Living Trust for Medicaid?

[athena53]

Quote:

Originally Posted by Mr._Graybeard +1. If I'm gonna go out under LTC, I don't want to waste away in some hellhole where I have to push the call button for hours just to get a bedpan.

I suspect the understaffed places rely on adult diapers, to be changed on THEIR schedule. (Shudder.)

[audreyh1]

Quote:

Originally Posted by joeea Using a trust to "protect" your assets from a potential lawsuit isn't much different from "hiding" your assets from the Medicaid look-back. In both cases, you "have the money" but have put it in a place so that others can't get to it.

Actually no, they didn’t have the money. It was in an irrevocable trust and was no longer theirs.

[ChrisC]

Quote:

Originally Posted by Mr._Graybeard +1. If I'm gonna go out under LTC, I don't want to waste away in some hellhole where I have to push the call button for hours just to get a bedpan.

Except for highly expensive and exclusive private pay facilities, in many locations skilled nursing facilities accept both private pay and Medicaid recipients so there is little, if any, difference in patient care. In places that we have looked for family members in NYC, Northern Virginia, and North Carolina, the only difference in such facilities for patient care between private pay and Medicaid recipents is whether you have a private room or shared room.

I think you're in for a rude awakening when you start looking at skilled nursing facilities. Even the better rated ones I've seen (that provide a priority to private pay residents) don't provide the optimal care you'd want for loved ones or yourself.

If I do need LTC, we will be using my LTCi for home care and if that runs out for 5 years, we have enough resources to take us further. The big uncertainty is LTC that can only be provided in a skilled nursing facility.

[PatrickA5]

Quote:

Originally Posted by pjm-7 Find a new attorney.

In all fairness to the lawyer putting on the workshop, he spent maybe 5 minutes of 90 minutes going over this. And, I imagine that just about every other estate lawyer would offer something similar since some people want this. Obviously, if you want to make money you offer what people want.

Right now, I'm struggling with what we want with a Trust and whether we need one at all.

[joeea]

Quote:

Originally Posted by audreyh1 Actually no, they didn’t have the money. It was in an irrevocable trust and was no longer theirs.

That's why I put the phrase in quotes. They manipulated their assets to take advantage of the rules.

Just like my wife and I "don't have much income", thus granting us ACA subsidies (thank you everyone for that).

You can take whatever the rules permit.

[ChrisC]

Quote:

Originally Posted by PatrickA5 In all fairness to the lawyer putting on the workshop, he spent maybe 5 minutes of 90 minutes going over this. And, I imagine that just about every other estate lawyer would offer something similar since some people want this. Obviously, if you want to make money you offer what people want. Right now, I'm struggling with what we want with a Trust and whether we need one at all.

I think you shouldn't be just considering shielding assets for Medicaid purposes, but determine whether the trust serves other purposes. We have trusts, but there isn't any Medicaid protection provisions in them because we don't intend to rely on Medicaid for any purposes. Our trusts are designed to make it easier for handing off our estates to a surviving spouse and later children/heirs, and provide for creditor and divorce protection for our children. My MIL created an irrevocable trust in the last few months of her life, but this was primarily designed for a special needs child (my BIL with MS) and to qualify her for VA benefits -- but she passed away before we could even apply for VA benefits for home and attendance benefits as a surviving spouse of a WWII era veteran. And if MIL needed LTC in a skilled nursing facility we were going to private pay for that from our own resources.

Many folks who get on this Medicaid protection, asset sheltering band wagon, have the tail wagging the dog. Determine what type of care you might need, what type of burden you might place on your loved ones, and go from there -- doesn't sound like a good plan to rely on Medicaid coverage as an initial step.

[travelover]

Re admission to a nursing home on Medicaid, we found that if a resident has to go to the hospital, they are considered to be vacating the nursing home. Then they (or loved ones) need to find a new nursing home if there are no beds open at the previous place, once they are well enough to leave the hospital. Once on Medicaid, it would seem to be even more difficult to get a "new" admission.

[Mr._Graybeard]

Quote:

Originally Posted by ChrisC Except for highly expensive and exclusive private pay facilities, in many locations skilled nursing facilities accept both private pay and Medicaid recipients so there is little, if any, difference in patient care. In places that we have looked for family members in NYC, Northern Virginia, and North Carolina, the only difference in such facilities for patient care between private pay and Medicaid recipents is whether you have a private room or shared room. I think you're in for a rude awakening when you start looking at skilled nursing facilities. Even the better rated ones I've seen (that provide a priority to private pay residents) don't provide the optimal care you'd want for loved ones or yourself.

