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Monday, March 30, 2009

Steps to Take for Transfers that Initially Would Appear to Give Rise to a Medicaid Penalty

Steps to Take for Transfers That Initially Would Appear to Give Rise to a Medicaid Penalty

1. I have seen many situations in which a parent has transferred virtually all of his or her assets to a child. If such parent goes into a nursing home within 60 months, there is a possibility of a substantial period of ineligibility.

2. One ameliorating possibility is that all transfers utilized by the child on behalf of the parent do not give rise to a penalty. The problem with such approach is that if a parent goes into a nursing home and funds are remaining, funds that have not been utilized for the parent are treated as uncompensated transfers.

3. If a transfer is made to a child and a parent goes into a nursing home very soon thereafter, the monies can be returned to the parent either directly or through a power of attorney. That is, any monies returned undo the transfer.

An interesting example would be the gifting of a home by a single parent to a child. If the parent goes into a nursing home more than 60 months after such gift, the gift would not be subject to penalty. Of course, the child’s basis (cost) becomes the basis of the parent.

A more interesting example is the parent giving the home to a child (or possibly two children) and the parent goes into a nursing home four years later. A possible planning technique would be for the child or children to pay for the nursing home for the remainder of the 60-month period.


Disclaimer: This article does not constitute legal advice and each person may have unique facts for which legal consultation may be necessary.


© March 2009, Post #18

Friday, March 27, 2009

Payment by Applicant for Care or Services Provided by Child

Payment by Applicant for Care or Services Provided by Child

A common occurrence is for a child to provide services in the past for someone who is now an applicant for Medicaid. The State takes the position that at the time the services by the child were delivered that they shall be presumed to have been intended to be delivered without compensation. Therefore, funds transferred by the applicant within the look-back rule to compensate a friend or relative shall be presumed to have been Medicaid penalizing transfers. This presumption may be rebutted by documentary evidence which was in existence at the time of the delivery of care or services by the child.

Generally, “documentary evidence” refers to a writing in the nature of a caretaker agreement by which the child would provide the necessary services (parent lived in home with child), which is intended to be reimbursed by the parent and avoid penalty implications.

Such caretaker agreement should include the following:

1. The specific nature of services provided by the child (delineated in an attached schedule to this agreement).

2. An independent valuation of such services possibly by a geriatric care manager if such services include care for the parent, tending to medical needs and related matters. I believe the independent valuation is absolutely necessary to maintain the validity of the agreement. Many attorneys draft caretaker agreements which include the attorney’s estimate of such value. In this regard, the State takes the position that “the amount of compensation or the fair market value of asset transferred [by the applicant] shall not be greater than the prevailing rates for similar care or services in the community. That portion of compensation in excess of the prevailing rate shall be considered to be uncompensated value.” Any portion in excess of such rates shall be deemed a transfer for eligibility purposes.

An improperly drafted agreement can raise very serious problems, particularly under the new transfer rules.


Disclaimer: This article does not constitute legal advice and each person may have unique facts for which legal consultation may be necessary.


© March 2009, Post #17

Wednesday, March 25, 2009

Qualifying for Medicaid

Qualifying for Medicaid

Ideally, representation for Medicaid eligibility should commence at least six months prior to the anticipated date of eligibility. Proper planning should result in the protection of resources, and, in many cases acceleration of the date of eligibility.

I. The General Problem

Counsel is engaged to represent an individual who recently entered a nursing home. Resources may include bank accounts, securities, E bonds, IRAs, life insurance policies and/or a residence. Individual may have current debts, such as doctor bills and credit card charges, and anticipates future debts, such as nursing home costs and income tax liabilities.

Topics which have been previously covered include the following:

1. Life insurance (Post #3)
2. Residence (Post ##6, 11 and 14)
3. Payment of Debts (Post #4)
4. Acceleration of Date of Eligibility (Post #5)

II. Priority of Payments

A. Debts, nursing home costs, the acquisition of excludable resources (such as burial arrangements) and income tax liabilities are the major expenditures incurred during the spend-down period. Debts should be paid immediately and expenditures paid as incurred with an eye toward the goal of meeting the resource requirement on the first day of the projected month. As indicated above, failure to meet the resource requirement by even a minimal amount requires that payment be made at the private rate until the resource requirement is met.

B. Projecting the date of eligibility is not an exact science as circumstances may require a revised eligibility date. On the expense side of the ledger are costs such as increased nursing home charges for a given month and unreimbursed medical bills. On the asset side of the ledger are receipts such as medical reimbursements and income tax refunds.

C. Maintaining an element of flexibility in making payments is the key to establishing a projected date of eligibility.

Example: Applicant is seeking July 1, 2009 eligibility. The resource requirement is $2,000. There is no deposit at the nursing home. All debts and expenses (including prepaid funeral arrangement of $5,000) have been paid. On June 25, applicant has $4,000 in resources. If funds not reduced to $2,000 on July 1, eligibility will be denied.

