Many people have sufficient income to maintain a regular lifestyle but are unable to afford the high cost of long-term care. With the average cost of long-term care around $7,000.00 a month, it is incredibly difficult for most families to afford it, even more so after retirement. That’s why it’s a good idea to plan for qualifying for TennCare, also known as Medicaid.
Evaluate and restructure your assets to qualify for TennCare
As we discussed in our blog last week, there are certain criteria you need to meet to be eligible for TennCare. As an elder law attorney, one of my jobs is to help families get their loved ones qualified for TennCare while maintaining resources available for the rest of the household.
One of the ways that we do this is by restructuring a family’s assets. We do this by turning resources that are countable for TennCare purposes into items that TennCare does not count as part of its eligibility assessment
This process is known in the elder law community as a spend-down. The goal of the spend-down is to make you or your loved one eligible for TennCare as far as your assets are concerned. If you are overqualified for income-based criteria, we can use a special type of trust called a Qualified Income Trust, or a Miller Trust, to reduce your income. The goal of a spend-down is to maintain the quality of life for all family members including those who need long-term care.
What is a “spend-down”?
Bob needs to go into long-term care. Bob is eligible based on his income. He makes $2,000.00 a month of social security retirement income. Bob also has a house, a car, and $50,000.00 in the bank. Bob is widowed and his children are adults.
We need to do something with at least $48,000.00 from Bob’s bank account in order to make him eligible for TennCare. His house and his car are not countable for TennCare purposes in most cases. What can we do?
Make improvements to his home that would improve his quality of life and access to the things that he needed in the home. This might include:
Grab bars in the shower or hallway.
A ramp into the main entrances.
Paving the driveway or expanding it closer to the door
Buy some things for Bob that his Medicare did not cover, such as:
Top of the line mobility devices
There may be other things that would improve Bob’s quality of life. There are things we can spend money on or convert into income. I am also going to suggest to everyone that they use the money to make arrangements for end-of-life needs if they have not done so already. Since at some point Bob’s children will need to make arrangements for his burial or cremation, paying for it now from his excess funds is a great way to make those funds unavailable for TennCare purposes and meet a future need.
Bob might want a Care and Savings Assessment
It’s not easy getting approved for TennCare / Medicaid, and we know it! That’s why we offer help in planning your steps to qualify. It doesn’t matter what your starting point is, we’re here to help you navigate the process with one goal: get our clients the quality of care that they need. Contact us if you would like to make plans for qualifying for TennCare.
Last week we defined TennCare and how it applies to our clients. This week I want to go more in-depth with how TennCare serves Tennesseans with long-term care.
Many people believe that Medicare benefits will cover nursing home care once an individual is 65 or older, but this simply isn’t true. While Medicare covers the first 100 days, it doesn’t cover long-term assisted living. Read more about Medicare here.
Back to TennCare/Medicaid…
My Mom doesn’t have long-term healthcare insurance. What are my options?
Payout of pocket until you run out of cash – This is an unrealistic option for most families. Nursing home care is expensive. Not a lot of people have an extra $7,000-$11,000 a month in their bank accounts.
Do a reverse mortgage on her home.
Qualify for the TennCare / Medicaid program called “CHOICES”.
As you can see, options 1 and 2 are very unpleasant and leave nothing left for a loved one’s legacy. However, option 3, CHOICES, is definitely something worth looking into.
What is CHOICES?
CHOICES is the category of TennCare that provides Long-Term Services and Supports (LTSS) such as nursing home care.
What is the process for getting qualified for CHOICES?
In order to be eligible to receive benefits from TennCare/Medicaid your loved one must first qualify within these three categories:
How does someone become medically eligible for TennCare CHOICES?
The state of Tennessee will determine who is medically eligible to receive TennCare Long-Term Services and Support (LTSS) by using a pre-admission evaluation (PAE). This PAE is used to determine if the applicant can do basic life skills on their own without help. The PAE will also determine if the applicant is safe in their current environment.
The PAE is a strict evaluation and it is performed on a case-by-case basis. An applicant must receive a score of 9 or higher on a 26 point scale in order to be considered medically eligible for TennCare Long-Term Support Services.
