The Ethics of Adjusting Your Assets to Qualify for Medicaid

A version of this article appeared in print on July 22, 2017, Section B, Page 1 of the New York edition with the headline: The Ethics of Trying to Qualify for Medicaid. The numbers quoted, and some facts have changed since 2017. I am publishing this edited article because I have had a number of people / clients ask if Medicaid planning is legal. The answer is YES. However, you have a choice to pay privately or go on Medicaid. But what happens if you need dentures, hearing aids, even cable tv for your room and you have no money!

Also, I am NOT making any political statements by modifying this article – you are free to choose and make your own decisions!

Modifications are in brackets <     >. Additionally, I have deleted some paragraphs from the Article.

The Ethics of Adjusting Your Assets to Qualify for Medicaid

At any given moment, there is a large group of citizens who want nothing more than to make absolutely certain that they are impoverished enough to qualify for Medicaid sooner rather than later. Someday, you might be one of them.

Welcome to the (perfectly legal) world of Medicaid planning, the plain-vanilla term for the mini-industry of lawyers and others who help people arrange their financial lives so they don’t spend every last dime on a nursing home. Once properly impoverished under the law, then Medicaid, which gets funding both from your state and the federal government, picks up the tab.

Whatever twists and turns the health insurance debates in Washington take, Medicaid will be at the center, and the program will probably affect you and your family more than you know. After all, if you run out of money in retirement, it is Medicaid that pays for most of your nursing home or home-based care.

The bill that contains the caps that Republican senators have proposed, which would remake Medicaid <Did not pass. However, Republicans are trying to revoke Medicare and Medicaid>

Most Americans haven’t saved enough to pay for decades of post-retirement living expenses and years of expensive end-of-life care, so it stands to reason that Medicaid will come under increasing strain.

What are we talking about when we talk about Medicaid planning? First, you have to qualify. So let’s begin by putting a fat “generally” in front of every statement below, along with a warning that you should not try this at home alone. A lawyer experienced in the field is a necessity.

Medicaid eligibility for long-term care can differ by state and also by marital status. Generally, you can’t have income higher than $2,205 per month per person, including Social Security <wrong> Asset restrictions of just a few thousand dollars also apply, unless you’re a spouse who is not receiving care, in which case you can have up to $120,900 while your husband or wife qualifies for Medicaid. Homes don’t count in the asset calculation, though there is a cap on home equity if you’re single that is either $560,000 or up to $840,000, depending on the state. The Medicaid officials in your state can also tap your estate for repayment under certain circumstances.

To get within those limits, lawyers may encourage gifts to family members (though if they are within five years of a Medicaid application, there can be penalties), annuity purchases, trusts of various sorts and a certain type of long-term care insurance that can shield some assets from the Medicaid calculation once you’ve made a claim.

< For more information go to our website at www.davidwingate.com>

That bit of relativism, however, does not erase a basic fact: Anyone who engages in legal Medicaid planning is attempting to qualify for a government program for the indigent when they do have at least some assets that could pay for their care.

Janet Kinzer, who lives in Silver Spring, Md., and whose father died last year at 92 with assets to spare, offered the most stinging rebuke: People who engage in such planning are privileged enough to be aware of it and can afford the legal fees. Shouldn’t tax dollars go only toward the care of people who lack such access?

The retorts are numerous. I heard several versions of the following in recent weeks: I’m a taxpayer and paid into this system. I was thrifty, and my neighbors were not. They went on vacation. In fact, I watched them go when I was home at Christmas, and they came back with suntans. And now my heirs should get nothing? To accuse me of gaming the system is absurd; I just don’t want to be taken by it.

If this sounds a bit like a sense of entitlement, that may not be far-off. In fact, several readers echoed something that Marcia Perna told me when I interviewed her about her late mother a few weeks ago. In plenty of other countries, she said, the government would pay for long-term care for everyone.

Now, take that to its logical conclusion. Here, Medicare pays the surgery and drug bills for people with heart disease and cancer. But dementia patients, like Ms. Perna’s mother, need expensive supervision, which Medicare generally doesn’t pay for. That’s not fair, one might argue, so doing everything legally possible to get a dementia patient eligible for Medicaid is like a form of political protest that corrects an inequity.

Then there are the parents who take the estate they bestow on their children as a point of pride. One adult child, who did not want to be named because her father is so emotional on the topic, said that he insisted on a trust even though she and her sibling did not ask for any money.

He is, she said, fighting for whatever is left of the meaning he can take from life in his 90s, while his wife slips away from dementia in front of his eyes. He grew up in the Depression, saw his friends evicted and their belongings tossed into the streets, and had to move in with family himself. His friends are now dead and most of his relatives are gone. All he has done is sweat and scrimp and save so he could leave something behind. Any discussion about not doing so causes him to cry and have panic attacks. So should his daughter really have tried harder to talk him out of a trust?

If you’re looking for another way to frame these issues, consider one other thing: If you or your relatives are already Medicaid-eligible by the time care is needed, there may be fewer choices available. Not every in-home caregiver or nursing home accepts Medicaid or has unlimited capacity for people on Medicaid even if they do accept it.

Would the care be worse if you or your relatives were on Medicaid, and because of that, limited to whatever nursing home or home-care agency was available?  <It is illegal to treat a Medicaid patient different from a private pay patient.>

By Ron Lieber

• July 21, 2017

Correction: 

Aug. 2, 2017

The Your Money column on July 22, about qualifying for Medicaid, referred incorrectly to income limits for Medicaid eligibility. Eligibility for long-term care through Medicaid generally has a maximum income of $2,205 per month per person; not all Medicaid programs have that income limit.

Email: lieber@nytimes.com

A version of this article appears in print on July 22, 2017, Section B, Page 1 of the New York edition with the headline: The Ethics of Trying to Qualify for Medicaid.

A version of this article appears in print on July 22, 2017, Section B, Page 1 of the New York edition with the headline: The Ethics of Trying to Qualify for Medicaid. The numbers quoted, and some facts have changed since 2017. I am publishing this article because I have had a number of people / clients ask if Medicaid planning is legal. The answer is YES. However, you have a choice! But what happens if you need dentures, hearing aids, even cable tv for your room and you have no money!

Please visit our website at www.davidwingate.com.

Peace of mind is only a call or click away! For an Initial Consultation call Estate and Elder Planning by David Wingate at (301) 663-9230 or visit www.davidwingate.com

David Wingate is an estate planning and elder law attorney at Estate and Elder Planning by David Wingate. The Estate and Elder Planning office services clients with powers of attorneys, living wills, Wills, Trusts, Medicaid and asset protection. The Elder Law office has locations in Frederick, Washington and Montgomery Counties, Maryland.

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