Spousal Impoverishment Laws in 2023

Medicaid eligibility is based on medical conditions, income, and resources. A spouse may require hospitalization, nursing home care, or the equivalent in-home care for assistance with daily living activities like bathing, dressing, and more.

The spouse requiring assistance must have an income of $2,742 monthly or less. However, if they exceed the limit, it’s still possible to qualify for benefits that will pay for long-term care.

The spouse in need of care must not have countable resources (money and personal property) valued over $2,000. However, the well spouse (community spouse) can keep up to $148,620 of their combined countable assets. If those assets exceed the limits, resources can be spent down to become eligible. This can be done in several ways:

• Use resources to pay for nursing home care
• Pay off debts
• Make home repairs and improvements
• Buy a new car or other personal property
• Prepay funeral and burial plans
• Pay for necessary non-medical equipment
• Purchase an annuity to provide income for the community spouse

Protecting Assets in an Irrevocable Trust

For many couples where one requires Medicaid benefits and the other remains at home, transferring assets to an irrevocable trust may be the best way to protect their home and savings while still qualifying for financial help with long-term care needs. But reorganizing assets must be done legally or it will result in penalties that delay coverage. If benefits are delayed, you will be responsible for out-of-pocket expenses until the benefits are approved.

The timeframe for delayed benefits is based on the value of the asset transfers made during Medicaid’s lookback period and the monthly cost of nursing home care in your state. An elder law attorney can review your situation and avoid mistakes that lead to these penalties with pre-planning for care. However, when there are immediate needs for long-term care, the goal is to qualify for benefits quickly, find out the best ways to pay for care until benefits begin, and reduce costs as much as possible.

Are You Caring for a Spouse at Home, or Is Your Spouse in a Skilled Nursing Facility?

When you’re caring for a loved one and serving as their support system, you shouldn’t have to worry about making ends meet, losing your home, or depleting a lifetime of savings. Spousal impoverishment protections help families stay together and get the care they need. Legal strategies can help you meet federal and state Medicaid eligibility requirements while protecting assets for a spouse and even preserving a legacy for your children.

Long-term Medicaid planning can help families avoid a medical or financial crisis. The sooner you start, the better. For immediate needs, time is of the essence. Either way, reach out to an elder law attorney today to discuss your options. You and your family will gain peace of mind knowing you’ve handled a potentially stressful and emotional situation.

To learn more about Medicaid eligibility criteria that protect against spousal impoverishment for recipients of home- and community-based services, contact our office at (740) 947-7277 and schedule a free consultation to discuss your legal matters. We look forward to the opportunity to work with you.

The post Provisions for Spousal Impoverishment appeared first on Seif & McNamee.

Estate Planning

The main goal of estate planning is to choose legal documents that will determine what will happen to you and your assets once you have passed away or become incapacitated. An estate planning attorney will help you make important decisions, such as:

• Who makes medical and financial decisions if you are unable
• Who is allowed access to your medical records
• How assets are distributed after you are gone
• Who cares for minor children if you become incapacitated or die
• Who manages money for your minor children if you are no longer able
• How to handle your funeral arrangements and burial

Durable Powers of Attorney

By using a general durable power of attorney document, you can name a person, or persons, to make financial decisions on your behalf if you are no longer able to do so. Expressing your end-of-life wishes requires designating a person to make healthcare decisions for you by completing a healthcare directive. By completing a Health Insurance Portability and Accountability Act (HIPAA) form, you will give your healthcare providers permission to share your medical records with the people listed on your HIPAA form.

Wills and Trusts

In your will, you can name the beneficiaries of your estate as well as a guardian to care for any minor children you may have at the time of your death. You can also name a conservator to manage the money you leave for their benefit. Some people create a trust, or trusts, to hold their assets during their lifetime and after death. They then sign a pour-over will that moves assets into their trust(s) upon death. You can leave instructions concerning your funeral or memorial service and what you want to happen to your remains in your will or a separate document.

Elder Law

Whereas estate planning focuses mostly on what happens after a person dies, the area of elder law focuses on a person’s last years or months. This can include planning for long-term care and applying for government assistance, such as Medicaid, Medicare, and veterans’ benefits, if applicable. Using elder law tools and strategies, an elder law attorney can help you find ways to preserve your assets while preparing to apply for benefits.

