Category: Medicaid New Jersey

Understanding Life Insurance Policies And How They Relate To Medicaid

Post author By sps
Post date December 3, 2014

Understanding Life Insurance Policies And How They Relate To Medicaid

When an individual is applying for Medicaid and has assets that exceed Medicaid’s resource limit, a Medicaid spend-down is necessary. Assets in excess of the allowable amount must be spent down in order to achieve financial eligibility. Some kinds of life insurance policies are included in the spend-down with a few exceptions. Below is a breakdown of what needs to be liquidated in order to be eligible for Medicaid.

There are two popular types of life insurance policies that have different effects on the Medicaid application process.

Term Life Insurance Policies:

Term Life Insurance Policies have premiums that increase as the individual’s age increases. These policies only carry a death benefit. They are also referred to as protection policies; their purpose is to assist the beneficiaries in the event of the policy holder’s sudden death. Since there is no current cash value in term policies they are not considered an asset according to NJ Medicaid guidelines. These policies may remain active and will not impede one’s Medicaid eligibility. Once an individual is on Medicaid he/she will have minimal assets and may not have the money to cover the monthly premiums. Some beneficiaries choose to cover the monthly premiums so that they can ultimately benefit from the death benefit once the Medicaid recipient passes.

Whole Life Insurance Policies:

Whole Life insurance policies generally have fixed premiums, death benefit and cash value reserves. These policies may be liquidated at any time. Being that they carry a current cash value, they are not exempt from the Medicaid spend-down and must be liquidated in order to meet Medicaid’s financial eligibility requirements. There is one exception to the rule! If the Whole Life Policy has a face value of less than $1,500.00, regardless of the cash surrender value, it is exempt from the Medicaid spend down and may remain open and active. “Face Value” is the original death benefit amount on the day the policy was purchased, prior to the policy holder making monthly premiums. While the policy is active it will accumulate cash value from the premiums as well as dividends from reinvestment money. The cash value may exceed the original death benefit (or Face Value). Once the policyholder passes, the beneficiaries will then be able to claim the total death benefit from the policy.

Medicaid Connecticut Medicaid New Jersey Medicaid New York

Utilizing A Special Needs Trust With The Excess “Spend-Down” Money

Post author By sps
Post date November 24, 2014

In order for an individual to be eligible for Medicaid, there are financial standards that need to be met. Many Medicaid applicants will have to spend some of their assets in order to meet Medicaid’s financial threshold. There are a few excludable resources that are exempt from the Medicaid spend down. These assets can be retained by the Medicaid applicant and will not impede Medicaid eligibility. An individuals personal possessions, a prepaid irrevocable funeral trust, and a special needs trust for a disable child are just a few excludable resources when applying for Medicaid.

Today we will discuss utilizing a special needs trust with the excess “spend-down” money. When a Medicaid applicant has a disabled child, a special needs trust allows the transference of assets from a parent to the child without jeopardizing the child’s government benefits.

Special needs trusts are also referred to as “supplemental care trust”. These trusts supplement the disabled child’s Supplemental Security Insurance (SSI) and Medicaid benefits. The money in a special need trust may only be used for specific items or services. The trust is meant to supplement and not pay for basics such as food and shelter. Some things that may be purchased through a special needs trust include:

• Home modifications to assist the disabled
• Medical treatments and equipment not already covered by government assistance programs.
• Education and recreation equipment
• Computers
• Musical instruments
• Sports equipment
• Travel expenses
• Prepaid funeral

When a parent creates a special needs trust for a disabled child, he/ she chooses a trustee. A trustee is an individual or institution who manages the assets in the trust. The trustee’s responsibility is to follow the terms and guidelines outlined in the trust as well as transferring the funds from the trust to the beneficiary or disabled child. A trustee can be a family member, attorney, bank or anyone that one chooses to assign as a trustee.

The trust restricts the beneficiary (or disabled child) and parent access to the assets in the trust. Only the trustee would have accessibility to the funds and therefore it’s considered an unattainable asset for both the parent and disabled child. To summarize, the Medicaid Applicant who transfers assets to a special needs trust for a child will not incur a Medicaid penalty. Additionally, the recipient will not jeopardize the government benefits which they receive.

