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Update 2014

Each year Medi-Cal releases new maximum values for the Community Spouse Resource Allowance (CSRA) and the Minimum Monthly Maintenance Needs Allowance (MMMNA). For 2014 eligibility calculations: CSRA $$117,240; MMMNA $2,931; APPR $7,549.

California officials have yet to implement DRA 05 rules (see accompanying article). Projected implementation has been moved into 2014.

Saving Mom and Dad...and You

Words of Praise

“I had the opportunity to read your book and loved it. This is a book I would be happy to give my clients, as I believe it would assist them in understanding the process. This is a wonderful book!”

- Christina Stone, JD
Attorney, certified specialist estate planning, trust and probate law
La Habra, CA

New laws likely to take effect during 2014

By Robert J Cullen, CFP®

The Deficit Reduction Act of 2005, passed in February 2006, does not change the basic eligibility requirements for obtaining Medi-Cal (Medicaid) assistance to pay for long-term care. The primary thrust of this legislation is to restrict several popular methods for sheltering assets. These include 1) Look-back periods extended 2) Half-a-loaf gifting curtailed 3) Elimination of ‘rounding down’ of gifts that are less than the Average Private Pay Rate (APPR) 4) Concurrent gifting penalty periods eliminated 5) Limitations imposed on home equity exemptions 6) Annuity use curtailed 7) Expansions of Community Spouse Resource Allowance restricted by implementation of 'income first' rules.

This is federal legislation; individual states must implement these new provisions to make them effective for consumers. Until these new provisions are implemented by individual states, county eligibility workers will follow existing eligibility rules.

California has already implemented the ‘income first’ rules for restricting expansions of the Community Spouse Resource Allowance. This means income from both spouses must be considered when calculating whether expansion of the Community Spouse Resource Allowance will be allowed. This new provision will curtail significantly the use of this planning technique.

In recent conversations with state officials, I confirmed that the use of spousal annuities to convert excess assets to income payable to the Well Spouse—as described in Chapter 5 and illustrated in Graphic M5 and Graphic M6—is still acceptable under Medi-Cal regulations.

We will continue to furnish updates as California implements the new rules.

CHAPTER 11 - CHOOSING A MEDI-CAL ADVISOR
Questions to ask prospective Medi-Cal advisors

First ask yourself: Am I typically penny-wise and pound-foolish? This is an important consideration when seeking a competent elder finance or elder law advisor.

If you answer ‘Yes’ to the above question, then you will likely be satisfied working with advisors who charge lower fees and deliver limited services. For example, former Medi-Cal eligibility workers advertise their services as Medi-Cal advisors. While these advisors understand Medi-Cal’s rules and regulations, they are often unschooled about financial planning, investing and legal matters. If you are content to pay for Medi-Cal-only guidance, such advisors may fulfill your needs. They typically charge less than professionally credentialed financial advisors and elder law attorneys.

Read more...

CHAPTER 2 - GRANDMOTHER
When income does not count as an asset

FOR YOUR GRANDMOTHER TO QUALIFY for Medi-Cal benefits for her nursing home care, her end-of-month bank balance must be under $2,000. She must also be over age 65, or blind, or disabled, and have a medical need for nursing home care. You receive her latest bank statement and your stomach knots when you see an ending balance of $2,800. “ Blast it!” you mutter: “Now she won’t qualify and I’ll have to pay the nursing home out of my pocket!”

Maybe not. Think about this: when you balance your checkbook, do you accept the balance printed on your statement as the current balance in your check register? Probably not, since you likely wrote checks during the period between the closing date of the bank balance and the date you balance your checkbook.

Read more...

Excerpts:

"The doctors hoped to stabilize him to complete a heart transplant. Jimmie’s $2 million of coverage from his health plan plus $1 million of coverage from Jenny’s plan had been exhausted during October. Jimmie and Jenny owed over $1 million to the hospital and counting."

Jennie and Jimmie, page 55

"Richard was forced to pay $500 per day--$15,000 per month—for sub acute care to maintain his wife in her comatose state."

Richard and Martha, page 57


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