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Med­icaid Planning

Last Updated: 3÷7÷2008

The Need for Planning

One of the greatest fears of older Amer­i­cans is that they may end up in a nursing home. This not only means a great loss of per­sonal autonomy, but also a tremen­dous finan­cial price. Depending on loca­tion and level of care, nursing homes cost between $35,000 and $150,000 a year.

Most people end up paying for nursing home care out of their sav­ings until they run out. Then they can qualify for Med­icaid to pick up the cost. The advan­tages of paying pri­vately are that you are more likely to gain entrance to a better quality facility and doing so elim­i­nates or post­pones dealing with your state’s wel­fare bureaucracy–an often demeaning and time-consuming process. The dis­ad­van­tage is that it’s expensive.

Careful plan­ning, whether in advance or in response to an unan­tic­i­pated need for care, can help pro­tect your estate, whether for your spouse or for your chil­dren. This can be done by pur­chasing long-term care insur­ance or by making sure you receive the ben­e­fits to which you are enti­tled under the Medicare and Med­icaid pro­grams. Vet­erans may also seek ben­e­fits from the Vet­erans Administration.

Medicare

Medicare Part A covers up to 100 days of “skilled nursing” care per spell of ill­ness. How­ever, the def­i­n­i­tion of “skilled nursing” and the other con­di­tions for obtaining this cov­erage are quite strin­gent, meaning that few nursing home res­i­dents receive the full 100 days of cov­erage. As a result, Medicare pays for only about 9 per­cent of nursing home care in the United States. Check out the Medicare sec­tion of this site for tips on making sure you receive the nursing care ben­e­fits to which you are entitled.

Med­icaid

For all prac­tical pur­poses, in the United States the only “insur­ance” plan for long-term insti­tu­tional care is Med­icaid. Lacking access to alter­na­tives such as paying pri­vately or being cov­ered by a long-term care insur­ance policy, most people pay out of their own pockets for long-term care until they become eli­gible for Med­icaid. Although their names are con­fus­ingly alike, Med­icaid and Medicare are quite dif­ferent pro­grams. For one thing, all retirees who receive Social Secu­rity ben­e­fits also receive Medicare as their health insur­ance. Medicare is an “enti­tle­ment” pro­gram. Med­icaid, on the other hand, is a form of wel­fare — or at least that’s how it began. So to be eli­gible for Med­icaid, you must become “impov­er­ished” under the program’s guidelines.

Also, unlike Medicare, which is totally fed­eral, Med­icaid is a joint federal-state pro­gram. Each state oper­ates its own Med­icaid system, but this system must con­form to fed­eral guide­lines in order for the state to receive fed­eral money, which pays for about half the state’s Med­icaid costs. (The state picks up the rest of the tab.)

This com­pli­cates mat­ters, since the Med­icaid eli­gi­bility rules are some­what dif­ferent from state to state, and they keep changing. (The states also some­times have their own names for the pro­gram, such as “Med­iCal” in Cal­i­fornia and “MassHealth” in Mass­a­chu­setts.) Both the fed­eral gov­ern­ment and most state gov­ern­ments seem to be con­tin­u­ally tin­kering with the eli­gi­bility require­ments and restric­tions. This has most recently occurred with the pas­sage of the Deficit Reduc­tion Act of 2005 (the DRA) which sig­nif­i­cantly changed rules gov­erning the treat­ment of asset trans­fers and homes of nursing home res­i­dents. The imple­men­ta­tion of these changes will pro­ceed state-by-state over the next few years. The rules for gaining eli­gi­bility to the pro­gram are explained in detail in the Med­icaid sec­tion of this site. But to be cer­tain of your rights, con­sult an expert. He or she can guide you through the com­pli­cated rules of the dif­ferent pro­grams and help you plan ahead.

Those who are not in imme­diate need of long-term care may have the luxury of dis­trib­uting or pro­tecting their assets in advance. This way, when they do need long-term care, they will quickly qualify for Med­icaid ben­e­fits. Giving gen­eral rules for so-called “Med­icaid plan­ning” is dif­fi­cult because every client’s case is dif­ferent. Some have more sav­ings or income than others. Some are mar­ried, others are single. Some have family sup­port, others do not. Some own their own homes, some rent. Still, a number of basic strate­gies and tools are typ­i­cally used in Med­icaid plan­ning. These are described below.

