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