Long Term Care Answer Book

Nursing homes generally cost approximately $7,000 per month.  Assisted Living typically costs between $2,000 and $5,500 per month based on the services provided.  Home health care provided by a certified nursing assistant typically costs $12-$22 per hour.

Becoming educated about your Long-Term Care Planning options sooner rather than later is always best. The sooner you are educated and possibly commence a Long-Term Care Plan the more options you will have. The federal and state laws are in a constant state of flux. Having a knowledgeable attorney in your corner is the basic building block to making sound and informed decisions when formulating a Long-Term Care Plan

Your best defense against the costs of long-term care is being educated and knowing your options.  Having Long-Term Care insurance provides an additional line of defense in obtaining the care needed, while protecting assets.  However, there is no blanket answer as to who should obtain long-term care insurance.  There are numerous factors, such as your health, the costs of the basic insurance, the various options available on the insurance, such as a cost of living rider, among other, which are all relevant in making the decision to obtain a long-term care insurance policy. Knowing your options is free.

• The Home and Community Based Care Program (10-15 hours of help at home per week).
• The Assisted Living Diversion Program (approximately 50 facilities participate in Brevard County).  The majority of the nursing homes in Brevard County participate in this Program.

There is a gross monthly income cap in Florida, but exceeding the gross monthly income does not make an individual ineligible to receive Medicaid benefits. If the gross monthly income cap is exceeded by the Medicaid applicant, a special Medicaid Trust is needed.

• If you are single:  a homestead home with an equity interest in the amount not to exceed $525,000; a vehicle of any value; any vehicles seven (7) years or older (no collector’s items or motor homes); prepaid irrevocable burial arrangements; a burial fund of up to $2,500; term life insurance; life insurance with an aggregate face value of $2,500 or less; and $2,000 of other assets (generally tangible personal property is not counted).
• If you are married:  you can have a homestead home of any value and the healthy spouse can have $113,640 of assets in addition to the assets listed above.

The present federal look-back period is five (5) years for gifts.  It has been three (3) years in the past.  Florida adopted the federal five (5) year look-back period for gifting in January 2010.

Florida Medicaid Rules permit an individual to “undue” previous gifting and erase the penalty period associated with the gift, thereby making the individual potentially eligible to receive Medicaid benefits.

No. Although gifting within the federal annual gift tax exclusion is legal, Medicaid still assesses a penalty of ineligibility to be able to receive Medicaid benefits for the gift being made.

No.  It is never too late to have a Medicaid Plan.  Many of the planning techniques can be implemented at the time of the need (although it is preferable to plan in advance to optimize your planning technique choices).

Yes.  Benefits paid from a Long-Term Care insurance policy are considered income for both Medicaid and VA Programs.

No.  Medicaid is a benefit of last resort, so you must apply for any and all benefits you may be entitled to at the time you are applying for Medicaid benefits.

Nearly anyone can legally become eligible to receive Medicaid benefits if they receive competent and up to date legal advice.  The biggest mistake is failing to meet with an attorney and becoming educated about your options.  Do not assume that you cannot become eligible for Medicaid regardless of your current asset situation.

Medicaid does not recognize Pre-Nuptial Agreements.  Assets of both parties count toward the one spouse’s Medicaid eligibility.  However, there are Medicaid Planning techniques to eliminate this issue.

Generally, Medicaid nursing home benefits are available immediately.  However, there is a waiting list for the Home and Community Based Care Program and the Assisted Living Program.

Generally, Medicaid nursing home benefits are available immediately.  However, there is a waiting list for the Home and Community Based Care Program and the Assisted Living Program.

The Medicaid Programs provide for a diversion of the institutional spouse’s income to the community spouse based on each individual’s gross monthly income and housing costs.

Divorce is almost never the answer.  There are various legal planning techniques which can be implemented without the necessity of divorce.

Yes.  Both Florida Medicaid Law and VA Aid and Attendance permit an individual to own a homestead home and still become eligible to receive benefits.  The Florida Constitution protects homestead homes post-death when the decedent has heirs at law.

Yes.  However, Revocable Living Trusts are helpful because, if funded properly, they avoid probate after death and can control the timing and amount of distributions to beneficiaries.

If a person served in the United Stated military during a war time declared by the US Congress and the Veteran served at least ninety (90) days of continuous service, one day of which is during a declared wartime, with no service connected injury, then the veteran may be eligible to receive a monthly payment for use to pay for long-term care.

Over $2,000 a month for the veteran and over $1,300 a month for the surviving spouse of a veteran.

The VA Aid and Attendance benefit is lost.  However, if your last spouse was also a veteran, you would become eligible through their military service.

Generally VA Aid and Attendance benefits are only receivable at home or in an assisted living facility, and they drop down to $90 a month in a nursing home.

