Medicaid Planning

[golfgal]

Being poor doesn't mean anything for having Medicaid. Yes the reason you go Medicaid is because you have no money left but that doesn't mean you are poor. No one in this day and age has any money let alone when you get older have any money set aside. You could have all the money in the world and then spend it in a nursing home and then have to go on Medicaid. So what. Alot of people including the elderly are on Medicaid whether in the community or in a nursing home. It just means you need help with your healthcare and costs.

And just because you buy a long term care insurance does not mean it covers everything. Just like an insurance premium you have - you have to really read the fine print. Yeah some are better than others but that doesnt mean it covers everything. I have yet to see one that does. I mean yes its a good investment if you can afford it for now but eventually no its not. I try to tell people just read the fine print on everything. Just because it looks good doesnt mean it is. Always compare plans.

For my parents (my dad is retiring soon) i have already told them - Use Medicare - everyone takes it - no referrals no nothing. Just get a secondary in which they have AARP which is usually good. Right now they have PC - which has copays. I should know - I have it too. But in different situations those copays are high and some are low. Hence why I say use Medicare.

But anyway -- its not up to anyone but the people making the decisions. They have to make the smartest decision they feel they can make at that time and thats it. Good Luck.

Medicare is the health care plan for seniors, MediCAID is nursing home care for the poor. They are two totally separate things-they just happen to have similar names. Medicare covers dr's and hospital bills (with the appropriate supplements). Medicaid requires people to be poor by either not having any money to begin with or to spend down all their assets to become poor to then go live in a nursing home on a small monthly allowance ($80/month here). Each state has a look-back period where if you have given away money in that time they can require you to pay that amount toward your care before they will pay. This is what the OP is talking about, NOT the health care plan.

 

[disneyjunkie]

Add me to the agree with Dawn list.

I think these medicaid planners are in the same boot as those who lie and cheat to collect welfare.

 

[disneyjunkie]

Add me to the agree with Dawn list.

I think these medicaid planners are in the same boot as those who lie and cheat to collect welfare.

 

[FinallyBoughtDVC]

I want a level playing field. I feel the same way about college financial aid.

Two cases:
My dh's elderly aunt needed nursing home care at 88. She had no children, her husband had predeceased her. We were her only family. We wanted her to move in with us, she didn't want that at all. She had worked hard, paid her taxes and saved money. She went on one vacation as a senior citizen. She lived modestly. She wanted what money she had saved (and paid taxes on) to go to our children's education. She moved into the nursing home and to the tune of $9200 a month. She gave my dh power of attorney to pay her bills. After 3 1/2 years, her life savings were completely gone. She died one month later. There was just enough left to bury her. After spending over $350,000 in nursing home care, the nursing home told my husband that if we threw out our aunt's personal belongings, we'd have to pay a $25 dumpster fee.

She befriended a woman who was in her 90s. This woman traveled the world and spent every nickel she had. She got a free ride.

Case two: Our friends...they live in our neighborhood in a home valued the same as ours. Our family incomes are nearly identical. We each have three children. We saved and played by the rules and set up accounts, etc. They traveled the world, spent every nickel they had.

When it came time for our oldest children to go to college (they were born 5 days apart), we both filled out FAFSA. We were told we had enough money to pay $46,000 a year out of pocket. They were told they basically could get a free ride for their daughter. I can tell you, I really wished I had taken those extra trips every year and redid my kitchen twice, etc.

When people like us start seeing people like them and my dh's great aunt's friend getting free rides after living the high life...and we play by the rules, it makes you stop and think. You can bet your bippy my dh and I will plan and have already consulted (at 45 and 48 yo) with a specialist in elder law to stay current on our knowledge of the law and what we can do to protect our assets.

Fool us once, fool us twice...no more. Give me a level playing field and I'll play the game fairly. But, we haven't been given one. I can tell you this - there was not one patient in that nursing home (which was lovely) who got one less drumstick or one less nurse's visit because they were medicaid patients.

So, while I definitely see everyone's point of view...and, I do, the laws have been set up this way. And, having had to write out those checks each month, knowing full well how much my dh's aunt gave up to save that money, all the while knowing others were getting a free ride...well...I think you have to live it to understand it. It broke our heart to know that she died thinking she had worked her whole life and thought her money was going to her niece and nephews and it didn't. We never had the heart to tell her there was nothing left.

