By David R. Okrent, CPA, Esq.
Elder Law focuses on planning for Long Term Care and includes such things as how your medical and financial decisions will be made if you can’t, how to minimize taxes, reduced estate administration burdens and costs, and, if you need long term care, how could it be paid for without losing everything you have worked hard for. Every Elder Law plan should start out and end up with its primary goal being to protect your independence, dignity, and control.
Since the primary focus of Elder Law is Long Term Care, let’s define it, review what it costs and how it can be paid for. Long term care is the care we receive when we need help with the activities of daily living, such as hygiene (bathing, grooming, shaving and oral care), continence, dressing, eating (the ability to feed oneself), toileting (the ability to use a restroom), transferring (actions such as going from a seated to a standing position and getting in and out of bed). The care can be provided at your home, in a social or medical model daycare, in an Assisted Living Facility or in a Nursing Home. Where and how the care is received usually depends upon many factors. Home care on Long Island typically costs about $20.00 to $25.00 an hour with 24 hour companion care, (which is typically the least expensive), being about $1,500.00 a week for live in care. From there the cost of care increases up to the most expensive, generally being the nursing home, which, on Long Island, is about $15,000.00 a month.
There are four typical payment sources to cover these costs: Private Pay, Medicare, Long term Care Insurance and Medicaid. Medicare will pay if an individual has received 3 days of skilled care in a hospital and is admitted to a nursing home within 30 days, where they are receiving skilled, rehabilitative care. Then Medicare will pay for the first 20 days paid in full. From day 21-100 a co-insurance payment of $137.50 per day in 2010 is required. However, if the individual has the right Medigap insurance it will pay the co-insurance payment. Both Medicare and most Medigap insurance stops paying after day 100.
The next payment source is Long Term Care Insurance, which is designed to specifically pay for these types of care. There are many types of policies with new ones being developed every day. Generally, these policies provide you with a pool of money that can be used for the cost of this care. The premiums vary greatly depending on your health and the benefits you select. Purchasing Long Term Care insurance is typically a good idea. However, in order to buy it, you must be healthy enough and be able to afford it. For people who do not qualify for Long Term Care insurance, Medicaid eligibility is important. In many cases, even where Long Term Care Insurance is purchased, planning to become Medicaid eligible is a good fall back. There is always the possibility that the purchased coverage will not be enough in the future, you may not be able to keep paying the premiums or a host of other reasons may come up, so including planning for Medicaid is always worth considering.
Medicaid. There are two basic types of Medicaid we discuss with our clients; we refer to them as “Community Medicaid” and “Institutional Medicaid. Community Medicaid generally pays for care at home and medical model day care. Institutional Medicaid generally pays for Nursing Home Care and Social Model Day Care. At the time of writing this article, a single person can have no more than $13,800.00, a home they are living in with equity equal to, or less than, $750,000, and a prepaid funeral. There are exceptions and special rules for certain assets, like retirement assets, i.e. IRAs, 401k plans, and annuities. The special rules are beyond the scope of this article and will be topics for future articles. Note, the home exemption is very limited since a person is not living in their home if they are in a Nursing Home. In addition, if the applicant dies and the home is part of their probate estate any Medicaid paid out for their care can be recovered. With respect to income, an individual is permitted to have $50 a month if they are in a nursing home and $787 a month if they are at home. There are methods available to keep more income for a person living at home, for example the use of an “income protection trust”.
For married couples the numbers change. If one spouse is in a nursing home while the other is at home, the spouse at home can have a home of any value and between $74,820 and $109,560 in assets. In addition, the spouse at home is permitted to have $2,789 a month in income. There are exceptions to these limits, such as spousal refusal, and some assets have their own special rules, like retirement assets, i.e. IRAs, 401k plans, and annuities. Again, there is a special rule for spouses, referred to as spousal refusal, where the community spouse has more than the exempt amount and refuses to make it available for the institutionalized spouse’s care. This is a crisis-planning tool because Medicaid does have a right to recover the excess should they choose to. In order for a spouse to use the spousal protections, the assets need to be transferred to the community spouse. If the institutionalized spouse is now incompetent, hopefully they executed a Durable Power of Attorney and a Health Care Proxy. The Power of Attorney allows a named person to handle financial transactions for the principal, which if the Power of Attorney was properly prepared, would allow the transfer of the assets to the community spouse. The Health Care proxy and Living Will allows someone to make medical decisions. Without these documents a guardian needs to be appointed by a Court and permission must be granted to make any transfers, even to a spouse. These proceedings take months and costs thousands of dollars.
