Useful Info During COVID v.4
May 12, 2020
Dear Friends,
This is our fourth newsletter during these interesting COVID times. It’s funny – my writing bug tends to come in waves and then go away for a while. Apparently it’s been sticking around lately. I’m sure you can relate when it comes to your writing, art, or hobbies. This week I want to focus on what our office can do for you, right now. You can revisit our prior newsletters here.
Get Your House in Order a/k/a Get Your Ducks in a Row
If you have time on your hands right now, maybe it’s a good moment to spend a few hours working out the what / who / how of your estate plan. I can help you make sure that those who matter most know what matters most to you in terms of your health care. We can think through and plan for how to make sure that you get the hands-on care you might need over the years. We can figure out what the best vehicle is for you to create an inheritance process for your heirs. We can talk through who the best people are to be your health care proxy, power of attorney, executor, and trustee. We can wrestle with and work through the various components of getting your house in order (or, if you are sick of being at home – we can call it getting your ducks in a row).
Billing & Discharge Issues from the Hospital, Rehab, or Nursing Home
For anyone on Medicare (plus a supplement, or, on a Medicare Advantage Plan), you need to know that Medicare has strict billing requirements. If the hospital, rehab, or nursing home bills incorrectly to Medicare and the supplemental insurance, the provider will be in trouble. Not only will they not be paid for the particular service that they incorrectly billed for, but they may even owe a penalty. If you are having billing problems with a provider, you need to understand this. And, it gets tougher – during this state of emergency, CMS (the federal agency housing Medicare) has changed MANY of their billing and service requirements. It is very understandable that some medical billing offices could be confused, receiving conflicting guidance, etc. If you are having billing problems, first, be patient with the person on the other end of the phone, and second, feel free to call me for help.
MassHealth Applications
If you find out that your loved one needs to stay in a nursing home and you are worried about how to pay for that, please reach out and we can analyze whether it may be appropriate to apply for MassHealth. If it is, then Doreen and I can handle the application for you. Or, if the situation is sufficiently straightforward, I can give you some advice and then you can handle the application on your own.
Guardianship & Conservatorship
If your loved one has lost cognitive capacity and does not have an acceptable health care proxy or durable power of attorney, then you might need the probate court to appoint a guardian (to make health care decisions) and/or a conservator (to handle finances and real estate). If you need this, you have two options: If a hospital or nursing home is telling you that you need a guardianship and/or conservatorship, they may have their attorney handle it, for free. If that’s the case, just make sure that the attorney is naming someone that the family agrees would be a good choice. If the free work is not an option for you, then call me and I can handle the guardianship and/or conservatorship for you. (Pro tip: Don’t ever put your family in this position – instead get your ducks in a row now and sign a health care proxy and power of attorney!)
Stimulus Checks to the Deceased
Some of you have received stimulus checks made out to persons no longer living. Turns out, you need to send those back. If you still have the check, you can mail it to the IRS. If you cashed it or received it by direct deposit, you will need to write out a check to mail to the IRS. Here are the (very clear) directions from the IRS on how and where to mail it (see Q41).
Pick the Lawyer’s Brain
Go bold or go home. Oh wait, I’m already working from home. In any event, I’m trying something new: a Zoom call to ask me anything related to elder law, special needs planning, veterans benefits, or estate planning. Let’s try this and see how it goes! Thursday, May 14 from 2:00 – 2:30. Limited to 15 people. Reply to this newsletter, or email Doreen (doreen@alexislevitt.com), and we will send you the login information.
Also I am converting a playhouse into a chicken coop, so I am happy to receive any and all chicken coop construction advice!
Be good to yourself and each other, and get outside to enjoy this glorious spring.
– Alexis & Doreen
Elder Care Workshop Series at Norwell Public Library
March 7, 2017
Gifts and the Five-Year Lookback
November 19, 2014
I often hear from clients that they “have made gifts in the last five years – but it’s ok, they were all less than $14,000 so they won’t count under the five-year lookback – right?”
Unfortunately, that’s simply not the case. While it IS true that you can give up to $14,000 per year (as of 2014), per recipient without paying a gift tax for federal income tax purposes, MassHealth (Medicaid) views the situation very differently. Should you need a nursing home and ask the state to help pay for your care, any gifts you have made within the last five years will be scrutinized and will render you ineligible from receiving MassHealth assistance in paying for your nursing home care until the amount of the gift(s) is paid back.