 

[DisneyBamaFan]

OT but, IMO, the government has no place in long term elderly care unless daily medical assistance is required. Families should be caring for their elderly. When we stopped caring enough about our elderly to keep them until they passed, our society began to crumble.

Nursing home care is not loving care, though many who work in the industry try to make it so. I cannot imagine doing this to my mother. Take care of your elderly and the money can all stay in the family...

 

[FinallyBoughtDVC]

OT but, IMO, the government has no place in long term elderly care unless daily medical assistance is required. Families should be caring for their elderly. When we stopped caring enough about our elderly to keep them until they passed, our society began to crumble.

Nursing home care is not loving care, though many who work in the industry try to make it so. I cannot imagine doing this to my mother. Take care of your elderly and the money can all stay in the family...

That's simplistic. We begged her to move down here. It would have been much easier for us rather than commuting weekly 3 hours each way to see her. She didn't want to leave the area where she had lived her entire life. Her parents had been founders of the nursing home where she lived. That was part of her life plan, in her mind. Work hard, save her money, own her own home, and when it became too much, move into the nursing home.

And, the reality is, my dh and I both work full-time. We could never have provided the round the clock care she needed. We would have spent nearly the same amount of money in therapists, nurses, modifying our home, etc. And, she would have hated it. She lived her whole life to make her own decisions. It was her choice. Who am I to tell her I'm going to start treating her like a child and make decisions for her?

In any event, it's a simplistic view that doesn't take into account all situations, personalities and life choices. I would have loved to have had her here. She was a blast. I really miss her.

 

[DisneyBamaFan]

...In any event, it's a simplistic view that doesn't take into account all situations, personalities and life choices. I would have loved to have had her here. She was a blast. I really miss her.

Yes, it is simplistic, and I am sorry for your loss.

No single strategy works for everyone. There have always been homes for elderly people who either prefered living with other elderly people in their last few years, needed constant care, or simply had no family - but the government didn't fund it. But, more importantly (IMO), we lost the wisdom of our elders when we began pushing them into nursing homes. They used to help us raise our children. They used to help us make decisions in our lives. Now, they are "inconvenient"...

 

[DVC~OKW~96]

OT but, IMO, the government has no place in long term elderly care unless daily medical assistance is required. Families should be caring for their elderly. When we stopped caring enough about our elderly to keep them until they passed, our society began to crumble.

Nursing home care is not loving care, though many who work in the industry try to make it so. I cannot imagine doing this to my mother. Take care of your elderly and the money can all stay in the family...

This statement, althought I understand it's intent (I hope) is one of the most damaging things that can be said to a family who is facing the use of nursing homes or assisted living facilities for their loved ones. Not everyone is admitted to those types of care facilities because their families won't care for them.

People are admitted for any number of reasons and to summarily dismiss those many and varied reasons is to be not only simplistic, but implies that because a family can't take care of a loved one at home, they are somehow "lesser" than those who can.

Medicaid planning is necessary in some respects. A good elder law attorney will know the applicable laws for a given state, and yes each state (after complying with CFR within the context of CMS) will define it's own application of Medicaid.

I too prefer to see elders spend their money on themselves, but that is not the general concept of many Americans. All too many "children" expect to inherit their parents money/estate and do not look at spending parental earnings/savings on care for the parents as a good use of "their inheritance."

I see it every day.

I have no easy simple answers, as each situation is very complex and contingent upon the specifics of that family alone.

If there are laws that allow people to plan for the legal use of Medicaid, then no one should be faulted for complying with those provisions.

 

[Pixie Dust for Me!]

Please, let me share with you my story in hopes that it may temper the criticism of those who have had to make a choice they didn't want to make and place their parents or grandparents into a nursing home.

I will agree that many years ago it was the "norm" for multiple generations of families to live under one roof, just as it was normal for children to live their entire lives in the same town they were born in. But times have changed (some for the better...some not) and people live much longer today.

While I would have loved to have my grandparents move in with me, the fact is I had a small child of my own, worked full-time, and couldn't find the resources necessary to care for them at home (even if I quit my job!).

