Contra Costa Elder Law Blog










authored by F. Michael Hanson, Attorney at Law

Covering the Gamut of Elder Law and Related Estate Planning Issues
Contra Costa Elder Law Blog | F. Michael Hanson

Saving Something for the (Better) Nursing Facility


Saving Something for the (Better) Nursing Facility


November 5, 2010

As most are aware, Medi-Cal benefits are not available for assisted living facility expenses or even board and care facility expenses - but only for nursing home (convalescent hospital) care. 

This can create something of a nightmare as families watch remaining funds dwindle, spent on an incapactiated loved one's care at, for instance, a board and care facility.  Though care at a board and care facility is preferable to care at a nursing facility, the question becomes how long and to what extent should those available funds be spent on board and care expenses before the move to a nursing facility is made?  Do you spend the funds down to the last penny, or gift extra funds away, and then move your loved one to a nursing facility at that time - i.e. at the last minute when no cash is remaining? ... and then apply for Medi-Cal coverage?  

In making this decision (i.e. in spending the remaining money, or converting it to "exempt" assets. or gifting it away - and, please, get some professional elder law guidance before you do any gifting!) you must remember that there exists a "spectrum" of nursing facilities - which starts with the "good ones" and extends downward toward and to the "less-than-good ones" - and you'll obviously want to get your loved one into as good a facility as possible.

In all cases accomplishing this will typically mean saving some your loved one's funds for purposes of "buying-in" to a better facility.

To get a better idea of the issue here, let's take a look at this "spectrum" of nursing facilities.

At the "really good facility" side of the spectrum, you have the purely "private-pay" facilities (they accept no Medi-Cal patients).  These are the places which charge anywhere from $10,000 to $15,000 (and up) per month for the care they provide, and these places are great: private rooms, large TV sets, colorful prints of Renoir, Degas, and Monet on the walls, and food which is better than anything I think I have ever cooked for myself.  But these places are exactly like hotels - when you run out of money, out you go.

At the opposite end of the spectrum are what I refer to as the "pure Medi-Cal" facilities.  These are the facilities which accept almost all Medi-Cal patients who apply for residency.  However, because their budget typically consists of the $5,500 - $6,800 per month which the State Medi-Cal system pays for Medi-Cal patients, these facilities will exhibit a lesser overall quality of care reflective of that budget: this will be seen in the generally lesser cleanliness of the facility, a lesser quality of food, a less than responsive attitude of the caregiving staff, etc.   This makes perfect sense - with less money to spend there will be less quality afforded the residents.

In the middle of this spectrum are what I refer to as the "hybrid facilities". These are the facilities which accept both private-pay money and Medi-Cal money for the care of their residents.   The average monthly private-pay rate for these facilities (in my county, Contra Costa) is about $8,600 per month.  These facilities are the ones to target - if your loved one is to be an eventual Medi-Cal beneficiary (because their combined private-pay and Medi-Cal budget affords a better quality care and environment).  But here's the "rub":  even though it is true that one who is already a resident of one of these facilities cannot be "kicked-out" once he or she converts to Medi-Cal, the facility can play "economic politics" with you at the front door - asking you about your loved one's remaining assets - and thereby determining whether your loved one has the capability to pay at the private-pay rate for awhile... or for as many months as may then seem necessary to the admissions director.  And if your loved one's assets don't pass muster, he or she will be denied admission.

In my 20+ years of elder law practice I have had two nursing home adminsitrators from local private-pay nursing homes in my office (who were seeking to obtain accelerated Medi-Cal benefits for their mothers), and during our conference I asked them how many months of private pay money each would want to see before admitting a patient they knew eventually would become Medi-Cal eligible.  One replied 2 months, the other 4 months.  More in-depth conversation revealed that it was usually a function of their budgets (duh!) , but more specifically, and with respect to Medi-Cal residents, they wanted to make sure that they would be receiving private pay money during the time it would typically take a Medi-Cal application to be approved and benefits cleared for payment (that used to be about 2-3 months, now sometimes it can take up to 6 months).

As you can probably see, if you have spent all of your loved one's money on another type of care, or if you have gifted it all away, or have converted the remaining cash to "exempt" assets, and then, with nothing left, you approach one of these hybrid facilities requesting admission, you are more likely to receive more "No"'s, or "Sorry we have a waiting list", or "There are no rooms available just now" (though you're sure you passed at least 6 empty rooms on the way to the administrator's office) .... and all of these rejections are going to have the effect of pushing your loved one further and further toward the other and less favorable facilities in the spectrum I have been describing.

