Medicaid Not the Goal for Long-Term Care Planning

Be cautious of schemes that would allow you to hide or give-away assets in order to qualify for Medicaid’s long-term care benefit. Federal law provides middle and upper-middle class families to way to protect savings and provide for quality care.

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Medicaid Not the Goal for Long-Term Care Planning
10 Min Read July 13th, 2019 Updated:January 25th, 2021

It is no surprise that many Americans discuss how they will address their future aging and long-term care needs. There are several reasons why. Sure, the COVID-19 virus crisis has placed long-term care front and center. However, perhaps the biggest one is a personal experience. The impact of longevity hits most families. Most people know first-hand a parent, aunt, uncle, grandparent, neighbor, co-worker, or even spouse who needed help at some point due to changes in health due to an illness, accident, or the impact of growing older.

Without an advance plan, family members either become full or part-time caregivers. Caregiving is physically and emotionally demanding. Paid care can quickly drain retirement accounts and have a negative impact on a person's or couple's income and lifestyle.

Your Goal Should Never Be Medicaid if You Have Savings

You often will see internet articles, advertisements, and even direct mail promotions that promote the idea that you can use Medicaid as a way to pay for long-term care services. Unless you have very few resources, Medicaid should never be the goal or the solution to pay for the financial costs and burdens associated with aging. 

You might see internet stories or advertisements that say, "Medicaid has become recognized as the long-term care insurance of the middle class." That statement is just not true. Congress and the President put in place in 2005 a program to help people, especially in the middle and upper-middle class, to affordably pay for long-term care, either at home or in a facility, and protect their savings.

Medicaid has indeed become the primary payer of long-term care services in the United States. As the country's public health insurance program for the poor, Medicaid was never intended to pay for everyone's long-term care. 

The Deficit Reduction Act of 2005 ("DRA") limited the ability for those with money to transfer or hide assets so they can qualify for the Medicaid long-term care benefit. 

The law creates a sixty month lookback period for all assets transfers, including transfers to certain trusts. Assets in trusts, including Irrevocable Trusts, will be counted. Other than Miller Trusts and Special Needs Trusts, all other transfers of assets, including into trusts, face the sixty month lookback period.

The penalty period for these non-exempt transfers of assets made within the lookback period starts to commence when the person has $4,150 or less, is receiving institutional care, has applied to Medicaid for assistance, and would otherwise be approved but for the penalty period.  For many, this is the most extreme action contained in the DRA law.

However, most people are concerned with the quality of care, which often lacks with Medicaid due to their low reimbursement rate for providers.

The Kaiser Family Foundation reports six in ten nursing home residents are on Medicaid. One in three people, age 65+, will spend time in a nursing home, not to mention long-term care services people need in their own home, adult day care centers, assisted living, and memory care. 

Generally, Medicaid will only pay for care in a nursing home, but in some states, they are testing community care programs to give other options for those who require care and have little or no resources.

Health Insurance and Medicare are Not Long-Term Care Solutions

Don't confuse Medicaid with Medicare. Medicare is a health insurance program for those 65 and older. It becomes our primary health insurance when we are older (except for a limited amount of people under age 65 who are on social security disability).

This is a tax-supported program but is also not an answer for long-term care. Medicare will only pay for a limited amount of skilled services. They pay up to 100 days of "skilled nursing care" per diagnosis. However, you must use a Medicare-approved "skilled nursing facility" or nursing home within 30 days of a hospital stay that lasted at least three days. Plus, the care you receive must be for the exact same condition you were being treated for in the hospital.

For example, you have a stroke. You enter the hospital and stay six days. You then require rehab in a skilled rehabilitation nursing facility. Medicare (including benefits from a supplement) will pay up to 100 days in total. If you require care for a longer period of time, you will pay for that care out-of-pocket unless you have Long-Term Care Insurance. 

Also, keep in mind Medicare has large deductibles after day 20. Most people will have a supplement to Medicare, which will pay those deductibles. However, Medicare Supplements follow the Medicare rules and will not pay beyond the 100 days limit.

If you are poor and qualify for Medicaid, then Medicaid will pay for care in an approved Medicaid facility. 

Medicaid Rules

While Medicaid will pay for long-term care services, you need to have little or no assets to qualify. Generally, a person can have no more than $2,000 in assets; however, some states allow more. Some assets are excluded by law. Find your state on the LTC NEWS Cost of Care Calculator and see general information on not only the average cost of long-term care services and supports but the Medicaid requirements. Just click here. 

You can read the Medicaid rules by clicking here.

Hiding or Giving Away Assets? Not a Long-Term Care Solution

While some lawyers suggest finding ways to hide or give-away assets to qualify for Medicaid, most of these schemes are questionable at best. The Deficit Reduction Act of 2015 (DRA) placed more restrictions on these practices in an attempt to preserve the Medicaid program for the “true” 

poor, not for a clever person to find a way to get the taxpayer to pay for their long-term care.

The DRA made noteworthy changes to Medicaid’s long-term care rules, which include: 

• the look-back period • the penalty start date for transfers • the undue hardship exception • the treatment of annuities • community spouse income rules • home equity limits • the treatment of investments in continuing care retirement communities (CCRC’s) • promissory notes • life estates • long-term care partnership programs

Transfer Rules Under DRA Regulations

The DRA placed a five-year transfer rule (60 months) on assets given away. While you can give away up to $15,000 a year to your children (or anyone for that matter) without incurring an IRS gift tax, doing so in order to qualify for Medicaid is problematic. Under the rules of Medicaid, such a gift can trigger the penalty period if you did the transfer during the look-back period of five years.

While some very good facilities have some Medicaid beds, often, the quality care in primary Medicaid facilities is lacking due to the low reimbursements paid by Medicaid. If you can avoid Medicaid from the start, that would be ideal for quality care. 

