Divorce and Medicaid – Part 2
Last week I wrote about the recent calls we’ve received regarding couples in unhappy marriages where one spouse now needs care. Even though they may have kept their finances separate for many years, under Medicaid rules the healthy spouse’s assets will be counted as well as the ill spouse’s assets when determining eligibility. When we tell callers this they often are angry and/or disappointed, however, it doesn’t necessarily mean the assets all must be spent down. Let’s first go over the basic rules. In the case of a married couple the healthy or what is referred to as the community spouse can keep the home he/she lives in no matter the value and 1/2 of the countable assets up to a limit of $130,380 in 2021. With respect to the income, Medicaid only considers the Medicaid applicant’s income for eligibility purposes. The community spouse’s income does not factor into the equation. Understanding these basic rules gives us opportunities to protect more than the minimum for the healthy spouse while qualifying the ill spouse for benefits. For example, if the couple has a mortgage, paying down that mortgage converts countable assets to non countable assets, preserving them for the community spouse. Selling the home and buying another primary residence is
Divorce and Medicaid – Part 1
Divorce rates in America have steadily risen for years and much has been written about it. There are, however, many more couples in unhappy marriages who for varied reasons did not go the divorce route. For some, it may have been about being more comfortable with the life they know vs. the uncertainty of a new life. For others it may have been about the disappointment or anger of family and friends. For still others it may have come down to finances. Splitting the marital assets to pay for two separate households is more expensive than for one and then there are the legal fees and court costs. We see many of these couples call us when one of them needs long term care and the realization hits that the cost of that care could impact both of them. Often the healthy spouse calling our office talks in terms similar to an ex-spouse as far as what is owned by each spouse. In their minds there are no longer marital assets. Except that this really isn’t true if they are still married. If they don’t have long term care insurance, then they will need to use those assets until they are spent down to the level of assets needed to
2nd Stimulus Checks – Same as the 1st?
Last month Congress and President Trump finally agreed to additional stimulus checks to be sent to Americans in need during the current pandemic. This is the second such round of payments since the COVID crisis hit. There are some differences, however between this second payment and the first. The most important change is the amount of the payment - half of what was received in the spring. Eligible persons are to receive $600. Married couples will receive $1200 total. The income limits have also changed slightly. A single person with less than $75,000 of adjusted gross income as disclosed on his/her 2019 income tax return will receive the full amount. The amount gets reduced for those with higher income up to a limit of $87,000 at which point there is no longer any entitlement. Married couples with income under $150,000 receive the full $1200 and then it is reduced until phased out completely at $174,000 of income. What has not changed is that these payments are treated in the same way as the first payments for those who are receiving or applying for Medicaid benefits. That means they will not be counted as assets in determining whether an applicant is below the $2000 limit for Medicaid eligibility. Recipients have one year from
Medicaid Applications – Like a Tax Audit on Steroids
While I am not an accountant and have never experienced an income tax audit, when describing the Medicaid application process I often reference it to a tax audit. It is an intrusive government review of an applicant’s finances over a 5 year time period. I have been filing Medicaid applications for 25 years and it seems with each passing year the requests by the State become more burdensome and the hurdles we must jump through more voluminous. Since the last change in the Medicaid laws 15+ years ago, 5 years of statements for every asset the applicant owned has been required, up from 3 years. In the past year, however, I am finding that the State is doing much more. It is more frequently running checks of an applicant’s Social Security number and coming back to us with requests for documents concerning other financial accounts-in many cases with little to no information other than the name of the bank. Often this information is incorrect, with the bank telling us no accounts exist. This then leads to a back and forth with county caseworkers concerning the accuracy of their sources. The state is also routinely asking for the statements for all credit cards for the past 5 years. Scrutinizing these statements, it requests invoices to prove the charges were
A Word about the PAS (Part 2)
Last week I wrote about the medical part of Medicaid eligibility. The preadmission screening (PAS) process requires the state to certify that the applicant needs nursing home level care. Nursing home level care means needing assistance with at least 3 of the activities of daily living. Those activities are transferring (eg. in and out of bed or chair), dressing, bathing, toileting, eating and incontinence. Before COVID in the case of an applicant for Medicaid benefits at home, the State would send out a nurse to the applicant’s home to do the evaluation. Now, however, these evaluations are being done by teleconference but expect delays. Additionally, we have seen many instances where the PAS request is not being processed until the actual application has been filed. This is problematic for a number of reasons. Since both financial and medical eligibility are required for approval, any delay in obtaining the medical PAS will obviously delay the receipt of benefits. While the PAS can be issued retroactively in the case of nursing home Medicaid (ie. approval back to the date of the request), this is not the case for the community Medicaid programs so timing is critical. This creates another potential problem for married couples where one spouse is applying for Medicaid benefits. The healthy
A Word about the PAS
When talking to clients about achieving Medicaid eligibility, we spend most of our time focused on the financial requirements. That includes an asset test and an income test and transfers that are potentially subject to a Medicaid penalty. However, I always tell families that we can’t forget about the medical test. If we do everything right on the financial side of the equation but the applicant fails to meet the medical test - as determined by Medicaid by way of an exam and reflected on a form called a Preadmissions Screening or PAS, then the application will fail. Because there are 3 distinct Medicaid programs that cover nursing home level care - in a nursing home, in an assisted living facility and at home - the rules of each are not exactly the same. If the applicant is in a nursing home or an assisted living facility and applying for Medicaid, the facility makes the request for the PAS. This triggers an evaluation by Medicaid to determine if the applicant meets the test of needing assistance with at least 3 of the activities of daily living. Once the facility is informed of the intention of the applicant to file a Medicaid application, it is the facility’s