Tip – There are very specific rules to become eligible for Medicaid.

In Idaho, the Idaho Department of Health and Welfare (IDHW) administers the state’s Medicaid program and provides services for nursing home care through the Home and Community Based Services or Aged and Disabled waiver program for qualified individuals who are age 65 or older who need long term care. Medicaid is a means-tested entitlement program. Eligibility for Medicaid is based on the applicant’s medical condition, their assets, and their income. When applying for Medicaid, the IDHW requires proof of citizenship or legal status, residence in Idaho, social security, pensions and other incomes, assets and for couples, proof of marriage.

Medical eligibility. To be eligible for Medicaid, a person age 65 or older must have a medical need. In Idaho, IDHW uses a Uniform Assessment Indicator form to determine whether the candidate meets the medical need requirements. An application for Medicaid will require a Level of Care Verification from a physician or nursing home representative showing that the participant meets the required level of care.

Resource Eligibility. Medicaid strictly limits the assets people may own while accepting benefits.  Generally, the assets that do not count against the beneficiary are the following:

• The principal residence
• One car
• Burial plot/prepaid funeral
• $2,000 in cash

All other assets count toward the state determined maximum, which in Idaho for a single person is $2,000. Countable assets are bank accounts, CDs, cash, stocks, retirement accounts, second cars, recreational vehicles, camp trailers, and any other items that can be turned into cash.

When there is a community spouse (the spouse still living at home), Idaho has established levels of exempt assets within a range of what’s allowable under federal standards. These exempt assets, called the Community Spouse Resource Allowance (CSRA), will be the amount of money available to a community spouse as a resource allowance when an institutionalized spouse applies for benefits under the Medicaid program. For 2023 the minimum CSRA in Idaho is $29,724 and the maximum CSRA is $148,620. If the couple’s assets are below the minimum CSRA, the community spouse is allowed to keep all the couple’s assets. If the couple’s assets exceed this amount, the community spouse may only keep half of the couple’s countable assets calculated at the time the couple’s resources are assessed up to the maximum Community Spouse Resource Allowance.

When assessing the couple’s resources to determine the resource allowance, the resources are assessed on a snapshot date which is the first day of a continuous period of long-term care that lasts at least 30 consecutive days or the date a physician states that the institutionalized spouse meets the required level of care. Establishing a snapshot date is crucial in protecting the couple’s countable assets for the community spouse.

Once the resource allowance is determined, if the couple’s assets exceed the minimum CSRA, the couple must spend down their countable assets before the institutionalized spouse will qualify for Medicaid benefits. The issue for the elder law attorney is to educate and guide the couple in spending down their countable assets. To spend down assets a couple may convert their countable assets into noncountable assets. For example, the couple may purchase a new car or pay down a mortgage.

Income eligibility. For 2023, a candidate for Medicaid cannot have more the $2,742 per month in income in order to qualify for Medicaid. Income is anything that can be used to meet needs for food or shelter. Income is cash, wages, pensions, in-kind payments, inheritances, gifts, awards, rent, dividends, interest, or royalties the participant receives during a month. If a potential participant has too much income, they may still qualify for Medicaid by creating a Miller Trust. The Medicaid applicant may divert the excess income into a Miller Trust account bringing their income below the income cap. The diverted income is used to pay for the Medicaid applicant’s monthly care costs.

View our “Senior’s Guide to a Well-Planned Future” on our website! Packer Elder Care Law – with you for life!

Tom Packer is an Elder Law Attorney serving all Southeast Idaho. As part of his law practice, Tom offers Life Care Planning to deal with the challenges created by long-term illness, disability and incapacity. If you have a question about a Senior’s legal, financial or healthcare needs, please call us.

June 2023

Tip – There’s a lot of misinformation and misunderstandings about these two programs.

On July 30, 1965, President Lyndon B. Johnson signed the Medicare and Medicaid Act, also known as the Social Security Amendments of 1965, into law. It established Medicare, a health insurance program for the elderly, and Medicaid, a health insurance program for people with limited income.