The DRA did offer something that middle and upper-middle-class families can take advantage of when they are planning for future retirement. The solution for many American families is the Long-Term Care Partnership Program. The DRA extended the partnership program from the four original states and made it available, with updated rules, to the remaining states.

LTC Partnership Program Does Provide Dollar-for-Dollar Asset Protection

Forty-five states now have active partnership programs in place. Find your state by clicking here. The Long-Term Care Partnership Program may be one of the biggest secrets in retirement planning. 

If you purchase a qualified partnership certified Long-Term Care Insurance policy, you receive additional dollar-for-dollar asset protection or what a state bureaucrat would call “asset-disregard.” In the event you exhaust your benefits from your policy, you are then able to legally shelter part of your estate based on the amount of money the policy paid out for your care and still qualify for Medicaid. 

In other words, you can get government assistance and not be poor. Many facilities will allow you to stay if you exhaust your insurance benefits and accept the Medicaid payment (as long as you had paid the normal rates for some time).

The choice is still the primary reason to avoid any scheme where you can hide or give-away money to access Medicaid. With an affordable Long-Term Care policy, you get coverage for your choice of care. It doesn't matter if you want your care at home, adult daycare, assisted living, memory care, or a nursing home; most Long-Term Care Insurance policies will provide coverage. 

It also doesn't matter if you need skilled or custodial care. All types of care in many settings are available. This gives you control and independence. 

Some people will argue that Long-Term Care Insurance is expensive. This is just not true in most cases. First, policies are custom designed. You decide on the amount of coverage. If you live in a partnership state, this gives you extra flexibility since you can design an affordable plan and protect as little or as much of your savings as you wish.

Fact: Long-Term Care Insurance is Affordable

Premiums are based on several factors, including your age, health, and family history. Plus, Long-Term Care Insurance is custom designed. You select the total amount of benefits you wish to have in place. The more benefits you wish to have, the larger the premium.

Generally, you select a monthly or daily benefit. This is the maximum amount of benefits you have available each day or month. Next, you select an initial "pool of money," which is how much your policy is worth at the time of inception.

You can also select an inflation benefit that increases your benefits every year. You also will have an elimination period. The elimination period is a deductible based on "days," not "dollars."

Many people can find the appropriate coverage for under $150 a month, sometimes less if you are younger and in good health. Discounts are also available for couples. Shared benefits also exist for spouses/partners. Death benefits even exist with some policies.

If you have more assets to protect, you might want a more significant policy. You can even select a policy which has unlimited benefit.  However, policies, big or small, provide many additional benefits including with most plans professional case management that help you and your family develop a plan of care and find and arrange for care. This reduces the amount of stress that is otherwise placed on your family members.

Many States Have Rate Stability Rules in Place

Many states have rate stability rules that make it very difficult to increase premiums on today's Long-Term Care Insurance. See if your state has this consumer protection by clicking here. 

Asset-based policies that combine life insurance or annuities with a rider for long-term care can be purchased with one single premium or ongoing premiums. These policies are called "hybrid" policies in that they combine the benefits of a life insurance or annuity policy with that of a Long-Term Care policy. They also give you the extra security of a death benefit.

Your choice of quality care, asset protection, and peace-of-mind comes with a Long-Term Care policy but does not come from a scheme that places you directly into the Medicaid program. Experts suggest planning prior to your retirement, in your 40s or 50s, for the most options at the lowest premiums.

Start Your Research with LTC NEWS Tools

It would be best if you started your research by finding the current and future cost of long-term care services where you live. The LTC NEWS cost of care calculator is an outstanding tool. Access this tool by clicking here.

Your financial advisor or general insurance agents are usually not qualified to help you find appropriate coverage. The American Association for Long-Term Care Insurance, a national consumer advocacy and education group, recommends seeking the help of an experienced Long-Term Care Insurance specialist who works with multiple top insurance companies. 

Be sure they understand underwriting rules, policy design, partnership, hybrid options, and claims. You can find a qualified Long-Term Care specialist to help you design and shop for the best coverage at the best value by clicking here.

Know the facts and understand the real risks of longevity on you, your family, savings, and lifestyle.

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About the Author

Linda is a former journalist who now enjoys writing about topics she is interested in so she “can keep her mind active and engaged”.

LTC News Contributor Linda Maxwell

Linda Maxwell

Contributor since December 11th, 2017

Editor's Note

Your retirement plan should include a solution for long-term care. Longevity requires advance planning. For many American families, this means that affordable Long-Term Care Insurance may be a solution to safeguard savings and income and reduce the stress otherwise placed on those you love.

Know the Facts About Long-Term Care Insurance

  • Long-Term Care Insurance is custom designed. You get to decide the total amount of coverage. Even a small policy can reduce the stress and burden on your family.  
  • Long-Term Care Insurance is affordable, especially if you are under age 65. However, premiums can vary well over 100% or more between insurance companies. A Long-Term Care specialist will shop all the major companies to match you with your age, health, and family history to find you the best value. 
  • Long-Term Care Insurance is rate stable. Most states now have rate stabilization rules, which make it very difficult to raise premiums in the future. Some companies offer single pay or limited pay options as well, which eliminates the need to keep paying premiums. 
  • Long-Term Care Insurance is underwritten based on your health history. This includes the medications you are taking and other factors. Every company has different rules. You will have to answer questions to get an accurate quote. 
  • Long-Term Care Insurance is comprehensive. Most policies will pay for all levels and types of long-term care, including care in your own home. 
  • Long-Term Care Insurance provides guaranteed benefits, and policies cannot be canceled unless you stop paying your premium.

Give your family peace-of-mind and the time to be family when you get older. Start your research now.

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