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An increasingly important concern for people setting up their estate plans is how to plan for the cost of long term care, including nursing home costs. Long term care insurance is by far the preferred option, since it offers the possibility of keeping people out of nursing homes by paying for care in the home or in assisted living facilities. However, most people do not purchase long term care insurance and are forced to rely on other alternatives to pay for long term care costs. Unfortunately, the other alternatives often do not include care in the home and instead require the long term care to be in a nursing home or other approved facility.
Absent a good long term care insurance policy, there are two primary options for the payment of nursing home costs. First, a person may have sufficient income and assets to pay for such costs on a private pay basis. However, since such costs average in excess of $6,000 per month, the private pay option is not viable for most people. The second option is the Long Term Care Medicaid Program. Since this is a government benefit program, there are strict asset and income requirements to be met in order to qualify. The rules differ depending on if you are single or married. As a result of the rigorous eligibility determination process, many clients structure their estate plans in a way to enhance their eligibility in the event such costs become necessary. The remainder of this article will focus on one of the more popular estate planning tools used to enhance Medicaid eligibility for long term care costs.
A Medicaid Asset Protection Trust (MAPT), often referred to as an Irrevocable Trust, has become a popular planning tool for people trying to protect assets from the costs of nursing home care. It is important to note that many people have set up trusts, however, the most common trusts are revocable trusts, which offer no protection from nursing home costs. In order to gain eligibility, one must either give away assets or structure assets in a MAPT. As a general rule, gifting assets to your children is inadvisable, since those assets then become exposed to the children’s debts and liabilities, divorces, etc. In addition, some children may spend the money, refuse to give it back when needed, or pass away before the parent and pass those gifted assets on to their heirs. For these reasons, the MAPT may be a preferred option.
As with most asset transfers, the creation and transfer of assets to a MAPT is subject to a Medicaid “look back” period of five years. This means the Trust should be created and funded at least five years prior to applying for any Medicaid benefits. It is important to note that most clients who set up a MAPT elect to keep a sufficient amount of assets out of the trust so they will have full access and control to a comfortable level of assets for their lifestyle and enjoyment. IRA’s and other retirement plans are usually left out of a MAPT, as it is generally not advisable to put such assets into a trust in the first place. In many cases people have an immediate need for nursing home care and cannot wait the 5 year look back period. For such immediate need cases there are options available including a “gift plan”. The goal of a gift plan is to protect 50-60% of the remaining assets. A Medicaid gift plan is a complex planning strategy that may be suitable for certain situations where an immediate need is present.
In summary, planning for the cost of long term care is an important issue that many people need to consider when setting up their estate plan. In the event long term care insurance is not an option, a person should consider other estate planning tools, such as a MAPT, that will enhance their ability to obtain government benefits, while at the same time offering some level of protection for their support and maintenance in the future. For people who have an immediate need, there are other options available such as a gift plan to protect some assets for single persons requiring nursing home care. This type of planning is very specialized and should only be implemented with the help of an experienced elder law attorney.
Adam is the managing Member of Farrar & Williams, PLLC and can be reached at (501)525-4401 or at adam@farrarwilliams.com .