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MEDICAID home admission in
PLANNING: BEFORE a presentation to
IT'S TOO LATE the Massachusetts
Alzheimer's
Course Outline Association Map
Through the Maze
Working with conference in Comments from people who attended
Medicaid's 5 year Marlboro, Attorney Roberts’ presentation at the
look back period is Massachusetts on 2008 Map Through the Maze
challenging, but May 14th. Conference
spend down and
impoverishment of If you would like
an elder are not the Attorney Roberts to
only options when a present this 90
nursing home minute course to
admission appears your group of
to be inevitable. organization, please
call
Attorney Roberts
Return to our elder law website:
explained how 413 567-5600 MassHealthHelp.com or
Medicaid planning
can save assets, and our Estate Planning website:
provide resources EstatePlansPlus.com
for care that will
delay or altogether
prevent a nursing
LAW OFFICE OF JOHN L. ROBERTS, LONGMEADOW, MASSACHUSETTS ● (413) 567-5600 ● MassHealthHELP.com
1. Single The house is non-
countable and can be
130 CMR 520 (MassHealth Financial Eligibility Regulations)
Individuals. transferred to: 520.007(G)(8): House is countable, unless occupied by:
(i) a spouse;
Medicaid ► sibling with a legal (ii) a child who is under age 21 or who is blind or permanently and totally
disabled;
interest going back 1 year (iii) a sibling who has a legal interest in the home and who was living there for a
Basics for every ► caregiver child, who
saved the need for nursing
period of at least one year immediately before the applicant's or member's
admission to the medical institution;
Applicant. home for 2 years or more
(highlighted in the box)
(iv) a son or daughter who was living in the applicant's or member's home for a
period of at least two years immediately before the date of the applicant's or
member's admission to the medical institution, and who establishes to the
satisfaction of the MassHealth agency that he or she provided care to the applicant
Medicaid planning saves Any assets can be or member that permitted him or her to live in the home rather than in a medical
exempt assets, and transfers transferred to a: institution; or
assets to exempt people. An (v) a dependent relative. A dependent relative is any of the following who has
understanding of these tools ► disabled child any kind of medical, financial, or other dependency: a child, stepchild, or
will help you provide hope for grandchild; a parent, stepparent, or grandparent; an aunt, uncle, niece, or nephew;
► trust for disabled person a brother, sister, stepbrother, or stepsister; a half brother or half sister; a cousin; or
caregivers and family under age 65 an in-law.
members who may feel like ► pooled trust for the
life is spinning out of control. nursing home resident 520.019(D) Permissible Transfers of resources:
(3) transfers to the nursing-facility resident's permanently and totally disabled or
Most people are aware of the blind child or to a trust, a pooled trust, or a special-needs trust created for the sole
Assets can also be benefit of such child.
non countable assets that transferred to: (4) transfers to a trust, a special-needs trust, or a pooled trust created for the sole
are allowed to every Medicaid benefit of a permanently and totally disabled person who was under 65 years of
long term care applicant: ► an annuity for the nursing age at the time the trust was created or funded.
home resident, or for a (5) transfer to a pooled trust created for the sole benefit of the permanently and
► Prepaid funeral contract disabled person.
totally disabled nursing-facility resident.
(6) transfer of the principal residence to one of the exceptions listed above.
► $1,500 Irrevocable burial
account ► an annuity purchased with
► Burial plot. qualified plan assets, which 520.007(J)(2) Treatment of Annuities Established on or after February 8,
will be exempt from the 2006.
But family circumstances requirement that annuity is (c) The purchase of an annuity is considered a disqualifying transfer of assets
need careful review, to make unless the annuity satisfies 130 CMR 520.007(J)(2)(b), or unless the annuity
actuarially sound and have names the Commonwealth of Massachusetts as a beneficiary as required under
sure that the family is not uniform payments. 130 CMR 520.007(J)(2)(a) and the annuity is: . . . . [qualified by the Internal
denied needed resources. Revenue Code as an IRA or pension plan}
LAW OFFICE OF JOHN L. ROBERTS, LONGMEADOW, MASSACHUSETTS ● (413) 567-5600 ● MassHealthHELP.com
2. Married fragile, consider dividing the
assets of the fragile couple.
Couples. “Tenants in Common”
ownership can provide
flexibility. By splitting
The regulations say that ownership, either spouse
countable assets of the can:
spouse who lives at home • pass a ½ share to
cannot exceed $101,640. But other family members
it is permissible to: upon death
• transfer ½ ownership
► Annuitize Countable back to community
Assets. The spouse at home spouse if nursing
can take all the countable home admission is
assets over that amount, and needed
buy an annuity that complies
with the regulations. The ► Testamentary Trust (a
regulations say that the state Trust inside a Will) can
must be named a remainder transfer assets owned at
beneficiary if anything is left death by the spouse at home
over after the death of the to a Trustee for the benefit of
spouse. But current the nursing home spouse,
MassHealth policies do not and leaving remaining assets
enforce that requirement. for family members.
