2. • ACTIVITIES OF DAILY LIVING (“ADLs”)
– Transferring (Walking)
– Bathing
– Dressing
– Eating
– Continence
– Toileting
MEDICAID:
Activities of Daily Living

3. • Healthy Married Couple: When some aging
illness is diagnosed or no earlier than 70s
• Single Person with No Kids: NEVER (Private pay
caregiving is better than Medicaid care)
• Disabled Family Member: Immediately
• Disabled Minor Family Member: Prior to them
attaining age 18
When To Start Medicaid Planning?

4. The type of Medicaid benefit you receive determines “look back” periods (I.e. the
penalty for transferring assets)
Home / Community Care
Personal care, physical therapy, home
health care and home health aid services;
clinical or out-patient basis; includes
physicians, dentists, pharmaceutical,
nursery
Institutional Care
Hospitals, medical facilities, nursing
homes
Does NOT usually pay for “Assisted
Living facilities”
Types of Medicaid

5. ASSETS
$14,850 in the recipient’s name
EXCEPTIONS:
• “Burial Allowance” of $1,500
• Life Insurance: $1,500 cash value
• Personal Property (unlimited)
• Client’s House (ONLY for Home & Community care) IF
UNDER $828,000
• Supplemental Needs Trusts
• Medicaid Trusts
•Retirement Plans (IRAs) are exempted from assets if
they are in “payout status” (Required Minimum
Distributions or Separate and Equal Periodic Payments
if recipient is under age 59 ½), in which case payments
are included in Income
MONTHLY INCOME
HOME CARE: $825 per month
• Any excess income must go to the
recipient’s “SPEND DOWN”
o Often goes to a “POOLED TRUST”
INSTITUTIONAL: ALL of the recipient’s
monthly income in excess of $50 must be
paid to the Nursing Home to offset
Medicaid payments
Financial Eligibility Requirements for an Individual

6. Medicaid Asset / Income Limits
and Exceptions
One Sick Spouse Two Sick Spouses
Resource
Limits
Sick Spouse: $14,850
Well Spouse: $74,820 – $119,220
- $21,750
Income
Limits
Sick Spouse: $825 / mo.
Well Spouse: $2,980 / mo.
- $1,209 / mo.
Exceptions
(see next
slides)
Retirement Plans – if RMD or SEPP
Residence – many rules
Burial Allowance - $1,500
Irrevocable Burial Trust – Unlimited
Life Insurance – only $1,500 of cash value
Medicaid Trusts & Supplemental Needs Trusts

7. Department of Social Services and Medicaid impose a “Lookback Period” for transferring
assets outside of the proposed recipient’s name
Home & Community Care
3 MONTH Lookback
One Strategy:
Transfer all financial assets (except $14,850)
to a non-spouse, wait one month for bank
statements to be updated, then apply for
Home Care.
DOWNSIDE: If the recipient needs Nursing
Home care… the 5 Year Look back rule
applies
Nursing Home
5 Year Lookback Period, and the Homestead can be
attached by Medicaid
EXAMPLE: In January, 2011 Mary transfers her Coop and most of her
assets to her son Joe (total of $280,000), and applies for Home Care. In
March 2015 Mary goes to a Nursing Home. She failed to make the 5
year Lookback (4 years & 2 months). Nursing Home Care in Manhattan
equals approximately $12,000 per month.
$280,000 (amount gifted) = 23.3 MONTH
$12,000 (monthly benefit) “Penalty Period”
Medicaid will not pay Mary’s Nursing Home benefits for 23 months.
..and Joe is liable. Joe should have paid for Mary’s care for 10 more
months to get through Mary’s Lookback Period.
Transfer Penalties

8. What You Don’t Do, or Do Wrong, HURTS Your
Disabled Beneficiary
8
- Examples:
- No Will = No choice of who gets what
- Improper Beneficiary Designation = Leaves funds
to beneficiary outright
- Worst: Leave Nothing to Beneficiary out of fear!!!
- The Result:
- Beneficiary’s assets are too high, and get kicked
off of “Needs-Based” programs
- May have to PAY BACK Medicaid, other programs

9. Medicaid Time Bombs
• Commercial Annuities
– Non-Qualified: LIFO requires tax payments
– Annuitized: extra income adds to spend down
• Large Life Insurance Cash Values
– $1,500 limit causes potential income issues, even though FIFO
• Coops:
– Don’t like 1st party money (Medicaid Trusts, 1st Party SNTs)
• New York Real Estate
– Often too expensive to be exempt under $828,000 Community
Care exclusion
– Not large enough to house a sibling or child caregiver

11. • The “Community Spouse” is entitled to some assets and income, but they are limited
• If spouse is in a Nursing Home:
– $3,022.50 of income per month
– $74,180 - $120,900 of resources
• If s spouses have Home Care:
– Combined income of $1,192 per month
• During the Medicaid Application process the well spouse may exercise a “Spousal
Refusal” to avoid inclusion of his/her assets and income
– Medicaid may accept this (varies county to county), but will have a claim against the well spouse
when he/she dies
• New “Spousal Impoverishment” rules avoid liens
What About the “Well” Spouse?

12. Retirement Plan Exceptions
• For Medicaid Participant
– Excluded as a Resource, but MUST be in payout
• RMD or SEPP payments
– Included as Income instead
• Thereby adding to spenddown
• For “Well” Spouse

13. Residence Exceptions
• Primary Residence under Community Care
• Spousal Refusal / Impoverishment
• Sibling Caregiver
• Child Caregiver
• Parent / Child dual Medicaid recipient

14. Trust Exceptions
• MAPTs
• SNTs
• Pooled Trusts

15. Spousal Refusal

16. Spousal Impoverishment