FREQUENTLY ASKED QUESTIONSQ: Didn't the new Deficit Reduction Act (DRA) Medicaid laws passed by Congress in 2006 make it impossible to protect assets from Medicaid?
A: Not at all. The rules are certainly different, but it just means that there had to be some adjustments in the Medicaid asset protection strategies we employ. Some strategies that were useful in the past may no longer be effective. On the other hand, new rules mean new opportunities and new strategies.
Q: If we utilize your services, how much of the assets could we protect?
A: In the case of a married patient, the vast majority of our clients will be able to protect/preserve virtually 100 percent of the value of their assets. In the case of a single (unmarried) patient we can generally protect between 50 and 75 percent of the value of the assets, but sometimes up to 100 percent.
Q: How much do your services cost?
A: The initial interview, review and consultation are always free. If the client decides to move forward, and the situation involves a patient who is married, our normal fee is $1,900. In the case of an single (unmarried) patient, our usual practice is to charge a reasonable one-time fee, but only after a complete discussion with the client concerning the anticipated results. The fee will vary depending on the specifics of the case, but generally won't be more than $2,500.
Q: If we have you "rearrange our resources" to get my spouse qualified, how in the world am I going to explain what has been done to the Medicaid worker?
A: You won't have to. We will provide the worker with a complete report and description of the financial and related transactions involved. And if the Medicaid worker misunderstands or misapplies the rules, we will take the steps necessary to ensure proper application of the rules.
Q: What types of benefits will Oregon Medicaid provide?
A: Medicaid in Oregon provides benefits for nursing home care, which typically includes room and board, care, prescriptions, supplies and medical coverage. In addition, other types of care, often referred to as 'community based care', such as assisted living, residential care, adult foster care, memory care, in-home care and adult day care, are also covered.
Q: If my loved one is on Medicaid, won't they get substandard care?
A: The quality of care is more a function of the specific facility, rather than the pay status of the patient. The truth of the matter is that the majority of long-term care patients are already on Medicaid. Sure, there are some "high class" facilities that cater specifically to those clients for whom cost is not a consideration. However, most facilities will generally have a mixture of Medicaid and private pay patients. For the most part, the actual caregivers have no idea, nor do they care, which is which. Besides, every facility must abide by both state and Federal standards of care. It is against the law to provide substandard care. In addition, every state has an Ombudsman program available to patients and their families to investigate such problems. And, regardless of whether the patient is private pay or on Medicaid, the more involved the family, typically the better the care of the patient.
Q: Is what you do legal?
A: Absolutely! What we are doing is using the Federal and state Medicaid eligibility rules exactly as they are written. We use the rules to your advantage, not try to get around them.
Q: What if the Medicaid worker doesn't like what we've done and disqualifies my spouse from benefits?
A: Don't worry. As we say, "the rules are the rules." The worker's opinion of actions has nothing to do with Medicaid qualification. And even if the worker misinterprets the rules, we'll make sure they get applied correctly.
Q: My spouse and I have all our assets in a revocable living trust. The person who set up the trust said it would protect our assets from Medicaid. Was he right?
A: He was not. A revocable living trust, although it may have other benefits, provides little or no protection from Medicaid.
Q: Once in a nursing home, doesn't Medicaid require you to 'spend down' most of your money on care before you can qualify for Medicaid benefits?
A: That's what Medicaid would like you to believe. Although you may have to reduce your assets to a particular level before you can qualify for Medicaid, you are not required to spend your money on anything in particular, including care. In fact, you are not required to spend it at all.
Q: Isn't it against the rules to shelter your assets for the purpose of becoming qualified for Medicaid?
A: No. What is a violation of Medicaid rules is to take various actions with your assets, for whatever reason, and then not disclose that fact at the time of Medicaid application. What we do is to optimize the structure and timing of the Medicaid asset protection strategies and techniques designed to maximize the portion of your assets that can be protected. And, since everything is legal and "above board," we can share with the Medicaid worker the details of everything we have done. There is absolutely no need to hide anything.
Q: Don't you have to be broke to get on Medicaid?
A: Not necessarily. For single patients, that is true. However, when the patient is married, Medicaid has provided protection for some minimum of assets for the spouse. Unfortunately, even with these spousal protection rules in place, there is often a significant spend down requirement (in some cases, in the hundreds of thousands of dollars) before the patient can qualify for any assistance. The strategies we use in a married situation concentrate on completely eliminating the spend-down in its entirety. For single (unmarried) patients our objective is to maximize the transfer of assets to family members prior to Medicaid qualification.
Q: My husband has income of $3,100 per month. I was told he that he makes too much to qualify. What can we do?
A: This is really not a problem. Even if the patient's income is over the current cap of $2,205, the establishment of a simple Income Cap Trust solves the problem.
Q: We gave our daughter $25,000 last year. Isn't my husband disqualified for five years?
A: No! That's one of the common misconceptions. The look back period of five years is not the same thing as the disqualification.
Q: Can't I find out from the Medicaid office how to protect assets?
A: Do you really think that Medicaid is interested in helping you learn how to protect assets while qualifying for Medicaid? Besides, Medicaid workers are not trained, nor are they allowed, to give financial or legal advice.
Q: This is the second marriage for both of us. We have always kept our assets separate, and we also have a pre-nup. When we apply for Medicaid for my husband, won't they only look at his assets, since mine have never been in his name?
A: Unfortunately, no. Medicaid does not care who owns which assets, where the assets come from, or how long you've been married. If you are married they look at "combined countable" resources. Whatever is available to one spouse is assumed to be available to the other. The existence of a pre-nup does not change that.
Q: If there were a way to protect assets from Medicaid, wouldn't my attorney tell me about it (which he has not)?
A: Most attorneys know little or nothing about Medicaid qualification in general, or Medicaid asset protection in particular. And, of those that do, very few have the knowledge or experience to really put together an aggressive plan to maximize the protection of assets while preparing a patient for Medicaid qualification. But that is exactly what we have been doing since 1995. With our experience and knowledge, we can show you, and your attorney, exactly what needs to be done.
The Financial Aid Center
531 NE 'E' Street, Unit B
Grants Pass, OR 97526