So with respect to your loved one's remaining funds - before you spend it all, or gift it all away, or convert it all to exempt assets, keep in mind that by doing so you are likely limiting your loved one's access to the better facilities.   Instead, be sure you save something for the better facility.

Of course, there are always exceptions to the general concept described here, even for those who find themselves with absolutely no cash, and the need to find a better nursing facility.  A qualifed elder law attorney can help you through such a situation. 

In the meantime, don't make your loved one too poor too fast.  It may not be the best choice you can make.

Don't Transfer the Home! (Part Four)


Don't Transfer the Home! (Part Four)


December 6, 2009

This is the last of a four-part blog exploring the risks and consequences of transferring an elder adult's home prematurely.

Again, for purposes of illustration in this last segment, assume the following background facts:

  1. That the elder adult is my father, who purchased his home in Walnut Creek for only $16,000.

  2. That my father's home is now worth $816,000 (i.e. it has appreciated $800,000).

  3. That my father and I "panicked" in light of his first minor stroke or fall... and he transferred ownership of his home to me.

The Fourth Reason Not to Transfer the Home - Avoiding Capital Gains Taxes at My Father's Death.

Assume my father transferred the home to me, and he later passes away. If I decide to sell the home after his death, I will suffer large capital gains taxes on the sale calculated as follows:

Gross proceeds: $816,000
Less: basis (my father's purchase price) -$16,000
Taxable proceeds: $800,000
Capital gains taxes: $194,400
(taxes calculated assuming combined State and federal rates of 24.3%)

My sale of the home generates an income tax obligation of $194, 400. This is because when my father gift-transferred the home to me, I am required to use, for income tax purposes, the $16,000 tax basis my father had in the home.

On the other hand, if I inherited the home from my father after his death (i.e. at his death he owned the home in his individual name, or in the name of his living trust, or had other recognizable "incidents of ownership" in the home at his death), I would inherit that home with a new tax basis equal to the value of the property at my father's death (i.e. $816,000!)

This means that when I sell the property after his death and as a result of inheriting it after his death (as opposed to having received it as a gift before his death), there will be no income taxes on the sale proceeds!

It is true that if my father was admitted to a nursing home and needed Medi-Cal services in his declining days, the State would be entitled to have its Medi-Cal expenditures reimbursed from the property which remains in his name at his death (and for that reason some still believe that it is better to transfer the home early). But if the State of California is paying a maximum of approximately $4,500 per month for my father's nursing home Medi-Cal care, it would take, comparatively speaking, 43 months (3½ years) before the State's Medi-Cal estate claim came even close to the $194,400 tax "hit" I suffered above.

Interestingly enough, with the correct estate plan documents in place, there would be a method by which I could transfer my father's home to myself before his death, and this method would both (1) avoid the State's Medi-Cal estate claim and (2) obtain the higher ($816,000) income tax basis in the property which avoids the taxes.

For all of these reasons it would be better for my father to keep ownership of his property, and for us to carefully plan his future use of that property.

The Bottom Line: Rather than making a haphazard gift of the home, an elder adult in the same situation (and even before the first mini stroke or other accident or adverse diagnosis occurs) should contact and consult with a qualified elder law and Medi-Cal planning attorney - to create modifications and adjustments to the elder adult's estate plan - modifications which can authorize the elder adult's child (or other trusted relative) to take actions which both benefit the elder adult and, when necessary, protect the elder adult's home, or the proceeds thereof, and all other assets, from excessive income taxes, gift taxes, Medi-Cal ineligibility, and Medi-Cal estate claims. It can all be done if the correct documents are in place.

Don't Transfer the Home! (Part Three)


Don't Transfer the Home! (Part Three)


December 6, 2009

This is the third of a four-part blog exploring the risks and consequences of transferring an elder adult's home prematurely.

Again, for purposes of illustration in this four-part series, assume the following background facts:

  1. That the elder adult is my father, who purchased his home in Walnut Creek for only $16,000.

  2. That my father's home is now worth $816,000 (i.e. it has appreciated $800,000).

  3. That my father's home is free and clear (the purchase loan was paid-off long ago).

  4. That my father has, aside from his home, only modest resources of, say, $12,000.

  5. That my father and I "panicked" in light of his first minor stroke or fall... and he transferred ownership of his home to me.

The Third Reason Not to Transfer the Home - My Father Should Have Access to the Entire Value of the Property.

