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.
“ Choices” is Tennessee’s Medicaid program for long-term care services and support
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:
Medical eligibility
Income threshold
Asset threshold
Being medically and financially eligible is necessary for TennCare approval
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:
Transfering
Mobility
Communication
Medication
Orientation
Eating
Behavior
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!
In conclusion
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.
This month we will discuss the subject of powers of attorney. In week one, we will discuss how to name a financial power of attorney. This is also known as a durable power of attorney.
There are many things to consider when appointing a financial power of attorney (aka an attorney-in-fact). This is an important position. Whoever you appoint would have the ability to make decisions regarding how you manage your finances. While it may seem obvious, it’s important to focus on choosing someone who is organized, trustworthy, and financially responsible.
What powers does an agent have when they have a financial power of attorney?
As stated earlier, the agent with a financial power of attorney can handle your finances just as you can. An agent will have the ability to go to your bank and handle banking transactions. They can contact your investment account broker and manage those funds. They can handle your insurance and sell your house. Of course, you want your agent to only make financial transactions in your best interest while you are incapacitated.
Can things go horribly wrong? Yes! Your agent has the power to clean out all of your bank accounts and sell your home. Heck, if they wanted to, they could take your assets, move to Fiji, and set up a little beach bar! I want to reiterate: It’s important that you choose someone who would never even think of doing something like that. You need to choose someone who will only have your best interest at heart.
Who should be your financial power of attorney?
When considering who should serve as a financial power of attorney, a lot of people are compelled to choose someone close to them. A lot of times this will be a relative, such as your children or possibly a sibling, but it doesn’t have to be. The agent could also be a close friend or even a professional if that is who fits that role in your life. In our practice, we like to make sure that our client acknowledges this very important point: the person you name as your agent in a financial power of attorney will have the ability to handle your finances pretty much the same as you will.
Choose an agent who can communicate effectively
Not only do you need to trust your agent, but we also recommend that you find someone that other people trust! While this element is not completely necessary, it may be important to you that your agent be relied upon to communicate important information effectively with the people in your life.
For example, if one of your relatives says to your agent: “Hey, my Aunty saved a lot of money and invested it well, how much does she have now and what has the spent money been used for?”. Ideally, you would have an agent that relatives intuitively trust to spend your funds in your interest. However, it would be really awesome if your agent took the time out of their day to respond thoroughly to your relative’s questions.
Choose an agent that is comfortable with online banking
Your agent should be good at bookkeeping
In a perfect world, your agent with financial powers of attorney would be held accountable for the transactions coming out of your assets. A good agent can effectively answer questions about spending and back it up with good bookkeeping!
An agent with power of attorney does not have to live in your state
As we mentioned before, the era of digital banking is here and it allows us the option to choose from a larger pool of agents, regardless of their location. Now, many people think that their agent under a power of attorney cannot be someone who lives out of state. And that is simply not true. Sometimes it helps to have somebody who lives in the state, but that is not a requirement in Tennessee. We do so many things by email and telephone, texting, and online business transactions that your financial power of attorney person, your agent, will likely be handling any business transactions online.
Choose an agent who will outlive you
While this is not a requirement, it is a good idea to think about someone who will outlive you. Generally, when you are using your power of attorney, it’s when you’re incapacitated. While there are times when a durable power of attorney is used on a temporary basis, such as during a medical event, it is more likely going to be during a period when we are at the end of our lives and are experiencing some type of ongoing health condition that is not likely to improve. We recommend that you look for an agent who can help on a continuing basis. A well-suited agent allows everyone to relax and enjoy the time you have left on this earth.
Who should NOT be your durable power of attorney
Again, while it may seem obvious, it is important to reiterate that anyone who is untrustworthy, unlikeable, terrible with money, incapable of balancing a checkbook, or unable to effectively use online banking might not be the best choice for becoming an agent of financial power of attorney. The goal is to find someone who can keep good accounting records and knows exactly where your money went, down to every last penny! A good agent is someone who is willing to communicate with everyone without hesitation. The main point is that no one in your circle should be concerned that your agent is taking advantage of you if you are incapacitated.