(Is Med­icaid plan­ning eth­ical? For ElderLawAnswers.com’s opinion on this, click here.)

Trans­fers

As explained in the Med­icaid sec­tion of this site (see The Transfer Penalty), Con­gress has estab­lished a period of inel­i­gi­bility for Med­icaid for those who transfer assets. The DRA sig­nif­i­cantly changed rules gov­erning the treat­ment of asset trans­fers. For trans­fers made prior to enact­ment of the DRA on Feb­ruary 8, 2006, state Med­icaid offi­cials will look only at trans­fers made within the 36 months prior to the Med­icaid appli­ca­tion (or 60 months if the transfer was made to or from cer­tain kinds of trusts). But for trans­fers made after pas­sage of the DRA the so-called “look back”? period for all trans­fers is 60 months.

While the look back period deter­mines what trans­fers will be penal­ties, the length of the penalty depends on the amount trans­ferred. The penalty period is deter­mined by dividing the amount trans­ferred by the average monthly cost of nursing home care in the state. For instance, if the nursing home res­i­dent trans­ferred $100,00 in a state where the average monthly cost of care was $5,000, the penalty period would be 20 months ($100,000/$5,000 = 20).

Another sig­nif­i­cant change in the treat­ment of trans­fers made by the DRA has to do with when the penalty period cre­ated by the transfer begins. Under the prior law, the 20-month penalty period cre­ated by a transfer of $100,000 in the example described above would begin either on the first day of the month during which the transfer occurred, or on the first day of the fol­lowing month, depending on the state. Under the DRA, the 20-month period will not begin until (1) the trans­feror has moved to a nursing home, (2) he has spent down to the asset limit for Med­icaid eli­gi­bility, (3) has applied for Med­icaid cov­erage, and (4) has been approved for cov­erage but for the transfer.

For instance, if an indi­vidual trans­fers $100,000 on April 1, 2006, moves to a nursing home on April 1, 2007, and spends down to Med­icaid eli­gi­bility on April 1, 2008, that is when the 20-month penalty period will begin, and it will not end until December 1, 2009. How this change is imple­mented from state-to-state will be worked out over the next few years.

Trans­fers should be made care­fully, with an under­standing of all the con­se­quences. People who make trans­fers must be careful not to apply for Med­icaid before the five-year look back period elapses without first con­sulting with an elder law attorney. This is because the penalty could ulti­mately extend even longer than five years, depending on the size of the transfer.

One of the prime plan­ning tech­niques used prior to the enact­ment of the DRA, often referred to as “half a loaf,”? was for the Med­icaid appli­cant to give away approx­i­mately half of his or her assets. It worked this way: before applying for Med­icaid, the prospec­tive appli­cant would transfer half of his or her resources, thus cre­ating a Med­icaid penalty period. The appli­cant, who was often already in a nursing home, then used the other half of his or her resources to pay for care while waiting out the ensuing penalty period. After the penalty period had expired, the indi­vidual could apply for Med­icaid coverage.

Example: Mrs. Jones had sav­ings of $72,000. The average private-pay nursing home rate in her state is $6,000 a month. When she entered a nursing home, she trans­ferred $36,000 of her sav­ings to her son. This cre­ated a six-month period of Med­icaid inel­i­gi­bility ($36,000 ÷ $6,000 = 6). During these six months, she used the remaining $36,000 plus her income to pay pri­vately for her nursing home care. After the six-month Med­icaid penalty period had elapsed, Mrs. Jones would have spent down her remaining assets and be able to qualify for Med­icaid coverage.

While you could gen­er­ally give away approx­i­mately half your assets, the exact amount depended on a variety of fac­tors, including the cost of care, the transfer penalty in your state, income, and pos­sible other expenses. One of the main goals of the DRA was to elim­i­nate this kind of plan­ning. To deter­mine whether it is still an avail­able strategy in your state as it imple­ments the DRA, you will have to con­sult with a local elder law attorney.

