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September 20, 2021 by bob mason 69 Comments

Medicaid in an Assisted Living Facility? Think again!

You’ve been looking at assisted living facilities for Mom, who simply can’t be left home alone anymore and who cannot afford round the clock in-home care.

The admissions people at the assisted living facility have asked. “Are you going to be applying for Medicaid?” They’re curious. They want to be paid. It is also the wrong question to ask.

The name of the program is State/County Special Assistance for Adults. Call it “Special Assistance.” Now burn this into a plaque somewhere: “Special Assistance is NOT Medicaid.” The rules can be very different in a few critical areas.

Clients are constantly confused by this (as are many workers in assisted living facilities who should know better). You need to know the differences if someone you care for is in an assisted living facility.

First, a bit of background.

Levels of Care

Do not confuse an assisted living facility or adult care home with a skilled nursing facility. They are two different facilities with different rules and different programs.

A skilled nursing facility (what most of us call a “nursing home”) is a place for folks who are (usually) nonambulatory and with some chronic medical condition that requires skilled care on a daily basis. Think of it as a “step down” from a hospital meant for longer term stays. In the industry we call these “SNFs” (skilled nursing facilities).

Do not confuse these facilities with assisted living facilities. An assisted living facility is a facility for frail individuals who need assistance with a number of what we call activities of daily living (ADLs). Think assistance with bathing and toileting, mobility, personal hygiene, feeding. In the industry we call these ALFs (assisted living facilities).

To add to the confusion, some ALFs have special units usually called “Memory Care” or some similar variation (the bureaucratic term is “special care unit” or “SCU”). A special care unit is a separate area of an ALF with locked doors and a higher level of supervision for residents with various forms of dementia. Care in a SCU is NOT skilled nursing. It is still part of an ALF.

Paying for It

Generally, SNFs are charging around $10,000 a month. As we’ll discuss in a moment, Medicaid will pay for most care in most SNFs for eligible individuals. At 10 grand a month, most folks are keenly interested in whether Mom will qualify for Medicaid. But Mom is in an assisted living facility, so forget about it. If you want to read about Medicaid in a skilled nursing home, read North Carolina Medicaid Nursing Home Rules: The English Translation.

Generally, ALFs run around $3,500 to $4,000 a month for the general areas and perhaps $6,000 to $8,000 for a SCU or Memory Care Unit (those locks and extra supervision get expensive). Medicaid does NOT pay for ALF room and board and most incidental services. They simply aren’t considered “medical.” That’s where Special Assistance comes in.

If Mom is in an assisted living facility and IF she qualifies for SA, there will be a cap on how much they can charge for room and board (basically her income plus whatever the state pays them). Also, if Mom qualifies for SA, she MIGHT qualify to receive some additional personal care services paid for by Medicaid.

Did I just say MEDICAID!? Yes, but it is not the same as nursing home Medicaid. In this case it won’t be very much – perhaps a few hundred or a thousand bucks. Plus, unlike the SNF which has to be happy with the Medicaid payment as complete payment, the ALF might ask for a little bit extra from the family. But at least they aren’t paying “full freight.”

Special Assistance Background

Did I already write that Special Assistance is NOT Medicaid? Special Assistance actually borrows most of the rules that apply to the federal Social Security Supplemental Security Income (SSI) program. There are some significant differences from Medicaid.

Special Assistance Transfer Rules

SA has transfer rules, as does Medicaid. But Medicaid looks at any transfer made within 5 years of applying, divides the value of the transfer by $6,810, and uses that number to establish a penalty period in months that Medicaid will not pay for the SNF . . . beginning when the person is finally in the SNF and otherwise eligible for Medicaid.

SA looks at any transfer made within 3 years. The value of the transfer is divided by $2,000, and the result is used to calculate a number of months the individual is ineligible for SA. Unlike Medicaid, the transfer penalty begins the first day of the month following the transfer.

Special Assistance Asset Rules

These are very similar to Medicaid. A $2,000 countable asset cap. Some differences in real property rules.

A huge difference from Medicaid: SA does not count assets in the name of a spouse! If Mom qualifies for SA, Dad could be a millionaire.

Special Assistance Income Rules

This is VERY different from Medicaid and causes, perhaps, the most confusion. Under Medicaid, if income is less than the SNF’s private pay rate, there is no problem. Most of my clients do not have income exceeding seven or eight thou a month.

Under SA, when qualifying for the general area of an ALF (not the SCU) the gross income cap is just $1,247.50 a month. That’s GROSS income. Count Social Security BEFORE deductions for Medicare or other insurance. Count all other income from any source (well, except VA benefits . . . but that’s another story). If income is a penny over $1,247.50, then forget about general SA.