Now, if you are not incapacitated, your agent should only be acting if you are telling them to do so. Even if you have your power of attorney take effect immediately, your agent can and should only act under your direction. If you find that the agent acts otherwise, there are legal actions you can take against them in court.
In conclusion
A power of attorney is a useful tool for organizing the “adulting” part of your life, especially in incapacitation. A financial power of attorney should be someone that you absolutely trust; someone who will not give pause to others in your life. Someone who is financially responsible and organized, and someone who is familiar with handling online transactions. It does not matter if your agent lives in your state. In short, find an agent you believe will always have your best interest at heart.
There are many types of powers of attorney. Many powers of attorney are used when creating a well-thought-out estate plan. Do you think you could use a durable power of attorney in Nashville? Schedule an initial call to see if we can help you with your situation.
When you aren’t clear about your wishes, you leave a blank space for your loved ones to try to fill in. This can be incredibly stressful to them – even if you’ve expressed your wishes to them but didn’t write them down – so it’s important to know your wishes ahead of time. Learn what could happen to you if you don’t make your wishes known.
What Happens if You Become Incapacitated in Tennessee?
If you become incapacitated in Tennessee (a temporary coma, for instance,) and have no medical power of attorney set, your loved ones may have to go to court and then a judge will decide who can make medical decisions for you if you’re unable to communicate your wishes.
Trying to determine your wishes after you can no longer express them can be an extremely stressful time for your family, which is why it’s so important to communicate your wishes ahead of time, just in case anything happens to you.
What Happens if You Die without a Will or Trust in Tennessee?
If you die without a will, that is called “intestate.” This means that whatever inheritance you leave behind, including your property, is subject to Tennessee intestate succession laws. Intestate laws typically leave your property to your surviving spouse and/or children, but parents, siblings, nieces, and nephews could become eligible too.
Here’s a quick breakdown of what would happen in Tennessee if you are married or have children:
If you have a spouse but no children, the spouse would inherit your entire estate, even if you’re separated.
If you have a spouse and children, the estate would be divided equally among all parties (except that the spouse can receive no less than 33% of the overall estate).
If you only have children, your estate would be split equally among all the children.
Keep in mind that only your biological and adopted children will inherit from you if you do not have a will. If you would like to leave part of your estate to step-children, foster children, godchildren, or other children who are close to your heart, you’ll want to make plans for that in your will or through non-probate beneficiary designations.
Here’s what would happen if you died unmarried and without children:
If you have a parent, the entire estate would go to your parent(s).
If you have sibling(s) but no living parents, the estate will be split equally among your siblings.
If you have no parents or siblings, the estate will be split equally among your siblings’ children.
If you’ve none of the above, the estate would be split equally among paternal and maternal aunts and uncles.
You don’t have to die to see how this one might end if you don’t write your decisions out!
Who Makes Funeral Decisions if You Die in Tennessee?
Similar to the above, if no one has been legally designated to make funeral decisions on their loved one’s behalf, it falls to the next-of-kin, which would be the spouse or adult children. Once the family member takes responsibility for making and paying for their loved one’s funeral arrangements, they sign a legal contract that obligates the funeral home to follow instructions from that family member alone.
Make sure you tell your family what you want so there’s a consensus during a difficult time..
What if there are no next of kin?
If there are no next of kin (as defined above) and no personal representative, any other person willing to assume responsibility and arrange the funeral (including the funeral director) can make funeral decisions, after attesting that a good faith effort has been made. As for your estate, if no family can be found it will ultimately be turned over to unclaimed property.
Learn More from Graceful Aging Legal Services
Don’t leave a blank space for your family members to fill in regarding your end of life wishes. Don’t keep them second-guessing. Instead, leave something that people can read like a magazine to know what you want your life – and death – to be like. Want more tips like this one? Sign up for our newsletter!