Any transfer strategy must take into account the nursing home resident’s income and all of her expenses, including the cost of the nursing home. Also, be very, very careful before making trans­fers. Also, bear in mind that if you give money to your chil­dren, it belongs to them and you should not rely on them to hold the money for your ben­efit. How­ever well-intentioned they may be, your chil­dren could lose the funds due to bank­ruptcy, divorce or law­suit. Any of these occur­rences would jeop­ar­dize the sav­ings you spent a life­time accu­mu­lating. Do not give away your sav­ings unless you are ready for these risks.

In addi­tion, be aware that the fact that your chil­dren are holding your funds in their names could jeop­ar­dize your grandchildren’s eli­gi­bility for finan­cial aid in col­lege. Trans­fers can also have bad tax con­se­quences for your chil­dren. This is espe­cially true of assets that have appre­ci­ated in value, such as real estate and stocks. If you give these to your chil­dren, they will not get the tax advan­tages they would get if they were to receive them through your estate. The result is that when they sell the prop­erty they will have to pay a much higher tax on cap­ital gains than they would have if they had inher­ited it.

Trans­fers should be made care­fully, with an under­standing of all the con­se­quences. In any case, as a rule, never transfer assets for Med­icaid plan­ning unless you keep enough funds in your name to (1) pay for any care needs you may have during the resulting period of inel­i­gi­bility for Med­icaid; and (2) feel com­fort­able and have suf­fi­cient resources to main­tain your present lifestyle.

Remember:

You do not have to save your estate for your chil­dren. The bumper sticker that reads “I’m spending my children’s inher­i­tance” is a per­fectly appro­priate approach to estate and Med­icaid planning.

Even though a nursing home res­i­dent may receive Med­icaid while owning a home (the DRA has restricted Med­icaid eli­gi­bility for some homes; click here for more infor­ma­tion), if she is mar­ried she should transfer the home to the com­mu­nity spouse (assuming the nursing home res­i­dent is both willing and com­pe­tent). This gives the com­mu­nity spouse con­trol over the asset and allows him or her to sell it after the nursing home spouse becomes eli­gible for Med­icaid. In addi­tion, the com­mu­nity spouse should change his or her will to bypass the nursing home spouse. Oth­er­wise, at his or her death, the home and other assets of the com­mu­nity spouse will go to the nursing home spouse and have to be spent down.

Per­mitted Transfers

While most trans­fers are penal­ized with a period of Med­icaid inel­i­gi­bility of up to five years, cer­tain trans­fers are exempt from this penalty. Even after entering a nursing home, you may transfer any asset to the fol­lowing indi­vid­uals without having to wait out a period of Med­icaid ineligibility:

  • Your spouse (but this may not help you become eli­gible since the same limit on both spouse’s assets will apply)
  • Your child who is blind or per­ma­nently disabled.
  • Into trust for the sole ben­efit of anyone under age 65 and per­ma­nently disabled.

In addi­tion, you may transfer your home to the fol­lowing indi­vid­uals (as well as to those listed above):

  • Your child who is under age 21.
  • Your child who has lived in your home for at least two years prior to your moving to a nursing home and who pro­vided you with care that allowed you to stay at home during that time.
  • A sib­ling who already has an equity interest in the house and who lived there for at least a year before you moved to a nursing home.

Trusts

The problem with trans­fer­ring assets is that you have given them away. You no longer con­trol them, and even a trusted child or other rel­a­tive may lose them. A safer approach is to put them in an irrev­o­cable trust. A trust is a legal entity under which one person — the “trustee” — holds legal title to prop­erty for the ben­efit of others — the “ben­e­fi­cia­ries.” The trustee must follow the rules pro­vided in the trust instru­ment. Whether trust assets are counted against Medicaid’s resource limits depends on the terms of the trust and who cre­ated it.

A “revo­cable” trust is one that may be changed or rescinded by the person who cre­ated it. Med­icaid con­siders the prin­cipal of such trusts (that is, the funds that make up the trust) to be assets that are count­able in deter­mining Med­icaid eli­gi­bility. Thus, revo­cable trusts are of no use in Med­icaid planning.