Grandma had rapidly progressing alzheimer's disease (she was beginning to wander and I was fearful for her safety) and my grandfather had lost his eyesight to macular degeneration and most of his hearing as a result of not having protected his hearing at a younger age. In short, I had one that couldn't remember and one that couldn't see at all or hear well and that was in congestive heart failure -- but sharp as a tack!

My grandfather couldn't bear to be separated from his wife of nearly 60 years so I placed them together at a well-regarded nursing home and saw them every day or every other day. Six months later, my grandfather passed and my grandmother lived on for four and half more, very long, years. In the end, her alzheimer's took not only her memory, but every last shred of dignity. It wasn't so bad that she didn't remember me after a year of being in the home (I became her "hairdresser" as I came in to wash, brush and braid her hair every other day) -- what was bad was when she couldn't feed herself any longer, couldn't use the restroom, babbled like an infant, and was confined to bed as she couldn't remember how to walk or sit.

So, while yes, we used to care for our elderly at home many years ago -- please remember that it was another time. I'd also ask that you remember that medical care wasn't as focused on life preservation at that time so people just honestly didn't live as long as my grandparents did. In the end, after paying nearly $10,000 per month for alzheimer's care for my grandmother, she died penniless and on Medicaid (Medicare does not pay for long-term care or "custodial" care).

In my mind, the true "crime" isn't that I wasn't able to care for her at home -- the true crime is that our health care system isn't set up to support families as they care for the elderly. I'm sorry but spending more than $500,000 to care for my grandparents in nursing home care was (and still is) absurd!

Could I have "taken" that money and cared for them at home -- no. Even if I quit my job, I simply couldn't be awake 24 hours per day and provide the constant care and monitoring my grandmother needed (it's amazing but some who have alzheimer's need very, very little sleep!). What's even sadder is that our health care system won't provide a level of support or resources to help those who are trying to care for someone at home (I looked -- I could get 4 hours of "respite" care per week -- no more than 18 hours per month!) Hiring a "night nurse" for 10 hours per day, seven days per week, would have cost just as much as having them in a nursing home 24 hours per day (did you know you pay time and a half for overnights?).

So, as my parents are now aging, I understand their desire to "preserve" some assets for their children and grandchildren instead of giving it all away to a nursing home. I'm not saying that intentionally setting oneself up to be Medicaid eligible is right -- but neither is paying $10,000 per month for nursing home care! If we're talking about "morally right and wrong" -- believe me I think it's just as wrong to violate the "spirit" of the law on this one as it is for us as a society not to have a health care policy in place that puts families into this circumstance! It's one of the many reasons why we need some type of healthcare reform in this country.

Just my "been there, done that" perspective -- and I fear I will be "doing it again" much sooner than I want.

K

 

[Pixie Dust for Me!]

Oh, and by the way, administering medication, and providing "custodial" care (changing diapers, etc.) is not considered "daily medical assistance" under the current Medicare and Medicaid laws.

(I'll also add that neither is administering food through a feeding tube -- which I was shocked to read but have fortunately never had to experience -- isn't considered "medical" care either!)

 

[DisneyBamaFan]

...I'm not saying that intentionally setting oneself up to be Medicaid eligible is right -- but neither is paying $10,000 per month for nursing home care!

You did the research and found that it costs this much for nursing care, but you think that nursing homes are wrong for charging this much? And they have to pay additional costs for the facilities and food.

Do you think that nurses are charging too much? Not sure where you think costs should be cut?

Yes, the elderly are living longer, and that drives up care costs by putting a volume strain on the system, but when people steal from the government like this thread proposes, it shifts that cost burden onto everyone else. It isn't like the cost disappears when the family's money runs out. And the government doesn't have any money to spend on this care. It comes from us.

So, when a person steals like this, they are stealing from you and me. Personally, I don't like thieves...

 

[Pixie Dust for Me!]

I hope you never have to face what you criticize others for. I don't advocate "stealing" nor do I enjoy thieves...but if you think that nursing homes aren't making a very handsome profit (some while providing substandard care), then you haven't walked in the same shoes I've been in...and I hope that you never are.

 

[DisneyBamaFan]

I hope you never have to face what you criticize others for.

Stealing from the government/taxpayers? Goodness, let's hope that I never have to steal from anyone.

I do not criticize others for necessarily placing their parents into a nursing home. If you get that from my post, it is because of what you bring to the table. I do know, however, that I would never help my mother "dispose" of her assets (aka, medicaid planning) before moving into a nursing home...