My father might actually want access to the equity value of his home to pay for in-home care services - so he can stay at home and not be forced into a skilled nursing facility, or any other type of care facility, earlier than necessary. The equity value in his home could be obtained for this purpose in a variety of ways:

(a) a Credit Line or Refinance Loan on the home could be acquired, and thereby cash obtained, so he would have more money available to pay for his own care at home. My father may not need in-home or other care services yet, but we should not deprive him of this equity-access option. 

If my father did need care services at home, and care services were being provided, it is true that there would be "double payments" in this scenario: (1) payments to the care-givers on the one hand, and, (2) loan payments on the credit line or mortgage on the ohter. And although this option seems a wasteful use of his equity, it is still wise to keep it "on the table". Why? Because my father has no interest in entering a nursing facility, or going anywhere else, earlier than necessary. Although it may seem "smart" to transfer the home now, later, and in hindsight this may not appear to have been such a good idea - my father will likely wish he still had this option available - to at least consider.

And where it is true that I could, when the time came, transfer the home back to my father, for such loan purposes, title companies and lenders will be less likely to approve a loan on property which has been "trading-hands" between us lately. It arouses, in their minds, worries about possible creditors or liability problems which my father and I are attempting to avoid; in short, transfers back and forth compromise the probability of loan approval.

(b) Although a Reverse Mortgage on a home is typically viewed as an unfavorable option, it could be timely obtained to assist my father with his care. A reverse mortgage could generate a significant amount of cash to assist in the payment of (if necessary) in-home care services for my father. An FHA reverse mortgage, also called a Home Equity Conversion Mortgage (or HECM), could generate as much as a $389,000 advance (in the case of my father and his property) and unlike conventional loan financing, no credit or income qualifications are necessary to obtain a reverse mortgage (you might want to check this AARP link to enter the relevant data about elder adult(s) whom you think might find such an arrangement beneficial for in-home care purposes or other living expenses).

And the possibilities here are significant. As part of President Obama's stimulus program, Congress recently raised the HECM loan limit from $417,000 to $625,500! (though this higher loan limit may expire at the end of this year if Congress does not grant an extension to the program).

With a reverse mortgage no monthly payments need be made to the lender, and the loan need not be repaid so long as the elder (or elders, or the survivor of them) continues to own and occupy the home as his or her residence. See this federal FHA site as well, for more information on the terms and conditions under which these federal supervised reverse mortgages are available.

There are, admittedly, considerable costs and other conditions which accompany an FHA reverse mortgage arrangement, and they should be examined very carefully (and you'll also want to make sure that the reverse mortgage arrangement is not accompanied by, or followed-up by an investment advisor who pressures the elder adult into purchasing an annuity or some other "exotic" investment with the reverse mortgage proceeds) but the point is: transferring my father's property out to me at this time would be equivalent to taking the reverse mortgage option "off the table" as well.

Now, in the case of a reverse mortgage, I could transfer the property back to my father, because there is no minimum period of ownership required in order for him to be eligible for a reverse mortgage. But considering the other risks which could endanger the property (described in Part One of this series) and the tax consequences of an early transfer (described further below), why should he transfer the property to me at all?

Side Note: I do not sell or sponsor the sale of reverse mortgages. And I typically consider the reverse mortgage option conservatively, mostly as a "last resort" to any long term care planning approach. However, reverse mortgages do have a place in long term care planning, and I do appreciate the benefits which an FHA reverse mortgage can offer disabled elder adults, that being, quite simply, cash - cash which can help them with living expenses and, more importantly, keep them at home, even if just a little longer.

(c) Selling the Home Can Create Cash, But if I Own the Home There Will be Excessive Income Taxes. Selling my father' s home can generate useful cash, but there will be significantly higher income taxes on that sale if the home is owned by me rather than my father.

Such a sale might be necessary - because the transfer of my father's home to me triggered a Medi-Cal ineligibility period (See Part Two of this Series - and I haven't retained a elder law attorney to help me undo that mistake) - or because a sale of the home seems favorable in order to generate cash to pay for my father's care in an assisted living or board and care facility (since he only has $12,000 of available cash to pay for such care).