Probate laws in Tennessee play an important role in the orderly distribution of a person’s assets after they die and help to settle their affairs. The probate process typically begins when you hire an attorney who will file a petition on your behalf in the appropriate probate court, initiating the legal proceedings.
The court then appoints a Personal Representative (aka the executor) to oversee the estate, and their primary responsibility is to manage the assets and debts of the deceased loved one. Notification of heirs and beneficiaries is a critical step to ensure all interested parties are aware of the probate proceedings.
If you are nominated or appointed as a Personal Representative, there are several things you’ll want to keep in mind to ensure a seamless probate process.
Probate Court Jurisdiction and Venue
In Tennessee, your attorney will file for probate in the county where your loved one lived at the time of their death. This is wherever they consider to be their permanent home.
Across Tennessee, your probate case may be heard in a different type of court than a friend’s in another county. For example, in Davidson County the Circuit Court hears probate cases while in Rutherford County they are handled in General Sessions Court. Many counties process probate petitions through their Chancery Court. An experienced probate attorney will be able to tell you the procedure in the county where you live.
Tennessee Intestacy Laws
Intestacy laws in Tennessee come into play when there is no valid will. These laws dictate the distribution of assets when a person passes away without explicit instructions, outlining the order of inheritance among surviving family members.
Myth-busting: Many people are concerned that if they do not have a will, the government will take their belongings instead of their family. While there are certain exceptions where the government can claim funds that are owed to them, your closest family members will inherit if you do not have a will.
Validity and Execution of Wills
Tennessee recognizes several types of wills, from handwritten wills to the ones you think of that are typed up and signed in a lawyer’s office in front of a notary. Each type of will has different requirements in order to be “admitted to probate.” This just means that the court needs to make sure that the will is authentic before it is acted on.
The law is specific about how that authentication can happen. Probate laws delineate the requirements for a valid will and the various types of wills recognized in the state. Ensuring compliance with these stipulations is imperative for a seamless probate process.
Probate Inventory and Appraisal
Part of the probate process involves creating an inventory of the deceased’s assets and how much those assets are worth. This allows the heirs and beneficiaries to know what to expect in terms of inheritance and for the court to require insurance to protect those funds if needed.
Many people are concerned about their privacy if the inventory is made a part of the public record, but informal inventories are often used instead of filing as part of the public record. This can be written into your will or agreed to by your family after your death.
Creditor Claims and Debts
To handle creditor claims and debts, personal representatives must notify creditors and prioritize the settlement of outstanding debts so ensure that the distribution of assets is fair and equitable.
One primary responsibility of the personal representative is to pay any valid claims of the estate. Your attorney will assist you in notifying creditors, both by mail and in the newspaper, so that they can come forward and file claims if there is money owed. Your attorney will guide you through the process of evaluating whether those claims are valid and paying them (if appropriate).
Estate Administration and Accounting
Once all assets have been gathered and all creditors have been paid, it’s time to distribute the funds. An accounting, whether formal or informal, will assist the personal representative in getting the numbers right. Depending on family dynamics and the requirements of the will, the accounting may or may not need to be filed with the Court’s Clerk.
While the term “accounting” sounds scary, all it means is that you are keeping track of what funds come into and out of the estate. Your attorney will assist you in preparing the accounting if one is required by the court.
Will Contests and Disputes
Probate laws in Tennessee address the possibility of will contests and disputes, outlining the grounds for contesting a will and the specific procedures involved in resolving such disputes.
Probate taxation is an overview of estate taxes, potential tax liabilities, and exemptions are governed by Tennessee probate laws. Understanding and following the laws around taxation ensures proper estate planning and compliance.