However, if Mom has dementia and needs to be in the Memory Care unit, the cap is $1,580.50. That helps some, I guess.

Here is how crazy the rules are. Remember Mom with millionaire Dad? She is drawing just $500 a month Social Security. All assets are transferred to Dad. SA only looks at Mom. She is qualified for SA.

Now think of Mom, who is widowed. She has just a few thousand dollars in countable assets. Her gross income is $1,248. Too bad. She doesn’t qualify. After years of working around this issue, I still have trouble accepting it.

Estate Recovery

SA has none! Estate recovery is a Medicaid issue. Did I already write that Special Assistance is NOT Medicaid?
Now, be careful, if Mom was on SA and managed to receive a few personal care services paid by Medicaid there might be estate recovery when she dies – but we’re talking perhaps a few hundred dollars a month.

I hope this helps clear up some confusion. Now you can amaze them at the assisted living facility when they ask, “Are you going to apply for Medicaid.” You can give them a puzzled look, then a knowing grin, and say, “No, I’m not. But I will be applying for Special Assistance.”

Questions? Just ask in the box below.

Filed Under: Assisted living, Medicaid, Nursing Homes, Reader Favorites, Uncategorized

September 20, 2021 by bob mason 7 Comments

Tying the Knot? Or Just Moving In?

a-famous-late-second-marriage

A Famous Late Second Marriage!

When a client tells me that he or she is considering a second marriage, for terribly unromantic reasons (I guess I’m the anti-cupid…darn lawyer!) I recommend that the client plan carefully—very carefully—before going into a later-in-life second marriage. The religious prescription not to enter a marriage “unadvisedly or lightly” applies in spades to a later marriage.

“Bob,” a client once asked, “are you suggesting we see an attorney before the preacher?” My answer: “Yes.”

Here’s why.

Some of the biggest and most expensive messes (I like the term “elder law train wreck”) I have had to clean up have been after the death of a second spouse when there had been little or no advance planning.

Adult step-siblings (who may not even know or like each other) can be counted on to be looking out for whatever it is that they believe their biological parent accumulated for them.

Most “planning” I have seen of late-marriers (is that a word?) consists of simple verbal agreements to the effect of “what is yours is yours, and what is mine is mine.” Lawyers know that won’t cut it. Most of the following difficulties can be addressed with a well-drafted prenuptial agreement.

All couples are different, but here is a partial list of issues that may be important to consider in further detail.

Intestacy and Poorly Planned Testacy.

As attorney I might question the sanity of any couple that enters into a late marriage with no wills. But, it happens. The North Carolina Intestate Succession Act provides that a surviving spouse is entitled to a share of real and personal property of a deceased spouse depending upon how many children (and other descendants) survive the deceased spouse (and whether any parents survive – but since we’re discussing late-in-life second marriages, I’ll assume there are no surviving parents). If Dad dies intestate survived by his “precious bride” (Dad’s term of endearment) of just a few years she will take the first $60,000 of his personal property and take either one-half or one-third of everything over $60,000 depending upon whether Dad is survived by just one or more than one child. If Dad had any real property, the “evil witch” (that according to Dad’s surviving relations) will be entitled either to half the real property (if Dad is survived by one child) or to one-third (if Dad is survived by more than one child).

Fortunately, the right to an intestate share is waivable.

But perhaps love truly is blind, and the newlyweds have downloaded snazzy, but simple and inexpensive, “I love you wills” that leave everything to the surviving spouse with the understanding that she or he will “do the right thing.” The prior-marriage-children can call me for a good litigator.

Even with wills that leave everything to the children of the deceased spouse, there may be problems with an “elective share” statute.

Elective Share and Year’s Allowance Statutes

Like most other states, North Carolina has an “elective share” scheme. The elective share statute enables a surviving spouse to “elect” to receive a share of the deceased spouse’s estate, the size of which depends upon how long the couple were married. A marriage of less than five years entitles the survivor to a total of 15% of the deceased spouse’s estate (for example, if Hilda left Henry $10,000 pursuant to the terms of her will, but had an estate of $1,000,000, Henry could elect another $140,000). After five years, the percentage pops to 25% of the estate, then to 33% after ten years and to 50% after fifteen years.

In fact, one interesting South Carolina case made waves a few years ago.