Income-only Trusts

An “irrev­o­cable” trust, on the other hand, is one that cannot be changed after it has been cre­ated. In most cases, this type of trust is drafted so that the income is payable to you (the person estab­lishing the trust, called the “grantor”) for life, and the prin­cipal cannot be applied to ben­efit your or your spouse. At your death the prin­cipal is paid to your heirs. This way, the funds in the trust are pro­tected and you can use the income for your living expenses. For Med­icaid pur­poses, the prin­cipal in such trusts is not counted as a resource, pro­vided the trustee cannot pay it to you or your spouse for either of your ben­e­fits. How­ever, if you do move to a nursing home, the trust income will have to go to the nursing home.

You should be aware of the draw­backs to such an arrange­ment. It is very rigid, so you cannot gain access to the trust funds even if you need them for some other pur­pose. For this reason, you should always leave an ample cushion of ready funds out­side the trust.

You may also choose to place prop­erty in a trust from which even pay­ments of income to you or your spouse cannot be made. Instead, the trust may be set up for the ben­efit of your chil­dren, or others. These ben­e­fi­cia­ries may, at their dis­cre­tion, return the favor by using the prop­erty for your ben­efit if nec­es­sary. How­ever, there is no legal require­ment that they do so.

One advan­tage of these trusts is that if they con­tain prop­erty that has increased in value, such as real estate or stock, you (the grantor) can retain a “spe­cial tes­ta­men­tary power of appoint­ment” so that the ben­e­fi­cia­ries receive the prop­erty with a step-up in basis at your death. This will also pre­vent the need to file a gift tax return upon the funding of the trust.

Remember, funding an irrev­o­cable trust can cause you to be inel­i­gible for Med­icaid for the fol­lowing five years.

Tes­ta­men­tary Trusts

Tes­ta­men­tary trusts are trusts cre­ated under a will. The Med­icaid rules pro­vide a spe­cial “safe harbor” for tes­ta­men­tary trusts cre­ated by a deceased spouse for the ben­efit of a sur­viving spouse. The assets of these trusts are treated as avail­able to the Med­icaid appli­cant only to the extent that the trustee has an oblig­a­tion to pay for the applicant’s sup­port. If pay­ments are solely at the trustee’s dis­cre­tion, they are con­sid­ered unavailable.

There­fore, these tes­ta­men­tary trusts can pro­vide an impor­tant mech­a­nism for com­mu­nity spouses to leave funds for their sur­viving insti­tu­tion­al­ized hus­band or wife that can be used to pay for ser­vices that are not cov­ered by Med­icaid. These may include extra therapy, spe­cial equip­ment, eval­u­a­tion by med­ical spe­cial­ists or others, legal fees, visits by family mem­bers, or trans­fers to another nursing home if that became nec­es­sary. But remember that if you create a trust for your­self or your spouse during life (i.e., not a tes­ta­men­tary trust), the trust funds are con­sid­ered avail­able if the trustee has the ability to use them for you or your spouse.

Sup­ple­mental Needs Trusts

The Med­icaid rules also have cer­tain excep­tions for trans­fers for the sole ben­efit of dis­abled people under age 65. Even after moving to a nursing home, if you have a child, other rel­a­tive, or even a friend who is under age 65 and dis­abled, you can transfer assets into a trust for his or her ben­efit without incur­ring any period of inel­i­gi­bility. If these trusts are prop­erly struc­tured, the funds in them will not be con­sid­ered to belong to the ben­e­fi­ciary in deter­mining his or her own Med­icaid eli­gi­bility. The only draw­back to sup­ple­mental needs trusts (also called “spe­cial needs trusts”) is that after the dis­abled indi­vidual dies, the state must be reim­bursed for any Med­icaid funds spent on behalf of the dis­abled person.

For more on sup­ple­mental needs trusts, click here.

For more on trusts in gen­eral, see the Estate Plan­ning sec­tion of this site.

Pro­tec­tion of the House

As explained in the Med­icaid sec­tion of this site, after a Med­icaid recip­ient dies, the state must attempt to recoup from his or her estate what­ever ben­e­fits it paid for the recipient’s care. This is called “estate recovery.”

