Boston Medicare Attorneys Cohen & Oalican discuss the Deficit Reduction act and its impact on their Elder Law Clients in Boston, Raynham and Andover. On February 8, 2006, President Bush signed the Deficit Reduction Act of 2005. The Deficit Reduction Act of 2005 significantly changes Federal Medicaid laws. The three most important changes concern: 1. The transfer of assets to qualify for Medicaid; 2. Medicaid annuities; 3. Medicaid’s treatment of the primary residence.

1. Medicaid LawsDeficit Reduction Act 2005 The Deficit Reduction Act of 2005 significantly changed Medicaid laws Cohen And Oalican Boston (617) 263- 035 Andover (978) 749-0008 Raynham (508) 821-5599 Boston Elder Law Attorneys http://www.cohenoalican.com

2. Deficit Reduction Act of 2005 On February 8, 2006, President Bush signed the Deficit Reduction Act of 2005 The Deficit Reduction Act of 2005 significantly changes Federal Medicaid laws. The three most important changes concern: The transfer of assets to qualify for Medicaid; Medicaid annuities; Medicaid’s treatment of the primary residence.

3. Transfer of Assets Medicaid, a.k.a "MassHealth," penalizes applicants who transfer assets by imposing one month of ineligibility for nursing-home benefits for every $6,960 (as of 2005) given away. By changing two important aspects of the Medicaid rules, Congress has imposed much stricter penalties than ever before. Under the old rules, Medicaid would review three years (or in the case of trusts five years) of financial statements in order to identify any disqualifying transfers. This is known as the “look-back period.” The new law extends the look-back period to five years for all transfers. The new law also changes the date on which the penalty period begins.

4. Transfer of Assets (con’t.) Under the old rules, the penalty period started when the transfer was made. The new law shifts the start-date of the penalty period to the date when the person is in a nursing home and his or her funds have run out. The new law will not apply to transfers made prior to February 8, 2006. Congress has allowed the states to implement the statute at a later date if they choose to do so, so the effective date in Massachusetts may fall after February 8.

5. Transfer of Assets Example The easiest way to explain the change is by way of an example. Let’s assume Mrs. Smith transfers $20,000 to her grandson on March 15, 2006. On April 15, 2007, Mrs. Smith suffers a stroke and is admitted to a skilled nursing facility. Assume she spends down her assets below $2,000 as of August 2007.

6. Under the old transfer rules, the March 15, 2006, transfer would have made Mrs. Smith ineligible for Medicaid benefits for almost three months, starting March 1, 2006, and ending at the end of May 2006. Under the old rules Mrs. Smith would have been eligible in August 2007. Under the new rules, the transfer penalty would not start until August 1, 2007 and would end in November. The question then arises: How will Mrs. Smith pay the facility if the transferred funds are gone and she is not eligible for Medicaid?

7. Annuities Congress has also changed the annuity regulations. Medicaid allows a spouse whose assets exceed the Medicaid limit to protect those “excess assets” by purchasing an irrevocable, immediate annuity. The old Medicaid rules allowed the spouse to name anyone he or she wanted to receive the remaining annuity payments if the spouse died during the annuity term. Under the new rules, Medicaid requires that annuities name the Commonwealth of Massachusetts as the beneficiary.

8. Annuities (con’t.) Although the revised statute is somewhat ambiguous, it appears that the Commonwealth can only seek reimbursement from the annuity for benefits provided to the community spouse. The new rule does not apply to annuities purchased prior to February 1, 2006. Buying annuities remains an effective strategy to protect assets for the spouse of a nursing home resident; however, the new rules have added a risk to this strategy.

9. The Primary Residence In the past, Medicaid did not count the value of an applicant’s home in determining eligibility. This meant that an individual did not need to sell his or her home, regardless of value, in order to qualify for Medicaid. Under the new rules, however, a house valued at over $500,000 is now counted in determining Medicaid eligibility.

10. Massachusetts has the option of increasing this threshold to $750,000. Under the new rules, a single person whose home is worth more than $500,000 cannot qualify for Medicaid unless he or she agrees to sell the house. Even under the new rules, a house continues to be noncountable if a spouse, disabled or blind child, or child under the age of 21 lives there.

11. Conclusion As you can see, these changes dramatically alter the Medicaid program. Nursing homes will have to work closely with residents and their families to ensure that residents are able to smoothly transition from paying privately to receiving Medical Assistance from MassHealth. As always, our office is available to answer your questions or to provide any assistance you may need.

12. Boston Elder Law Attorneys Boston Medicaid Attorneys Boston MassHealth Attorneys Cohen & Oalican, LLC 617-263-1035- Boston 508-821-5599 – Raynham 978-749-0008 - Andover