Transcript Legal Planning

What to do about Mom
and Dad:
Staring points for longterm care planning
Christina Lesher
2719 Colquitt
Houston, Texas 77098
713-529-5900
www.lawlesher.com
Planning for Mom and
Dad*:

Estate Planning
Documents- the
foundation of a good
long-term care plan
Planning for Incapacity
& Avoiding
Guardianship
Planning for Medicaid/
Long-Term Care
* Or family member,
friend or special needs
person
Start with Tailored
Estate Planning
Documents

Will
– Special Needs Trust
– Planning for Minor or Disabled
Children

Maybe Trust
 Durable Power of Attorney
 Medical Power of Attorney
 Directive to Physicians
Planning for
Long-Term Care

Number of baby boomers is greatly
increasing.
 Longer life spans mean a greater
need for long-term care services
such as at home care, assisted living
and nursing home care.
 What about intergenerational
planning?
 Average cost of nursing home care in
Texas can be between $3,000-$5,000
per month.
Who Pays for LongTerm Care?
 Limited
Medicare
Coverage
 Veteran’s Benefits
 Long Term Care
Insurance
 Private Pay
 Medicaid
Medicare vs. Medicaid
 Medicare
– Federally Administered
– Entitlement
– Not Means Tested
– Part A- Hospital Insurance
– Part B- Medical Insurance
“needs based”
– Uses State & Federal
Funds
– State Administered
– Means Tested
 Medicaid-
Medicaid
Myths & Rumors

I have too much money
 You should have done
something three years ago- now
five years
 You should transfer your house
to your kids
 The State will take your home
(maybe!)
 “The Miller Trust Is All You
Need”
What Does Medicaid
Pay For?

Medical and Support needs
 Prescriptions*
– (Medicare Part D)

Does not cover:
– Dental work
– Bed hold charges
– Some miscellaneous medical
supplies
Who qualifies for Medicaid
Nursing Home Benefits?

Over 65 or disabled
 Meet the Income, Resource and
Medical Necessity
Requirements
 Are in a “Medicaid” bed and
state approved facility
Down side to Medicaid
Planning

Limited choice of nursing
homes
 Better care
 Client Values
 Medical Necessity Requirement
Nursing Home
Medicaid
 Income
requirement
 Resource
 Medical
requirement
necessity
requirement
Income Requirements

Name on the check rule
 Single- No more than $2,022 gross
each month (“Miller Trust”)
 Couple- (married couple in nursing
home) No more than $4,044 gross
each month (“Miller Trust”)
Exempt vs. Countable
Resources

Exempt
– Your house ($500,000 unless there is a
–
–
–
–

community spouse or minor or disabled
child at home)
One car
Your wedding set
Term life insurance
Pre-need funeral contract
Countable
– Checking & Savings Accounts
– Annuities (unless meets certain
requirements)
– Retirement Accounts
– Second Car, Home
– Cash Value of Life Insurance Policies
Resources- Single

$2,000 in countable resources
 Homestead is exempt up to
$500,000- unless minor or disabled
child (but estate recovery applies)
Resources- Married

Depends on the amount of countable
resources they had as of the first
month of stay in the medical
institution
 Depends on the income of the
Community and Institutionalized
Spouse
 Many couples will spend down their
assets needlessly
 There are many techniques such as:
– Gifting (must do with advice from
–
–
–
–
attorney),
Administrative appeal,
Purchase of annuity,
Purchase exempt assets,
Special Needs Trust
Medical Necessity

Requires a medical disorder or
disease requiring attention by
RN or LVN on regular basis

Does not include inability to
attend to “activities of daily
living” such as bathing,
grooming and eating
Estate Recovery

Recover from Medicaid recipients
the amount expended for their care
 Some Exemptions:
– During lifetime of surviving
spouse
– Surviving child under 21
– Surviving child with blindness or
disability
– Undue hardship (low value
homes)
– Recovery not cost effective
Deficit Reduction Act
 “Look
back period” now
five years for transfers
 Penalty period start delayed
 Cap on value of homestead
(unless exception applies)
 Changes in annuity
requirements- state is now
the remainder bene.
 What are the real life
implications for this?
Why Consider Long
Term Care Insurance?







Medicare provides limited nursing
home coverage
Some of the best facilities do not
take Medicaid
Tax benefits
You want to stay at home
You want to protect your estate for
your family
You can afford the premiums
You want to remain independent!
What is a Care
Manager?






Assists in locating appropriate
placement
Assess needs and situation to
establish a plan of care
Find and secure resources that meet
your needs and budget
Your own personal tour guide
through the maze of healthcare
Monitor care in nursing home care,
assisted living, adult day care, etc.
Saves you time, energy and money,
provides peace of mind
The End!
Christina Lesher
WWW.LAWLESHER.COM
[email protected]
2719 Colquitt
Houston, Texas 77098
713-529-5900