► Consider the exceptions ► Transfer income
listed on the previous page, producing real estate to
such as a disabled child, or a the healthy spouse, after
caregiver child who lived in the ill spouse is approved for
their home for the past 2 Medicaid.
years.
► Asset Splitting. In cases
where both spouses are
LAW OFFICE OF JOHN L. ROBERTS, LONGMEADOW, MASSACHUSETTS ● (413) 567-5600 ● MassHealthHELP.com
520.016(B) Treatment of a Married Couple’s Assets When One
Spouse Is Institutionalized.
. . . the MassHealth agency must determine the couple's current
total countable assets, regardless of the form of ownership between
the couple, and the amount of assets allowed for the community
spouse as follows . . .
The community spouse’s asset allowance is the greatest of the
following amounts:
(i) the combined total countable assets of the institutionalized
spouse and the community spouse, not to exceed $101,640;
(ii) a court-ordered amount; or
(iii) an amount determined after a fair hearing in accordance with
130 CMR 520.017.
520.007(J)(2) Treatment of Annuities Established on or after
February 8, 2006.
(a) The purchase of an annuity will be considered a disqualifying
transfer of assets unless:
(i) the Commonwealth of Massachusetts is named as the remainder
beneficiary in the first position for at least the total amount of
medical assistance paid on behalf of the institutionalized individual;
(ii) the Commonwealth of Massachusetts is named as such a
remainder beneficiary in the second position after the community
spouse, or minor or disabled children; or
(iii) the Commonwealth of Massachusetts is named as such a
remainder beneficiary in the first position if the community spouse
or the representative of any minor or disabled children in 130 CMR
520.007(J)(2)(a)(ii) disposes of any such remainder for less than
fair-market value.
LAW OFFICE OF JOHN L. ROBERTS, LONGMEADOW, MASSACHUSETTS ● (413) 567-5600 ● MassHealthHELP.com
3. Medicaid because they recognize the
time that each family member 4. Medicaid from sale of the house if it is
sold by the family after 2009.
Planning gives to care, provide an
organized schedule for care With 5 Years ► Rental property as a
Within 5 Year and other services, and
prevent arguments and (or more) to planning tool: Use rents to
pay overhead on Life Estate
Look Back. misunderstandings among
family members. Plan. property that will avoid estate
recovery.
Working with Medicaid’s 5 Many options are open when
year look back period is ► Review all residential there is more time to plan. ► Intentionally Defective,
challenging, but spend down options to delay nursing ► Create equity interests Irrevocable Income Only
and impoverishment of an home admission. AARP in siblings: The regulations Trust. If elder applies for
elder are not the only options counsels: look into buying a will protect the interest nursing home assistance
when a nursing home less costly home, renting an owned by the non- from Medicaid 5 years after
admission seems inevitable. apartment, or moving into institutionalized sibling, she funds the Trust, Medicaid
assisted living or other assuming the interest is should not consider her the
Medicaid planning can save alternative housing. created 5 years before owner of anything in the
assets and provide resources Medicaid eligibility is needed. Trust.
for care that delay or prevent ► Combination of Asset Unlike Medicaid, the IRS
a nursing home admission. Transfers, Trust and/or ► Life estates: if a does consider the elder to be
annuity, to cover the years conveyance can be made the owner of the Trust assets
► Consider modifications that remain in the look back before the 5 year look back including her house. So, the
to the home, and paid period. period, consider this option. If house will still be covered by
caregivers to make at-home the proposed life tenants are the Principal Residence
care safe for the Alzheimer’s ► Reverse Mortgage can both relatively young and Exclusion, if the day comes
patient and the care givers. provide funds to bridge the 5 healthy, they probably will when the house needs to be
Delaying a nursing home year look back period. Elder make the 5 years. Consider sold during elder's lifetime.
admission with quality care at can take mortgage proceeds LTC insurance to cover risk Elder can move to assisted
home care can provide time monthly, in a lump sum or “as of older clients. But living or condo using money
to make asset transfers. needed” in an equity line. remember to consider from the house sale.
pending changes in the
► Caregiver agreements income tax laws that will
were always a good idea cause taxes on the profit
LAW OFFICE OF JOHN L. ROBERTS, LONGMEADOW, MASSACHUSETTS ● (413) 567-5600 ● MassHealthHELP.com
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