Medicaid Presentation
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MEDICAID PLANNING: HOW TO MANAGE THE $6-7,000/MONTH COST OF STAYING IN A NURSING HOME P. Haans Mulder, JD, MST, CFP ® Cunningham Dalman, P.C. 321 Settlers Road Holland, MI 49423 (616) 392-1821 [email protected]
Transcript of Medicaid Presentation
MEDICAID PLANNING: HOW TO MANAGE THE $6-7,000/MONTH COST OF STAYING IN A NURSING HOME
P. Haans Mulder, JD, MST, CFP®
Cunningham Dalman, P.C.321 Settlers RoadHolland, MI 49423(616) [email protected]
Background• Grew up in Holland.• Attorney and Partner at Cunningham
Dalman, P.C.• Have a Masters in Tax (MST), CFP®
and specialize in estates/elder law and business planning.
Serving the Holland area since 1900
Background• Cunningham Dalman, P.C. is located in
Holland and has been serving the greater Holland area since 1900.
• We have 15 attorneys specializing in all areas of the law.
Serving the Holland area since 1900
Overview• Discuss the Medicaid rules and process.• Cover the what, who, when, where, and
how’s…. • Give you some ideas to plan for managing
the cost of staying in a nursing home ($6-7,000/month).
Serving the Holland area since 1900
What is Medicaid?• It is a state and federal program that
pays for medical treatment (including long term care).
• Oftentimes confused with Medicare.
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When does Medicaid apply?• Historically, it only paid for nursing
home care. • In certain counties (that have the MI
Choice Waiver program), it will pay for care in someone’s home or an assisted living facility.
Serving the Holland area since 1900
Who does Medicaid apply to?
• Applies to people who are 65 years or older, blind, or disabled.
• Must satisfy the medical requirements (level of care assessment).
• Need to meet the income and asset tests.
Serving the Holland area since 1900
Who does Medicaid apply to?
• Your monthly income cannot exceed the monthly cost of your stay in a nursing home ($6-7,000 in this area).
• For the Waiver program, your income (not your spouse) must be less than $2,022/month.
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Who does Medicaid apply to?
• The asset test requires that a single person cannot have more than $2,000 in countable assets.
• You can keep your home (if it’s owned properly) as well as a vehicle.
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Who does Medicaid apply to?
• Asset test allows a married couple to keep their home (again, if it’s owned properly), a vehicle, and one-half of their other assets (up to a maximum of $109,560).
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Where do you apply?• Apply for Medicaid at the Department of
Human Services (DHS).• DHS offices are located in each county.• Apply at the county office that the
nursing home is located.
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Planning Example #1• Clients are husband and wife.• They have an estate plan (including a
joint living trust to avoid probate).• A couple years later, the husband’s
health begins to decline.
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Planning Example #1• They are worried about him needing
nursing home care in the future.• They are also concerned about him
passing and what “safety net” would be available for his wife.
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Planning Example #1• To plan for these risks, they convert
their joint living trust to a single living trust.
• If one spouse passes away, the single living trust becomes a “survivor’s trust.”
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Planning Example #1• Upon the first spouse’s death
(regardless of which one), it protects virtually all of their assets for Medicaid purposes.
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Planning Example #1• It allows the husband to likely qualify
immediately for Medicaid (i.e. no spend-down).
• It creates a “safety net” so that expenses not covered by Medicaid can be paid for (as opposed to children paying them).
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Planning Example #1• If the wife needs nursing home care in
the future, she will likely qualify immediately for Medicaid.
• It also creates a “safety net” so that expenses not covered by Medicaid can be paid for (as opposed to children paying them).
Serving the Holland area since 1900
Planning Example #1• The husband must still be competent.• There must be a trustworthy child (to
act as trustee for the “survivor’s trust”).• The assets will have to be probated
and it may result in paying taxes earlier than planned.
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• Clients are husband and wife.• They have an estate plan.• A couple years later, the wife’s health
declines significantly and has to go to a nursing home.
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Planning Example #2
• They have a house, vehicle, and $250,000 of investments.
• She didn’t have a three day stay in the hospital so Medicare didn’t cover any of the stay at the nursing home (immediate $6-7,000/ month cost).
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Planning Example #2
• They could keep the house (because it was properly owned) and their vehicle.
• Without any Medicaid planning, they would have to spend down one-half of their investments.
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Planning Example #2
• A Medicaid trust (different from their living trust) is drafted that allows them to protect all of their investments.
• She immediately qualifies for Medicaid and it protects their $250,000 of investments.
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Planning Example #2
• If the wife passes first and the husband needs nursing home care, he will qualify immediately for Medicaid.
• It also creates a “safety net” as the “survivor’s trust” did (so their children do not have to pay these costs).
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Planning Example #2
Questions……
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Thank YouP. Haans Mulder, JD, MST, CFP®Cunningham Dalman, P.C.321 Settlers RoadHolland, MI 49423(616) [email protected]
Serving the Holland area since 1900
