Estate recovery allows states to recoup Medicaid costs from a recipient's estate after death. It applies to those over 55 who received long-term care through Medicaid. The presentation discusses how estate recovery works, which assets it applies to like bank accounts and homes, and ways for patients and families to protect assets like using a ladybird deed for the home and trusts for other property. It also notes estate recovery could impact businesses by incentivizing longer home care or selling homes for liquid assets.

1. ESTATE RECOVERY IS HERE: HOW TO HELP PROTECT YOUR PATIENTS AND THEIR FAMILIESP. Haans Mulder, JD, MST, CFP®Cunningham Dalman, P.C.321 Settlers RoadHolland, MI 49423(616) 392-1821phmulder@holland-law.com

2. BackgroundAttorney and Partner at Cunningham Dalman, P.C.Have a Masters in Tax (MST), CFP® and specialize in estates/elder law and business planningServing the Holland area since 1900

3. BackgroundCunningham Dalman, P.C. has been serving the lakeshore since 1900We have 15 attorneys specializing in all areas of the lawServing the Holland area since 1900

4. OverviewDiscuss the Medicaid rules and processCover the what, who, when, where, and how’s of Medicaid…. What is estate recovery and why is it important to your patients and their familiesServing the Holland area since 1900

5. OverviewWhat types of assets does estate recovery apply toHow it might impact your businessHow do your patients and their families protect against itServing the Holland area since 1900

6. What is Medicaid?It is a state and federal program that pays for medical treatment (including long term care)Oftentimes confused with Medicare Serving the Holland area since 1900

7. When does Medicaid apply?Historically, it only paid for nursing home care In certain counties (that have the MI Choice Waiver program), it will pay for care in someone’s home or in an assisted living facilityServing the Holland area since 1900

8. Who does Medicaid apply to?Applies to people who are 65 years or older, blind, or disabledMust satisfy the medical requirements (level of care assessment)Need to meet the income and asset testsServing the Holland area since 1900

9. Who does Medicaid apply to?A patient’s monthly income cannot exceed the monthly cost of the nursing home ($6-7,000 in this area)For the Waiver program, a patient’s income (not a spouse) must be less than $2,022/monthServing the Holland area since 1900

10. Who does Medicaid apply to?The asset test requires that a single person cannot have more than $2,000 in countable assetsA patient can keep his or her home (as long as its not in a trust) as well as a vehicleServing the Holland area since 1900

11. Who does Medicaid apply to?Asset test allows a married couple to keep their home (again, if it’s owned properly), a vehicle, and one-half of their other assets (up to a maximum of $109,560)Serving the Holland area since 1900

12. What is estate recovery?It is a process that the State of Michigan gets reimbursed for the Medicaid services it has paid forIt does not put a lien (i.e. Medicaid lien) on exempt assets during a patient’s life or force a sale Serving the Holland area since 1900

13. What is estate recovery?It applies to people age 55 years or older who have received Medicaid (i.e. long term care) servicesCovers Medicaid services back to September 30, 2007Serving the Holland area since 1900

14. What assets does estate recovery apply to?It only applies to assets that have to be probatedThat has the potential to include all assets (house, bank accounts, investments, vehicle, personal property, etc.)Serving the Holland area since 1900

15. What assets does estate recovery apply to?But…the only assets that are typically left are: bank account, personal property (including vehicle), and a patient’s houseThe house will be the most significant asset, but do not lose sight of the othersServing the Holland area since 1900

16. What effect might this have on your business?Estate recovery might incentivize patients to stay at home longerPatients might be more likely to sell their house and have more liquid assets for their careServing the Holland area since 1900

17. How do people protect against estate recovery?The most effective way to protect the house is with a “ladybird deed”The house remains an exempt asset during the Medicaid recipient’s lifeThe costs and hassle of probate are avoidedServing the Holland area since 1900

18. How do people protect against estate recovery?What about other assets besides the houseThe patient should make sure those assets avoid probate (i.e. having a trust named as owner, naming a beneficiary, etc.)Serving the Holland area since 1900

19. Some other things to be concerned aboutWhen a single person is on Medicaid, he or she can keep the houseHowever, he or she will not be able to use Social Security and other income to pay the house expensesServing the Holland area since 1900

20. Some other things to be concerned aboutThis typically means that a child or beneficiary must pay these expensesChildren should protect their right to be reimbursed by executing and recording a mortgage against the houseServing the Holland area since 1900

21. Some other things to be concerned aboutThis gives a child’s reimbursement claim higher priority than the State of Michigan’s estate recovery rightA child will get paid when the house sells Serving the Holland area since 1900

22. Some other things to be concerned aboutYou should make sure the Medicaid recipient has signed a financial (also known as a general durable) power of attorneyThat way, the agent can execute the mortgageServing the Holland area since 1900

23. This is subject to change so you have to stay informed… Serving the Holland area since 1900

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25. Questions……Serving the Holland area since 1900

26. Thank YouP. Haans Mulder, JD, MST, CFP®Cunningham Dalman, P.C.321 Settlers RoadHolland, MI 49423(616) 392-1821phmulder@holland-law.commary@holland-law.comwww.holland-law.comServing the Holland area since 1900