Contrast: Facts same as above except funeral costs have not been paid. Resources are, therefore, $4,000 (original June 25 balance) plus $5,000 (monies set aside for funeral, but not paid), or $9,000. Funeral arrangements should be made so that the cost is at least $7,000.

Rule: Prepaid funeral arrangements should be one of the last expenditures prior to the anticipated date of eligibility. The inherent flexibility in the amount of this payment allows for the resource requirement to be met.

D. One of the first liabilities to be determined and paid is state and federal income taxes. As indicated herein, failure to address this issue could result in delaying the date of eligibility, or even worse, could result in a liability when no monies are available or in payment from community spouse’s protected funds.


Disclaimer: This article does not constitute legal advice and each person may have unique facts for which legal consultation may be necessary.


© March 2009, Post #16

Monday, March 23, 2009

New Transfer Rules and Their Effect

New Transfer Rules and Their Effect

When I commenced writing articles for my blog, I promised I would not immediately discuss the new transfer rules as it is my opinion that the basics should be understood first. This article compares the prior transfer rules to the new transfer rules in a general sense as I feel the time is appropriate to have such discussion.

However, before discussing the current rules, I will review the prior transfer rules as a comparison.

I. Transfers – Prior Law

A. Transfers within 36 months of application are scrutinized by Medicaid; may or may not give rise to a period of ineligibility.

B. Transfer Penalty = amount transferred divided by penalty rate (assume $6,525). Example: individual transfer $30,000 to daughter upon entering nursing home. Penalty is $30,000/6,525 = 4.59 months (rounded down to 4 months).


C. New Jersey Medicaid has adopted the favorable rule that penalty periods are “rounded down”. For example, if a transfer gives rise to a period of ineligibility of 4.9 months, treat it as a penalty of 4.0 months. This favorable rule has been changed by the new law as will be discussed.

D. Numerous Exemptions to the Transfer Rules – Typical exemptions are transfers to spouse, real estate to designated individuals, transfer for sole purpose other than Medicaid eligibility, transfers to disabled child or trust for disabled child, transfers to a trust for a disabled individual under age 65 (the applicant), assets transferred that are returned to the individual.

II. The New Law (Transfers)

A. Transfers – deemed to have been made on date individual would otherwise be eligible for Medicaid but for the new law. Example considers only single applicant.

1. five-year lookback.

2. individual in nursing home.

3. assets down to $2,000 (except if income exceeds the income cap of $2,022 in which case the number is $4,000).

B. Basically, transfers within 60 months treated as made when assets reduced to $2,000. That is, the penalty commences when an individual is out of funds, and has no money to pay the nursing home. Statute makes no sense in that the period of ineligibility commences when individual has no funds to pay for nursing home.

C. Major Effects of New Transfer Law

1. Individual has no funds but has obligation to pay nursing home until end of penalty period.

2. Nursing home does not receive Medicaid nor payments from individual who has exhausted his or her assets. New law creates burden on nursing home to review resident’s records prior to admission to determine any transfers within 60 months. Nursing home might face financial problems as fewer people might apply to nursing homes in light of the onerous transfer rules.

3. Families will be seeking alternative living arrangements such as day care and home care.

4. Children might have to pay for nursing home costs till end of penalty period.

5. Long-term care insurance will increase in popularity, and the typical period of coverage will increase from 36 to 60 months. In addition, individuals will be more likely to purchase long-term care insurance options such as cost of living adjustment.

6. People will be transferring assets to children at younger ages (possibly when in good health to beat the 60-month rule).

7. Hardship waivers will be sought by applicant or by nursing home on behalf of applicant. Individual could qualify for hardship waiver for Medicaid when application of transfer rules would deprive individual of medical care such that individual’s health or life would be endangered or is deprived of food, clothing or necessities of life. Nursing home could apply for waiver on behalf of individual. States have the option to pay nursing home costs for 30-day period while application is pending.


Disclaimer: This article does not constitute legal advice and each person may have unique facts for which legal consultation may be necessary.


© March 2009, Post #15

Thursday, March 19, 2009

The Significance of a Dependent Relative Residing in the Home with Applicant

The Significance of a Dependent Relative
Residing in the Home with Applicant

On many occasions a child will be residing in the home with applicant, and such child might not have any disability or problem of any kind. I have spoken to several Medicaid supervisors and they assumed that the home would be an available resource.

See Program Instruction No. 85-8-9 detailed below which indicates that if the home is occupied by a dependent relative, the home is an exempt resource. The letter ruling lists numerous relatives that can qualify as dependent, and “dependency” is defined broadly. Pursuant to N.J.A.C. 10:49-14.1(g) if a “family member” of a deceased Medicaid beneficiary has, prior to the Medicaid beneficiary’s death, continuously resided in the home which was also beneficiary’s primary residence, the Division will not enforce the lien until the property is sold, or the resident family member either dies or vacates the property. The only issue with such a ruling is that the words “family member” is not defined.