In any event, if my father's home is to be sold for such purposes, it would be better if the home were still in his name, and not mine. If title to the property remained in my father's name, he can take advantage of the $250,000 residential income tax gain exclusion on the sale of his home (because he has both "owned and used" the home as his principal residence for at least 2 out of the last 5 years). Under these circumstances, taxes on the sale of his home (assuming he received sales proceeds of $816,000) would be:

Gross proceeds: $816,000
Less: basis (his purchase price) -$16,000
Less: the exclusion -$250,000
Taxable proceeds: $550,000
Capital gains taxes: $133,650 (net proceeds retained: $682,350)
(taxes calculated assuming combined State and federal rates of 24.3%)

However, if I own the property and sell it for my father's benefit, I do not qualify for that $250,000 exclusion. Therefore, taxes on the sale would look like this:

Gross proceeds: $816,000
Less: basis (his purchase price) -$16,000
Less: the exclusion (none) -$ -0 - (I am not eligibile for this exclusion)
Taxable proceeds: $800,000
Capital gains taxes: $194,400 (net proceeds retained: $621,600)
(again, taxes calculated assuming combined State and federal rates of 24.3%)

As you can probably see... the result of transferring my father's home to me, and then my selling it, creates an additonal $60,750 in income taxes payable to the State and federal government.

Can I transfer the property back to my father and have him sell the property in his name? Yes, unless the transfer back to him occurs any later than 3 years after he transferred the property to me. If the transfer is made any later than 3 years after his initial transfer to me, he cannot claim the $250,000 exclusion because he will not be able to state that he has both "owned and used" the property "2 out of the last 5 years" (it would be something less than 2 years - because, despite his continued "use", I owned the property in my name for more than the last 3 years). So the damage can be reversed if the problem is detected early enough, but if I forget about this 3-year limitation sometime after his transfer of the property to me, and 3 years pass, the tax loss is permanent.

Transferring the Home Between Us Can Create Unexpected and Damaging Gift Taxes. Consider, also, the following gift tax nightmare scenario: I transfer the property back to my father so he can acquire a loan, or a reverse mortgage on the property, or so he can sell it and avoid the excess income taxes. And then, later, he determines, that he wants to gift transfer the home (or the remaining proceeds of the sale) back to me anyway - because skilled nursing care seems certain at a later point in time. Aside from the Medi-Cal ineligibility which would result from this secondary transfer, there would also be an unexpected and devastating gift tax on the second transfer of the same property (or its proceeds).

Though the federal estate tax exclusion on the death of a person is currently set at $3, 500,000, the lifetime gift-tax exclusion is limited to $1,000,000. At the point where the total value of the gift-transfers my father has made to me exceeds $1,000,000, the excess value transferred incurs a gift tax, and at the rate of 45%.

The first gift-transfer of my father's $816,000 residence to me uses-up $803,000 of his available $1,000,000 lifetime gift tax exclusion (a $13,000 per person annual gift exclusion would be applicable to this gift-transfer and not be counted against the lifetime exclusion number, hence only $803,000 of the $1,000,000 exclusion is used-up). As a result, and as to all future gifts made by my father, there is only $197,000 of the lifetime gift tax exclusion remaining. Therefore, if my father were to transfer his home to me "again" there would be huge gift taxes payable.

For instance, assume I transfer the home back to my father so he can obtain a reverse mortgage on the home, and that he does qualify for and receives a reverse mortgage and $389,000 of loan proceeds. This would leave the home with a net value of only $427,000. When he transfers that net-valued $427,000 home to me, it will create a payable gift tax of $97,650! ($427,000 transferred, less the remaining gift exclusion of $197,000, and less another $13,000 annual exclusion (if applicable), leaves $217,000 of a taxable gift; and at a 45% rate, this creates payable gift taxes of $97,650).

Don't Transfer the Home! (Part Two)


Don't Transfer the Home! (Part Two)


November 30, 2009

This is the second of a four-part blog exploring the risks and consequences of transferring an elder adult's home prematurely.

First of all, assume the same facts as before, but focus on the following facts: (1) that the home has an assessed value of $160,000, and (2) that the home is still in my name (rather than my father's ) as a result of his early transfer of the home to me.

The Second Reason Not to Transfer the Home: Such a Transfer Could Create Ineligibility for Medi-Cal Coverage if the Elder Adult Should Actually Need Nursing Home Medi-Cal Benefits Anytime Soon.

If it is conceivable that my father will have to enter a skilled nursing facility in the near future, the transfer of his home will, after a Medi-Cal "look-back" analysis of that transfer, create a period of ineligibility - a period of time during which my father will not be entitled to receive nursing home Medi-Cal benefits but will instead have to use his own assets to pay for his nursing care.

More specifically in this case, the Medi-Cal personnel will calculate the period of ineligibility by taking the $160,000 assessed value of the home (not the fair market value of the home, thankfully - just the assessed value) and dividing that value by $5,698 (the APPR figure for 2009). The result of this analysis will be 28 months of Medi-Cal ineligibility ($160,000/$5,698 = 28.08).

