Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Wellness at Brown! Presentation on Elder Care Law: Planning for Incapcity

782 views

Published on

Introductory seminar on Elder Care Law and Medicaid, presented to Brown University's Wellness at Brown! program.

Published in: Law
  • Be the first to comment

  • Be the first to like this

Wellness at Brown! Presentation on Elder Care Law: Planning for Incapcity

  1. 1. HEFFNER & ASSOCIATES ELDER LAW Mark B. Heffner, Esq. , CELA Heffner & Associates 615 Jefferson Boulevard Warwick, Rhode Island 401-737-1600 mheffner@hefflaw.com www.hefflaw.com Planning for Incapacity: Wellness at Brown!
  2. 2. HEFFNER & ASSOCIATES ELDER LAW Disclaimer •Materials are for general education and should not be substituted for consultation with a competent estate planning attorney in your state •Materials presented from the perspective of Rhode Island •Rules and practice vary significantly from state to state and are subject to change
  3. 3. HEFFNER & ASSOCIATES ELDER LAW Lifetime Planning: Health Care Decisionmaking Advance Directive Durable Power of Attorney for Health Care Living Will Selection of Agent Selection of Successor Agent
  4. 4. HEFFNER & ASSOCIATES ELDER LAW Lifetime Planning: Financial Decisionmaking Joint accounts: Be careful! Durable Power of Attorney for finances Determination of Powers to provide Again, selection successor Agent Selection of Agent (aka, “Attorney in fact”) Ex: Gifting and Estate planning
  5. 5. HEFFNER & ASSOCIATES ELDER LAW Lifetime Planning: Financial Decisionmaking Revocable Trust, aka, “Living Trust” Avoids/Reduces “Push-Back” of Institutions with use of Durable Power of Attorney Selection of Trustee & successor Trustee critical Provide no protection for assets for nursing home cost Instead, would need Irrevocable Trust
  6. 6. HEFFNER & ASSOCIATES ELDER LAW Planning for post-death Will—requires probate Selection of Executor—same person generally as agent under financial DPOA Revocable Trust—if “funded” will avoid probate for those assets Note: Need to check beneficiary designations (IRAs, life insurance, annuities), joint titling, as general “trump” Will or Trust provisions
  7. 7. HEFFNER & ASSOCIATES ELDER LAW What happens if long-term care needed? Medicare--limited long term care (LTC) coverage 20 days full payment, up to 80 additional days with co-pay ($164/day) Medicare LTC coverage initially applicable if individual has a three day prior hospital admission & continues to require skilled care After that….
  8. 8. HEFFNER & ASSOCIATES ELDER LAW Private Pay costs for nursing home care What is the average monthly cost of a nursing home in Rhode Island (according to the Rhode Island Department of Human Services)? $9,113/month (approx $290/day) Actual costs range from approximately $7,500/month ($240/day) — $10,800/month ($360/day)
  9. 9. HEFFNER & ASSOCIATES ELDER LAW Public benefits available for long- term care Medicare: (limited) skilled nursing home & (potentially unlimited) home care Medicaid: pays for skilled nursing home and (limited) home & community-based services Veterans benefits: (limited) nursing home and Aid and Attendance benefits
  10. 10. HEFFNER & ASSOCIATES ELDER LAW What is Medicaid? •It is not Medicare! •Medicaid: in addition to general criteria (age, blind, disabled) & needing a level of care, must also fall within financial criteria (assets, income, transfer restrictions) •Medicare: insurance model; no asset or income qualification requirements •Substantial state to state variations
  11. 11. HEFFNER & ASSOCIATES ELDER LAW Resources Excluded (Single Person) •Home (equity value limit: $560K) if “intent to return” •Household goods & personal effects( no value limit, unless exceptional) •Vehicle (limit: $4500, unless used for transportation to medical appts) •Life Insurance ($4000 face limit) •Irrevocable Burial Contract, or funds set aside for burial ($1500) •Funds otherwise available (limit: $4000) Available EVERYTHING ELSE
  12. 12. HEFFNER & ASSOCIATES ELDER LAW Resources Excluded (Married Couple) •Home: no equity limitation if residence of “Community Spouse” (CS) •Vehicle: if used by CS, no limitation on value •CS retains “Community Spouse Resource Allowance” (CSRA)
  13. 13. HEFFNER & ASSOCIATES ELDER LAW Transfers of Assets Any transfer occurring on or after February 8, 2006 is subject to five year lookback period Q: What types of transfers fall within lookback period? A: Uncompensated (UV) transfers--i.e., those for which fair market value (FMV) not received by applicant or the applicant’s spouse Parent gives adult children each $10,000 Uncompensated transfer: $30,000
  14. 14. HEFFNER & ASSOCIATES ELDER LAW Medicaid Planning Techniques Highly individualized—one size definitely does not fit all! • Spenddowns—debts, taxes, burial contracts. • Specialized annuities—married couples only “Crisis planning” techniques include: • “Reverse half a loaf” planning • Many more opportunities exist for married couples; however still “never too late” for single individuals
  15. 15. HEFFNER & ASSOCIATES ELDER LAW Medicaid Planning Techniques Non-crisis, or “pre-crisis” planning techniques include: • Make transfers, incur five year lookback period • Transfers—must be mindful of tax implications, creditors—grantor Irrevocable Trusts useful device. • Durable Powers of Attorney with estate and Medicaid planning authority provided to agent • Again, highly individualized as to what techniques to use & timing of use of techniques
  16. 16. HEFFNER & ASSOCIATES ELDER LAW How to get started Arrange for consultation with competent elder attorney Preparation: provide elder law attorney wi individual family, financial and health information Initial meeting should be at least an hour Expect fee for initial consultation
  17. 17. HEFFNER & ASSOCIATES ELDER LAW National Elder Law Foundation www.nelf.org Locating competent elder law attorney Certified Elder Law Attorney Provides interactive state map of Certified Elder Law Attorneys (CELA) in each state
  18. 18. HEFFNER & ASSOCIATES ELDER LAW Mark B. Heffner, Esq. , CELA Heffner & Associates 615 Jefferson Boulevard Warwick, Rhode Island 401-737-1600 mheffner@hefflaw.com www.hefflaw.com

×