Gifting Medicaid New Jersey

When a Medicaid applicant owns a home – could it be successfully transferred to a child?

Post author By sps
Post date November 5, 2014

Senior Planning Services is the premiere Medicaid application company in the states of NY, NJ, PA and CT. We have been privileged to successfully process thousands of Medicaid applications on behalf of our clients. Our unique vantage point allows us to identify trends that have been occurring in regard to Medicaid’s enforcement of rules and policies. The following is a recent trend that we have identified.

When a Medicaid applicant owns a home, there are circumstances in which the asset is exempt and may be transferred without jeopardizing Medicaid eligibility. In the past, the applicant’s home could successfully be transferred to a child if the following two criteria were met:

1. The son or daughter has lived in the home of the applicant for a minimum of two years prior to institutionalization

2. There is a signed doctor’s note stating that the applicant was kept at home (as opposed to a facility) due to the care of the child who lived with the applicant.

Senior Planning Services has noted that the above referenced criteria have become less liberal. Medicaid may now disallow the transfer on the basis of any of the following:

1. If the child had a job that would impede their ability to fully care for the applicant, the Board of Social Services may request documentation in order to determine whether or not
the care was supplemented

2. If the applicant’s medical records do not reflect a need for care, a doctors note may not suffice as proof that there was a need for care.

Although we have seen numerous cases approved without the additional scrutiny, we have also seen cases where the additional requirements were enforced. If the Medicaid applicant meets the criteria of the more stringent interpretation of the policy, educating them to provide this information when applying may help facilitate faster Medicaid approvals.

Senior Planning Services is the most comprehensive and efficient Medicaid application company in the industry. The fact is that many long term care facilities absorb financial losses caused by preventable errors. Slow Medicaid approvals preceded by long pending periods, Medicaid penalties and worst of all Medicaid denials rob facilities of untold sums of revenues. Very often, the root cause of the aforementioned issues are based on actions or inactions attributable to the Medicaid applicant.
For a free Medicaid consultation contact Senior Planning Services at 1855.S.Planning (775-2664).

Medicaid New Jersey

Can the Community spouse keep the home when the second spouse is getting onto Medicaid?

Post author By sps
Post date September 17, 2014

I recently received a call from Samantha who posed a question to me. What would happen to her home should her husband, Nicholas be approved for the Medicaid benefit?

Samantha and Nicholas have been married for fifty-three years. Nicholas was a former general contractor and Samantha was a teacher. They were hardworking individuals who extended themselves to provide for their two children. After years of putting away money, the couple purchased a home and diligently paid their mortgage every month until it was finally paid off. Unfortunately, Nicholas was recently diagnosed with Parkinson’s disease and is in need of a higher level of care. When Samantha heard that she will need to spend down some of their assets for Nicholas to be eligible for Nursing Home Medicaid, she became concerned about what would happen to their home. Would she have to move? It was Samantha’s dream to be able to leave her home to her children. She was afraid that applying for Medicaid for Nicholas would inhibit her ability to do so.

I was delighted to be the bearer of good news, and informed Samantha that according to NJ Medicaid guidelines, a community spouse may keep the home. However, Nicholas, the spouse in need of Medicaid, would have to have his name removed from the deed. The full ownership would now be under Samantha and the home will no longer affect Nicholas’s eligibility. Samantha was relieved, thanked me for my time and will be working with Senior Planning services to get Nicholas approved for Medicaid.

In our next blog we will discuss other situations relating to a home in connection to Medicaid.

*Please note that there are other asset preservation concerns that one should take should the community spouse pass away.

Medicaid Connecticut Medicaid New Jersey Medicaid New York Medicaid Pennsylvania

Medicaid Spend Down and Special Needs Trust

Post author By sps
Post date September 16, 2014

In order for an individual to be eligible for Medicaid, there are financial standards that need to be met. Many Medicaid applicants will have to spend some of their assets in order to meet Medicaid’s financial threshold. There are a few excludable resources that are exempt from the Medicaid Spend down. These assets can be kept by the Medicaid applicant and will not impede Medicaid eligibility. An individual’s personal possessions, a prepaid irrevocable funeral trust and a special needs trust for a disabled child, are just a few excludable resources when applying for Medicaid.