In fact, any asset transferred for less than fair market value will be scrutinized and can potentially disqualify you from MassHealth assistance. For example, if you sell your son-in-law your $20,000 Mercedes for $1,000, or add your children’s names to the deed on your house (and they didn’t pay you fair market value), MassHealth will view these transactions as assets transferred for less than fair market value.
How does the disqualification work? Let’s say in the last 5 years you have gifted $50,000 in assets. You will be disqualified from MassHealth assistance for $50,000 worth of care – and the disqualification only begins to toll once you have spent down your other assets to the allowable $2,000. In other words, you will pay privately for your care until you have just $2,000 in the bank, then you’re responsible for the $50,000. But now you only have $2,000 left – so who pays it? Either the recipients can return the gifts to “cure the defect,” or someone else – likely a spouse or child, will have to foot the bill for the next $50,000. Then and only then will you be eligible for MassHealth assistance. This is a scary prospect, for you and your family alike!
Of course, there are exceptions to the no-gifting rule. You may always transfer assets to your spouse. Likewise, if your child has been living in your home and taking care of you for two years, you may be able to transfer your home to the caretaker child without penalty. You may also be able to transfer assets to a special needs trust or pooled trust for a disabled child, though you should consult with an elder law attorney before making any transfers in the latter two of these scenarios.
Gifting to your family and loved ones during your lifetime can be a wonderful, helpful, and rewarding thing. Before making any gifts, however, you should consult with a trusted financial professional, an elder law attorney, or better yet, both. If you’re wondering if giving gifts during your lifetime is plausible in your situation, don’t hesitate to contact our office to set up an appointment.
Michelle Singletary – She’s Done It Again
May 7, 2014
I love her columns, I really do. A few weekends ago, she nailed it once again. Read her column here where she tells older parents why they need to talk to their adult children about the care they would like as they age. Keep in mind that the cost figures she cites are national averages – and so, you guessed it, Massachusetts $$ numbers are higher.
I haven’t read the book she is suggesting, but if Michelle Singletary likes it, I’m sure it’s good.
Caregiver Contracts – Tax Benefits
April 30, 2014
If you would like to care for your parents full-time, or close to it, and your parents want to pay you for this, then there are some tax issues that you need to be aware of.
Most importantly, if you are providing hands-on care, making meals, doing the shopping, taking your parents to doctors’ appointments, etc., then you are an employee (as opposed to an independent contractor). And if you are an employee, then there are some rules that you need to comply with.
First, you and your parents need to report your income. Second, you and your parents need to pay taxes (they pay employer taxes, you pay income taxes). Now before you throw something at your computer screen, consider this: You want to pay payroll taxes. Why? Because FICA earnings will translate down the road into your own retirement Social Security check. Spending years working but not contributing to FICA can result in a lower Social Security check when you eventually retire. Same goes for Social Security Disability (SSDI) if you become disabled before 65.
Also consider this: Your parents can recapture part of the employer taxes they are paying in the form of a tax deduction – If they spend more than 7.5% of their AGI (adjusted gross income) on health care, then they can deduct health care costs. If they are paying for your many hours of care, in addition to other out-of-pocket health care costs, it is quite likely that they are spending over 7.5% AGI on those costs.
The payroll requirements for an employer are detailed. Rather than asking your parents to try to keep the records and handle the reporting to the IRS and DOR themselves, it is exponentially easier to hire a payroll company to take care of all the details for you. One payroll company working exclusively for home care situations is Care.com/homepay. I haven’t worked with them, but I think they are the only payroll company focusing on home care.
You can read here about what goes into a caregiver contract, and you can read here about how your parents can end up in big trouble later with MassHealth if they pay you without a caregiver contract in place.
Nursing Home Care & MassHealth – Eligibility Rules for the Single Person
April 24, 2014
As you well know, privately paying a nursing home bill is a very costly undertaking. Should you need nursing home care someday, typically Medicare and your supplemental insurance cover up to 100 days. After that, you either privately pay or look to Medicaid (MassHealth) to pay. This post explains the basic MassHealth rules for a single person needing nursing home care. See this post for the rules where one member of a couple needs nursing home care.