Program Instruction No. 85-8-9

The Medicaid Only Manual (at N.J.A.C. 10:94-4.4(b)(i) provides for the exclusion of a home as a resource during temporary absences, including trips and hospitalizations. That policy is hereby expanded and appears below.

A home may be excluded as a principal place of residence during temporary absences so long as the individual intends, and may reasonably be expected to return home. With the exception appearing in the paragraph below, an absence of more than six months shall be assumed to indicate that the home no longer serves as the principal place of residence. That period may be extended only with approval from the Division of Public Welfare.

If the absence is not temporary and the home is occupied by a spouse or dependent relative, the home shall be considered to be the principal place of residence so long as the spouse or dependent relative continues to reside there, regardless of the length of the absence. In determining if the exclusion of a home applies, a dependent relative included only the following individuals: son, daughter, grandson, granddaughter, stepson, stepdaughter, mother, father, stepmother, stepfather, half-sister, half-brother, niece, nephew, grandmother, grandfather, aunt, uncle, sister, brother, stepsister, stepbrother, mother-in-law, father-in-law,
sister-in-law, brother-in-law, daughter-in-law, and son-in-law. The nature of the dependency (e.g., financial, medical, custodial or any other type of dependent relationship) of any such relative must be determined on a case-by-case basis and must be documented in the case record.


However, it would seem, that a dependent member of the immediate family would allow the home to be excludable as a resource for eligibility purposes and would be not be subject to the lien until such time as the property is sold, the family member dies or vacates the property.

I provided this ruling to a Medicaid supervisor and she re-instituted its significance at a recent meeting with the authorities in Trenton.


Disclaimer: This article does not constitute legal advice and each person may have unique facts for which legal consultation may be necessary.


© March 2009, Post #14

Wednesday, March 18, 2009

Community Spouse Not Limited to Community Spouse Resource Allowance After Date of Eligibility of Applicant

Community Spouse Not Limited to Community Spouse Resource Allowance
After Date of Eligibility of Applicant

Previously, it has been discussed (see Post 11) that after the applicant’s receives Medicaid, the community spouse is not limited by the Community Spouse Resource Allowance. Relevant administrative regulations are included for reference.

For example: (see Post 11, one of the reasons for transferring the house to the community spouse is that a sale by the community spouse of the primary residence after the applicant receives eligibility, would result in proceeds not subject to the Medicaid computations. Proceeds of a sale before the date of eligibility would be treated as part of the “pot” and, therefore, preclude current Medicaid eligibility.

Another common situation is an inheritance by the community spouse. N.J.A.C. 10:71-4.4(b)6. indicates that property in probate is an inaccessible resource. Therefore, if the community spouse is a beneficiary of the estate, his or her share of assets of the estate does not enter into the “pot” until distributed. If distribution occurs after the applicant receives Medicaid, the resources received are free without encumbrance. However, if distribution is made prior to eligibility, the resources become part of the “pot.”


Disclaimer: This article does not constitute legal advice and each person may have unique facts for which legal consultation may be necessary.


© March 2009, Post #13

Monday, March 16, 2009

"Bread and Butter" Planning Techniques for Medicaid Eligibility

“Bread and Butter” Planning Techniques for Medicaid Eligibility

Many potential Medicaid eligibility cases do not require sophisticated planning techniques. Relevant administrative regulations are referenced.

I. Hypothetical

Husband is about to permanently enter nursing home. The husband and wife have the following assets:

Residence $($30,000 mortgage) $200,000 (net of mortgage)
Bank accounts (jointly held) 100,000
Life insurance on husband
($100,000 face, $5,000 cash value) 5,000
Investments (jointly held) 25,000

Debts and anticipated debts are $10,000, which includes attorney’s fees, accountant’s fees and needed repairs on the home.

The planning goals are Medicaid eligibility, maximum preservation of assets and avoidance of loss of Medicaid eligibility.

II. Recommendations

A. Transfer all bank accounts and investments into the name of the wife for management purposes.

B. Residence should be transferred into wife’s sole name. Home should not be sold by wife until after husband is eligible for Medicaid (spouse’s cash not counted toward husband’s assets after husband’s eligibility).

C. Life insurance policy should be cashed in after institutionalization (see N.J.A.C. 10:71-4.4(b)4.).

D. After husband enters the nursing home, pay off mortgage ($30,000), debts and expenses ($10,000), cash in life insurance.

Note: The Community Spouse Resource Allowance is $65,000 (one-half total of bank accounts, investments and cash value of insurance). The amount which is not protected need not be used on nursing home costs, and payment accelerates the date of Medicaid eligibility.

E. Balance of funds used to pay nursing home costs and wife’s expenses in the community. Other possibilities are prepayment of taxes, prepaid funeral funds and general debts.

Suggestion: For alternative arrangements, see Additional Post-Eligibility Considerations, Post No. 2.



Disclaimer: This article does not constitute legal advice and each person may have unique facts for which legal consultation may be necessary.


© March 2009, Post #12