Where it is true that a residence is considered an "exempt" asset in a Medi-Cal eligibility context, that "exempt" status exists only if my father has the legal right to occupy the home (and can claim on the Medi-Cal application that he intends to return home). If my father, has, however, transferred full ownership of his home to me, he no longer has a legal right to occupy the home, and therefore cannot claim the applicable exemption. As a result, the home will not be "exempt", but instead subjected to the look-back transfer and ineligibility penalties described above.

This result would force me to sell my father's home to pay for the 28 months of nursing care which Medi-Cal will not cover - and this sale would cause unhappy income tax consequneces.

See Part Three of this series which includes a discussion of the damaging income tax consequences which attend a child's ownership and sale of the elder adult's home.

Don't Transfer the Home! (Part One)


Don't Transfer the Home! (Part One)


November 29, 2009

This four-part blog explores the risks and consequences of transferring an elder adult's home prematurely.

Often when an individual elder adult has suffered his (or her) first minor stroke, or has received an early diagnosis of dementia or some other debilitating disease, the children (even the elder himself) will decide to "take action" - because the threat of huge, inevitable nursing home expenses, followed perhaps by a State's "lien", seems certain.

And the action taken is frequently an immediate deed-transfer of the elder's home to one or more of the elder's children. The belief is that the home is "safer" in the children's hands, away from the reach of the "system", and, if necessary, the home can still be sold by the child(ren) to pay for the elder's care.

However, this typical “knee-jerk reaction” transfer is a critical error which creates more risks and damage than the protection it is intended to accomplish.

First of all, for purposes of illustration in this four-part series, let's assume the following background facts:

Background Facts:

  1. That the elder adult is my father, who purchased his home in Walnut Creek for only $16,000.

  2. Assume further his home is worth $816,000 (i.e. it has $800,000 of appreciation).

  3. Assume further that my father's home is free and clear (the purchase loan was paid-off long ago).

  4. Assume further that the assessed value of his home is $160,000.

  5. Assume further that my father has, aside from his home, modest resources of, say, only $12,000.

  6. Assume lastly my father and I "panic" in light of his first minor stroke or fall... and he decides to transfer his home to me.

The First Reason Not to Transfer the Home: Despite the Child’s Good Intentions, the Home Could be Lost to Misfortune.

My father's home, now in my hands, is at considerable risk - not because he can't trust me, but because Murphy's Law and just "bad luck" are forever busy.

For instance, what if I were to suffer some major injury which wasn't totally covered by medical insurance, and as a result of the huge medical debts (or other bills I couldn't pay because I was out of work, recuperating, for a month or more), I had to file for bankruptcy? Because I (rather than my father) now own the home, the bankruptcy trustee would be force-selling the home to satisfy my creditors' claims - and my father would be "on the street".

What if I were to run-down Rush Limbaugh (or some other commentator or politician) in a cross-walk for whom no insurance was enough money, and I was consequently sued in a ridiculously large lawsuit.... or just some other lawsuit..... and my insurance was insufficient (or I had none) to handle the resulting judgment against me? Again, because I now own the home (rather than my father), my judgment creditors would be placing their judgment liens on, and force-selling, my father's home to satisfy their judgments - and my father would be "on the street".

What if I was "so sure" that ... if I just obtained a modest loan on the home... and I just invested the loan proceeds through my Scottrade account in, let's say, "sure thing" investments like Lehman Brother's stock, or Washington Mutual stock, or with Bernard L. Madoff''s Investment Securities, LLC, - and I was mistaken, and the investment became worthless... or just worth less? A sizable portion of my father's equity in the property is lost...

What if I unexpectedly predecease my father (driving home on our local 680 freeway these days is like "running with the bulls"... and almost as hazardous). At my death my estate, which includes my father's property, would be left to..... whom??

There are more examples, but this should be sufficient to make the point. My father should keep the ownership of his home in his own name. In my hands, and despite my best intentions, I cannot guarantee his home will always be there for him.