VA Aid and Attendance benefits can be applied for through your local VA Office.  All applications are processed in Philadelphia, PA, and take at least seven (7) months to process.  VA benefits are paid retroactive to the date of application after they are approved.

Presently, as of December 2012, there is no look-back period for gifting when applying for the VA Aid and Attendance Program.  However, there is federal legislation pending which would make a three (3) year look-back period for gifting.  However, Medicaid has a five (5) year look-back period and many times an individual may need to qualify for Medicaid benefits also.

Under the present law, an individual can receive benefits under both the Medicaid and VA Programs.

No. VA Aid and Attendance benefits are based on UME’s (uncovered medical expenses).

Yes, there are asset limits to VA Aid and Attendance.  The asset limit is based on an internal sliding scale based on the age(s) of the individuals.

Yes.  Your homestead home, your vehicle, your burial arrangements, and term life insurance are among the exempt assets.

Both the husband and wife’s assets are counted when determining eligibility for the veteran for the Program.

Regardless of how long you have been married, a spouse cannot sign on behalf of the other spouse by virtue of being married. Often people confuse this issue because they have access to most assets due to the fact that they are held in the spouses’ joint name.  However, in dealing with some assets, such as retirement accounts and real property, a spouse needs the other spouse’s Power of Attorney.

Third parties, such as financial institutions, do not take their obligations with regard to honoring a Power of Attorney lightly.  Generally, all Powers of Attorney are screened by the financial institution’s Legal Department.  If there is even the slightest reason, a Power of Attorney may be rejected.  Therefore, keeping your Power of Attorney up to date is important.  The last change to the Power of Attorney Statute in Florida was in November 2011.  If you are older or have health issues and you are naming the same Agent in the Power of Attorney, you may want to keep the old document.  Also, you may want to obtain a note from your physician indicating you are competent and retain same in your and your attorney’s records.

In general, at the time a Power of Attorney is signed, it becomes effective.  There are Powers of Attorney which are “springing” and go into effect upon an illness, but these are relatively rare and present another obstacle that an Agent attempting to use the Power of Attorney must prove to a third party to have their authority recognized.

Yes, multiple Agents can be listed in a Power of Attorney acting together, acting individually or acting in succession.

No. An Agent under a Power of Attorney does not have the power to trump the authority of the creator of the Power of Attorney.  Even if an individual has created a Power of Attorney, a guardianship can be necessary if the individual will not take actions in their own best interest (such as ceasing to drive when the doctor indicates they cannot drive).  The individual who created the Power of Attorney can also revoke the Power of Attorney at any time.

At the time of the death of the individual, if the individual revokes the Power of Attorney, or if a guardianship action is commenced for that individual.

While this may be evidence of incompetency, it does not make an individual incompetent.  Only a Judge can declare an individual legally incompetent through a guardianship action.

If you are unable to make your own medical decisions and you do not have a Health Care Surrogate nominated, the Florida Statutes provide a “proxy” which contains the default order of who would make your medical decisions for you.

Although there are many sources to obtain information such as books, friends, relatives, the internet, financial professionals and other people in the industry, unfortunately, much of the information available is either inaccurate, outdated, too technical, or too watered down.  The Medicaid Law is state specific.  The best source of information is a knowledgeable attorney who has years of experience practicing in the field of Long-Term Care Planning and who keeps up with the ever-changing federal and state laws which govern your options when implementing a Long-Term Care Plan.

• Gather the documents required for Medicaid
• Copy, organize and audit the file to determine what is missing.
• Make sure the countable assets and income are under Medicaid’s caps.
• Determine if a Qualified Income Only Trust is needed due to excess gross monthly income.
• If there is a spouse, determine if they are entitled to any Medicaid Diversions (a means to increase the healthy spouse’s income using the Medicaid applicant’s income).
• File Medicaid application.
• Supply the Medicaid Office with documentation.
• Notify the nursing home we are applying for Medicaid.
• Make sure the doctor fills out the 3008 level of care form.
• Apply to the VA, as Medicaid is a benefit of last resort.
• Supply all documentation to the Medicaid Office necessary to complete the application.
• Wait for Medicaid approval.
• Choose a Medicaid provider.
• If Transitioning down from a nursing home to an Assisted Living facility:
• After at least 60 days on Medicaid, the applicant can participate in Medicaid’s Transition Down Program and avoid the 25,000 person waiting list in Florida for Medicaid’s Home or Assisted Living Program.
• Do a CARES Unit referral so that they can measure the applicant’s medical needs to see if she can safely go to a lower level of care.
• Re-apply for Medicaid benefits.
• Go back home or to location an appropriate Assisted Living Facility.
• Meet with Provider, develop a Plan of Care and a care manager is assigned.
• Deal with lump sum payment from VA:  part is income and part is assets; need break-down of same from the VA as may be applicable.
• Comply with annual re-certification of benefits requirements of Medicaid and VA.