For a single person to receive MassHealth assistance with paying for nursing home care, generally speaking she can have no more than $2,000 to her name in liquid assets and minimal life insurance. She can own a home and be accepted into MassHealth, but the agency will require her to sell the home and use the proceeds towards her care. If the home does not sell during her lifetime, the agency will place a lien on the home and be paid back out of the member’s estate (“estate recovery”).
MassHealth uses a five-year look-back period. From the date of application, MassHealth looks back five years to see if you have made any gifts (typically anything over $100 must be explained). MassHealth disqualifies applicants who have made gifts in the last five years. Read here about what to do if you have over $2000 in assets.
Couples: Protect Your Assets from the Cost of Nursing Home Care
As you well know, privately paying a nursing home bill is a very costly undertaking. Should you need nursing home care, typically Medicare and your supplemental insurance cover up to 100 days. After that, you either privately pay or look to Medicaid (MassHealth) to pay.
For a married person to receive MassHealth assistance with paying for nursing home care, generally speaking, the couple can have no more than $119,240 in liquid assets (technically, the nursing home spouse can keep $2000, and the at-home spouse can hold the remainder) and minimal life insurance. The couple (or just one spouse) can own a home. If the nursing spouse owns an interest in the home, MassHealth will place a lien on the home, to potentially be paid back out of the member’s estate (“estate recovery”).
MassHealth uses a five-year look-back period. From the date of application, MassHealth looks back five years to see if you have made any gifts (typically anything over $100 must be explained). MassHealth disqualifies applicants who have made gifts in the last five years.
For many couples, MassHealth is a double-edged sword. Many at-home spouses are terrified of spending all their savings on their ill spouse’s care – MassHealth spares them that. On the other hand, if a healthy spouse is young and seems to have a long life ahead of her, then reducing her assets to just $119,240 is a very scary proposition. Contact our office for strategies to help the at-home spouse keep more of her assets, so that she is not living in fear of becoming impoverished.
The Single Person: Protecting Your Assets from the Cost of Nursing Home Care
If your loved one is single and would like MassHealth to pay her nursing home bill, then the basic rules are these: (1) She medically requires nursing home level care, (2) she has no more than $2,000 in “countable” assets (that’s money in the bank, retirement accounts, life insurance, etc.), and (3) she has not made any sizeable gifts in the last five years. This post focuses on options if she has over $2,000 in liquid assets.
The most important thing to remember is that you want to do what you can to give your loved one in the nursing home the best quality of life you can – keeping in mind that she is frail, perhaps cognitively impaired, not living in her own home anymore, not really in charge of what she eats and when, and other basic comforts. I usually tell clients to “spend down” on things that their loved one really enjoys – a new tv for her room? Books on tape? New clothes? An iPad loaded with pictures of the grandchildren? One client loved chocolate frappes from Friendly’s – so as part of her “spend down,” her niece bought a few hundred dollars’ worth of Friendly’s gift certificates and brought her aunt frappes at least twice a week. The little things make a big difference.
In addition to spending down on the “little things,” you can place extra assets into a “pooled trust.” This allows you to have a “savings account” for things that will inevitably come up while your loved one is in the nursing home. For example, if there is a family wedding and you want to bring your loved one home for the weekend, you can use the pooled trust to pay for a wheelchair van and 24-hour aides.
Another example is the “bed hold.” If your loved one needs to leave the nursing home, say to go to the hospital, MassHealth will pay to hold the room for only ten days. If your loved one will be out of the nursing home for longer than that, and you want her to be able to keep her room (i.e., not be moved to a new room upon her return), then you can ask the pooled trust to pay for the room until the elder returns. These are just two examples of things that MassHealth doesn’t cover – and the $2,000 that they permit the member to keep in her own name certainly won’t cover, either.
What happens if you own a home and sell it, putting you over the $2,000 limit? Once you sell the home and have more than $2,000 in the bank, you are no longer eligible for MassHealth. One approach often used at this point is to pay for the nursing home privately for some stretch of time, and then spend down on useful things and move some funds into the pooled trust to bring your own account back down to $2,000. Again, having the funds in the pooled trust gives you a savings account for the things that MassHealth won’t cover and that the minimal assets in your own name won’t either.
If you would like to explore whether placing your funds in a pooled trust is right for you, please call our office. We are here to help.
Consider Using a Pooled Trust with MassHealth Nursing Home Planning
If a single person wants MassHealth assistance with paying for nursing home care, but has more than the $2,000 in assets that MassHealth will permit her to keep, one option is to transfer the excess assets to a pooled trust.