Important Side Note: I often remind clients that the State of California does not develop rights against a person's home simply because that person "might" need nursing home care in the future. The State does not impose any pre-nursing-home liens or claims against a person's home or other assets. A person's home does not become an immediate target upon his first broken hip or an arguable case of dementia. Quite to the contrary (and it is very important to remember this) the State has no claim to any property of a person until it spends at least "dollar one" on that person's care through the Medi-Cal system (and note that I am here referring to the Medi-Cal system, not the MediCare system - you need not worry about Medicare expenditures - neither the State nor federal government attempts to recover for Medicare benefits paid). Moreover, should the State of California start spending money on a person's care through the Medi-Cal system, it can only later recover the amount of money it actually spent on that person's care. The State is not entitled to a "windfall"; it can not lay a claim to a person's entire home or assets simply because that person began receiving Medi-Cal benefits. And then again, with proper estate planning, that potential "recovery" can often be entirely eliminated.

With an updated and properly structured durable power of attorney, one which authorizes specific gifts of real property and other assets in the event of permanent nursing care, my father can continue to keep his home and other assets securely in his own name, and still empower me to transfer his home, cash, investments, etc. - if the need later arises.

So don't transfer your home prematurely. Instead update your estate plan documents with my assistance, or with the assistance of another experienced elder law and Medi-Cal planning attorney. Your home is the most valuable asset you own. Don't make a risky, haphazard transfer of it.

See Part Two - Medi-Cal ineligibility which a transfer of the home will create.

The California Nursing Home Medi-Cal Look-Back Period – It's 30 Months (Not 36 Months or 60 Months) and an Easy Way to Discover the Incompetent.


The California Nursing Home Medi-Cal Look-Back Period – It's 30 Months (Not 36 Months or 60 Months) and an Easy Way to Discover the Incompetent.


November 29, 2009

In my practice I frequently encounter the same "how many months?" question regarding the nursing home Medi-Cal “look-back” period in California (that being the amount of time Medi-Cal personnel can “look-back” from the date of your nursing home Medi-Cal application to determine if any ineligibility-triggering gifts have been made). In California the look-back period is 30 months (Title 22 of the California Code of Regulations, Section 50411.3). It has been 30 months since January of 1990 and has never changed. It is not 36 months or 60 months (it might be changed in the future, but right now it is 30 months) and fortunately this simple distinction can be used for purposes of instantly recognizing incompetent “Medi-Cal Specialist” companies and misinformed annuity salespersons. These folks will vigorously advise you, in support of their own products, annuities, and services, that you cannot possibly qualify for Medi-Cal benefits because the “look-back” period is “36 months” or “60 months”. Happily, such comments and website “warnings” are a dead giveaway - a telltale sign of an inept (or dishonest) advisor.

However, even if they get the “look-back” number right, you must be careful not to buy-into their “one size fits all” solutions. Remember these companies and salespeople will frequently use inaccurate information in order to convince you to purchase their products, annuities, and services. This is because they have no ethical obligation to consider your current or future needs or, more importantly, to advise you of other less expensive and less restrictive options. To them it’s just a question of getting you to sign on the bottom line, and too often, the bottom line of a purchase document which absolves them of any misrepresentations.

To the contrary, an elder law attorney will not be selling annuities or other exotic products, but instead offering detailed and non-sales-motivated information about other options to obtain Medi-Cal eligibility – options which can avoid the Medi-Cal “spend-down” requirements, options which will not violate the 30-month look-back rule, and more importantly, options which will allow you to keep your money and investments in your own pocket rather than “locking-up” your last remaining funds in an annuity or other product where later withdrawals will be accompanied by stiff (typically 8% to 12%) penalties.

So these words to the wise: if websites or salespersons start their pitch with the “discouraging” saga of California’s “36” or “60” month look-back period, you know for sure you’re dealing with dishonesty or incompetence. And even if they attempt to “discourage” you with the correct “30” month look-back number, don’t buy into that discouragement – instead call us and find-out about all of your options. It's your money. . . and it's our job to see that you keep as much of it as possible.

The CLASS Act - A Government Contribution to Long Term Care Assistance


The CLASS Act - A Government Contribution to Long Term Care Assistance


November 29, 2009

I am watching the 2,000 page House health care reform bill with particular interest, if for no other reason, because it contains a long term care program referred to as the Community Living Assistance Services and Supports Act (or what the House calls "The CLASS Act" - I continue to enjoy the labels Congress constructs for some of its arguably helpful measures... let’s see, there was the protective financial blanket known as "TARP"; now we have "the Class Act" - I wonder sometimes if Congress assumes we just blindly listen to the acronyms and say.. "I guess that must be good, because it sounds good").