Like estate planning, it is best to start the elder law planning process well in advance. To qualify for benefits, such as Medicaid, you may have to sell or transfer ownership of some assets years before applying for benefits. Gifting or transferring assets out of your name must be done according to government requirements, so applying for benefits can be a complicated process. Hiring a skilled attorney can make the difference between receiving benefits quickly or not at all.

Since seniors are at a greater risk for discrimination, neglect, and abuse, elder law attorneys can help seniors and their family members recognize when a senior’s rights are being violated and take legal action to counter and remedy the situation.

Tying Estate Planning and Elder Law Together

It is best to start your estate planning process as soon as possible since the decisions involved could come at any time due to an accident or an illness. Planning for end-of-life care and the benefits associated with it may come later in life, but preparing well in advance lets you legally reduce assets for an extended period to qualify for benefits, like Medicaid.

Even younger families just starting their estate planning process may look at elder law planning at the same time for senior family members’ needs. Some estate planning tools, such as trusts, are often used when helping a parent plan for Medicaid and other government benefits for long-term care expenses. An attorney experienced in both estate planning and elder law can advise you in these areas and help you navigate complicated processes.

This article offers a summary of aspects of estate planning law. It is not legal advice and does not create an attorney-client relationship. For legal advice, you should contact an attorney.

We hope you found this article helpful. Contact our office at (740) 947-7277 and schedule a free consultation to discuss your legal matters. We look forward to the opportunity to work with you.

The post What Is the Difference Between Estate Planning and Elder Law? appeared first on Seif & McNamee.

A living will only take effect in the event of medically diagnosed incapacity; depending on your state, one or two doctors will make this determination. Your family should know where you keep your living will to present to the hospital if necessary. Having predetermined your boundaries for medical care will provide great relief to your family during the heightened emotional time of dealing with a loved one’s incapacity.

Treatment Options to Consider When Preparing Your Living Will

• Do you want all treatments available to try to save your life?
• Do you want all treatments but add a timeline to stop them if they are not working?
• Do you only want treatments that cause no pain or discomfort?
• Do you prefer only palliative (comfort) care? Palliative care will provide only medication to alleviate pain but not treatments to prolong or save your life.

More Detailed Medical Treatment Decisions

• Treatment types – There may be treatments you always want to have, such as pain medication. There are also those you may never want to receive, such as dialysis or long-term ventilator care.
• Short and long-term treatments – If a short-term treatment provides a good chance of getting better, you may want that. For example, if you are recovering from surgery, you might opt to have a feeding tube for a short while. Alternatively, if you sustain a severe and long-term brain injury, you may not want a permanent feeding tube. You can create time limits for life-sustaining treatments so that you do not linger in a vegetative state if treatments remain unsuccessful.
• Invasive tests and treatment options – Many of these procedures create discomfort and pain. Lab tests, antibiotic treatment, blood transfusions, and surgery may prolong your life even when recovery is no longer possible. You may not want to receive a blood transfusion if you are not COVID-19 vaccinated because of the risk of receiving blood with the mRNA vaccine.
• Feeding tubes – This procedure, also known as artificial hydration and nutrition, can sustain your body if you are unconscious or can’t swallow. A tube from which the sustenance flows is put into your stomach by a healthcare provider.
• Life support – If some of your organs are no longer functioning, life support treatments can help sustain the function of the damaged organ. If your kidneys don’t work, you can receive dialysis to remove impurities and wastes from your blood, or if you can’t breathe, you may be placed on a ventilator.
• CPR and DNR – Without specific instructions to disallow CPR or electric shock, which attempts to restart your heart if it stops beating, healthcare emergency responders and medical providers will use these techniques to save your life. A DNR (do not resuscitate) is a legally binding physician order and can be part of your living will. A copy of your DNR order needs to also be on file with your medical records.