Although Tennessee no longer has an inheritance or estate tax, taxes are still an important process of probate and estate planning. As part of the probate process, the personal representative will be responsible for filing the deceased person’s final income tax return, as well as any federal estate taxes. There may also be state tax returns due based on what types of assets the decedent had.
Your attorney and accountant will assist you with maintaining the deadlines and knowing what these requirements are.
Closing the Probate Estate
In the final phase of the probate process, assets are distributed to heirs and beneficiaries, and the personal representative or administrator is officially dismissed of their duties. Take some time to celebrate – you’ve made it!
Common Issues and Pitfalls
The probate process takes a lot of time and effort (and maybe three hundred takeout coffees). The costs include court filing fees, attorney fees and possibly personal representative fees, which adds up. It’s important to have an attorney who knows the laws and the best way to complete the process efficiently so as much money goes to the people that your loved one wanted to have it.
Most people want to know how long the process will take or have heard horror stories out of other states (looking at you, Florida!).
In Tennessee, it can take as little as six months, depending on when your person died, how fast the court moves, the assets involved, family dynamics, and other variables. In most cases, it takes at least a year, and often more. If everyone gets along, it’s not such a bad process, and the attorney will handle much of it for you.
We also encourage the use of an after-loss professional like Sunny Care Services who can take some of the most frustrating tasks off your plate.
If you’ve become the Personal Representative for your loved one’s estate and want to prevent a lengthy probate process, it’s a good idea to start planning now. Talk with an attorney who has experience with probate and estate planning. (Psst – that’s us!)
Recent Developments in Tennessee Probate Laws
Probate laws are subject to change, and recent developments, including legislative updates and notable court decisions, can impact the probate landscape. Staying informed about these changes will help you navigate the probate process instead of asking, “Is it over now?” when you’re only halfway through.
Fortunately, Graceful Aging Legal Services can help you stay informed on such topics with our newsletter. Sign up today!
Caregiving is an important responsibility. It involves providing essential services to another person (often a senior), helping empower them to live their best life even as they age.
Understanding the Caregiver Role
Caregivers must understand the tasks and responsibilities they may be taking on, and think carefully about what boundaries they’d like to set in advance. Doing this is a crucial part of performing the job well and ensuring each person receiving care gets the help they need.
Caregiving works best when it’s a community effort. There’s a lot of joy in caregiving (which is something not everyone expects when they go into it). You may think of caregiving as “This is how I’m helping someone else,” but you’re actually helping your future self as well. Caregiving provides an opportunity to think about your goals and be more proactive about aging than you would have been if you weren’t a caregiver.
It takes a village to be a caregiver – so don’t forget to lean on the support of others during this time. (More about that later!)
Some typical roles of a caregiver include tasks such as:
Planning or providing transportation for loved ones
As a caregiver, it’s important to remember that the role can sometimes present physical and emotional challenges. Working to meet this head-on and find solutions is an important part of advocating for the individual you care for and yourself. Don’t forget to laugh where you can – it’s a great way to cope with the emotional and physical strain, build rapport, and enjoy this season!
Planning to Help Them Age in Place
Aging in place refers to the ability of an individual to live in their home and community safely and independently. Caregiving can help facilitate this process, enabling seniors to keep their homes rather than move into an assisted living facility.
(Aging in place isn’t the only option, however; some older individuals prefer to downscale or move into an assisted living facility for more companionship. Make the choice that works best for you and your family.)
Proactive caregiving should always provide a supportive environment for daily living activities. Evaluate the home for potential hazards and make necessary modifications and adaptations.
Some helpful and simple changes that can significantly increase safety include:
Everything they need, on one level. Although most people opt for single-story homes, it is possible to have a multi-story home and still embrace this principle. For example, April has everything she needs on the ground floor of her home except her washer and dryer. But she plans to hire someone to do her laundry once she can’t make it up and down the stairs safely!
Installing grab bars and ramps. All of us lose our balance sometimes, but as we age, it can become more common. Having something to provide stability within the home is important.