 

[golfgal]

Please, let me share with you my story in hopes that it may temper the criticism of those who have had to make a choice they didn't want to make and place their parents or grandparents into a nursing home.

I will agree that many years ago it was the "norm" for multiple generations of families to live under one roof, just as it was normal for children to live their entire lives in the same town they were born in. But times have changed (some for the better...some not) and people live much longer today.

While I would have loved to have my grandparents move in with me, the fact is I had a small child of my own, worked full-time, and couldn't find the resources necessary to care for them at home (even if I quit my job!).

Grandma had rapidly progressing alzheimer's disease (she was beginning to wander and I was fearful for her safety) and my grandfather had lost his eyesight to macular degeneration and most of his hearing as a result of not having protected his hearing at a younger age. In short, I had one that couldn't remember and one that couldn't see at all or hear well and that was in congestive heart failure -- but sharp as a tack!

My grandfather couldn't bear to be separated from his wife of nearly 60 years so I placed them together at a well-regarded nursing home and saw them every day or every other day. Six months later, my grandfather passed and my grandmother lived on for four and half more, very long, years. In the end, her alzheimer's took not only her memory, but every last shred of dignity. It wasn't so bad that she didn't remember me after a year of being in the home (I became her "hairdresser" as I came in to wash, brush and braid her hair every other day) -- what was bad was when she couldn't feed herself any longer, couldn't use the restroom, babbled like an infant, and was confined to bed as she couldn't remember how to walk or sit.

So, while yes, we used to care for our elderly at home many years ago -- please remember that it was another time. I'd also ask that you remember that medical care wasn't as focused on life preservation at that time so people just honestly didn't live as long as my grandparents did. In the end, after paying nearly $10,000 per month for alzheimer's care for my grandmother, she died penniless and on Medicaid (Medicare does not pay for long-term care or "custodial" care).

In my mind, the true "crime" isn't that I wasn't able to care for her at home -- the true crime is that our health care system isn't set up to support families as they care for the elderly. I'm sorry but spending more than $500,000 to care for my grandparents in nursing home care was (and still is) absurd!

Could I have "taken" that money and cared for them at home -- no. Even if I quit my job, I simply couldn't be awake 24 hours per day and provide the constant care and monitoring my grandmother needed (it's amazing but some who have alzheimer's need very, very little sleep!). What's even sadder is that our health care system won't provide a level of support or resources to help those who are trying to care for someone at home (I looked -- I could get 4 hours of "respite" care per week -- no more than 18 hours per month!) Hiring a "night nurse" for 10 hours per day, seven days per week, would have cost just as much as having them in a nursing home 24 hours per day (did you know you pay time and a half for overnights?).

So, as my parents are now aging, I understand their desire to "preserve" some assets for their children and grandchildren instead of giving it all away to a nursing home. I'm not saying that intentionally setting oneself up to be Medicaid eligible is right -- but neither is paying $10,000 per month for nursing home care! If we're talking about "morally right and wrong" -- believe me I think it's just as wrong to violate the "spirit" of the law on this one as it is for us as a society not to have a health care policy in place that puts families into this circumstance! It's one of the many reasons why we need some type of healthcare reform in this country.

Just my "been there, done that" perspective -- and I fear I will be "doing it again" much sooner than I want.

K

As a result of your experience have you purchased long term care insurance for you and your DH so your kids don't have to go through the same thing, right?? For that same $10,000 for ONE year of care you can pay years and years of premiums. You have found for the amount of care required that $10,000 is not really out of line.

 

[FinallyBoughtDVC]

As a result of your experience have you purchased long term care insurance for you and your DH so your kids don't have to go through the same thing, right?? For that same $10,000 for ONE year of care you can pay years and years of premiums. You have found for the amount of care required that $10,000 is not really out of line.

It's $10,000 a MONTH, not a year. That was upstate New York. It's my understanding that nursing homes here on Long Island are over $12,000 a month. That's $144,000 a year.

As for long-term insurance policies, most would never have come close to paying for the time my husband's great aunt spent in a nursing home.

As for me and my family, we have multiple life insurance policies, pay for our own health insurance (we are self-employed), pay for our employees' health insurance, disability insurance, etc.