For example, a caregiver or healthcare provider may be asked about a patient’s level of ability to do things and how much assistance is needed.
The following Activities of Daily Living (ADLs) are covered in the PAE evaluation:
If you or your loved one is unlikely to get to a nine or higher on the PAE, it is always appropriate to ask for a “safety determination” evaluation as an alternative route of becoming medically eligible for Choices.
How can someone become financially eligible to receive CHOICES?
You must be able to prove that the applicant has a low income and little assets. As of January 2022, an individual applying for TennCare CHOICES cannot have an income exceeding $2,523.00 per month. Additionally, the applicant cannot have more than $2,000 in assets. This includes any money in the bank and investment accounts but also requires consideration of retirement accounts, life insurance policies, real estate, artwork, jewelry, and any other valuables. When we talk about the assets for a couple of things get a little more complex. The most important thing is that both the applicant and their family are taken care of, both medically and financially.
My Mom is over the limits for income and assets? What do we do?
If the applicant is in excess of the amounts we can plan for that! We have a tool to help people who have excess income and assets yet need to qualify for TennCare/Medicaid called the “Care and Savings Assessment”. With this Care and Savings Assessment, we work to determine the best way to structure you or your loved one’s finances, either now or in the future. We plan so that our clients have the peace of mind knowing they can qualify for TennCare if and when they need it!
It is often helpful to have an attorney assess your financial situation and offer recommendations on how those finances may be restructured to qualify for TennCare Long-Term Services and Support (LTSS). As an experienced TennCare planning attorney, I can help you evaluate your risk and create a plan that takes care of everyone in the family.
Are you ready for help with TennCare planning? Contact us and we can discuss your plan. Next week we will go over some examples of how we restructure an individual’s finances to meet their needs for long-term care.
Quite simply, TennCare is Tennessee’s Medicaid program. While the name “TennCare” has the word “care” in it, it is NOT Medicare. In order to further clarify the difference between the terms “Medicaid” and “Medicare,” you need to remember that we use “Medicare” to “care” for our elders and “Medicaid” to “aid” those, of any age, in need. Essentially TennCare is Tennessee’s brand of Medicaid. Hopefully, that little trick will help you remember the differences between each program.
Who qualifies for TennCare?
Now that you are familiar with the difference between Medicare and Medicaid, let’s discuss who qualifies for TennCare (Medicaid).
There are three qualification criteria that you must meet in order to obtain Medicaid/TennCare.
1. Medical qualification –There is a special medical test that applicants must pass in order to qualify. Usually, a care facility will handle this piece of the Medicaid application.
2. Asset qualification – A TennCare applicant who is single can only have $2,000.00 in assets before they are eligible for TennCare. Vehicles and real estate are usually exempt from the count of assets. A “Care and Savings Assessment” is a good place to start if the applicant needs help with figuring out what they have in assets and what options are available to make excess assets “non-countable” for TennCare purposes.
3. Income qualification – A TennCare applicant can only receive $2,382.00 per month (as of 2021) in order to receive TennCare. If an applicant has more than this amount in income, an attorney can resolve it through what is called a Miller Trust or a Qualified Income Trust.
Why should I be concerned about long-term care services?
Unless you are a millionaire or multi-millionaire, TennCare eligibility and designation could have a major impact on your finances and your family. While you may not need TennCare now, you will want to plan as if you will need it in the future. As you may have heard us say before “we hope for the best, and plan for the worst.” Having a plan is an effective way to ensure that you will have long-term care coverage when you need it. This isn’t to say that you won’t find yourself needing TennCare much sooner than expected. When this happens we call it “TennCare Crisis Planning”.
I don’t know where to start!
The biggest obstacle to TennCare planning is determining what to do with your assets and income; especially if there is excess in any category. There are a lot of rules and potential pitfalls that you need to look out for. Fortunately, we have some great financial planning and legal resources that can help our clients. If you have an immediate need for TennCare or want to plan for TennCare we can supply the client with what we call a “Care and Savings Assessment”. It’s a wonderful tool that helps people effectively navigate through their options.
How do we help our estate planning clients with TennCare planning?
