Real Client Stories

A Case for Division of Assets: George and Ruthanne

The names have been altered for the sake of client confidentiality.

In early December of 2017, I met with the Adams family for an initial consultation while they were in the middle of a healthcare crises. Dad, George Adam, was in rehab at the time of our meeting and so I met with George's wife, Ruthanne, and their daughters, Sara and Amy. The Adams family shared with me that they were not sure if Dad would be able to come home. They felt that the reason they came to me was because they were lost in a sea of information given to them by various people, the internet, the nursing home, the rehab folks and their financial planner. They were not even sure what an elder law attorney was or what I could possibly do for them. They just knew they were struggling to work through information and needed a game plan.

The more the story progressed, the more certain I became that unfortunately Dad would definitely not be able to return home. Dad is in his late 70s and is physically weak. He has fallen on multiple occasions and most recently has broken one of his hips. Currently he is in his second week of rehab, but is about to be discharged.  He can not seem to regain strength enough to support his own weight. He can dress himself, but only with the help of an aide. He can roll himself to the toilet in his wheelchair, but he can't lift himself from the toilet to the stool and back again to his wheelchair. Dad also suffers from dementia. In his current condition, this means that Dad often forgets that his legs are not sufficiently strong enough to support his weight and, consequently, he falls when he attempts to stand, leading to further injury. He requires constant supervision. He and his wife, Ruthanne, live alone in their home of many years.

Ruthanne knows that she can't bring George home, but she is equally terrified that she can not afford to keep him at the nursing home. She would even be willing to bring George home to "give it a try," contrary to her doctor's advice, because of the fear she has of losing everything they have worked their lives to earn. The billing representative from the nursing home stopped in to visit with her and relayed that once the rehab days end, the base cost of the care required for George is $250 per day. $250 a day for the care is not all inclusive, but covers most things except for medications, incontinence supplies, haircuts, clothing, personal needs. The Adams have income from only three sources: his social security, her social security and a small pension that George receives from his former employer. They have never really looked at their income as "his income" or "her income," but I had to ask in order to help them.

The Adams family have approximately $200,000 in assets, in addition to their car and their home. They own their home outright. The value of the home is somewhere around $150,000. George has an IRA worth $50,000 and Ruthanne has an IRA worth $50,000. They have $100,000 in CDs. Someone told the Adams family to put everything into George's name, since George was going to need a nursing home.

My job was to provide the family with knowledge, resources and options. I offered the suggestion of the Division of Assets process and guided the Adams family step by step through the process. Ruthanne did not have to become impoverished in order to ensure that George gets the care that he needs. I helped Ruthanne to apply and qualify George for MEDICAID and keep significant amounts of their joint assets. In Kansas, the name for the Medicaid program is KANCARE. In Missouri, the name for the Medicaid program is MoHealthnet. Both programs share the same basic goal of preventing Ruthanne from becoming impoverished. It is not true that Ruthanne should have rushed out and changed the CDs into her name as soon as she felt that George was too weak to return home. It is irrelevant whose name is listed as the owner on the CDs; as a married couple, the assets of one are considered the assets of both. There is an exception for retirement assets in Kansas. In Kansas, the retirement assets of Ruthanne are not part of the equation. Ruthanne can keep her $50,000 IRA.

The process for protecting the Adams assets for the benefit of Ruthanne is called Division of Assets. It is extremely important to know that Ruthanne did not have to "spend-down" all of the Adams family assets before KANCARE will take over and help pay for George's nursing home care. The Division of Assets process will permit Ruthanne to keep the house. She was able to keep all of her $50,000 IRA, as she is a Kansas resident. The remaining assets, consisting of the $50,000 IRA belonging to George and the $100,000 in CDs are first divided, resulting in $75,000 in each. Then, the $75,000 in George's share can be used to buy exempt assets. For example, the funeral plans of both Ruthanne and George can be purchased with George's share. In addition, home repairs, furniture, electronics, hearing aids, a new car, a new wheelchair, can all be purchased from George's share. Lastly, once all desired purchases have been made, then Ruthanne can consider options to supplement her income. In other words, she can used any of George's remaining share to purchase a stream of income. Often this will take the form of either a promissory note or an annuity. Either method is approved by the state of Kansas.

The timing of the Division of Assets process is key. Ruthanne should not spend-down any money that she would otherwise not wish to spend before George enters into long term care. Spend-down for purposes of the Division of Assets does not occur until after George entered the hospital to seek care for his broken hip. After the process is initiated, then Ruthanne must remove George's name from the CDs and other assets. Ruthanne should absolutely not give Sara and Amy an annual gift of $10,000-$15,000 that her neighbor told her would save the money from the government.  Thankfully, the Adams family sought elder law advice before they started paying for the nursing home care for George. George was able to stay at the nursing home and KANCARE will take over paying for the care he receives. Ruthanne will get to keep the house and the vast majority of their assets.

