NURSING HOME MEDICAID: ELIGIBILITY AND PLANNING LONG TERM CARE NEED. FUNCTION Activities of Daily Living 4/3/2018. Instrumentalities of Daily Living
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1 NURSING HOME MEDICAID: ELIGIBILITY AND PLANNING Presented by: Jessica Kruse & Danielle Kincaid LONG TERM CARE NEED 1 in 3 people turning 65 will require nursing home care at some point during their life. (Henry J. Kaiser Family Foundation, Medicaid s Role in Nursing Home Care, June 2017) In 2015, more than two thirds of those in nursing homes were women. (Henry J. Kaiser Family Foundation, Medicaid s Role in Nursing Home Care, June 2017) The average length of stay in a nursing home is 835 days (CDC, Nursing Home Care Fast Stats, 2014) Medicaid pays for 60% of nursing home patients. (Henry J. Kaiser Family Foundation, Medicaid s Role in Nursing Home Care, June 2017) FUNCTION Activities of Daily Living Bathing/shaving/combing hair Dressing Eating (food from table to mouth, chewing) Toileting Continence Transferring Ambulating Instrumentalities of Daily Living 1
2 PLACE Home (independent living) Senior-citizen apartment Residence Home with Assistance Family/spouse who owns the home? Home health Companions Adult Day Care Assisted living facilities Assisted Living Facilities Residential care facilities Nursing homes Skilled nursing facilities Intermediate care facilities PLACE (cont.) COSTS Usual at Home Expenses Home Health or Family Caretaker Living with family Residential Care Facility Assisted Living Facility Nursing Home 2
3 RESOURCES Income Social Security Pension Other Long-Term Care Insurance Assets Active Passive Government Benefits MO HealthNet BASICS Nursing Homes and possible home care Federal & state funded medical assistance program for low income Elderly (65 and over) Disabled (SS definition) Children and parents Missouri Max Benefits Only $2, allowed in countable resources No income cap for nursing home & ICF-MR assistance LONG-TERM CARE INSURANCE What per diem to buy Cost of nursing home care & spousal expenses Less expected income when retire Health when apply Assets to protect ($100,000 to $200,000 +) Partnership policies Inflation (compound >61, simple 61-76, none 76<) Affordability of premiums Company strength Call MO Dept of Ins.: or Complaint Index Company rating (higher the rating, the stronger the company) 3
4 MEDICAID ASSET RULES Non-Countable (exempt) Personal residence Vehicle Irrevocable burial plan Personal property Term life insurance Countable (non-exempt) Everything else PENALTY CALCULATION Divestment penalty divisor Average private pay rate for semiprivate room Rules since February 8, year lookback Aggregate gifts Penalty assessed in month of application if otherwise eligible MARRIED COUPLE RULES (DIVISION OF ASSETS) 1988 Spousal Impoverishment Act Countable assets divided in 2 shares Community spouse resource allowance Minimum and Maximum Changes each year Income for Community Spouse vs. Institutional Spouse 4
5 ASSET PROTECTION STRATEGIES Pre-planning Gifting outright to individuals Medicaid asset protection trust (MAP trust) Must involve giving up complete control Crisis Planning Medicaid compliant annuities Strategic gifting Must consider tax implications of these strategies BENEFITS OF LTC PLANNING Life plan including long-term care Public benefits becoming more restrictive Legacy of assets & values for family Fiduciaries ready to step forward Assistance in Finding appropriate care Applying for benefits Protection of assets (if goal) Accomplishment of identified goals Some never want to enter nursing home Workout issues between client and family members Peace of mind Powers of Attorney A Power of Attorney is a legal document where the principal names a trusted person to make medical and/or financial decisions for the principal under the guidelines provided by the principal in the Power of Attorney. The person named by the principal is called an Attorney in Fact, Agent, Proxy, Surrogate, or Representative. A power of attorney does NOT take away the Principal s right to make their own decisions if the Principal has capacity. 5
6 Financial Power of Attorney Springing vs. Immediate General Powers vs. Broad (Super) Powers Funding a Trust Making a Gift Adding a beneficiary designation Considerations in naming the Agent Not all Powers of Attorney are the same! Healthcare Power of Attorney and Physician s Directive Is only triggered during incapacity Considerations in naming the Agent Physician s Directive (also known as a Living Will or Advanced Healthcare Directive) Alternative to Powers of Attorney Guardianship& Conservatorship Public information Court filing fee Service by Sheriff Guardian ad Litem Attorney fees Court hearing: testifying against loved-one Court oversight/yearly settlements 6
7 Questions? (417) Offices in Springfield, Ozark, Nixa*, & Joplin* *By appointment only Attorneys Jessica Kruse, Danielle Kincaid, Lori Rook, Angela Myers, and Elyse Hartley 7
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