Getting
Ready to Be On Medicaid* in
How
Should You "SPEND DOWN"?
(revised
(Not
Legal
Advice - Consult Your Own Attorney)
Lisa
Nachmias Davis
Davis
O'Sullivan & Priest LLC - Attorneys at Law
davis@sharinglaw.net
~ www.sharinglaw.net
1. First,
what does it MEAN to “spend down” assets?
To
qualify for Title 19 (Medicaid) for LONG-TERM CARE* (unless
on Husky D for low income adults
19-65 without Medicare) you can ONLY
have:
•
If unmarried: $1,600 plus certain “Exempt
Assets”
•
If married with spouse living at home: $1,600
plus UP TO $123,600 for your spouse,
total maximum $125,200. (Usually, spouse
gets only 1/2 of COMBINED assets or 123,600 whichever is less -- but
this can
vary and go up -- consult an elder law attorney or see Medicaid for
Marrieds.)
If
you have more
than this, you do not qualify (possible
exception:
if you are married and your combined income
is under $3,090; in some cases, even if income is more --
consult an attorney first). The
Department of Social Services, which
administers Medicaid in
Suppose you
have not $1,600, but
$51,600. You have $50,000 too much. You
have to “spend down” to $1,600 before you will be eligible. YOU HAVE TO
BE
"SPENT DOWN" BY MONTH'S END TO BE ELIGIBLE FOR THAT MONTH.
"Spent" means the money is GONE --
the State
doesn't care if you owe debts -- the State isn't interested in your
"net
worth." Note: a check that
hasn't cleared is not GONE! And don't
forget -- the cash value of LIFE
INSURANCE is an ASSET -- you may have to cash it in and get it spent by
month's
end!
2. How
should you “Spend Down” assets if you are NOT married?
MEDICARE
SUPPLEMENTAL INSURANCE may still
be purchased and cover you even if you are in a nursing home. This can be vital to cover the co-pays for
days 21 - 100 of the nursing home stay which might be $10,000+
otherwise.
CAUTION: TALK TO A LAWYER FIRST if you made a
"gift" within the past 5 years. Note: you
may not need this if you have gross income of or under $2,135/mo and
apply
for the QMB "Medicare Savings Plan."
FUNERAL
ARRANGEMENTS: $8,000 maximum for
an irrevocable funeral contract, no limit on a "burial
trust" for
casket,
grave
lining, etc. One cemetery plot (one for
each, if married).
GET YOUR TEETH
CHECKED. The Title 19 program can have
terrible dental
coverage, especially for nursing home residents, and few dentists are
willing
to participate. The State will pull your teeth
for you,
but that’s about it. Also, dentures can get
stolen in the nursing home. NOW IS THE TIME to
have your teeth checked thoroughly, all dental work completed and all
fixtures
bought. If you are in a nursing home,
ask whether you can be transported to a dentist outside.
If the work won't be done before you have
"spent down," arrange to pay the bill up front.
GET YOUR EYES
CHECKED. The Title 19 program is not much
on eyes
either. NOW IS THE TIME to buy spare
pairs of glasses, or if you prefer, contact lenses and all the
fixtures. Glasses
also can get stolen in the nursing home!
CHECK
YOUR FEET, SKIN, EARS.... Title 19
covers the basics. You do NOT have your
choice of doctor and you may not get everything done that can be done. The State may only pay for a crummy $400
hearing aid. Podiatry may not be covered. NOW
IS THE TIME to attend
to any problems that
the State may not find important, especially getting the best hearing
aid/wheel
chair/voice adapter/ventilator money can buy. And... hearing aids get
stolen in the nursing home!
GET
YOUR AFFAIRS IN ORDER. Whether or not
you will really need a will, you should have a General Durable Power of
Attorney, and if it
does not
include health care provisions, then also a Designation of Health Care
Representative. It is a good idea to
appoint a Conservator in case one is required. If you are married and
the home is in your name, transfer it to your spouse! Finally,
many people
want Living
Wills that authorize life support to be withheld or withdrawn if you
are
terminal or in a "persistent vegetative state." You
MAY add more specific instructions,
too. All health matters can be combined
in one document. Check my article,
"What You Owe Your Family."
MAKE ANY EXEMPT
TRANSFERS. While many gifts can cause
problems for
Medicaid eligibility,
some do not. These include (if NO
STRINGS ATTACHED):
•
Transfer of your home, or anything else, to a child receiving
Social Security Disability or SSI benefits.
Consult an elder law attorney or other knowledgeable attorney if
you
plan to transfer anything to a disabled person who gets benefits.