Long-term care policies have caps and are, for the most part, a bandaid, when considering the astronomical costs of nursing home or in-home nursing care. I have yet to seen one that would cover more than half the daily cost of a nursing home in our area. I have yet to see one that didn't have a cap that was substantially more than one year of nursing care. Until then, they are, in my opinion, a waste of money.

Until there are better remedies, more equity and fairness in the system and real solutions, we will utilize the services of our attorney and financial planner to safeguard and protect our family's assets, within the scope and intent of the law.

This is definitely a situation where one must walk in the shoes to fully understand. It's very easy to sit on a high horse and declare people to be "thieves" - when you know how hard someone has worked, what they sacrificed to save, what their intent was for those they love and to see a lifetime - 70 years of savings - gone in three short years is mindboggling and heartbreaking.

 

[mom-2greatkids]

when you know how hard someone has worked, what they sacrificed to save, what their intent was for those they love and to see a lifetime - 70 years of savings - gone in three short years is mindboggling and heartbreaking.

But why should taxpayers be responsible for footing the bill? IMO "Medicare planning" is nothing more than shifting your responsibilities to others.

 

[Junebugwv]

I care for my 89-year-old mother and her older sister. They both prepared well for their old age, making sacrifices, working hard for many years so they would have security in their latter years. I think that is awesome.

My aunt has a LTC policy and it has not been of any use so far. When she was ready to be released from the rehab unit of a nursing home after a broken hip ( the same day my mom was discharged from the same unit after a fall and broken ribs) I had to make arrangements for their care. I was able to find caregivers to stay with them in their home or my home for $8-10 an hour. Of course, her LTC would not cover that because the caregivers were not from a licensed agency. An agency charges more than triple which would eat up the TLC daily maximum in a about 4 hours.

My husband and I purchased TLC this year and have been very particular in what we chose for coverage. This has been an eye-opener for us.

 

[bumbershoot]

OT but, IMO, the government has no place in long term elderly care unless daily medical assistance is required. Families should be caring for their elderly. When we stopped caring enough about our elderly to keep them until they passed, our society began to crumble.

Nursing home care is not loving care, though many who work in the industry try to make it so. I cannot imagine doing this to my mother. Take care of your elderly and the money can all stay in the family...

My MIL would disagree. She's from Korea, and they have no safety net (at least not the last time she asked anyone from her family, all of whom still live in Korea). It's ALL on the family. Actually, it's all on the first born son (if there is one, or if the son is old enough). That's who parents are expected to move in with when they can't take care of themselves anymore. And the first born son gets to take care of them. Along with his wife of course (sure did shock the heck out of my MIL when my BIL's then-boyfriend outed him). Forever and ever.

I married a second born son. Now my BIL has distanced himself from the family, and I am so afraid of my relatively evil MIL wanting to move in with us....thankfully she's very Americanized now, and feels that the way they do it in her home country is not OK, b/c just too much can happen.

If you don't have kids, if your kids hate you, if your kids move to America (like she did...thankfully for her mom she wasn't the eldest) and you don't want to, if your kids are broke, if your kids die....if if if. In Korea, there's no safety net. If you get old alone...there's...nothing. (according to MIL last time she talked about this with her family)

That doesn't sound like much fun at all, and I'm glad that the US has something to catch old and sick people when they fall. (and that's super-hard for me to say, b/c I'm a wanna be expatriate and have been for over a decade!)



And I thought I'd re-post this, because it was really helpful.

i supervised a medicaid unit and i saw far too many people who needed it desparatly find that what they thought was correct pre-planning on their part in actuality make them ineligible whereas if they had left things the way the were they would have been totaly eligible.

best bet is for a person to go to a attorney who SPECIALIZES in elderlaw and MEDICAID planning. they know the regulations and can give the best advise. with any lawyer who does'nt specialize in it you run the risk of them setting up stuff so that you will NEVER be eligible (i saw irrevocable trusts that were set up wrong and made people ineligible FOR LIFE).

the medicaid laws are very liberal despite public opinion to the contrary-one of the classes myself and my staff took (and this was 15 years ago so adjust up for inflation) was titled (realy-i'm not kidding) "how a couple with one million dollars in assetts can be eligible to medicaid" 8 hours of training in all the different types of assetts a person can have that have to exempted, have to be allocated in certain ways for one spouse, in certain ways for the other, stuff you could only count a certain percentage of....it's an insanely complicated program.