Life Estates

For many people, set­ting up a “life estate” is the most simple and appro­priate alter­na­tive for pro­tecting the home from estate recovery. A life estate is a form of joint own­er­ship of prop­erty between two or more people. They each have an own­er­ship interest in the prop­erty, but for dif­ferent periods of time. The person holding the life estate pos­sesses the prop­erty cur­rently and for the rest of his or her life. The other owner has a cur­rent own­er­ship interest but cannot take pos­ses­sion until the end of the life estate, which occurs at the death of the life estate holder. As with a transfer to a trust, the deed into a life estate can trigger a Med­icaid inel­i­gi­bility period of up to five years.

Example:

Jane gives a remainder interest in her house to her chil­dren, George and Mary, while retaining a life interest for her­self. She car­ries this out through a simple deed. There­after, Jane, the life estate holder, has the right to live in the prop­erty or rent it out, col­lecting the rents for her­self. On the other hand, she is respon­sible for the costs of main­te­nance and taxes on the prop­erty. In addi­tion, the prop­erty cannot be sold to a third party without the coop­er­a­tion of George and Mary, the remainder interest holders.

When Jane dies, the house will not go through pro­bate, since at her death the own­er­ship will pass auto­mat­i­cally to the holders of the remainder interest, George and Mary. Although the prop­erty will not be included in Jane’s pro­bate estate, it will be included in her tax­able estate. The down­side of this is that depending on the size of the estate and the state’s estate tax threshold, the prop­erty may be sub­ject to estate tax­a­tion. The upside is that this can mean a sig­nif­i­cant reduc­tion in the tax on cap­ital gains when George and Mary sell the prop­erty because they will receive a “step up” in the property’s basis.

Life estates are cre­ated simply by exe­cuting a deed con­veying the remainder interest to another while retaining a life interest, as Jane did in this example. In many states, once the house passes to George and Mary, the state cannot recover against it for any Med­icaid expenses Jane may have incurred.

Trusts

Another method of pro­tecting the home from estate recovery is to transfer it to an irrev­o­cable trust. Trusts pro­vide more flex­i­bility than life estates but are some­what more com­pli­cated. Once the house is in the irrev­o­cable trust, it cannot be taken out again. Although it can be sold, the pro­ceeds must remain in the trust. This can pro­tect more of the value of the house if it is sold. Fur­ther, if prop­erly drafted, the later sale of the home while in this trust might allow the set­tlor, if he or she had met the res­i­dency require­ments, to exclude up to $250,000 in tax­able gain, an exclu­sion that would not be avail­able if the owner had trans­ferred the home out­side of trust to a non-resident child or other third party before sale.

Spending Down

Appli­cants for Med­icaid and their spouses may pro­tect sav­ings by spending them on non­count­able assets. These expen­di­tures may include:

  • pre­paying funeral expenses,
  • paying off a mortgage,
  • making repairs to a home,
  • replacing an old automobile,
  • updating home furnishings,
  • paying for more care at home, or even
  • buying a new home.

In the case of mar­ried cou­ples, it is often impor­tant that any spend-down steps be taken only after the unhealthy spouse moves to a nursing home if this would affect the com­mu­nity spouse’s resource allowance.

Imme­diate Annuities

Imme­diate annu­ities can be ideal plan­ning tools for spouses of nursing home res­i­dents. For single indi­vid­uals, they are usu­ally less useful. An imme­diate annuity, in its sim­plest form, is a con­tract with an insur­ance com­pany under which the con­sumer pays a cer­tain amount of money to the com­pany and the com­pany sends the con­sumer a monthly check for the rest of his or her life. In most states the pur­chase of an annuity is not con­sid­ered to be a transfer for pur­poses of eli­gi­bility for Med­icaid, but is instead the pur­chase of an invest­ment. It trans­forms oth­er­wise count­able assets into a non-countable income stream. As long as the income is in the name of the com­mu­nity spouse, it’s not a problem.

