Vicki J. Bowers, B.C.S., CELAFlorida Bar Board Certified Elder Law Attorney

Certified Elder Law Attorney –National Elder Law Foundation

VA Accredited

4540 Southside Boulevard, Suite 603Jacksonville, Florida 32216Phone: 904-998-0724

What is Elder Law and what makes it unique?

“Elder Law” issues concern ALL ages

Holistic approach to the law

Estate Planning - Property Management Medical Decisions – Guardianship

Health Insurance Long term care insurance Medicare --- Medicaid ----- Veterans Benefits

Special Needs Planning

Disability Planning

Is your family prepared?

Planning considerations:

Never too soon Could be too late! Take action now Have ‘the conversation’ before a crisis occurs

Your plan is unique to you!- Each family situation is different- Are you a blended family?- Is anyone Disabled or have Special Needs?- Anyone unable to manage property?

Property Management during lifetime Health Care Decisions How will you pay for care Are you entitled to Veterans or other benefits What about Medicare -- What is Medicaid End of Life Decisions Who will inherit your estate Are your assets properly titled Probate Do you have a taxable estate Children age 18 or over Disabled loved ones (child, sibling, parent, spouse…..)

Further considerations….

What type of care is needed

Skilled nursing care

Assisted Living

Independent with some assistance

Medication management

What type of support is needed / available

How to pay for it

Cost of Care

Nursing Home = $250+ per day, room and board only

Assisted Living - $2,500 + monthly

Home Health Care – hourly or daily

Caregiver burnout

MEDICARE AND HEALTH INSURANCE DO NOT PAY FOR LONG TERM CARE

Long term care insuranceYounger = lower premiumElimination PeriodNursing Home CareAssisted LivingHome Health CareDaily BenefitPolicy BenefitTax ConsiderationsSpouse Shared PoliciesPartnership Program Policies

Medicaid Needs based health insurance Many different programs !!!! Pays for long term skilled nursing care Can pay co-pays if no supplemental insurance – unless on an HMO Income must be used toward care If Income over limit, need Qualified Income Trust Countable Asset limit = $2,000 individual Healthy spouse at home can have more assets Rules are EXTREMELY TECHNICAL Rules vary among States

Gifting = IneligibilityLookback periods:

Trusts = 5 years

No Trust = phasing into 5 year lookback

January 2013 - 36 monthsFebruary 2013- 37 months . . . . .October 2013 - 45 months. . . . .December 2014 - 60 months

Penalty starts at Application, NOT date of gift $7,638 Monthly Transfer Penalty Calculation

BUT WAIT !!!!

Transfers between Spouses are Okay!!! UNLESS Spouse has “excess assets” and Refusal is

invoked

Transfers to Disabled Child are Okay!!! BUT – Could create problem for Child on Medicaid

Assets that do not count for Medicaid eligibility Homestead - in Florida (but equity limit may apply)

Personal Property

Automobile

Irrevocable funeral plans

Cemetery plots – bring the family!

IRAs if taking Required Minimum Distributions (counts as income toward care)

Rental Property – caution: not exempt after death!

Inaccessible Joint Assets (other than with spouse)

Example: Brokerage Account joint with Son requires both to liquidate

Real property owned with a sibling who refuses to sell

Care Contract – lifetime agreement

Annuities – requirement to name State as beneficiary after spouse or disabled child

Third Party Special Needs Trusts No transfer penalty – third party funds No payback requirement

Self Settled Special Needs Trusts No transfer penalty d4(A) for under age 65 Pooled Trusts (any age in Florida) Payback requirement

Irrevocable Trusts Transfer penalty for Medicaid Five-year lookback Assets/Income count to extent available

To Trust or Not to Trust?

What about income limits?

Differs depending on Medicaid program

Nursing Home/Home Community Based Services: $2,130.00 month

Qualified Income Trust is the solution

Don’t forget VA Benefits! Available for Veterans and Surviving Spouses

Service-connected injury not necessary

Can help with Assisted Living Expenses

Can help with at-home medical expenses

Duval County VA Service Office904-630-3680

Wartime veteransSurviving spouses of

wartime veterans

The key is to qualify and to APPLY FOR IT !!

Service connectedNon-Service connected

There is Money Available For

• Service Connected Disability compensation is not limited by Veteran’s income or assets

• Surviving Spouse/ Dependents may be eligible for Dependency and Indemnity Compensation (DIC)

V.A. Disability Compensation

Non Service Connected DisabilityRequirements for Extra Money

90 days Wartime Service (or widow of wartime Veteran)

Discharge other than dishonorable Medical expenses Based on household income and assets Assistance needed Housebound Aid and Attendance

WAR TIME PERIODSWorld War I (April 6, 1917 – November 11, 1918)

World War II (December 7, 1941 – December 31, 1946)

Korean conflict (June 27, 1950 – January 31, 1955)

Vietnam era (February 28, 1961 – May 7, 1975 for Veterans who served in the Republic of Vietnam during that period; otherwise August 5, 1964 – May 7, 1975)

Gulf War (August 2, 1990 – through a future date to be set by law or Presidential Proclamation

Cannot leave house without assistance

Does not mean they cannot take care of self within the house

Cannot drive

What Housebound Means

Inability to dress/undress

Inability to keep oneself presentable

Inability to bathe oneself

Inability to take medications

Inability to feed oneself

What Aid & Attendance Means

How can A&A help? Pay Caregivers – including Family !

Assisted Living

Nursing Home Care

Excess unreimbursed medical expense

MAPR is the maximum available pension depending on the need of the claimant

Maximum Available Pension Resource (MAPR)

The VA will not pay anything

toward needs-based benefits if

IVAP is greater than the MAPR.

The Importance of Calculating Income

MAPR is $24,652 ($20,795 for single veteran)If IVAP is zero or less Veteran qualifies for

entire amount

Couple’s Gross Income: $45,000UME (Unreimbursed Medical Expenses): -49,000

IVAP: ($ 4,000)MAPR: -24,652

Maximum Pension Allowed: $24,652

Married Veteran in Need of Aid & Attendance

Couple’s Gross Income: $45,000UME: -25,000

IVAP: $20,000MAPR: -24,652

Maximum Pension Allowed: $ 4,652

If IVAP is greater than MAPRBenefit to Veteran will be reduced

What if UME was less than their income?

Unlike Medicaid, the VA doesn’t have a set asset limit.

This is where the greatest needfor planning exists.

Limits on Net Worth

Asset test considers age, health, other resources, liquidity, household

Rule of Thumb: $80,000 married

$50,000 single

Residence

Personal Property

Burial Policies/Plans - VA cemetery option

Life Insurance

Assets VA does NOT count

Joint Owned Assets = count percentage ownership only (different from Medicaid rules)

IRA s – may count as asset AND income If annuitized – income only

If annuity within IRA – income and asset

This is different from Medicaid rules!

Care Contracts – useful but different from Medicaid

Certain Irrevocable Trusts Certain Annuities availability/liquidity is key

VA = No Transfer Penalty!

Planning opportunities to transfer BEFORE application

Create Income Only Trust (this is different from Qualified Income Trust for

Medicaid)

Third Party Trusts = but avoid step transaction/straw man

WARNING WARNING WARNING WARNING

Transfers made to obtain VA benefits today

can result in Medicaid ineligibility

tomorrow due to transfers!!!

THINK BEYOND TODAY………………………………………..

Questions?

Thank you !!Vicki Joiner Bowers, PA4540 Southside Boulevard, Suite 603Jacksonville, Florida 32216Phone: 904-998-0724

Visit our Website to learn more:www.bowerselderlaw.com