For our estate planning clients, we like to take into consideration the possibility that you may need TennCare in the future.
For example, it is our priority to set up our client estate plans to make sure that TennCare is accessible if it is ever needed. As with many government organizations, Medicaid has lots of rules to follow and many people find that they did not know what rules they were supposed to be following until it was too late! Fortunately for our clients, we know the rules and can help you plan in advance of ever needing to apply for TennCare to cover medical care. Additionally, we create documents that make sure that someone can apply for Tenncare on your behalf. This is useful if you become incapacitated in the future.
How do we help our Conservatorship clients with TennCare?
Many of our conservatorship clients are caregivers for a loved one who requires skilled nursing to keep them safe. The average cost for this type of care is about $7,000.00 per month or more. There is usually a large gap between monthly income and fees. Our firm can navigate the TennCare application process and assure that the appropriate language is in the conservatorship order paperwork with the court so that the client may obtain the appropriate benefits for their loved one.
How do we help clients with TennCare Crisis planning?
For those who have never considered the cost of long-term care until they or a loved one need to enter a nursing facility, the cost of care is likely to come as a shock- and an unaffordable, but necessary, expense. This is when we can step in with what we call “crisis planning,” meaning that you need a plan and you need a plan now.
In these cases, we are able to look at the household financial situation of the person needing skilled care, as well as the family situation overall, and come up with a plan for how to best use existing resources and get them qualified for TennCare benefits to pay for the nursing home bills. This process called our “Care and Savings Assessment”, is one of the most rewarding things that we do! It allows us to help people get the care that they need while still providing a quality of life for themselves and their families.
If you are concerned about accessing TennCare benefits for long-term care, contact our office for a complimentary initial call using our online calendar here.
Last week we looked at red flags you should pay attention to with regards to caregivers and professionals in your network. This week we’ll look at how to prevent abusive caregiver situations and how to deal with abuse once it has occurred. Below are some actions you can take to guard against people in your network taking advantage of you.
Things you can do now:
Take advantage of your free yearly credit report.
You can get a free credit report from each of the three credit reporting agencies (Experian, TransUnion and Equifax). Hot tip! Space them out! Sign up to get one every four months. This will make it easier to discover any irregular activity fairly quickly.
Ask your banker if they have completed the “BankSafe” program from AARP.
BankSafe is a training platform designed to help financial professionals identify and stop suspected exploitations from caregivers. Ask your bank if they have participated in this training. If your bank has not had this training, encourage them to do so! Or consider moving funds to a bank or credit union that has already participated.
Budget for paid assistance.
Remember that as much as family and friends may want to help, sometimes they can’t. It’s important to make sure that you are able to afford assistance for things like traveling to appointments, grocery shopping, laundry, nutritious meals, cleaning, and other personal help you may need if you were injured or developed a medical condition. Endeavor to have enough of your retirement savings to ensure you can afford a positive work environment for your future caregivers.
Create a Durable Power of Attorney.
This Power of Attorney allows someone you trust to monitor and manage your finances, if needed. This could be a family member or close friend. With access to bank accounts and credit card statements, they should be able to notice quickly if your spending habits change or if there is fraudulent activity on your account and they’ll be able to file a claim to protect your money!
Things to keep in mind for later:
Listen to your loved ones.
If you have a caregiver that is not in your family, do yourself a favor and trust a loved one’s opinion if they sense unsettling behavior from that caregiver. Sometimes others are able to see things that we are too close to observe.
Don’t become too reliant on one person.
You can have a housekeeper come every other week to clean the surfaces, a home health nurse to check on your health, and a food delivery service to prepare your meals or deliver groceries. Surround yourself with people who like their jobs.
Let family and friends know you welcome their visits and calls.
Tell them what has been going on in your life and find out what is going on with them. Maybe a few favorite snacks in the cupboard will even bring the grandkids by.
Don’t give up your routines.
Self-care is so important, we all know that! If you feel yourself falling into a slump, get outdoors, go to the store, call a friend or ask someone for help. You deserve to be loved and to love yourself. No matter what anyone says, you are the conductor of your life.
“Stranger danger” isn’t just for children.