Limiting Certain Treatments

Certain situations can occur where you may want to limit treatments because of the degradation to your quality of life and little hope of getting better:

• You can use a wheelchair, but you can’t walk
• You experience constant and severe diarrhea or nausea
• You are unable to control urination and bowel movements
• You require caregivers to bathe, help you with toileting, dressing, and feeding
• You need a ventilator to breathe
• You need a feeding tube to eat
• You require kidney dialysis to survive
• You can’t think straight or communicate effectively
• You no longer recognize family and friends
• You experience severe or constant pain

Other Questions to Ask

A living will is instructive but can’t possibly determine every scenario for an end-of-life situation; however it can include important ones. Consider what medical intervention you would want if you were in a persistent vegetative state or long-term coma. Do you have fears about your life ending? Is pain relief crucial to you, or do you want to remain alert and awake even if experiencing pain? Do you have religious or other beliefs that should be followed before you die? Who do you want with you as support? Do you want to be in a hospice care facility or at home? Questions that strike at the heart of mortality can be unsettling, but you may find a sense of peace when you have confronted and described them in a living will.

Talk About Your Choices

Speak to your family, estate planning attorney, and healthcare providers about your wishes. Sometimes they might challenge your thoughts or ask questions that help you better prepare your living will. If you are at odds with a medical doctor and can’t agree, it is best to seek new medical care to support your wishes. Include aspects for funeral arrangements, burial or cremation, and where you want to be when you die (if that is an option). Your estate planning attorney can explain your state’s legal requirements regarding signatures, witnesses, and other rules.

Tell your family, friends, and healthcare providers that you have a living will and keep legal copies on file in the appropriate places. Healthcare providers should put a current copy in your medical records at your hospital. Keep your original document in a safe place but also one that is easy to find. Some states have registries that store copies of your living will and other advance directives, and some will even provide healthcare workers access via computer. Some houses of worship may also store a copy of your living will for you. Talk to your estate planning attorney for input regarding your situation.

Creating and Reviewing Your Living Will

When do you create or review your living will? Since a living will only go into effect when you are deemed medically incapacitated, you can create one and change or cancel it at any time. Once completed, your living will is a legal document, and you can’t just tear up your copy and think existing copies will not be relevant. You must legally cancel your last living will to create a new one or have your lawyer make changes and provide copies of the new living will to family, healthcare providers, or wherever else you keep copies.

A good rule to follow for reviewing your living will include:

• Decade – At the beginning of each new decade of your life (the 30s, 40s, 50s, etc.)
• Divorce – Significant changes to your family or personal relationships
• Death – Your spouse or a close relative dies
• Diagnosis – You receive a diagnosis of a serious disease or health condition
• Decline – Your health diminishes, and you find self-care harder

Life is an uncertain experience. Those things you can control through legal preparation will benefit you and your family if you become incapacitated. Having a living will is for all adults, not just seniors. Younger individuals may take more risks and experience higher incidences of accidents, leaving them unable to make medical care decisions. Whatever your adult age preparing a living will brings peace of mind, protects your medical future as you wish, and reduces the decision-making burden on your family and loved ones. Get started with an estate planning attorney to implement this critical document.

We hope you found this article helpful. Contact our office at (740) 947-7277 and schedule a free consultation to discuss your legal matters. We look forward to the opportunity to work with you.

The post A Guide to Writing a Living Will appeared first on Seif & McNamee.

The Benefits of a Medicaid Annuity

In what circumstances is a Medicaid annuity beneficial? Many Medicaid applicants are denied coverage for long-term care because they have too much money or too many assets. However, Medicaid applicants applying with insufficient funds to pay their nursing home bills can leave a healthy spouse destitute in the short term if paying out of pocket. A Medicaid-compliant annuity can accelerate eligibility for the joint state and federal Medicaid health insurance program, which pays for a person’s medical bills and nursing home care while providing reliable income for the healthy at-home spouse.

To properly plan for a Medicaid-compliant annuity, seek the advice of an elder law attorney who understands your state’s Medicaid rules. There are ordinary immediate payout annuities that are not Medicaid-compliant, so it is critical to receive the correct advice before your purchase. The goal for married couples is for the healthy spouse (the annuity owner) to collect the annuity income while the spouse needing medical benefits from Medicaid-funded extended care and nursing home benefits remains eligible.