Using non-slip flooring and removing throw rugs. What is the point of throw rugs, anyway? Over time, they all curl up and cause a major tripping hazard.
Use cord covers. Unless you want to go entirely off the grid as you age, cords will be a part of your life. They can be a tripping hazard, but cord covers can help!
Exploring accessible technology resources. Another aspect of aging can be limited vision and hearing. It can be helpful to find ways around these impairments.
Using medication management apps. Reminders are especially important to those who need to take their medicine at the same time daily.
Building a Support Network
Anyone who has worked in caregiving knows that it is overwhelming. Having a strong support network for both caregivers and the senior individual is of the utmost importance.
Caregivers should seek to involve family and friends in the caregiving journey as much as possible. These people can provide much-needed assistance and emotional support as the situation is navigated. It’s also wise to utilize professional support, such as home healthcare aides or respite care services. Remember, you can’t pour into someone else’s life if you are empty, so respite care can be vital for your well-being!
There are also many community organizations and support groups that connect caregivers with others who understand their experiences.
Remember – a support network doesn’t have to just include those providing care to the person who needs care. A good support network should also provide care to the caregiver. As April says, “Don’t think you need to be a first-line caregiver to be important in the caregiver support system.”
Self-Care for Caregivers
Taking good care of yourself provides a strong foundation to care for others. Burnout is a common issue for caregivers but must be dealt with for the overall well-being of both the caregiver and the person who is receiving care.
So how should caregivers manage their mental health and levels of burnout?
Here are some ideas:
Practice mindfulness to stay emotionally healthy
Engage in hobbies to keep your creativity alive
Move your body and exercise
If you’re still feeling burned out despite your best efforts to manage your stress, it can be a wise idea to seek respite care services. These services can help provide you with a break from your caregiving responsibilities and allow you to rest. You can also consider joining a support group designed especially for caregivers!
But what if you’re a friend or family member of a caregiver and want to know how to support them?
Here are some specific examples you can use:
A daily or weekly phone call to check in
Giving your friend a break every now and then
A monthly hike with a friend (boom – friendship and exercise!)
Send a thoughtful card or letter their way to encourage them
Bring them homemade meals or gift cards
Communication and Decision-Making
Trust is one of the most essential components of caregiving and aging in place. Good communication helps facilitate this trust, allowing caregivers and those receiving care to speak honestly about future goals and preferences.
Legal preparations, such as establishing power of attorney or creating a living will, can help ensure the senior’s wishes are respected and get all involved parties on the same age about end-of-life planning. Ensure all decision-making processes are clearly outlined to avoid any conflicts or misunderstandings.
Supported decision-making involves everyone – not just the person who is approaching end of life, but those who are involved with their care and part of the overall support system. The most important thing a person of any age can do is to talk to their support system in advance.
First, talk to your family about your wishes, then write them down. Make sure everyone’s on the same page. If you can only do one of the two things, talk to your family.
Financial Considerations
Having finances in order is also crucial for aging in place. Understanding the insurance options and government assistance programs is important for caretakers to assist seniors with tasks like budgeting and managing support services. Resources that could prove helpful include FiftyForward and TCAD in Tennesee.
Long-term care insurance, veteran’s benefits, Medicaid, and Medicare are some common options that can help with the financial aspects of caregiving and aging in place. It’s best to seek help from a trusted financial advisor or insurance agent to work through these options and determine the best way to combine them, if possible.
Resources and Recommendations
Consider checking out books from your local library about caregiving or finding helpful websites about caregiving.
You can also ask for recommendations from caregiving friends or family about programs that will support you!
Community programs like meal delivery programs and dial-a-ride services provide social engagement opportunities and promote overall well-being for seniors. Be sure to find out what services are available in your area, as they can be wonderful enrichment opportunities.
Contact Graceful Aging Legal Services to Learn More!