As adults we get comfortable interacting with all kinds of people, but remember that not everyone has your best interest in mind. Beware of helpful people who appear out of nowhere! Trust your instincts and listen to your inner-voice.
Don’t keep secrets.
If anyone tells you to keep a secret from your friends or family, something is very wrong. Red alert!
Report anyone who threatens to physically harm you.
Call the police and tell your trusted loved ones. There are no second chances when it comes to your personal safety.
Remember that “no” is a complete sentence.
If you are a people pleaser, practice different ways of saying “no” so you’ll be more comfortable in situations where you need to say it.
Last week I provided a handy list of preventative measures to help you avoid financial scams. But what do you do about the tricky people in your life who want to take your money? Half of all abuse comes from someone the victim knows. This means friends, paid caregivers, and professionals you depend on. While I’m not advocating for you to be untrusting of those around you, I am telling you that it’s important to pay attention to the red flags.
You should ask yourself: Is there anyone in my network that might want to take my money or anyone that “feels” that I owe them money? Here’s a list of the red flags to look out for:
Do I have new friends who are overly helpful?
Look out for the con artist. These tricksters will use coercion, flattery and manipulation. How can this happen to you? I’ll paint you a picture:
Let’s say you have recently met someone who is really interested in helping you around the house or with errands. Your new friend is charming and really interested in knowing you and being around you. Over time you start to trust this person and maybe even depend on them for your day-to-day activities. In the end, you do things you wouldn’t normally do such as gift-giving, especially after they tell you about all of the difficulties in their life. How nice of you to just “give” your low-mileage car to that nice new friend of yours! You think your new friend is being helpful. Nope! They are grooming you to take advantage of your kindness.
Is anyone resentful or angry about helping me?
Pay attention to those who are resentful or angry about any requests to help out with caregiving. This is the type who feels that they are “owed” something for their efforts. This mentality leads to all kinds of abuse such as abandonment, starvation, denial of care, physical harm or threats to place you in a nursing home. Additionally, the abuser may steal your money, pay for things with your credit, take your valuables, or make you sign things you don’t agree with or understand.
Am I my caretaker’s golden goose?
There are people out there who are really down on their luck and are desperate enough to hold you hostage in exchange for caretaking. Unfortunately these caretakers see you as a golden goose and have no problem using caretaking on a quid pro quo basis.
Have you ever read the book “Misery”? The story is of a woman who discovers that her favorite author has crushed his leg in an accident. She “cares” for him but ultimately holds him hostage, afraid for his life, unless he writes a novel for her. This horror novel is an extreme example of an abuser who holds their victim hostage. While the story is far-fetched, it’s not usual for us to rely on our friends and families for certain things during different times of our lives. An abusive caregiver could hold you hostage or tie their efforts to what you can do for them in ways that aren’t appropriate. It’s clear to see how you can easily lose control of your finances in these circumstances.
Do my hired professionals really have my interests at heart?
Beware professionals who are unethical. While most professionals will be honest with you, unfortunately we can’t say the same about everyone out there. Some “sketchy” professionals will intentionally confuse older adults in order to take advantage of them. These professionals could be your banker, accountant, financial advisor, doctor, or even lawyer (yes, we know the jokes too!). It could be anyone who has a professional relationship with you. These criminals are more than happy to help you line their pockets via forgery, lying, coercion, and misrepresentation.
On the September 24, 2021 episode of the true crime podcast Criminal episode “Family Money,” journalist Phoebe Judge investigates the case of two bankers who siphoned off millions of dollars from their grandmother after she entrusted them with her accounts. Because she trusted them and they also held a formal relationship as her bankers, they were able to move money out of her accounts and make investments that only benefited themselves- not her. This situation demonstrates how all three of our situations listed can work together, especially for people who you think would NEVER take advantage of you. And for most people that’s the case. But it never hurts to have a second or third set of eyes on things if it seems like something might be amiss.
I know these are scary things to think about, and we generally don’t want to frighten our readers, but planning is important. And in this day and age, where so many scammers are out there not only online, but also those who may be coming into your home, it’s important to have a plan to protect yourself. If you need help creating a plan to protect yourself or a loved one, click here to schedule a call with us.