Medicare is an entitlement program that pays for hospital, doctor, and prescription medication costs. Medicare covers skilled-nursing services, physical, vocational, and speech therapy, and hospice care whether provided in a facility or in the home. It will cover up to 100 days of rehabilitation following a hospital stay in a rehabilitation center. Medicare does not pay for personal care services or the cost of care in an assisted-living facility or a skilled-nursing facility beyond the 100 days. There is no repayment requirement for any services you receive from Medicare. To qualify for Medicare all you have to do is to turn 65 and apply for the program.

When the elderly need long-term care they apply to Medicaid. Medicaid is not an entitlement program, and you must prove eligibility to receive Medicaid benefits. For an individual to qualify for Medicaid, they must have liquid assets of less than $2,000, which does not include their home, a single vehicle, or a prepaid funeral policy. A Medicaid recipient who is single cannot have income over $2,567 a month. (as of May 2023). However, if their income does exceed that amount, they can set up and use a Miller Trust, and still qualify. Finally, they must meet certain healthcare needs as evaluated by a nurse who is working for the Department of Health and Welfare.

Medicaid will pay for limited personal care services in the home, or it will pay for long-term care in an assisted-living facility or skilled-nursing facility. If you apply and qualify for the Medicaid program, your monthly income is applied to the cost of your care at the facility, and then Medicaid will pay the unpaid balance. You are allowed to keep a small amount of your income for personal needs and to pay for prescription costs. The calculation for a married couple is more complicated.

Generally, the spouse who is not in the facility can keep the home, car, and half of the liquid assets to provide for their needs.

Unlike Medicare, the benefits paid to you for your care under the Medicaid program must be repaid from your estate when you pass. This program is known as Estate Recovery. Your personal representative must notify Estate Recovery of your passing, and then your estate will receive a claim against it for the money that was paid by Medicaid for your care. I often compare it to a student loan; once you graduate from school, you receive a letter from the government saying that you now must pay your student loan back.

It has been my experience that there is a lot of misunderstanding and misinformation about how these programs work. It makes sense to talk with an attorney who specializes in this area of the law to help you receive the benefits you need.

View our “Senior’s Guide to a Well-Planned Future” on our website! Packer Elder Care Law – with you for life!

Tom Packer is an Elder Law Attorney serving all Southeast Idaho. As part of his law practice, Tom offers Life Care Planning to deal with the challenges created by long-term illness, disability and incapacity. If you have a question about a Senior’s legal, financial or healthcare needs, please call us.

May 2023

Tip – There are much better ways to get help with your finances.

Some parents, when their health begins to fail, decide to put a child on their bank account to help them manage their finances, pay bills, etc. Sometimes, doing this does not give rise to any problems. Other times, it can lead to problems after the parent has passed away. For example, after the parent passes, the child may decide to close the account and take the money that remains for themself— claiming that was mom or dad’s intention. This position taken by the child conflicts with Idaho Code Section 15-6-104, which states that “Sums remaining on deposit at the death of a party to a joint account belong to the surviving party … as against the estate of the decedent if an intent to give the account can be shown by the surviving party…” If the intent to give the remaining money in the account to the child who took it cannot be shown, the other children must seek legal action to recover the money if they want it to be distributed according to the parent’s Will.

If the parent intends to give the sums remaining in the account to one of the surviving children, the parent could state this in his or her Will, or the parent could make the account a Pay on Death (P.O.D.) account, which would make the parent’s intent crystal clear. In this situation, after the parent dies, the child gives the bank a death certificate and the bank will release the remaining funds to the child.

Another problem that occasionally occurs when you put a child on a parent’s bank account is that the child begins to take money for his or her personal use, while the parent is still alive. When this happens, it is almost impossible to get the child taken off the account.

There is a better way for a parent to get help with their finances. The parent can give an agent of his or her choosing a Power of Attorney (POA) for finances and property. The POA gives the agent the authority to help pay bills, sell property, apply for Medicaid, or do any other needed transactions. If a problem arises in the way that the child uses the POA, it is easily revoked. In addition, the Power of
Attorney ends when the parent passes away, so the child cannot withdraw any sums remaining in the account at the parent’s death.

Using a Durable Power of Attorney for Finances rather than putting a child on the bank account as a joint owner can avoid many problems.