BUT-it's the only "public assistance" program i ever administered where the regulations said that the job of the eligibility worker was to FIND eligibility for an applicant (we honestly had to tell people how to move and shift asetts within the laws in order to create eligibility).

 

[golfgal]

It's $10,000 a MONTH, not a year. That was upstate New York. It's my understanding that nursing homes here on Long Island are over $12,000 a month. That's $144,000 a year.

As for long-term insurance policies, most would never have come close to paying for the time my husband's great aunt spent in a nursing home.

As for me and my family, we have multiple life insurance policies, pay for our own health insurance (we are self-employed), pay for our employees' health insurance, disability insurance, etc.

Long-term care policies have caps and are, for the most part, a bandaid, when considering the astronomical costs of nursing home or in-home nursing care. I have yet to seen one that would cover more than half the daily cost of a nursing home in our area. I have yet to see one that didn't have a cap that was substantially more than one year of nursing care. Until then, they are, in my opinion, a waste of money.

Until there are better remedies, more equity and fairness in the system and real solutions, we will utilize the services of our attorney and financial planner to safeguard and protect our family's assets, within the scope and intent of the law.

This is definitely a situation where one must walk in the shoes to fully understand. It's very easy to sit on a high horse and declare people to be "thieves" - when you know how hard someone has worked, what they sacrificed to save, what their intent was for those they love and to see a lifetime - 70 years of savings - gone in three short years is mindboggling and heartbreaking.

Obviously you haven't looked into LTC then. There are policies out there that do NOT have caps and as a business owner you have some great tax advantages paying LTC premiums. Our policy would EASILY cover what you paid. We have a $330/day policy with a lifetime benefit, with increasing daily benefit annually. That is about $10,000/month in coverage-exactly what you need. We could have gotten a policy for twice that coverage but the $330/day is the average cost of nursing home care in our state so we went with that. As a business owner I get to deduct a good portion of our premiums AND our state gives us a small deduction on our personal taxes. If I were a C-Corp the premiums would be 100% deductible. You need to buy from a good company. We looked into some other companies and yes, their policies wouldn't come close to doing anything. You may consider them a waste of money but what did you just go through with the nursing home-that wasn't a waste??

If your financial planner and attorney aren't pushing you to buy LTC you need to find someone that understands the policies and get some help with them.

 

[FinallyBoughtDVC]

But why should taxpayers be responsible for footing the bill? IMO "Medicare planning" is nothing more than shifting your responsibilities to others.

We have planned and saved and played by the rules all along. I have paid into that system, more than most. I will protect my family's interests, our business interests (which also includes multiple employees and their families).

We will pay for our own care, but we will not allow it to bankrupt us. If such catastrophic care is needed that will completely drain our family's resources, we will be prepared for that.

If either of us need nursing home care, we will pay for that so we have choice of facility, which one does not have with Medicaid - in fact, if a patient is in a nursing home and is hospitalized during their stay, they can be placed into a completely different nursing facility without any choice. We've worked too hard all our lives to lose our right of choice and we will pay for that.

However, our assets will be protected if long-term or unforeseen events take place. While we plan to pay our way until the day we die, we will plan for the absolute worst case scenario - and if that means that some of the hundreds of thousands of tax dollars I've paid over the years come back in my direction, then so be it. I'm only 45 years old - I can't even begin to imagine what costs will be, what the law will be, what programs will be in place.

My point is - the law is set up to allow people to plan for their futures, to have these discussions with their children and children's children. I think it's disgraceful that in a country such as ours, where we are told to work hard, pay taxes, invest in the American dream, that a lifetime can be swallowed up in three years because those who screwed up get a free ride and those who did the right thing pay through the nose.

The law is set up to help those of us who do the right thing protect that for which we have worked so hard. I intend to pay my way, and, I'm sure, the ways of others, for the rest of my life. But, if something unforeseen happens, I will not allow my lifetime of hardwork disappear in the blink of an eye.

I am really only repeating myself at this point. I think those that have actually lived through a real life situation and watched how the system works have a much different viewpoint than those who have not. It's just unbelievable to see how completley idiotic and illogical the entire system is.