Anyway... if included in the final House and Senate version of the health care reform bill, this CLASS Act will create a voluntary program through which Americans can pay a monthly premium to the government, estimated to be, initially, around $65 per month. In return, and if the person paying these premiums has contributed to the program for at least five years, and is in need of long-term care assistance, he or she will be eligible for a modest benefit to help pay for a certain services related to the degree of disability being suffered. The idea is to assist the contributor to stay in his or her home. In the House bill, this benefit would depend on the degree of incapacity, but estimates indicate it would average about $50 a day.

(By the way, the Senate's version of this program, similar in its concept, is a creature of their Health, Education, Labor and Pensions committee - the "HELP" committee (sounds good, doesn't it?)).

At this point it is unclear which version of the CLASS Act, or what blended House and Senate version, will be incorporated into the final health care reform bill (if a final bill is passed at all), but the CLASS Act has one huge advantage that could ensure its survival: it will be, at least initially, a revenue generator for a few decades. In its preliminary analysis of the House bill, the Congressional Budget Office projected that because the CLASS Act would pay out far less in benefits than it would receive in premiums over a 10-year budget window, it would reduce deficits by about $72 billion, and by a smaller amount in the following decade.

After 2029, however, the program will start contributing to the federal deficit, but by a comparatively small amount compared to other provisions of the health care reform bill.

As currently structured in the House bill, this program offers between two and six different benefit levels, depending on level of the contributor's disability. The House version indicates there will be a sliding scale of benefits, ranging from, say, $30 a day for inability to perform two "activities of daily living" (ADLs) to a benefit of $70 a day for five or six ADLs. Under the House version, enrollees have to be working when they first enroll, but can quit a job after they sign up and still be in the program.

The insurance industry is lobbying to remove the CLASS Act from health reform legislation, arguing that its modest benefit will not adequately protect Americans who need nursing home care or 24-hour home health care services. A survey by the American Council of Life Insurers, which is spearheading the opposition to the Act, found that public support for the CLASS Act drops when respondents learn about its potential cost. The survey found that only 3 percent of respondents would participate in the program if premiums reached $160 monthly, which is the level the American Academy of Actuaries-Society of Actuaries argues will be required for the program to remain solvent.

Frankly, I do not believe these results reflect a fair survey of potential enrollees. If you keep increasing a sample or "test" premium you can discourage 97% of any group of survey respondents - it's just a question of amount. And the $160 per month solvency benchmark isn't particularly persuasive. I do not recall the lack of solvency as ever dissuading Congress from a proposed course of action. So using a $160 amount as a sample premium is, at best, specious.

I wonder if the survey participants were apprised of the total picture. For instance, if I was allowed the opportunity to pay $65 per month for a minimum of five years (a total of $3,900), or even $160 per month for five years (a total of $9,600)(neither of these monthly payments is even near your standard car payment these days), and I knew that my contributions would eventually afford me an average of $50 per day of assistance in the event of a disability (this would be $18,250 of benefits in just the first year alone!), I would see a definite value. To be certain, the benefits are modest, but even a little help can make the difference between home... and a nursing home.

Actually, this program does "sound good".

The Community Spouse Resource Allowance (CSRA) and the Spousal Income Allowance (MMMNA) to Remain the Same in 2010


The Community Spouse Resource Allowance (CSRA) and the Spousal Income Allowance (MMMNA) to Remain the Same in 2010


November 29, 2009

The federal Centers for Medicare and Medicaid Services (CMS) has announced (because there has been no increase in the consumer price index upon which their determination of spousal impoverishment standards are based) there will be no increase next year in either the Community Spouse Resource Allowance (CSRA) or the Minimum Monthly Maintenance Needs Allowance (MMMNA).

Here in California this means that the Community Spouse Resource Allowance (CSRA) now set at $109,560, will remain the same for the year 2010. The spousal monthly income allocation (also called the Minimum Monthly Maintenance Needs allowance, or MMMNA) which is now set at $2,739 per month, will also remain the same throughout 2010.

Are these numbers important? Yes!

The CSRA:

If one spouse is admitted to a skilled nursing facility, the other spouse at home (which the Medi-Cal program refers to as the "community spouse") should be careful not to needlessly liquidate and "over-spend" assets before requesting Medi-Cal coverage for his or her ill spouse's care. Some folks believe that the at-home spouse must spend available assets down to just $2,000 before attempting to qualify for nursing home Medi-Cal. This is not correct. In addition to those assets which are "exempt" under Medi-Cal (i.e. the home, a car, IRA's, retirement accounts, etc.) the spouse at home can also retain an additional $109,560 worth of any non-exempt assets, and still obtain Medi-Cal benefits for his or her institutionalized spouse. The CSRA is like a $109,560 protective "wild-card" which can be applied to shelter additional non-exempt assets which the couple owns. They need not spend their assets down to a meager $2,000. In some cases this $109,560 CSRA figure can be increased to protect an even larger amount of non-exempt assets.

