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Better Than No Loaf: Medicaid Planning Using “Half a Loaf” Strategies

October 15, 2021 By Barry Crimmins

While it is preferable to conduct long-term care planning well in advance of needing care, if you haven’t planned ahead, there are some strategies available to avoid spending all your assets. Three so-called “half a loaf” approaches allow a Medicaid applicant to give away some assets while still qualifying for Medicaid. 

In order to be eligible for Medicaid benefits a nursing home resident may have no more than $2,000 in “countable” assets (the figure may be somewhat higher in some states) in addition to the home, and the resident cannot have recently transferred assets. (A spouse living at home may keep more.)

Congress has imposed a penalty  on people who transfer assets without receiving fair value in return. This penalty is a period of time during which the person transferring the assets will be ineligible for Medicaid. The penalty period does not begin until the person making the transfer has (1) moved to a nursing home, (2) spent down to the asset limit for Medicaid eligibility, (3) applied for Medicaid coverage, and (4) been approved for coverage but for the transfer. 

If a Medicaid applicant has excess assets, he or she must spend down those assets in order to qualify for Medicaid. However, Medicaid applicants who want to preserve some assets have a few options: 

  • Gift and cure. The nursing home resident transfers all of his or her funds to the resident’s children (or other family members) and applies for Medicaid, receiving a long ineligibility period. After the Medicaid application has been filed, the children return half the transferred funds, thus “curing” half of the ineligibility period and giving the nursing home resident the funds he or she needs to pay for care until the remaining penalty period expires.
  • Promissory note. The nursing home resident gives half of his or her funds to the resident’s children (or other family members) and lends them the other half under a promissory note that meets certain requirements in the Medicaid law. The resident uses monthly repayments of the loan, along with his or her income, to pay nursing home costs during the penalty period.
  • Annuity. The nursing home resident gives half of his or her funds to the resident’s children (or other family members) and uses the remaining assets to buy an immediate annuity. In most states the purchase of an annuity is not considered a transfer that would make the purchaser ineligible for Medicaid. Income from the annuity can be used to help pay for long-term care during the Medicaid penalty period that results from the transfer. In such cases, the annuity is usually short-term, just long enough to cover the penalty period.

These strategies may not work in every state and none of them should be attempted without the help of an attorney. To find an attorney near you, click here.

 

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Law Offices of Barry R. Crimmins, PC

BRC Newsletter September

Elder Law News, September 2022

As the generation of Baby Boomers ages, many are finding their adult children aren’t in the financial position to provide support if long-term care is needed.

august newsletter

Elder Law News, August 2022

With healthcare and nursing homes being a hot topic as of late, you may have some questions regarding your care or the care of a loved one. If so…

Elder Law News - May 2022 Thumbnail

Elder Law News, May 2022

With healthcare and nursing homes being a hot topic as of late, you may have some questions regarding your care or the care of a loved one. If so…

Elder Law NEWS - April 2022

Elder Law News, April 2022

In 2022, change remains constant. But, as it applies to eldercare, some shifts are favorable, while others could directly impact the financial stability and level of care your loved one receives. 

Elder Law NEWS - March 2022

Elder Law News, March 2022

If you or a loved one were hospitalized and put under observation status, don’t worry – you have the right to appeal. The CMS (Centers for Medicare & Medicaid Services) recently announced that beneficiaries could appeal a hospital’s decision to assign observation status.

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