1. What to do about Mom and Dad: Staring points for long- term care planning Christina Lesher 2719 Colquitt Houston, Texas 77098 713-529-5900 www.lawlesher.com

2. Planning for Mom and Dad*: Estate Planning Documents- the foundation of a good long-term care plan Planning for Incapacity & Avoiding Guardianship Planning for Medicaid/ Long-Term Care * Or family member, friend or special needs person

3. Start with Tailored Estate Planning Documents Will – Special Needs Trust – Planning for Minor or Disabled Children Maybe Trust Durable Power of Attorney Medical Power of Attorney Directive to Physicians

4. Planning for Long-Term Care Number of baby boomers is greatly increasing. Longer life spans mean a greater need for long-term care services such as at home care, assisted living and nursing home care. What about intergenerational planning? Average cost of nursing home care in Texas can be between $3,000- $5,000 per month.

5. Who Pays for Long- Term Care? Limited Medicare Coverage Veteran’s Benefits Long Term Care Insurance Private Pay Medicaid

6. Medicare vs. Medicaid Medicare – Federally Administered – Entitlement – Not Means Tested – Part A- Hospital Insurance – Part B- Medical Insurance Medicaid- “needs based” – Uses State & Federal Funds – State Administered – Means Tested

7. Medicaid Myths & Rumors I have too much money You should have done something three years ago- now five years You should transfer your house to your kids The State will take your home (maybe!) “The Miller Trust Is All You Need”

8. What Does Medicaid Pay For? Medical and Support needs Prescriptions* – (Medicare Part D) Does not cover: – Dental work – Bed hold charges – Some miscellaneous medical supplies

9. Who qualifies for Medicaid Nursing Home Benefits? Over 65 or disabled Meet the Income, Resource and Medical Necessity Requirements Are in a “Medicaid” bed and state approved facility

10. Down side to Medicaid Planning Limited choice of nursing homes Better care Client Values Medical Necessity Requirement

11. Nursing Home Medicaid Income requirement Resource requirement Medical necessity requirement

12. Income Requirements Name on the check rule Single- No more than $2,022 gross each month (“Miller Trust”) Couple- (married couple in nursing home) No more than $4,044 gross each month (“Miller Trust”)

13. Exempt vs. Countable Resources Exempt – Your house ($500,000 unless there is a community spouse or minor or disabled child at home) – One car – Your wedding set – Term life insurance – Pre-need funeral contract Countable – Checking & Savings Accounts – Annuities (unless meets certain requirements) – Retirement Accounts – Second Car, Home – Cash Value of Life Insurance Policies

14. Resources- Single $2,000 in countable resources Homestead is exempt up to $500,000- unless minor or disabled child (but estate recovery applies)

15. Resources- Married Depends on the amount of countable resources they had as of the first month of stay in the medical institution Depends on the income of the Community and Institutionalized Spouse Many couples will spend down their assets needlessly There are many techniques such as: – Gifting (must do with advice from attorney), – Administrative appeal, – Purchase of annuity, – Purchase exempt assets, – Special Needs Trust

16. Medical Necessity Requires a medical disorder or disease requiring attention by RN or LVN on regular basis Does not include inability to attend to “activities of daily living” such as bathing, grooming and eating

17. Estate Recovery Recover from Medicaid recipients the amount expended for their care Some Exemptions: – During lifetime of surviving spouse – Surviving child under 21 – Surviving child with blindness or disability – Undue hardship (low value homes) – Recovery not cost effective

18. Deficit Reduction Act “Look back period” now five years for transfers Penalty period start delayed Cap on value of homestead (unless exception applies) Changes in annuity requirements- state is now the remainder bene. What are the real life implications for this?

19. Why Consider Long Term Care Insurance? Medicare provides limited nursing home coverage Some of the best facilities do not take Medicaid Tax benefits You want to stay at home You want to protect your estate for your family You can afford the premiums You want to remain independent!

20. What is a Care Manager? Assists in locating appropriate placement Assess needs and situation to establish a plan of care Find and secure resources that meet your needs and budget Your own personal tour guide through the maze of healthcare Monitor care in nursing home care, assisted living, adult day care, etc. Saves you time, energy and money, provides peace of mind

21. The End! Christina Lesher WWW.LAWLESHER.COM CLesher@LawLesher.com 2719 Colquitt Houston, Texas 77098 713-529-5900