Today we will discuss utilizing a special needs trust with the excess “spend-down” money. When a Medicaid applicant has a disabled child a special needs trust allows the transference of assets from a parent to the child without jeopardizing the child’s government benefits.

Special needs trusts are also referred to as “supplemental care trust” these trusts supplement the disabled child’s supplemental security insurance (SSI) and Medicaid benefits. The money in a special need trust may only be used for specific items or services. The trust is meant to supplement, and not pay for basics such as food and shelter. Some things that may be purchased through a special needs trust include:

Home modifications to assist the disabled,
Medical treatments and equipment not already covered by government assistance programs.
Education and recreation equipment
Computers
Musical instruments
Sports equipment
Travel expenses
Prepaid funeral

When a parent creates a special needs trust for a disabled child, He/ She chooses a trustee. A trustee is an individual or institution who manages the assets in the trust. The trustee’s responsibility is to follow the terms and guidelines outlined in the trust as well as transferring the funds from the trust to the beneficiary or disabled child. A trustee can be a family member, attorney, bank or anyone that one chooses to assign as a trustee.

The trust is an excludable resource for government benefits for both the parent applying for adult Medicaid and the disabled child receiving SSI and Medicaid benefits. The trust restricts the beneficiary (or Disabled child) and parent access to the assets in the trust. Only the trustee would have accessibility to the funds and therefore it’s considered an unattainable asset for both the parent and disabled child. It is for this reason that it will not impede Medicaid eligibility for either.

One should consult with a competent elder care attorney for advise on if and when such planning strategies are advisable.

Gifting Medicaid Connecticut Medicaid New Jersey Medicaid Pennsylvania

Medicaid Planning – “Failing to plan is planning to fail”

Post author By sps
Post date September 3, 2014

If a hiker was setting out to cross Arizona’s Sonoran Desert, he would begin by planning weeks or even months in advance. He would be certain to pack all necessities such as water, clothing, a trail map, sun hats and anything that may be needed along the way. He will take the time to educate himself on the plants, snakes and scorpions that are found in the Sonoran desert.

As an avid hiker, I often reference hiking metaphorically as an analogy easily understood. I find that it helps folks mentally prepare for the Medicaid application mindset. When asked by prospective applicants “at what point should I start thinking about Medicaid for myself or my loved one?” I reference the Sonoran desert. Certainly, the time to think about the process is well in advance. Otherwise, if you wait too long, you are like the poor desert hiker who hasn’t prepared. Certainly, this is not an enviable position to be in. Alan Lakein once said ” Failing to plan is planning to fail.”

In order to help folks prepare for the Medicaid journey I would like shed light on some guideline that can positively impact prospective Medicaid applicants.

Medicaid guidelines dictate that an applicant may not gift money within the five years prior to Medicaid eligibility, generally referred to as the five year ”look-back” period. However, many mix up the Gift Tax Exclusion Act with the Medicaid gifting laws and believe that gifting $13,000 annually is permitted for Medicaid purposes. For the IRS it is permitted, but for Medicaid purposes it is not. Should Medicaid identify any transfers or gifts in the applicants reviewed financial history, Medicaid will impose a penalty. A penalty period is a defined period of time in which Medicaid will not pay for care. The penalty period is calculated based upon the amount of funds that were gifted or transferred divided by the penalty divisor. The divisor is a figure derived from the average cost of care at a nursing home.

Most of us generally don’t know whether we will be needing Medicaid for ourselves or our loved ones over the next five years. Therefore, planning in advance is crucial in order to preserves ones assets. There are numerous asset preservation opportunities that Medicaid guidelines afford applicants. There are spousal rules that protect the community spouse. There are rules that protect disabled children. There are possible methods of preserving the home in certain instances. There are options that require forethought and planning in order to successfully achieve the desired goals.

When I am given the opportunity to speak to the senior population, the above is something that I always stress to prospective applicants. Understanding the rules and the possible scenarios that may arise ranks as the most critical aspects of a successful Medicaid outcome. Prospective applicants need to be ahead of their needs or risk finding themselves In the Sonoran desert without their sunscreen.