In order for the annuity pur­chase not to be con­sid­ered a transfer, it must meet three basic require­ments: (1) It must be irrevocable–you cannot have the right to take the funds out of the annuity except through the monthly pay­ments. (2) You must receive back at least what you paid into the annuity during your actu­arial life expectancy. For instance, if you have an actu­arial life expectancy of 10 years, and you pay $60,000 for an annuity, you must receive annuity pay­ments of at least $500 a month ($500 x 12 x 10 = $60,000). (3) If you pur­chase an annuity with a term cer­tain (see below), it must be shorter than your actu­arial life expectancy. (4) Under the DRA, the state must be named the remainder ben­e­fi­ciary up to the amount of Med­icaid paid on the annuitant’s behalf.

Example:

Mrs. Jones, the com­mu­nity spouse, lives in a state where the most money she can keep for her­self and still have Mr. Jones, who is in a nursing home, qualify for Med­icaid (her max­imum resource allowance) is $104,400 (in 2008). How­ever, Mrs. Jones has $214,400 in count­able assets. She can take the dif­fer­ence of $110,000 and pur­chase an annuity, making her hus­band in the nursing home imme­di­ately eli­gible for Med­icaid. She would con­tinue to receive the annuity check each month for the rest of her life.

In most instances, the pur­chase of an annuity should wait until the unhealthy spouse moves to a nursing home. In addi­tion, if the annuity has a term cer­tain — a guar­an­teed number of pay­ments no matter the lifespan of the annu­i­tant — the term must be shorter than the life expectancy of the healthy spouse. Fur­ther, if the com­mu­nity spouse does die with guar­an­teed pay­ments remaining on the annuity, they must be payable to the state for reim­burse­ment up to the amount of the Med­icaid paid for either spouse.

Annu­ities are of less ben­efit for a single indi­vidual in a nursing home because he or she would have to pay the monthly income from the annuity to the nursing home.

In short, imme­diate annu­ities are a very pow­erful tool in the right cir­cum­stances. They must also be dis­tin­guished from deferred annu­ities, which have no Med­icaid plan­ning purpose.

(The use of imme­diate annu­ities as a Med­icaid plan­ning tool is under attack in some states. Be sure to con­sult with a qual­i­fied elder law attorney in your state before pur­suing the strategy described above.)

Increased CSRA

Before pas­sage of the Deficit Reduc­tion Act of 2005 (DRA) com­mu­nity spouses in some states whose own income was less than their MMMNA (see dis­cus­sion under Med­icaid sec­tion of site) had an alter­na­tive to receiving the short­fall from the income of the nursing home spouse. These com­mu­nity spouses could peti­tion the state Med­icaid agency for an increase in their stan­dard resource allowances (called the com­mu­nity spouse resource allowance, or CSRA) so that the addi­tional funds could be invested in order to gen­erate income to make up the short­fall in the MMMNA. The DRA will put an end to this practice.

Under the new law, an increased resource allowance may only be granted to com­mu­nity spouses whose income is still not enough to reach the MMMNA after first receiving the income of the nursing home spouse.

Spousal Refusal

Fed­eral Med­icaid law states that the com­mu­nity spouse can keep all of his or her assets by simply refusing to sup­port the insti­tu­tion­al­ized spouse. This por­tion of the law, known as “just say no” or “spousal refusal,” is gen­er­ally not used exten­sively except in New York. Under the law, if a spouse refuses to con­tribute his or her income or resources toward the cost of care of a Med­icaid appli­cant, the Med­icaid agency is required to deter­mine the eli­gi­bility of the nursing home spouse based solely on his income and resources, as if the com­mu­nity spouse did not exist. In addi­tion, in 2005 a fed­eral appeals court upheld the right of the wife of a Con­necticut nursing home res­i­dent to refuse to sup­port her hus­band. The hus­band was able to qualify for Med­icaid cov­erage, and assets that he had trans­ferred to his wife were not counted in deter­mining his eligibility.