Medicaid-Compliant Annuity Requirements

• The MCA is for an individual and must be non-assignable and irrevocable
• The annuity income payout must be based on the life expectancy table equivalent to the Social Security life expectancy tables Medicaid uses
• The annuity terms can’t extend beyond the annuity owner’s life expectancy
• All premiums will return to the client by the end of their life expectancy
• The immediate irrevocable annuity must not have a cash value
• The restricted annuity may not have balloon payments, and the distribution of annuity payments to the owner must be equal and actuarially sound
• The Medicaid beneficiary structure must comply with the state’s Medicaid recovery rules
• Guidelines and recovery rules vary by state law, often asking the State Medicaid Agency to be named as beneficiary

Drawbacks for Medicaid-Compliant Annuities

These Medicaid-compliant annuities are challenging to set up, may not cover all of your assets, and preclude you from accessing them if you require them for future needs. However, because of long-term care’s prohibitive costs, many married couples are willing to accept these potential risks because Medicare does not cover long-term care. The national average for long-term care insurance for a couple both 60 years old is $3,400, and approximately 30 percent of applicants between 60 and 69 are declined coverage.

While that may seem like a lot of money to pay in premiums, if you qualify for the insurance, it pales in comparison to the national estimates of long-term care costs out of pocket. According to Genworth, the cost of long-term care in a 2021 survey cites the following monthly average costs:

annuity.org

Non-Countable Income Stream

Purchasing a Medicaid annuity converts an asset into a monthly income stream for the healthy spouse, and this income does not count toward Medicaid eligibility. Purchasing this annuity type means the couple’s assets do not have to be “spent down” for one to be Medicaid eligible. However, the annuity payments must be completed before the end of the healthy spouse’s life expectancy so that the annuity purchase does not become giftable to heirs.

A Medicaid-compliant annuity will convert liquid assets into a lifelong income stream that helps a healthy spouse maintain their quality of life while the spouse in need of long-term care can still qualify for Medicaid. The Medicaid-friendly annuity requires that it be irrevocable (unchangeable) and non-transferrable to heirs upon your death. Since this purchase must be irrevocable to achieve the goals, it is crucial to meet with an elder law attorney to ensure your selection is the right financial product for your circumstances. A Medicaid-compliant annuity can help both spouses in a marriage to get the resources they need should one require long-term care.

Contact our office at (740) 947-7277 to speak with experienced elder law attorneys who specialize in long-term care and Medicaid.

The post Couples Can Benefit From Medicaid-Compliant Annuities appeared first on Seif & McNamee.

The National Council on Aging (NCOA) works with thousands of national and local partners to provide tools, resources, advocacy, and best practices for every aging American to have health and financial security. Checking out if you qualify for senior benefits through government programs is easy to do with NCOA’s online BenefitsCheckUp tool.

Wasted Benefits

Every year billions of available dollars in US benefits programs are not claimed because older adults (55 or more) are unsure if they are eligible and, if so, how to apply. No registration is necessary, and requests for information are minimal. Personal data entered into the website will remain confidential, and accessing the database costs nothing. If you hate filling out forms and get confused by all the questions, estate planning and elder law attorneys go through this process every day. Contact them for help. There is rarely an upfront cost for legal help, and you will be in a much better financial position once you begin receiving assistance.

The Online Benefits Check Up

If you complete the benefits check-up online, NCOA will send a confidential report to your mailing address listing the help available to you and how to apply for it. Since 2001 this NCOA program has helped millions of older adults receive help paying for medicine, food, utilities, and more. More than 2,000 benefits programs are in the check-up system, including categories such as:

• Food and nutrition
• Health care and medication
• Housing and utilities
• Income
• In-home care and aging in place
• Disability services
• Skilled nursing facilities and other long-term care environments
• Tax help
• Legal, crisis, and general assistance
• Veterans’ programs
• Discounts and activities

The online BenefitsCheckUp site helps older individuals identify the federal and state assistance programs for which they can qualify. This NCOA website is newly revamped and permits error corrections and the addition of information if you feel the need to revise your answers. The resulting online individualized Eligibility Results report can be saved in a PDF format to email to yourself, your lawyer, or a trusted family member.