I can't speak to your experience with skilled care resources. Having studied LTC availability in my area within the last decade, I know of one top-notch nursing home that I would look to first if DW or I required it. My father and mother were both there for rehab over the last 20 years, so I've seen the staff at work up close. I'm confident in their quality of care.

Their literature says they accept Medicaid, but the reality is, you'd better have enough money to pay your way for several years if it looks like you're going to be a long-term resident. There are no shared rooms.

It's common practice here for skilled care facilities to ask how you're going to pay before you're admitted.

Up the road is a dump of a place where the plebeians go who can't afford better. Last summer a resident was fatally injured there in an electrical fire that burned the bed.

[tinlizzy]

Quote:

Originally Posted by audreyh1 We recently had a desperate post from a daughter whose parents could not access the funds they needed to buy into a CCRC because they had put everything, including the house, into a trust in the attempt to protect their assets from Medicaid. The children were scrambling to try to try to break the trust so the parents could move to where they wanted. The initial lawyer said it could not be broken. I think I now understand how the parents got themselves into this situation....

This is exactly what I thought of.

It makes me wonder if these lawyers have business interests in particular nursing homes in their area and are all but assuring future patients.

[Ginny]

This is medicare fraud and it does not work.

[athena53]

Quote:

Originally Posted by ChrisC I think you shouldn't be just considering shielding assets for Medicaid purposes, but determine whether the trust serves other purposes. We have trusts, but there isn't any Medicaid protection provisions in them because we don't intend to rely on Medicaid for any purposes. Our trusts are designed to make it easier for handing off our estates to a surviving spouse and later children/heirs, and provide for creditor and divorce protection for our children.

I'm in the same position- I have a Revocable Trust, which provides no Medicaid shelter, but that wasn't my intent. I set it up when DH was alive- all the assets were in my name (he was 15 years older and I was the one who liked managing investments) and it provided for my brother to take over as Trustee if I died first, taking care of DH and then managing the remainder for DS. DS is honest, thrifty, married to a wonderful young woman, but little interest in investing. I'm also a bit concerned that a large % of anything I leave may go to their church. My brother is a CPA and also a devout Christian but has managed to balance giving (I'm sure he tithes at the very least) with enjoying what he has. There's only so much I can do from beyond the grave but I'm hoping my brother can give DS enough perspective that he and DDIL use the bulk of what they inherit for a secure retirement.

DH died in late 2016 and I know I've got to get the darn thing updated even though it clearly set out how things would go if he predeceased me- we knew that was the likely scenario. I just hate to spend the money!

[Walt34]

Quote:

Originally Posted by ChrisC Except for highly expensive and exclusive private pay facilities, in many locations skilled nursing facilities accept both private pay and Medicaid recipients so there is little, if any, difference in patient care.

That was our experience with FIL as well. He had to have the assets to pay for a given amount of time (I think it was one year) but after that was exhausted they would have accepted Medicaid. However, this varies by nursing home and some will eject the patient to a Medicaid facility if/when assets are exhausted. In FIL's case, he passed before all assets were exhausted so the issue never came up. So you have to check with the individual nursing home since the policies on that do vary widely.

As far as it affecting care, understand that the people doing the hands-on care almost certainly are unaware whether a given patient is private pay or Medicaid, and they don't care. There is, I hope, a special place in Heaven for those folks though. At least the ones we saw.

Re shielding assets from Medicaid, the elder law attorney in MD where FIL was located did begin to implement a plan to shield half of his assets. It involved DW (who had POA) putting half of his assets into a separate account in her name, in effect "gifting" that amount to herself. Then, if FIL ran out of money, there was a 1-month penalty in receiving Medicaid benefits because of the five-year lookback BUT (I think, this was complicated and five years ago) if FIL paid for the month half of the month's penalty was either written off or forgiven. It also involved setting up a trust and making the account POD to the trust if DW got run over by that mad bus driver so her siblings would still get the funds.

Like I said, it's complicated and I never did fully understand it. He passed away before any of this happened so it became an academic exercise anyway.

Bear in mind that this was in MD. While Medicaid is a federal program, it is administered by the individual states and the rules can and do vary.

Initially both DW and I were uncomfortable with this idea for the same reasons that some others are. Then we concluded that we didn't write the rules and it was no different than arranging one's affairs so as to lower taxes or to get an ACA subsidy as so many others do.