After awarding Med­icaid ben­e­fits to the insti­tu­tion­al­ized spouse, the Med­icaid agency then has the option of begin­ning a legal pro­ceeding to force the com­mu­nity spouse to sup­port the insti­tu­tion­al­ized spouse. How­ever, this is not always done, and when such cases do go to court, courts in New York gen­er­ally allow the com­mu­nity spouse to keep enough resources to main­tain her former stan­dard of living. If the Med­icaid agency chooses not to sue the com­mu­nity spouse for sup­port, it can file a claim for reim­burse­ment against the com­mu­nity spouse’s estate fol­lowing his or her death.

The “just say no” strategy some­times is used in states other than New York in second-marriage sit­u­a­tions, where the healthy spouse truly refuses to sup­port the nursing home spouse.

The Attorney’s Role

Do you need an attorney for even “simple” Med­icaid plan­ning? This depends on your sit­u­a­tion, but in most cases, the pru­dent answer would be “yes.” The social worker at your mother’s nursing home assigned to assist in preparing a Med­icaid appli­ca­tion for your mother knows a lot about the pro­gram, but maybe not the par­tic­ular rule that applies in your case or the newest changes in the law. In addi­tion, by the time you’re applying for Med­icaid, you may have missed out on sig­nif­i­cant plan­ning opportunities.

The best bet is to con­sult with a qual­i­fied pro­fes­sional who can advise you on the entire sit­u­a­tion. At the very least, the price of the con­sul­ta­tion should pur­chase some peace of mind. And what you learn can mean sig­nif­i­cant finan­cial sav­ings or better care for you or your loved one. As described above, this may involve the use of trusts, trans­fers of assets, pur­chase of annu­ities or increased income and resource allowances for the healthy spouse.

If you are going to con­sult with a qual­i­fied pro­fes­sional, the sooner the better. If you wait, it may be too late to take some steps avail­able to pre­serve your assets.

Reverse Mort­gages

Under our “system”? of paying for long-term care, you may be able to qualify for Med­icaid to pay for nursing home care, but in most states there’s little public assis­tance for home care. Most people want to stay at home as long as pos­sible, but few can afford the high cost of home care for very long. One solu­tion is to tap into the equity built up in your home.

If you own a home and are at least 62 years old, you may be able to quickly get money to pay for long-term care (or any­thing else) by taking out a reverse mort­gage. Reverse mort­gages, finan­cial arrange­ments designed specif­i­cally for older home­owners, are a way of bor­rowing that trans­forms the equity in a home into liquid cash without having to either move or make reg­ular loan repay­ments. They permit house-rich but cash-poor elders to use their housing equity to, for example, pay for home care while they remain in the home, or for nursing home care later on. The loans do not have to be repaid until the last sur­viving bor­rower dies, sells the home or per­ma­nently moves out.

In a reverse mort­gage, the home­owner receives a sum of money from the lender, usu­ally a bank, based largely on the value of the house, the age of the bor­rower, and cur­rent interest rates. For example, a 70-year-old bor­rower with a $200,000 house in Westch­ester County, New York, would be able to receive a max­imum loan of $108,584 (based on 2007 fig­ures; see chart below). The lower the interest rate and the older the bor­rower, the more that can be borrowed.

Source: AARP

The largest amount of cash that may be avail­able through the HECM reverse mort­gage pro­gram for three homes in Westch­ester County, NY:
Value of home: $100,000 $200,000 $300,000
Age of borrower
65 $ 45,948 $ 98,588 $ 151,228
70 51,044 108,584 166,124
75 56,417 119,057 181,697
80 62,198 130,238 198,278
85 68,029 141,369 214,709
90 73,668 151,908 230,148

Home­owners can get the money in one of three ways (or in any com­bi­na­tion of the three): in a lump sum, as a line of credit that can be drawn on at the borrower’s option, or in a series of reg­ular pay­ments, called a “reverse annuity mort­gage”?. The most pop­ular choice is the line of credit because it allows a bor­rower to decide when he or she needs the money and how much. More­over, no interest is charged on the untapped bal­ance of the loan.

Although it is often assumed that an elderly person would want to use the funds from a reverse mort­gage loan for health care, there are no restrictions–the funds can be used in any way. For instance, the loan could be used to pay back taxes, for house repairs, or to retrofit a home to make it handicapped-accessible.

