation but these strategies carry a lot of real risk.  Risk that you don't time it right.  Risk that even if you do time it right, the law changes the timeline on you.  Risk of other unforeseen changes in the law that impact the strategy or cause it to collapse altogether.  Risk that your kids squander the money you give them.  Reality that you've turned over control of your assets to your kids and there's not much you can do.  Reality that your options become much more limited when your only option is medicaid.

Again, you can't count on the 5-year lookback being just five years.  Historically the lookback period has been increased time and time again, and has served to capture folks who thought they were safe under a previously-set lookpack period.

 

[q-school]

spiritrider wrote:

They are probably referring to what are known as a Medicaid Asset Protection Trust (MAPT) and other AKAs. It is an irrevocable trust with very specific provisions that meet Medicaid requirements.

Mom needs to be comfortable with total and irrevocable loss of control and totally trusts the trustee(s).

As pointed out there is a five (5) year look back period from Medicaid application.

My view on this, Backdoor Roths, ACA subsidies, etc… is simple. If congress didn’t want to allow it, they can change the law. Otherwise, it is your patriotic duty to take legitimate advantage of any government benefits and/or tax advantages. If you commit fraud or tax evasion they should throw away the key.

 

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man I loves me some spiritrider.

thanks for your thoughts.

 

[jacoavlu]

I have seen this happen in the midwest where farmers often "live poor, die rich" as estates may be largely comprised of farmland that has significantly appreciated in value, someone ends up in a nursing home without insurance or liquid assets, and a sale of the family farm is forced.

[Dr. Mom]

If my parents need a nursing home, I do not plan to limit them to Medicaid to pay for services.  Their money should be spent to make them as comfortable as possible and keep them in their home as long as possible.  Any inheritance will be split four ways between my siblings and myself anyway.  Since two of my siblings are less than financially responsible, I will be trustee for them.  My life gets much easier the more my parents spend/gift while they are alive.  We talk about this stuff frequently.  They know how I feel which is why they moved near me to make it easier to care for them when/if the need arises.  YMMV.

[q-school]

Dr. Mom wrote:

If my parents need a nursing home, I do not plan to limit them to Medicaid to pay for services.  Their money should be spent to make them as comfortable as possible and keep them in their home as long as possible.  Any inheritance will be split four ways between my siblings and myself anyway.  Since two of my siblings are less than financially responsible, I will be trustee for them.  My life gets much easier the more my parents spend/gift while they are alive.  We talk about this stuff frequently.  They know how I feel which is why they moved near me to make it easier to care for them when/if the need arises.  YMMV.

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I agree with you.  however my mom would rather live in medicaid poverty if it comes to that and leave a legacy.   doubly so if it's just her body that's still alive somehow.

she knows how I feel.  that's why I bought her a house ten minutes from my sister.

 

 

[LizFK]

There is a way to move assets to be able to have your parent eligible for both Medicare and Medicaid, so that you don’t get stuck with paying OOP.  There are several conditions like Parkinsons that is not covered by Medicare, and you may need Medicaid to pick up the costs.  If the parent doesn’t have secondary insurance, the 20% Medicare doesn’t cover can add up as well.

A really great book that discusses some of these issues, including what happens when you DON’T die (most wills only pertain to death, and there are many events that aren’t covered under a basic will) is :

https://www.amazon.com/Estate-Planning-Dead-Protection-Consumers/dp/1975780752/ref=asap_bc?ie=UTF8

The author uses many possible scenarios and explains how estate planning in the legal field is outdated and can leave you relying upon probate or having assets seized.

I also recommend this book.

 

[CrockettsRiver]

LizFK wrote:

There is a way to move assets to be able to have your parent eligible for both Medicare and Medicaid, so that you don’t get stuck with paying OOP.  There are several conditions like Parkinsons that is not covered by Medicare, and you may need Medicaid to pick up the costs.  If the parent doesn’t have secondary insurance, the 20% Medicare doesn’t cover can add up as well.

A really great book that discusses some of these issues, including what happens when you DON’T die (most wills only pertain to death, and there are many events that aren’t covered under a basic will) is :

https://www.amazon.com/Estate-Planning-Dead-Protection-Consumers/dp/1975780752/ref=asap_bc?ie=UTF8

The author uses many possible scenarios and explains how estate planning in the legal field is outdated and can leave you relying upon probate or having assets seized.

I also recommend this book:

https://www.amazon.com/Protect-Familys-Assets-Devastating-Nursing/dp/1941123074/ref=pd_sim_14_1?_encoding=UTF8&pd_rd_i=1941123074&pd_rd_r=a3aa4de3-8c8b-11e8-8042-83a887e2fe6a&pd_rd_w=WFVpW&pd_rd_wg=UfFEy&pf_rd_i=desktop-dp-sims&pf_rd_m=ATVPDKIKX0DER&pf_rd_p=2610440344683357453&pf_rd_r=C20JXHVG6JT28D3B34AY&pf_rd_s=desktop-dp-sims&pf_rd_t=40701&psc=1&refRID=C20JXHVG6JT28D3B34AY

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what on earth do you mean, "Parkinson's isn't covered by Medicare"? it certainly is. Please cite a source for this.

[LizFK]

I am sorry that I did not clarify. I should do a better job editing when I post at night after a long week. Parkinson’s is covered by Medicare for treatment itself, but Medicare will not pay for in-home care for Parkinson’s if the person does not want to go into assisted living. The first book I linked, Sstate Planning Is Dead, discuss this this and much better detail than I could.

“Medicare does offer assistance for individuals with Parkinson's. Unfortunately in the non-medical realm the program provides almost no help. Medicare will not pay for personal care at home, in assisted living, or in adult day care. Medicare does not provide for assistance with the activities of daily living with the exception being when they are provided in a nursing home, and Medicare's nursing home benefit is limited to partial coverage for a maximum of 100 days. Medicare does offer a home care benefit. However, this is for home health care, not for personal care at home.”
https://www.google.com/amp/s/www.payingforseniorcare.com/parkinsons/financial-assistance.html%3ftmpl=amp