View our “Senior’s Guide to a Well-Planned Future” on our website! Packer Elder Care Law – with you for life!

Tom Packer is an Elder Law Attorney serving all Southeast Idaho. As part of his law practice, Tom offers Life Care Planning to deal with the challenges created by long-term illness, disability and incapacity. If you have a question about a Senior’s legal, financial or healthcare needs, please call us.

December 2022

Tip – To qualify for Medicaid, a person must meet Medicaid’s health,
income and asset eligibility requirements.

Medicaid is a federal program administered by the Idaho Department of Health and Welfare (IDHW). The focus of this tip is Medicaid eligibility for seniors, age 65 and over, needing long-term care. For those that qualify, Medicaid will help pay for care provided to seniors in skilled-nursing facilities, assisted-living facilities, adult foster care, and home-based services for seniors in their homes.

To qualify for Medicaid, a person must meet Medicaid’s health, income, and asset eligibility requirements:

To determine if a senior meets the health requirement, a nurse from IDHW does an evaluation of the senior’s need for assistance with their activities of daily living.

To determine if a senior meets the income requirement, you look to see if their monthly income exceeds Medicaid’s income limit. In 2022 to qualify for Medicaid, the senior’s monthly income cannot exceed $2,543 a month. If their income exceeds this, they may set up a Qualified Income Trust, also known as a Miller Trust, and divert some of their income to the Trust to reduce their income thereby qualifying them for Medicaid. The Trust funds can only be used to pay for longterm care or medical expenses incurred by the senior. The Trust must be irrevocable and any Trust funds remaining in the Trust at the person’s death, must be paid to estate recovery.

To determine if a senior meets the asset requirement you look at their countable assets. In 2022, a single person’s countable asset limit is $2,000. The value of the senior’s home, one vehicle, and a prepaid funeral are not counted toward the asset limit. If a couple is applying for Medicaid, the asset limit is $3,000. For a couple with a spouse receiving long-term care and the other one remaining in their home, the asset limit for the applicant is $2,000 and the asset limit for the senior remaining in their home is $137,400.

If a senior is over the asset limit, the excess funds cannot be given away but may be spent down. For example, some excess money can be used to pay off their mortgage, repair their home, upgrade their vehicle, or prepay their funeral.

There is a lot of confusion about how Medicaid works. Here are two facts that you need to understand:
• First, if a senior qualifies for Medicaid, their monthly income is paid to the long-term care provider  or their care. The difference between the senior’s income and the cost of their care each month is aid by Medicaid. The senior is allowed to keep a modest personal needs allowance each month.
• Second, long-term care paid by Medicaid is a loan. It reminds me of my student loan from law school. When I was in school, I borrowed money. When I graduated from school, I received a letter  stating that it was time to start paying back the loan. Similarly, Medicaid helps pay for a senior’s care during their lifetime. When the senior dies, Estate Recovery will send a letter that the money paid by Medicaid for their care must be paid back out of their estate. For a couple, the letter is not sent until the passing of the second member of the couple.

Applying for Medicaid can be a complicated process. You may want to consider consulting an attorney familiar with Medicaid rules.

View our “Senior’s Guide to a Well-Planned Future” on our website! Packer Elder Care Law – with you for life!

Tom Packer is an Elder Law Attorney serving all Southeast Idaho. As part of his law practice, Tom offers Life Care Planning to deal with the challenges created by long-term illness, disability and incapacity. If you have a question about a Senior’s legal, financial or healthcare needs, please call us.

May 2022

Signing a financial institution’s power of attorney can resolve problems.

A power of attorney is the delegation of decision-making authority over an individual’s property to another. The person delegating the authority is called the Principal, and the person receiving the authority is called the Agent. Delegating authority can be for incapacity planning or for convenience. The agent acts in financial matters for the principal’s benefit. For example, the agent can deposit or withdraw money from bank accounts, buy or sell securities, operate or terminate an ownership interest in a business, purchase insurance, pay bills, lease or sell property, apply for government benefits, pay taxes, etc.