The deceased owner of Hooters (you know, the restaurant famous for . . . large burgers and chicken wings) left $1 million a year for 20 years to his quite younger surviving spouse. She felt $20 mil wasn’t enough, so she elected for 1/3 of Mr. Hooter’s estate. Mr. Hooter’s son (not the widow Hooter’s son, by the way) objected and claimed the South Carolina elective share statute (which is similar to North Carolina’s) is unconstitutional. Yours truly believes that argument had as much chance as a Hoot Owl in, well, Horry County. Hooter, Jr. and the widow Hooter settled for an undisclosed sum.

Notwithstanding the right of an elective share, a surviving spouse is entitled to a “year’s allowance” of $60,000 “off the top” of a deceased spouse’s estate. In other words, a surviving spouse is entitled to this subsistence-type allowance before any other creditors or heirs. This right, too, is waivable in a prenuptial agreement.

Powers of Attorney and Health Care Advance Directives

Effective January 1, 2018, North Carolina has a new power of attorney statute. Certain prohibitions on gifting, beneficiary designations, and the like make exceptions for spouses and children. Powers of attorney are not “just forms” (although many tend to treat them as such). In the case of a late marriage, powers of attorney and the powers granted (or withheld) in such an instrument under the new statute should be carefully considered.

The subject of health care decision-making can cause a bit of squirming for the happily engaged couple, especially after I explain the “default rules” that apply in the absence of a valid health care power of attorney. In the absence of a guardian of the person or a valid health care power of attorney, the spouse stands atop the heap of decision-makers, followed by the children of the principal. This may not go over well with Mom’s children given that the loser she’s marrying has had three earlier wives pass away under less than clear circumstances.

The Family Home.

Naturally the newlyweds do not want to see the bride or groom evicted upon the death of the other. On the other hand, children can become quite emotional over what may be perceived as “their home.” Chances are . . . putting the house in both spouse’s names is not a good idea. Read this for a very scary story (based on Mason Law facts). Try a life estate, or maybe a trust.

Social Security Benefits.

Remarriage can affect the Social Security benefits a newlywed had been receiving under a deceased or divorced spouse’s account. If you divorce after 10 years or more of marriage, you can collect retirement benefits on your former spouse’s Social Security record if you are at least age 62 and if your former spouse is entitled to or receiving benefits. If you remarry before age 60, however, you generally cannot collect benefits on your former spouse’s record unless your later marriage ends (whether by death, divorce, or annulment).

Annuities and Survivors Pension Payments.

Your client might be kissing a hefty survivor’s pension (corporate or military) goodbye when he or she kisses a new spouse. Advise checking those out before heading to the altar.

Income Taxes and Transfer Taxes.

There may be some tax planning advantages to marrying if estate and gift taxes are a concern because many planning techniques are available to married couples only. On the other hand, if their estates are large enough to pose transfer tax issues after the recently enacted Tax Cuts and Jobs Act ($11.7 million for an individual and $23.4 million for a married couple in 2021) any planning should be undertaken by sophisticated trusts and estates counsel.

Income taxes might also drop if one spouse is earning significantly more than his or her new spouse.

Long Term Care (Nursing Home) or Medicaid Planning.

This is a big consideration for older people considering remarriage. Medicaid rules and regulations do not recognize any plans or promises a couple has made in a prenuptial agreement when it comes to Medicaid and nursing home benefits. A carefully drafted prenuptial agreement is worthless if these issues arise. All Medicaid programs consider the assets of the couple. While rare, some couples have divorced within a few years of marriage when one spouse in declining health (usually the “poorer” spouse) has entered a nursing home.

It may be sad to see, but some couples are electing to do exactly what they would have DIED seeing their children do 30 years ago . . . “living in sin.”

Cupid

Bob Spreads the Love

 

Filed Under: Banking, General, IRAs & Retirement Plans, Medicaid, Miscellaneous, Nursing Homes, Social Security, Wills (or Not!) Tagged With: estate planning, Medicaid, special needs trusts, wills

May 10, 2021 by bob mason Leave a Comment

ASHEBORO, NC — Aug. 20, 2020: Best Lawyers® has announced that Asheboro, NC, elder law and special needs law attorney Robert A. Mason will be included in the 2021 edition of Best Lawyers in America in the category of Elder Law. Best Lawyers® bases its selection criteria exclusively on lawyer nominations and peer review ratings.

Further, Mason has been awarded “Lawyer of the Year” in the area of Elder Law in North Carolina’s Piedmont Triad area.

Mason’s selection will be listed in the 27th Edition of The Best Lawyers in America. ®

Mason is the owner of Mason Law, PC, Charlotte and Asheboro, NC, a firm devoted to meeting the legal challenges of seniors, the disabled and their families, using an array of sophisticated legal techniques.