The 5 year rule. A lot of people talk about the 5 year rule and Medicaid. What is it? If a person has more assets than permitted and wishes to protect them they typically consider gifting or transferring them. Any transfer made after February 8, 2006 is governed under the rules under the Deficit Reduction Act of 2005, otherwise known as “DRA”. Under the 5 year rule, every non-exempt gift draws a 5 year window. For example, if a person applies for institutional Medicaid, the government will ask for records going back 5 years from the date the person is institutionalized and has applied for Medicaid. If there have been any gifts during that time period the government will then calculate and impose a “penalty period” which is the amount of time that the applicant will not be eligible for Medicaid. There are many exceptions to the transfer penalty rule, like Community Medicaid, which has no 5 year rule. For planning purposes, it is simply good to keep in mind that you might need 5 years. In the event you don’t have 5 years there are still things we can do, but they generally result in protecting a lot less of your estate.
Ok, so how do we protect the home? There are three general methods used to protect the home: outright transfer of your home, transfer while retaining the right to live in it for life, and a “Life Estate Deed”, or a “Special Irrevocable Trust”. All of these will get you eligible for Medicaid subject to the Medicaid rules discussed above. So what makes them different? The difference is the tax consequences, sale consequences and your control of your home, independence and dignity.
Outright transfer of home. We very rarely use this. We never want to transfer a home in a way where it can be taken from you while you need it. If you transfer your home outright, for example to a child(dren) and something happens to them, (i.e. lawsuit, divorce, death or their own illness), the home would be exposed to their creditors and preditors. It has no protection and you may have no place to live. In addition, the outright transfer has some significant tax issues.
The tax issues we must evaluate with every transfer of a home are: estate and gift tax, income tax, and property tax. Under the current federal law, (as of June 2010) there is no Federal Estate Tax. There is a Federal Gift tax, with an exemption of $1,000,000.00, plus gifts of up to $13,000.00, per donee, per year. As long as the home is worth less than this amount there will not be a gift tax. With respect to income taxes, we need to look at the capital gain exclusion for a primary residence and a donee’s basis in the asset they receive. While you are alive, and generally if you have owned and lived in your primary residence for 2 out of 5 years, you may be entitled to a $250,000 capital gain exclusion ($500,000 for married couples) when it is sold. If you outright gift the home you may lose it. In addition, upon your death if the home is sold your beneficiaries’ basis will be your cost basis (generally equal to your purchase price plus improvements). This cost basis must be compared to the basis a beneficiary may receive if they inherited the property instead. An inherited basis is generally the fair market value of the property at your date of death, which usually is more then the cost basis and thereby eliminates any capital gain (please note: for the year 2010 there are some special basis rules in place which could alter this rule). The last tax we typically consider is property tax and your exemptions, i.e. veterans and star. Any property tax exemptions you may be entitled to as the owner and resident of the property you may lose if you no longer own the home.
In an attempt to address the negative aspects of the outright transfer, two techniques were developed, the “Life Estate Deed” and the “Special Irrevocable Trust”. The Life Estate Deed is a technique whereby the owner of a home transfers to an individual(s), who is then referred to as the “remainderman”, while retaining the right to live in it for life. The transfer is subject to the Medicaid transfer rules discussed above. When the waiting period is over, the life estate in the property cannot be touched by Medicaid. Also, with this technique, you keep your property tax exemptions and upon your death the property will pass outside probate and the remainderman will receive the fair market value basis. Ok, so that’s the good, now for the bad. If you need to sell the property during your lifetime it will be a mess! This is because both you and the remainderman own the property. Upon the sale you will get part of the proceeds and the remainderman will get the other part. The parts are actuarially determined. You may be entitled to the capital gain exclusion for your part, but the remainderman’s part usually is not, so a hefty tax has to be paid. Furthermore, the part you get is no longer Medicaid protected. A Life Estate in the real property is exempt, but the proceeds from the sale are not. This means you may have to start a new 5 year period for Medicaid eligibility. Sale of a home happens frequently when the life tenant enters a Nursing Home and the remainderman can’t continue to pay the expenses associated with it. In summary, more than half the value of the property may be lost if the property is sold during the life tenant’s lifetime. But that’s not all, there is one more draw back; your right to live there may not be asset protected from the remainderman’s creditors or preditors. As you can tell this technique has its own unique issues and because of them it is not one of my favorite options. I prefer the “Special Irrevocable Trust”.