[MRG]

Quote:

Originally Posted by Walt34 Snip Bear in mind that this was in MD. While Medicaid is a federal program, it is administered by the individual states and the rules can and do vary. Initially both DW and I were uncomfortable with this idea for the same reasons that some others are. Then we concluded that we didn't write the rules and it was no different than arranging one's affairs so as to lower taxes or to get an ACA subsidy as so many others do.

Great point.

When my DM was in a home in FL, probably 10 years ago an elder care attorney pointed out some bizzare law there. Mom had dementia and needed long term care, dad was healthy. At that time she was allowed to sign off joint assets and in her case she would be indigent and Medicaid would kick in.

They moved back to be closer to my sister and that wasn't an option.

[ChrisC]

Quote:

Originally Posted by Mr._Graybeard I can't speak to your experience with skilled care resources. Having studied LTC availability in my area within the last decade, I know of one top-notch nursing home that I would look to first if DW or I required it. My father and mother were both there for rehab over the last 20 years, so I've seen the staff at work up close. I'm confident in their quality of care. Their literature says they accept Medicaid, but the reality is, you'd better have enough money to pay your way for several years if it looks like you're going to be a long-term resident. There are no shared rooms. It's common practice here for skilled care facilities to ask how you're going to pay before you're admitted. Up the road is a dump of a place where the plebeians go who can't afford better. Last summer a resident was fatally injured there in an electrical fire that burned the bed.

Well, we might have different standards in assessing what is suitable for ourselves or our loved ones. What you describe as 'top-notch" might be sub-optimal to me, or conversely, what you describe as a "dump" might be adequate to me. But in my view, no skilled nursing facility that serves a large group of people and structured along institutional lines will be adequate for my wife and myself, especially given the level of care that we can afford now. Top-notch to me is home care, period, in your own home or in a care home with fewer than 6 residents.

[Teacher Terry]

I was the guardian for a good friend of mine when her husband died. She had alzhemer's and I put her in a home that would take Medicaid and could not kick her out once her $ was depleted. It took a little over a year for that to happen. I know someone in TX that got an attorney to shelter a large amount of his assets when his wife went into a home. When he died they went to his daughter. This I think is wrong even if it is legal.

[athena53]

Quote:

Originally Posted by Teacher Terry I know someone in TX that got an attorney to shelter a large amount of his assets when his wife went into a home. When he died they went to his daughter. This I think is wrong even if it is legal.

"Filial responsibility laws". Yeah, those can be scary. If my Ex hadn't died 11 years ago I'd have been very nervous for my son. The Ex was living on public funds for years before he died of multiple organ failure brought on by decades of alcohol abuse. It probably wouldn't have been a concern, though- my Ex never even paid child support and had no assets that he could have hidden from Medicaid even if that had been his intent.

[Walt34]

Quote:

Originally Posted by Teacher Terry I know someone in TX that got an attorney to shelter a large amount of his assets when his wife went into a home. When he died they went to his daughter. This I think is wrong even if it is legal.

I think PA is another state where they are allowed to go after the grown children's assets, although my understanding is that in practice they rarely do.

[MRG]

Quote:

Originally Posted by Walt34 I think PA is another state where they are allowed to go after the grown children's assets, although my understanding is that in practice they rarely do.

Yes! That was a big fear we had.

My DF had been gifting large sums to his church and well it just got stupid. While PA seldom do, they have.

[Bestwifeever]

Quote:

Originally Posted by Teacher Terry ...I know someone in TX that got an attorney to shelter a large amount of his assets when his wife went into a home. When he died they went to his daughter. This I think is wrong even if it is legal.

Do you mean the sheltered assets went to his daughter, or do you mean the state of Texas went to his daughter to recover the costs of the mother's care? I thought you meant the former, that the sheltered assets didn't go to pay for the care but went to the daughter?

PS if the sheltered assets went to the daughter instead of toward the mother's care, I have no problem with the state trying to get to get repaid for the care the mother received from the state, especially after the father passed away.

[Luck_Club]

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Ethically, I have somewhat of a problem with people shielding (hiding?) assets to qualify for government benefits. I mean if you have the money, why have taxpayers pay for it?

Many on this board "manage" their withdrawal strategies to maximize gov't subsides all the time.

Magic SS claiming time
Magic Roth Conversion formula
staying under ACA subsidies

Hypocrisy at its best!

I smell porky with this one...getting government out of the subsidy (charity) business would solve all these problems.