Mason, a Board Certified Specialist in Elder Law by the NC State Bar Board of Legal Specialization, served two terms as Chairman of the Elder Law Section of the North Carolina Bar Association, and is Fellow of the American College of Trust and Estate Counsel. Mason especially focuses his elder and special needs law practice on advanced asset protection techniques, trust law issues, and special needs trusts.

Mason has a Bachelor of Science in Communications from Northwestern University, Evanston, Illinois, and a Juris Doctor cum laude from Mercer University School of Law, Macon, Georgia.

Filed Under: News / Press, Uncategorized

May 10, 2021 by bob mason 2 Comments

Best Lawyers BadgeASHEBORO, NC — Best Lawyers® has announced that Asheboro, NC, elder law and special needs law attorney Robert A. Mason will be included in the 2023 edition of Best Lawyers in America in the category of Elder Law. Best Lawyers® bases its selection criteria exclusively on lawyer nominations and peer review ratings.

Further, Mason has been awarded “Lawyer of the Year” in the area of Elder Law in North Carolina’s Piedmont Triad area.

Mason’s selection will be listed in the 30th Edition of The Best Lawyers in America. ®

Mason is the owner of Mason Law, PC, Charlotte and Asheboro, NC, a firm devoted to meeting the legal challenges of seniors, the disabled and their families, using an array of sophisticated legal techniques.

Mason, a Board Certified Specialist in Elder Law by the NC State Bar Board of Legal Specialization, served two terms as Chairman of the Elder Law Section of the North Carolina Bar Association, and is Fellow of the American College of Trust and Estate Counsel. Mason especially focuses his elder and special needs law practice on advanced asset protection techniques, trust law issues, and special needs trusts.

Mason has a Bachelor of Science in Communications from Northwestern University, Evanston, Illinois, and a Juris Doctor cum laude from Mercer University School of Law, Macon, Georgia.

Filed Under: General, News / Press, Uncategorized

April 26, 2021 by bob mason 15 Comments

Something is perking in Washington that could end up costing many people a lot of money that they weren’t expecting to spend. If you own assets that have appreciated in value, this could be you.

As I write this article news outlets are running stories regarding changes to capital gains that will affect “the wealthy” (see this in the Wall Street Journal or this at CNN as examples). As I will explain, this will have an impact on many of my clients who do not consider themselves at all wealthy.

First, either tell yourself you know about the tax basis rules and how they relate to capital gains taxes. If you can’t do that, take a few minutes to go back and read my article on capital gains basics.

Shocked older womanSen. Chris Van Hollen is circulating for comment a bill that would cause immediate capital gains taxation upon gifting and at death. Rep. Bill Pascrell has introduced a very similar bill in the House. The Biden administration backs the proposals. Both bills incorporate ideas that have been tossed around for years. The Senate version is called the “Sensible Taxation and Equity Act of 2021” or “STEP Act.”

The Senate version would be retroactively effective and apply to transfers made on or after January 1, 2021. The House version would apply to transfers after December 31, 2021.

If a variation is enacted, the 100-year-old stepped-up basis rules will be history. Although both bills are being promoted to ensure “the rich pay their fair share” more than the rich will pay. Read this to find out if you could be affected.

Background

As I discussed earlier, the US tax system has historically not taxed appreciation in property until the property has been sold. Further, taxable appreciation of property is completely wiped out upon an owner’s death.

Example #1

As shown in my earlier post, if Edith and Ralph Flimster bought a 100 acre farm in 1972 for $50,000, and later sold it for $220,000, they would have $170,000 taxable capital gain.

If they gift the farm to the children, Jimmy John (“Sammich”) Flimpster and Janey Ack Flimpster-Cellar (“Janiac”), they will also receive their parents’ tax basis along with the farm. If they turned around and sold it for $220,000 they would have $170,000 capital gains.

If Sammich and Janiac inherited the farm (either directly from Edith and Ralph or through a trust upon the death of Edith and Ralph) their basis would be the fair market value on the date of the death that triggered the inheritance. If Edith and Ralph died immediately, Sammich’s and Janiac’s basis would be $220,000. If they immediately sold the inherited property for $220,000 they would have ZERO capital gain.

That is what President Biden and Senators Van Hollen and Pascrell want to stop. They say it is directed to “the rich” but if enacted it will have an impact on many not-so-rich.

How the Bills Work

Capital gains would be subject to immediate tax any time property is transferred, whether by gift or at death, unless an exception applies (transfers between spouses) or a dollar exemption applies (discussed below).