“Special Irrevocable Trust.” Generally, our Special Irrevocable Trust allows you to name anyone you trust, typically a child(ren), friend or an institution as a Trustee. In the trust you can retain the right to live in your home, the right to any ordinary income the trust generates, and the power to change the beneficiaries (again referred to as the remainderman) of the trust. The assets can be easily removed from the trust for any reason. The Trustee is given the power, upon the consent of another person you designate, to distribute to the remainderman, who can then give the assets back to you or use them for you (there may be a Medicaid impact on which method you use, so please consult with us first). This trust is an asset protection trust, not only for Medicaid but for all purposes. Because you cannot revoke this trust by yourself, it is a gift. However, because of your retained rights, the tax law classifies it as a “Grantor” trust under the Internal Revenue Code which causes you to remain the taxpayer for all purposes. In fact, the trust can use your social security number and does not even have to file its own tax return. This tool maintains all the benefits of the life estate, namely protecting the property tax exemptions, capital gain exclusion and fair market value basis at death and eliminates the other problems. No matter what happens to a beneficiary of the trust your home is protected. If you or one of your beneficiaries is sued, divorced, dies or becomes disabled it is of no affect to your safety as to your home. In fact, because you have the power to change remainderman you could eliminate, alter or change any remainderman’s interest any time you want without their knowledge or consent. This indirectly can work really well in controlling your kids and the Trustee’s authority. (If your Trustee/child does not follow your wishes you can threaten to take away their inheritance and they will certainly think twice.) If the home is sold during your lifetime, the proceeds belong to the trust, not to the individuals involved, eliminating the tax and Medicaid problems as described with the “Life Estate Deed”.
Trusts are great tools and work very well in the right situation when they are properly prepared. Every Elder Law plan should consider having a Trust, a Last Will and Testament, a Power of Attorney, a Healthcare Proxy and a Living Will. Are Trusts appropriate for everyone? No, but they should be considered. In the almost 20 years I have been doing this, I have not created the same Elder Law plan twice. Everyone’s Elder Law plan is specific to them and the tools we have available should be considered in light of each person’s circumstances and wishes. I am pleased to offer your membership the opportunity to have a consult with me, for no charge, to see what your Elder Law plan should look like.
*David R. Okrent, CPA, Esq. Managing Attorney of The Law Offices of David R. Okrent have been handling Tax, elder law, estate planning and administration, special needs and veterans benefits for over 26 years. Mr. Okrent was designated one of Long Island Alzheimer’s Foundation’s “Angels of Spirit” and is a recipient of the Long Island Coalition on Aging “Man of Spirit.” He is the NY State Bar Association’s Elder Law Section Co-Chief Editor of the Elder Law Attorney (it’s members quarterly publication), Vice Chairman of its Estate tax & Planning Committee and the Tenth District (long Island) delegate. He also serves as the Co-Chair of the Suffolk County Bar Association Legislation Review Committee and as an advisory member to its Academy of Law. He has served as the Co-Chair of the Suffolk County Bar Association’s Elder Law Committee and Chairman of its Tax Committee. He is a member of the National Academy of Elder Law Attorneys. He is also a past long time Chairman of the Long Island Alzheimer’s Foundation’s Legal Advisory Board, is a former IRS Agent and holds a CPA. For more information visit http://www.davidrokrentlaw.com or call (631)427-4600. The firm is gratefully to have an opportunity to serve your membership.
Tags: elder law,
long term care insurance,
medicaid,
medicare