Providing this eligibility information to your elder law or estate planning attorney is a smart strategy. Suppose you already receive disability benefits through SSDI, SSI, or other programs. In that case, adding other government assistance programs may result in unintended and negative consequences that may render you ineligible for the benefits you already receive. Your lawyer will know the strategies already in place and how additional programs may affect your current planning.

The chart above shows how many older adults struggled to manage basic expenses even before the inflationary circumstances of late 2021 – 2022 (and predicted beyond). Participation rates in government assistance programs are at a historic low, with a mere low to mid-sixty percent of eligible individuals participating.

Benefit take-up rates are low due to program enrollment barriers. Many older adults lack awareness that these benefits exist, and when they do, the application process for many programs can be cumbersome and complex. Additionally, perceived stigma about receiving government assistance and other program misconceptions contribute to lower participation rates.

Ramsey Alwin, NCOA CEO and President, admits, “In today’s economy, inflation is taking a bigger and bigger bite out of people’s incomes.” He adds, “We completely redesigned BenefitsCheckUp to make it even easier … no one should have to choose between paying for medications or food.”

To worry less and age better with more resources at your disposal, explore the NCOA’s BenefitsCheckUp website and learn what is available to you. Before you use the contact information to take the next step to apply, be certain to consult with your elder law or estate planning attorney. All assistance you receive should not interfere with existing plans and help you age successfully. More than 2,000 government benefits programs are available to help you, and it can make the difference between thriving or just surviving. We hope you found this article helpful. Contact our office at (740) 947-7277 and schedule a free consultation to discuss your legal matters.

The post Learn About Senior Benefits Offered by Government Programs appeared first on Seif & McNamee.

Understanding Meditation and Mindfulness

Mindfulness is an umbrella term that encompasses meditation. According to mindful.org, mindfulness is “fully attending to what’s happening, to what you’re doing, to the space you’re moving through.”

Negative patterns of repetitive thoughts, mind flurry or chatter, and list, craving, or fear spirals can gently fall away without judgment when using the anchor of mindful breathing and body scan to release areas that hold tension and stress. Some people use mantras to help guide and focus their attention on the present moment. The practice of walking meditation creates an entire focus of awareness on the feet being in contact with the earth for grounding properties. Trying new meditation techniques enhances the breadth of mindfulness in life and promotes general wellness.

Meditation refers to a formal practice of calming the mind and enhancing our self-awareness. Meditation practices may include mindfulness of breathing and compassion-focus via phrases or mantras, among other techniques. Common meditative practices include yoga, Tai chi, guided meditation, and more.

Long-term and consistent meditation practices bring about positive structural and functional brain changes. You can choose the type of meditation that best fits your lifestyle and situation. Many people start with guided meditation apps.

Meditation in Western Medicine

The Mayo Clinic details the benefits of meditation for managing pain, cancer, sleep and bowel dysfunction, depression, and more. In fact, many Western doctors are now recommending meditation and relaxation strategies as part of their comprehensive plan for patients suffering from various ailments. Unlike many therapies like surgery and medication, meditation is accessible, low-cost, and does not have unpleasant side effects.

Research shows that long-term, consistent meditative practices modify our brains’ plasticity for the better, changing the brain areas concerned with stress and anxiety and promoting inflammation regulation. The amygdala will begin to show a decrease in activity consistent with an improvement in emotional regulation. The prefrontal cortex, cingulate cortex, and hippocampus all show an increase in activity.

Chronic pain, illness, and everyday life put us at risk for significant stress. The effects of stress are lasting and profound. Incorporating meditative practices into your life can help you overcome mental distress and promote better physical health. You are never too young or too old to start enjoying the benefits of meditation.

You or a loved one may be experiencing stress related to chronic or long-term illness and looking for alternatives to increase your happiness and well-being. If you are struggling for the right level of care for in-home or nursing home facility services, an elder law attorney can help. Elder law services encompass both health and financial challenges that happen as people age and need more care and support for everyday activities. We hope you found this article helpful. Contact our office at (740) 947-7277 and schedule a free consultation to discuss your legal matters.

The post Managing Health and Stress Through Meditation and Mindfulness appeared first on Seif & McNamee.