A pooled trust is a trust managed by a non-profit for the benefit of disabled individuals. MassHealth regulations permit a single person to transfer assets to a pooled trust and still qualify for MassHealth. Transferring excess assets to the pooled trust would allow you to qualify for MassHealth while having funds held in the trust that you can dip into to supplement your care. For example, MassHealth won’t pay for those new dentures you need, or for a chair car to take you to your grandchild’s graduation. After you pass away, the pooled trust keeps about 25% of the balance (to support its mission of assisting disabled adults), and MassHealth is paid back for whatever it has paid the nursing home on your behalf.
Because of the payouts at the end to the pooled trust and to MassHealth, you can see that this is not a vehicle for preserving all of your assets for your family – but it is still a good planning option. First, MassHealth pays a lower rate to the nursing home than private payers, so in the end, you are paying the nursing home, but less than if you were to pay privately. Second, by transferring the funds to the pooled trust, rather than spending all your assets down to $2,000, you establish a “savings account” into which you can reach for extra expenses that MassHealth does not cover, such as companion care, or a home health aide for visits home. After the pooled trust and MassHealth are paid, your family will receive any balance.
For examples of pooled trusts in our area, check out:
Testifying at the State House
August 5, 2013
Last week, I headed to the State House to once again testify on bills that could plug some holes in the MassHealth nursing home payment system and make things a bit easier for families caring for frail elders.
The shorthand for this bill is the “transfer of assets” bill. It comes down to this: As you probably know, should you need nursing home some day, and if you need MassHealth to pay for it, MassHealth understandably looks through five years of bank statements to see if you’ve given any large sums away in the last five years. After all, it would not be fair if we could just give our money away and then ask our fellow taxpayers to foot our nursing home bills.
But the problem lies in abiding by this principle too strictly. The MassHealth regulations (based on federal law) actually state that you cannot transfer assets within the last five years with the intent of qualifying for MassHealth. The MassHealth regulations indicate that applications should be approved where the assets “were transferred exclusively for a purpose other than to qualify for MassHealth.” The problem is, MassHealth is not following its own regulations.
Quite frequently, nursing home placement is the result of a sudden decline, or an unexpected illness. It is fairly common for a healthy, active elder to do what she has always done – birthday gifts to family, donations to her church, help out a child divorcing or at risk of foreclosure – and a few years later be faced with a sudden turn of events and need to move to the nursing home. These elders should not be punished for not only not knowing about the five-year “look-back” rule, but worse – for being healthy and loving their families.
What happens to you if you are one of these unlucky people? Let’s say you were in good health, your child’s home was in foreclosure, you paid off her debt, and then let’s say four years later, out of the blue, your health fails and you need nursing home care. Well, you might pay down most of your remaining assets to the nursing home, and once you run out of money, you apply for MassHealth assistance. If you run out of money before you get to the five-year mark from making that gift, things are going to be difficult.
Imagine this: You are in the nursing home, you have spent all your savings, and you have no choice but to ask for MassHealth to pay your nursing home bill. It is only at this point – when you have no more money – that they impose the disqualification period that resulted from the gift. Let’s say you gave your kid $33,000 – that amounts to four months of disqualification. So you are in the nursing home, you have no money, and MassHealth won’t start paying for another four months. The nursing home isn’t paid to care for you, so now what? Is it fair that the nursing home should provide 24/7 room, board, and medical attention without being paid? They can’t operate that way. They try to evict you for nonpayment. And then things get ugly. You might bounce from hospital to hospital, or you might end up in your last choice of nursing homes. Not pretty.
The “transfer of assets bill” would make it clear to MassHealth caseworkers (the folks that review and then approve or deny your nursing home application) that transfers in the last five years shall not result in denials if the transfers were made for certain various reasons. These are reasons that you might categorize under “living my life” or “taking care of my family,” such as a pattern of small gifts (monthly donations to church or annual birthday checks); helping a relative in financial crisis, foreclosure, or with medical care; or, whatever the reason for the transfer, at the time of the transfer, there was no reason to think you would need MassHealth in the next five years.
The “transfer of assets” bill is actually two identical bills – one filed in the House by Representative John Fernandes (H1021) and one filed in the Senate by Senator Katherine Clark (S503). Please call your state representative and senator and ask them to support these bills. To find your rep and senator and their contact information, click here. And thank you.