The rates for most of us will stay the same (0% if taxable income – including any capital gains – is less than $40,000 for an individual; 15% if total taxable income is less than $445,851; 20% over that amount). The Biden administration proposes to raise the rate to 39.6% on incomes over $1 million (but remember that includes capital gains).

Dollar Exemptions

The STEP Act will give all taxpayers a $100,000 lifetime exemption and allow a $1MM exemption at death (MINUS any of the $100,000 lifetime exemption used earlier).

Basis in New Hands

Once a transfer has been made and subjected to the tax (or an exemption), the basis in the hands of the transferee is the value of the asset used for calculating the tax.

Example #2

As shown above, if Edith and Ralph Flimster bought a 100 acre farm in 1972 for $50,000, and later sold it for $220,000, they would have $170,000 taxable capital gain. Those rules haven’t changed.

But if they gift the farm to Sammich and Janiac, Edith and Ralph will have $170,000 taxable gain. However, each of them has a $100,000 lifetime exclusion. The statute isn’t explicit, but my guess is regulations would sort this out as follows:  Each of Edith and Ralph would contribute $85,000 of their $100,000 exclusion to wipe out any tax due (85,000 x 2 = 170,000). That leaves each of them with $15,000 lifetime exclusion and Janiac and Sammich with a $220,000 basis going forward.

Example #3

The following year they gift the kids stock worth $80,000 that they purchased years earlier for $10,000. The gain recognized will be $70,000. Each of Edith and Ralph use up their remaining $15,000 exclusion ($30,000 total), leaving $40,000 taxable. Their federal taxes alone will be $6,000 (assuming a 15% rate). If North Carolina elects to dovetail with the federal scheme, there could be another $2,100 state tax due (at 5.25%). The kids’ basis in the stock will be $80,000.

Example #4

The following year Ralph dies. His will leaves everything to Edith. Spousal transfers, recall, are exempt from gain recognition.  Edith inherits the existing basis in all the assets.

Arnold Abacus

Arnold Abacus, CPA

The following year, Edith dies and leaves everything to the kids. Because it is the year of her death, she has an exemption of $1,000,000 LESS the $100,000 lifetime exemption she used. Her estate consists of Flimpster Carpet Cleaning Solutions, Inc. (10 employees and a manager) that Ralph started in 1967. Arnold Abacus, the accountant says the fair market value is $1,500,000 and the basis is $150,000.  That’s $1,350,000 built-in capital gain.  There is also the family residence purchased in 1972 for $35,000 and now worth $250,000. That’s another $215,000 built-in capital gain. A total capital gain of $1,565,000.

After subtracting the $900,000 of the available exemption amount, the capital gains subject to taxation at Edith’s death will be $ $665,000. Sammich and Janiac will need to come up with $99,750 to cover the federal capital gains tax on $665,000. That’s the bad news. The good news is that the STEP Act would allow them to finance it with the IRS over 10 years.

Trusts

How the STEP Act treats trusts depends upon what kind of trust is under review. In my practice, I use both “grantor trusts” (trusts that for income tax purposes are treated the same as the person who set it up – everything goes on the Form 1040 of the person who set up the trust) and “nongrantor trusts” (trusts treated as separate tax entities. There are advantages and disadvantages to both. Either, if properly drafted, can do a good job of protecting assets (say, from nursing home costs).

The STEP Act says a transfer to a nongrantor trust will trigger tax. A transfer to a grantor trust will NOT trigger the tax.

Example #5

After Ralph’s death, Edith panics and transfers the residence to the kids “for safe keeping in case I need to go to a nursing home.” At the time she owns very few other assets. Recall, they bought the home for $35,000 and it is now worth $250,000. If Edith still has her entire $100,000 lifetime exemption, she’ll have gain of $115,000 (250,000 – 35,000 – 100,000). The federal bite will be $17,250, due immediately!

A Better Way

Instead of panicking Edith looks for good legal and tax advice. To protect the residence for Medicaid purposes, Edith should transfer the residence to an irrevocable trust. If the trust is carefully drafted as a “grantor trust” there will be no taxes due on the initial transfer.

If Edith dies later when the residence is worth $275,000, there’ll be capital gain of $140,000 (275,000 – 35,000). HOWEVER, because this is the year of her death, there’ll be an exemption of $1,000,000 to apply and there will be NO (ZERO) tax due.

Conclusion

The STEP Act, if enacted, will upend century-old rules regarding capital gains taxation. Contrary to political rhetoric, the Act will affect many more than “the wealthy” because people of ordinary means will pay for transfers of family property.

Stay tuned.

Filed Under: Medicaid, Reader Favorites, Tax Issues, Trusts generally

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