The MMMNA (spousal income allowance):

Once Medi-Cal eligibility is obtained for the institutionalized spouse, the spouse at home is allowed to keep, at least, the first $2,739 (and sometimes more) per month of both spouses' combined monthly incomes - for living expenses. If the at-home spouse's gross monthly income is less the $2,739, he or she will receive an allocation of the institutionalized spouse's income - in order to bring the at-home spouse's income up to (or as close as may be possible to) the $2,739 MMMNA limit.

So... if you are an at-home spouse, don't "over-spend" or "go broke" on nursing home expenses. Spend instead, just a little time with me, or any other elder law/Medi-Cal planning attorney, to learn about your options. Much of what you think must be sacrificed to the cost of nursing home care can actually be saved!

And the Future of the Federal Estate Tax?


And the Future of the Federal Estate Tax?


November 28, 2009

Beginning next year, and unless Congress soon enacts a rescue, we will have wandered into a death-taxless year - an unprecedented period during which there will be NO federal estate taxes due on the estates of persons dying in 2010.

I have always referred to this anticipated, historical anomaly as "The Motive Year". With so many different seasons and versions of CSI behind us, I can't but jokingly think that some are already involved in a darker form of "tax planning".

However, if Congress does "nothing", 2010 will be the only taxless year. The federal estate tax will, under the existing law, spring back to life in 2011 (affixed with the original $1 million exclusion amount).

Representative Earl Pomeroy (D-N.D.), I believe, was one of the first to embrace this approaching oddity.  Arguing more for the sake of saving the many farm-steads in his home state of North Dakota, he first introduced a bill in 2003 suggesting that the federal estate tax exclusion (which is now set at $3.5 million per person, with a 45% rate applying to any excess) be fixed at an even $3 million. In 2005 he repeated the process, then introducing a bill recommending that Congress adopt and fix a $3.5 million exclusion. Both of his proposals were rejected.

But now as the year draws to a close, the issue is drawing more attention.

Representative Jim McDermott (D-Wash.) has authored and introduced the "Sensible Estate Tax Act", as he has labeled it, which suggests the estate tax exclusion be lowered to $2 million (with any excess being taxed starting at 45% rates).

Representative Shelley Berkley (D-Nev.) has introduced a contrary bill which would set the exclusion level starting at $3.5 million, increasing it eventually to $5 million (by 2019) and starting with a 45% rate which decreases to a final 35% rate over the same time period.

Active lobbying by various groups is coming down on all sides of these proffered exclusion numbers. Those who argue in favor of lower exclusion numbers remind us that the federal government has invested huge amounts of money in the TARP and TALF programs, continues supporting our presence in Iraq and Afghanistan, continues its commitments and expenditures in Social Security, Medicare, and Medicaid, and is now embracing the health care reform bill with its estimated $1 trillion budget. Their summary? It's simple: a lower exclusion amount is necessary in order to generate badly needed revenue.

Opposing arguments include, notably, the comparatively small amount which the federal estate (and gift) tax contributes to the overall federal income picture. According to the statistics reported at the Tax Policy Center site (if this page has expired, from the main site search "historical quarterly receipts by source") of the Urban Institute and Brookings Institution - and employing some simple math - the federal estate and gift taxes constituted 1.34% of total gross tax collections in 2002 (this being the first year the $1 million exclusion applied). In 2007, with a $2 million exclusion in place, the estate tax generated .996% of total gross tax collections). There are, of course, no revenue numbers for the current year, but I expect another minuscule decrease in that benchmark 1.34% number.

I believe that Congress needs to recognize that "a million dollars" is simply NOT "a million dollars" anymore. If it chooses to install (or by default allow) the smaller $2 million (or $1 million) exclusion back into the estate tax scheme, many of the small and mid-size businesses and farms which form the backbone of this nation's economy, and which might otherwise contribute their part to our economic recovery, will instead over time and under pressure of confiscatory estate taxes, be carved-up and sold off in pieces, or closed-down, or simply abandoned . . . each time adding a complimentary donation to the unemployment rate.

And this choice will have added what? ... a fraction of a percent to the federal revenue base?

In the face of a persistent recession, decreasing the federal estate tax exclusion makes little sense.

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