Every story has twists and turns and gets tangled up here and there. This story is not intended to be legal advice, but is intended to demonstrate that there are unique solutions in every case to help Dad get the care he needs and to protect the remaining assets for Mom. Both Sara and Amy are "good" girls, not intending to take any money from George and Ruthanne. They gave back the gifts they had received in the last 5 years. George was never in the military. Neither of the children have a disability. The asset calculations are different in every case (there is a maximum that a well spouse can keep, for example).

I am grateful every day that my job is to help people.

CMS Reports 'Sharp' Drop in Avoidable Hospitalizations Among Long-Term Care Residents

From McKnight's...

http://www.mcknights.com/news/cms-reports-sharp-drop-in-avoidable-hospitalizations-among-long-term-care-residents/article/632414/

Jobs Report Offers Mixed Message On Disability Employment

From Disabilityscoop.com

The unemployment rate for Americans with disabilities fell significantly in the latest jobs report from the U.S. Department of Labor, but that doesn’t tell the whole story.

The jobless rate declined to 11.1 percent in July, the Labor Department said, down from 12.1 percent the month prior.

However, the shift appears to be at least partly due to fewer people being counted in the total disability population that the monthly jobs report reflects.

While less people were unemployed in July than the month prior, the number of employed people also dropped and the participation rate — which measures the number of people who are employed or actively looking for work — actually declined slightly as well.

At the same time, the economy added 255,000 jobs and the unemployment rate for the general population remained steady at 4.9 percent.

Federal officials began tracking employment among people with disabilities in October 2008. There is not yet enough data compiled to establish seasonal trends among this population, so statistics for this group are not seasonally adjusted.

Data on people with disabilities covers those over the age of 16 who do not live in institutions. The first employment report specific to this population was made available in February 2009. Now, reports are released monthly.

Written by: Shaun Heasley

Important Information for CPAs!!!!

If you advise the elderly, click on this link to read important information regarding Medicaid Eligibility & Spousal Responsibility.

https://drive.google.com/file/d/0B9JhZVsi7bYpbGtxSkhZYzNPdEk/view?ts=576fcfae

Approval of Medicaid Dollars to Fight the Zika Virus

From TheHill.com

States can use Medicaid dollars to pay for tools to fight the Zika virus such as mosquito repellent and condoms, according to a new memo from the Obama administration.

The five-page letter, distributed by the Centers for Medicare & Medicaid Services (CMS) on Wednesday, offers long-awaited guidance for states looking to bolster their response to the mosquito-borne virus without extra funding from Congress.  

For the first time since the beginning of the epidemic, the White House is taking steps to clarify how existing state funding can be used to fight the disease at a time when it says it is short more than $1 billion to fight the disease nationally.

President Obama has requested $1.9 billion for the domestic and international effort. The Senate has lowered that total figure to $1.1 billion, while the House has said it will provide $677 million — two amounts that congressional leaders will work to reconcile after the weeklong Memorial Day recess.

The White House has already moved about a half-billion dollars from its Ebola virus fund to speed up the national response. 

CMS's letter told states for the first time that they can receive Medicaid reimbursement for over-the-counter insect repellents when prescribed by a healthcare provider.

Written by: Sarah Ferris

Upcoming Event - Kansas Medicaid: Helping Your Clients Navigate KanCare

 Click on the link below for complete details and to register.

https://drive.google.com/file/d/0B9JhZVsi7bYpSXVNU3pHOGhmUlk/view?usp=sharing

Legal Recourse for Aging Parents When Their Adult Children Won't Visit?!?!?

 In Shanghai, not visiting elderly parents could harm children's credit ratings

Posted 4/7/2016

From China Daily - Children in Shanghai who fail to visit their parents regularly will find their credit standing adversely affected, according to a new rule set to take effect on May 1.

If a child refuses to visit an elderly parent, the parent can file a lawsuit. If the child still refuses to follow through with their obligations after the court makes a ruling, it will be recorded into a credit platform, which could adversely affect their future work and general life.

The rule, aimed at better protecting the rights and interests of senior citizens, also requires children who have sent their parents to nursing homes to regularly visit. If they fail to do so, nursing services have an obligation to remind them.

Shanghai has also stepped up legal support for senior citizens, including a series of free authentication services.

The city had a registered population aged over 60 of about 4.36 million by the end of 2015. The number will surpass 5 million by 2018, and exceed 5.4 million by 2020, according to statistics released by local authorities.