For the most part, powers of attorney work well and accomplish their intended purpose. Sometimes, however, problems arise when you present a power of attorney to the IRS, banks, or other financial institutions, who may hesitate to accept the power of attorney. The law states that institutions can be held liable for refusing to accept an acknowledged power of attorney. Nevertheless, institutions frequently cite their internal policies as the reason for their refusal.

One way to solve this problem is to ask the bank, the IRS, or other financial institutions for their power of attorney form, which you can sign in addition to your general power of attorney. IRS Form 2848 authorizes another person to represent an individual before the IRS. You can name an accountant, attorney, or a family member as your representative. This form allows your agent to transact matters for you with the IRS.

By signing IRS Form 2848 or a financial institution’s power of attorney form, you will have less problems with them rejecting your power of attorney and you will be able to transact business with them more smoothly.

Tom Packer is an Elder Law Attorney serving all Southeast Idaho. As part of his law practice, Tom offers Life Care Planning to deal with the challenges created by long-term illness, disability and incapacity. If you have a question about a Senior’s legal, financial or healthcare needs, please call us.

August 2021

Understanding the VA Aide and Attendance Pension

Veterans who have served on active duty during wartime are often unaware that they may be eligible for a VA Aide & Attendance Pension to help with the cost of assisted living, adult daycare, skilled nursing, and home care. A veteran’s surviving spouse may also be eligible for this assistance. The amount of this pension may be up to $1881 to $2230 per month, depending on the veteran’s family size, and the funds are given directly to the veteran or surviving spouse to help pay for his or her care.

The general qualifications include:

• A veteran must have served on active duty for at least 90 days, with at least one day during wartime.
• The veteran must have been honorably discharged.
• The veteran must be at least 65, or officially disabled if younger.
• A veteran must require help with activities of daily living.
• A veteran must meet the income and asset guidelines.

There are three levels of VA Pensions: Basic Pension, Aid & Attendance, and Housebound. A veteran must be eligible for the Basic Pension in order to qualify for the Aid & Attendance and Housebound benefits and must have limited income and assets to be eligible. However, the income and asset guidelines are considered quite generous, given that the VA allows veterans to deduct their projected ongoing medical expenses from their income to reduce the amount of their countable income.

For example, if Bill has an income of $32,000 per year, but has assisted-living expenses of $36,000 per year, he would show a deficit and may be eligible for the full pension amount of $1881 per month, for a single person. With these additional funds, he could easily afford to pay for his assisted-living care. While the guidelines are far more complex than outlined in this brief example, it is helpful to see how a veteran could potentially be eligible. There is also an asset limit of $123,600, not including a primary home and vehicle, as well as a look-back period of three years for gifts and items sold.

Assistance is available for veterans interested in learning more about the VA Aide & Attendance Pension or for those interested in applying. Remember, you do not need to have a service-connected disability to be eligible for this pension. The Veteran’s Service Officers are able to assist with this process at 208-235-7890 or more information can be found online at https://www.benefits.va.gov/pension/aid attendance_housebound.asp. You are also welcome to call our office to obtain more information.

Tom Packer is an Elder Law Attorney serving all of Southeast Idaho. As part of his law practice, Tom offers Life Care Planning to deal with the challenges created by long-term illness, disability and incapacity. If you have a question about a Senior’s legal, financial or healthcare needs, please call us.

March 2019

What to expect when Medicaid pays for your long-term care.

Medicare, which pays for hospital, doctor and medication expenses, does not pay for long-term care. Medicare is an entitlement program that you do not have to pay back. Medicaid funds long-term care services for individuals who meet the qualifying criteria. However, when an individual, 55 years or older, has received Medicaid funds to pay for his or her healthcare, the Department of Health and Welfare, IDHW, is required by federal law to recover the cost of their care through Estate Recovery.

If a married individual, who received Medicaid funds, passes away, IDHW will not make a claim against that person’s estate until the surviving spouse has also passed away. During the surviving spouse’s lifetime, there are no restrictions on how the assets in the estate are used, as long as they are used for the surviving spouse’s benefit, and not given away. In addition, the surviving spouse can continue to live in the house or sell it and make other living arrangements. Whatever is left in the estate when the surviving spouse passes away, is subject to Estate Recovery.