Proactive caregiving makes it possible for seniors to successfully age in place. As a proactive caregiver, you should make it a top priority to create a safe and comfortable living environment for the person you’re caring for.
Understanding your role and what resources are available is critical in ensuring seniors maintain independence and dignity as they age, and having the right support can help you ensure you’re providing the best care possible so both you and the person you’re caring for have a positive quality of life.
At Graceful Aging Legal Services, we aim to help seniors age well. Part of this includes planning for their future and the future of their families. Want to learn more about aging in place? Contact us today, and we’ll help you prepare and organize so that major decisions aren’t looming over your head!
Aging often comes with increased healthcare costs and healthcare costs impact everyone—regardless of income level. Miller Trusts are a legal tool that helps individuals with high income qualify for Medicaid long-term care benefits. With a Miller Trust in Tennesee, you can become eligible for TennCare even if you are over the “income cap” set by the state.
What is a Miller Trust?
The Medicaid program (called TennCare here in Tennessee) typically requires limited income to qualify. A Miller Trust is a legal arrangement designed to help those with high income qualify for Medicaid long-term care benefits. By establishing a Miller Trust, also known as a Qualified Income Trust, you can redirect your income into the trust, your income then becomes exempt from Medicaid income calculations.
Why are Miller Trusts Used in Tennessee?
Tennessee is an “income cap” state for Medicaid. That means that those who have income above the cap will not qualify for TennCare. Miller Trusts are used primarily as a tool to create eligibility for Medicaid/TennCare even when you might have too much income. There are times when assets may fall within Medicaid eligibility requirements while income exceeds eligibility limits. In this case, a Miller Trust can help.
Without a Miller Trust even when assets meet eligibility requirements, income may exceed the limits for Medicaid eligibility. By redirecting income into a Miller Trust, you can effectively reduce your income for Medicaid eligibility purposes, ensuring you can receive necessary long-term care benefits.
The Benefits of Miller Trusts
There are several key benefits associated with establishing a Miller Trust.
Qualifying for Medicaid
The primary benefit of a Miller Trust is that it allows individuals with middle to high income to qualify for Medicaid long-term care benefits. A Miller Trust provides a way to legally redirect income into the trust effectively lowering income for Medicaid eligibility purposes.
Preserving Income
Miller Trusts also provide a means to preserve income. Instead of having to find a way to reduce your income to meet Medicaid’s income requirements, you can redirect your income into the trust. This ensures you can continue to receive your income while still qualifying for Medicaid long-term care benefits. It provides a way to maintain some financial flexibility while accessing the necessary healthcare coverage.
The Process of Setting Up a Miller Trust
The process of setting up a Miller Trust involves several key steps.
Gathering Financial Information
The first step in setting up a Miller Trust is gathering all relevant financial information. Financial information must be thorough including all income sources and other financial details to create a comprehensive financial report. An effective Miller Trust helps you meet income qualifications for Medicaid. In order for a Miller Trust to work for you it is critical to have an accurate understanding of your current financial situation.
Selecting a Trustee
The next step, in setting up a Miller Trust is to select a trustee. It is important to choose someone who possesses good organizational skills, excellent financial management, and will always prioritize your best interests. Opting for a trustee (typically a family member) who works with a lawyer who has a focus on Medicaid planning to set up the trust ensures they can adeptly navigate the intricacies involved in establishing a Miller Trust. Once the trust is established, it’s usually not too difficult to care for the account.
Creating the Trust Agreement
Once a trustee has been selected the next step is to create the trust agreement outlining the terms and conditions of the trust, including how income will be deposited into the trust and how it will be used for qualified expenses. Consulting an attorney experienced in Medicaid planning is crucial to ensure that the trust agreement is drafted correctly and in compliance with all applicable regulations.
Funding the Trust
After the trust agreement has been created and signed, the next step is to fund the trust. This involves transferring income into the trust, which will then become exempt from Medicaid’s income calculations. This typically involves setting up your Social Security to be direct-deposited to the trust account. You can likely do this online if you have an online account with the Social Security Administration.