Bor­rowers who take out a reverse mort­gage still own their home. What is owed to the lender — and usu­ally paid by the borrower’s estate — is the money ulti­mately received over the course of the loan, plus interest. In addi­tion, the repay­ment amount cannot exceed the value of the borrower’s home at the time the loan is repaid. All bor­rowers must be at least 62 years of age to qualify for most reverse mort­gages. In addi­tion, a reverse mort­gage cannot be taken out if there is prior debt against the home. Thus, either the old mort­gage must be paid off before taking out a reverse mort­gage or some of the pro­ceeds from the reverse mort­gage used to retire the old debt.

Reverse mort­gages are some­what under­uti­lized now — only an esti­mated 60,000 to 75,000 of the loans have been made. But finan­cial insti­tu­tions, sensing an oppor­tu­nity as the pop­u­la­tion ages and people live longer lives, are expanding their reverse mort­gage programs.

The most widely avail­able reverse mort­gage product — and the source of the largest cash advances — is the Home Equity Con­ver­sion Mort­gage (HECM), the only reverse mort­gage pro­gram insured by the Fed­eral Housing Admin­is­tra­tion (FHA). How­ever, the FHA sets a ceiling on the amount that can be bor­rowed against a single-family house, which is deter­mined on a county-by-county basis. In Westch­ester County, New York, for example, that ceiling is $260,018 (in 2005). High-end bor­rowers must look to the pro­pri­etary reverse mort­gage market, which imposes no loan limits.

Is a Reverse Mort­gage Right for You?

While reverse mort­gages look like no-lose propo­si­tions on the sur­face, they also have some sig­nif­i­cant down­sides. First, the closing costs for these loans are about double those for con­ven­tional mort­gages. Closing costs on a reverse mort­gage for the $200,000 home described above would be more than $10,000. These costs can be financed by the loan itself, but that reduces the money avail­able to you.

Reverse mort­gage pay­ments also may affect your eli­gi­bility for gov­ern­ment ben­e­fits, including Med­icaid. Gen­er­ally, these pay­ments will not be counted as income as long as they are spent within the same month that they are received. If the funds are not spent, how­ever, they could accu­mu­late and push your resources over the allow­able limits for Med­icaid or SSI eli­gi­bility. In addi­tion, pay­ments from reverse annuity mort­gages may be counted as income for pur­poses of Med­icaid and SSI whether or not they are spent within the month they are received. This shouldn’t be treated as income, since it simply involves with­drawing equity from one’s home, but the state may view it dif­fer­ently since the funds come in a reg­ular monthly check. In any case, you should con­sult with an elder lawyer in your state if you have any con­cern about how a reverse mort­gage will affect your eli­gi­bility for fed­eral benefits.

Also, bear in mind that if your major objec­tive is to safe­guard an inher­i­tance for your chil­dren, a reverse mort­gage may not be a good idea. As soon as the elderly person (or the sur­vivor of an elderly couple) dies, it will be nec­es­sary to sell the home and much — if not all — of the sales pro­ceeds will have to be paid to the lender. But if you have a pressing need for addi­tional income and have no close heirs, or if you do not intend to ben­efit your chil­dren or your chil­dren don’t par­tic­u­larly want to inherit the house, a reverse mort­gage can be a way to sup­ple­ment income, per­haps without jeop­ar­dizing Med­icaid eligibility.

Reverse mort­gages are com­plex prod­ucts and bor­rowers are advised to acquaint them­selves with the dif­ferent options avail­able and then care­fully com­pare com­peting loan offer­ings. Fol­lowing are two out­standing Web sites to get you started in that process:

  • You can learn the basics about reverse mort­gages from the AARP’s excel­lent reverse mort­gage Web site. The site includes a cal­cu­lator for esti­mating the loan for which a bor­rower would be eli­gible. Go to: www.aarp.org/revmort
  • For more details, back­ground infor­ma­tion, and sup­ple­men­tary mate­rials, visit the National Center for Home Equity Conversion’s site at www.reverse.org

In addi­tion, the names of FHA-insured lenders are avail­able from the Fed­eral National Mort­gage Asso­ci­a­tion (Fannie Mae), (800) 7-FANNIE.