•
Transfer
of your home to a sibling who lived with you for the prior year and who
owns an
interest in your home (name is on the deed)
•
Transfer of your home in certain other situations to a child
who cared for you for 2 years and lived with you. Consult
an elder law attorney on how to
document this for the State.
•
SOMETIMES: transfer of
money to anyone who lived with / cared for you for 2 years - consult an
attorney!!
•
If you are under 65:
Transfer to a "special needs trust" or "pooled trust
account" for your own benefit!
Consult an elder law attorney. If
you are over 65, this option may not be available -- but it depends --
consult
an elder law attorney.
"Transfers"
or gifts can cause BIG
PROBLEMS if you don't follow the rules EXACTLY.
OTHER EXEMPT TRANFERS EXIST, TOO.
CONSULT AN ELDER LAW ATTORNEY.
SHOP 'TIL YOU
DROP or ask someone else to
help you! BUY whatever will make your
stay more comfortable. ONCE YOU ARE ON
MEDICAID, YOU HAVE TO MAKE DO ON $60/MONTH.
Buy a new TV/VCR/DVD, a portable tape or CD player, a laptop
computer,
pre-paid Cable or
internet service, magazine and newspaper subscriptions, a new
bed-jacket, your
favorite toothpaste, bedroom slippers.....
PAY
IN ADVANCE FOR HELP WITH THE MEDICAID APPLICATION.
If your financial affairs and plans are very
simple, you may not need help. In that case, a
friend or family member, or you, can complete the paperwork and deal
with the
State's questions. If you, your family
or friends are not "paper people" and might have trouble, or can't be
relied upon to respond quickly to the State's follow-up questions, or
if you
are married, OR IF YOU HAVE MADE ANY TRANSFERS, consult an elder law
attorney. This may, or may not, be a
disaster -- you will need help. IT IS
BETTER
TO PAY FOR THIS UP-FRONT WITH YOUR OWN MONEY, THAN FOR YOUR FAMILY TO
PAY LATER
WITH THEIR MONEY. Be sure to consult
only someone who is knowledgeable about Medicaid in your state.
USE AN ATTORNEY. DO NOT use the helpful "medicaid specialist"
company the nursing home recommends - at least not without also seeing
a lawyer. Read my article!
PAY
IN ADVANCE FOR "PERSONAL SERVICES."
If you do not have close family you can rely upon, you may want
to set
up a contract with a friend or care
provider who can attend care conferences about you,
run errands for you, visit you regularly, etc.
Consult an attorney and don't try this at home. It's hard
to persuade the state that you can pay a relative.
MAYBE A POOLED
TRUST ACCOUNT? Even if over 65, there may
be a way to set
aside a little fund
for extra needs --
the State will get it when you pass away.
Consult an attorney, don't try this at home. Much more
likely to work if you are getting long-term care services at home.
3.
How should you “Spend Down” assets if you ARE married?
In addition to the ways described above,
you can:
FIRST, SEE A
LAWYER ABOUT HELPING YOUR
SPOUSE,
BEFORE SPENDING ANYTHING. I am not
trying to be self-serving by saying that it is VITAL that you consult
an elder
law attorney. The State of
PUT
THE MONEY IN THE FAMILY HOME. Your home
is an exempt asset as long as your husband or wife (or under 21 or
disabled child)
is living there. Pay off the mortgage (unless
you are
trying to protect funds for your spouse, in which case check with your
lawyer). Install the vinyl siding; get a
new roof and furnace; buy the replacement windows; add a new carpet;
put in the
new kitchen your wife always wanted. She
can always borrow against the house later, or even sell it.
PUT THE MONEY
IN THE
FAMILY CAR. If you are married, you may
want to spend the money by investing in your car, which is an exempt
asset. Trade in that 2002 Chevvy for a
2018 Prius!
DON'T FORGET TO
PAY APPLIED
INCOME -- unless you have a spouse in the community with low income, in
most
cases your income (minus Medical insurance premiums, minus $60) will
have to be
paid to the nursing home every month you are on Medicaid.
DON'T FORGET or someone will have a nasty
surprise months later when the bill comes in and/or can get sued by the
nursing home. Read my article, "What
You
Still Have to Do"!
*Figures
change annually. ALSO: Some programs do NOT have an assets test
so NO spending down is at issue. The
"low-income Medicaid" program (Obamacare) in Connecticut (Husky
D) has
effectively no asset test so no spending down for that program. A
MARRIED PERSON IN A NURSING HOME MAY QUALIFY -- the other
spouse's income won't count.
Note: This
information on
USE
AT YOUR OWN RISK. Please
report changes, errors, and suggestions to Lisa Davis.
Lisa Nachmias Davis
Davis
O'Sullivan & Priest LLC - Attorneys at Law