When both spouses have passed away, the Personal Representative of their estate is required to provide written notice of the probate to the Estate Recovery division of IDHW. Estate Recovery is made against real and personal property in the estate. It is also made against property held in a revocable trust or property held in joint tenancy. However, IDHW does not make a claim against the death benefit of a life insurance policy.

There are some exemptions from Estate Recovery. One is, the decedent’s surviving spouse or adult children are allowed to keep any tangible, personal property such as household items, furnishings, automobiles, family heirlooms and personal effects, up to $10,000. Also, if an adult child pays fair market value for any item of property in the estate, they can keep it in the family.

Sometimes, I use this analogy to explain Estate Recovery. When I was in law school, I didn’t have enough money to cover all the expenses, so I took out a student loan. When I graduated, I received a letter from the bank with my loan repayment schedule. Similarly, when a person who received Medicaid “graduates,” or passes away, their estate will receive a claim from Estate Recovery to pay back the money they borrowed to pay for their care.

These are complex laws and regulations. Make sure to speak with someone who has experience in this area before making any decisions.

Tom Packer is an Elder Law Attorney serving all of Southeast Idaho. As part of his law practice, Tom offers Life Care Planning to deal with the challenges created by long-term illness, disability and incapacity. If you have a question about a Senior’s legal, financial or healthcare needs, please call us.

January 2019

Don’t believe everything you hear about Medicaid.

I have had several calls and questions about Medicaid that make it clear that there is a lot of misinformation about Medicaid. Here are some of the questions I fielded this past month:

1. “Is it true that if I am applying for Medicaid and sell my home, I have to use the proceeds of the sale to pay for my long-term care?” First, youdo nothave to sell your home. Your home does not count toward Medicaid eligibility. If you are a couple, after one spouse qualifies for Medicaid the home can be transferred to the non-Medicaid spouse, who can continue living in the home. If you are single, Medicaid allows you to sign a form that you intend to return home, if possible. This allows you to retain ownership and control of your home. However, Estate Recovery will make a claim against your estate for the costs of your care after you have passed away.

If you decide to sell you your home, Medicaid requires you to spend down your cash assets to $2,000 for a single person or $3,000 for a couple if both are on Medicaid. But the proceeds of the sale can be spent to benefit you personally. For example, you can pay off debts, buy a new car, pay for eye care, prepay funeral expenses, pay for travel, pay for dental and medical expenses not covered by Medicare or Medicaid, or for any other expenditures that benefit you. The proceeds of the sale of your house do not have to be used to pay for your care. One final point, you cannot give your money away. There is a 5-year lookback for any money that is given as a gift.

2. “Is it true that if I set up a Miller Trust, that I can use the money in the trust to pay medical bills or upgrade my room to a private room?” Youcannotuse the money in a Miller Trust to pay medical bills or upgrade a room. A Miller Trust helps you qualify for Medicaid when your monthly income exceeds the maximum limit allowed by Medicaid, which is $2270 per month in 2018. If your income exceeds that amount, you can use a Miller Trust, to qualify for Medicaid, but the money that goes into the Miller Trust is used to pay for your share of costs at the facility. Any money left in the trust at your death goes back to Medicaid.

Another trust, known as a Special Needs Trust, is a trust set up to supplement the needs of a person who is disabled and receiving Medicaid. If a person has a Special Needs Trust, it can be used to pay medical bills or upgrade a room. Apparently, the person who asked the question was confusing a Miller Trust and Special Needs Trust. These are different trusts that are used in different situations.

3. One last myth to dispel—If you are married, and only one spouse is going on Medicaid, the well spouse can keep half of the cash assets up to $123,600, and the other spouse can still qualify for Medicaid.

These Medicaid Myths that are passed around can cause you to spend down more cash than you need to. It is important to have accurate information when making decisions about Medicaid. The costs of long-term care represent a significant financial risk. Understanding how Medicaid works will allow you to access government benefits in the least, financially-disruptive manner possible.

Tom Packer is an Elder Law Attorney serving all of Southeast Idaho. As part of his law practice, Tom offers Life Care Planning to deal with the challenges created by long-term illness, disability and incapacity.  If you have a question about a Senior’s legal, financial or healthcare needs, please call us.

March 2018