It is essential to follow all necessary procedures and guidelines when funding the trust to ensure that it is done correctly and in compliance with Medicaid regulations. Make sure you work with a banker who is familiar with Miller Trusts to be sure that all regulations are followed and ensure that all necessary documentation is provided. Your attorney should be able to provide recommendations for banks they have successfully worked with in the past.
Meeting Medicaid Requirements
Finally, meeting all Medicaid requirements is essential. Income limits, reporting, documentation and any other Medicaid requirements must be met for a Miller trust to be effective. Consulting with an attorney with experience in Medicaid planning can help ensure all requirements are met.
Managing a Miller Trust
Once a Miller Trust has been established, proper management is essential. Here are a few key considerations.
Using Trust Funds for Qualified Expenses
The funds in a Miller Trust should be used exclusively for qualified expenses. This includes medical and long-term care costs that are not covered by Medicaid/TennCare. For example, if Medicaid covers one set of dentures every two years but you lose yours before it’s time to get a new set, you can use it to cover another set of dentures. It is important to keep accurate records of all expenses paid from the trust to ensure compliance with Medicaid regulations.
A trust can also be used for professional expenses. For example, a Miller Trust can be used to pay for legal fees.
Keeping Accurate Records
Record keeping is a vital aspect of managing a Miller Trust. Accurate records of all income deposits, expenses paid and other trust related financial transactions are necessary for proper trust management. The records are required for ongoing compliance as well as the TennCare redetermination period when you will need to submit proof that you still financially qualify for TennCare/Medicaid.
Reporting to TennCare/Medicaid
As a Miller Trust beneficiary it is important to report any changes in income or financial circumstances to TennCare/Medicaid if there is a significant increase. This includes significant increases in income sources, the amount of income deposited into the trust, and any other relevant financial changes. By keeping Medicaid informed – and by getting in touch with an experienced Medicaid attorney – beneficiaries can maintain their eligibility and continue to receive the necessary healthcare coverage.
For example, if you get a Miller Trust and then get an inheritance, you may no longer be eligible for TennCare/Medicaid. However, at that point, it would be wise to talk to an experienced Medicaid attorney, because they may be able to help you if you notify them quickly and before the inheritance is received.
Potential Challenges and Considerations
While Miller Trusts can be a valuable tool for Medicaid planning, there are some challenges and considerations to keep in mind.
Legal and Financial Implications
When establishing a Miller Trust there are serious legal and financial considerations making it vital to consult with an attorney who has Medicaid planning experience. An experienced attorney will help ensure all legal requirements are met and help you fully understand the implications of a Miller Trust.
Estate Recovery
In all cases, Medicaid will seek to recover expenses paid on behalf of a Miller Trust beneficiary from the beneficiary’s estate after their passing. In other words, anything in the Miller Trust at the end of life will go to the TennCare/Medicaid office This is known as estate recovery. It is important to understand the potential implications of estate recovery and to plan accordingly when establishing a Miller Trust.
Monitoring Eligibility Requirements
Medicaid eligibility requirements can change over time and it is important to monitor these changes to ensure ongoing eligibility. It’s in your best interest to stay informed about updates and changes to Medicaid requirements.
Consult Graceful Aging Legal Services for Your Miller Trust
Miller Trusts provide an option for individuals who have significant income and want to qualify for Medicaid long term care benefits. If you or someone you love falls into this category, a Miller Trust is an option to divert your income.
In addition to the oftendifficult conversations surrounding estate planning, establishing and managing a Miller Trust can be quite complex and challenging. It is advisable to seek assistance from a lawyer who focuses on Medicaid planning to navigate the process of establishing and managing a Miller Trust.
If you have more questions about Miller Trusts and would like to know if it’s a good option for you or your family, click here to schedule an initial call with our office. We’d love to work with you!
