Walnut Creek Elder Law Blog

Most (perhaps 99%) of all revocable living trusts and financial durable powers of attorney are defective for asset protection and government benefits planning, when incapacity occurs.
 
For the older client, we become focused on how we will pay for in-home care,  board-and-care, assisted living facilities and skilled nursing home costs. We are concerned about how to make our assets last longer for our own care. We want to protect assets, and we would like to hopefully leave something to our loved ones.
 
We become concerned with how to qualify for and utilize Medi-Cal  and VA benefits for our care. 
 
The standard language in the revocable living trust and financial durable powers of attorney do not allow for asset protection, protection of the home from a Medi-Cal lien, transfers of assets between spouses (including the home), transfers to children or to other trusts for government benefits planning, if incapacity occurs.
 
Updating the revocable living trust and financial powers of attorney  before incapacity occurs is good planning. 

Written Michael J. Young, lawyoung1@gmail.com, elder law attorney in Walnut Creek, CA. www.WalnutCreekElderLaw.com mike@WalnutCreekElderLaw.com. 1931 San Miguel Dr., Suite 220, Walnut Creek, CA 94596. 925-256-0298. Mr. Young serves Contra Costa and Alameda Counties, including the cities of Walnut Creek, Alamo, Danville, Concord, Brentwood, Pleasant Hill, Antioch, Clayton, etc.

     Medicare is a Federal health insurance program. Social Security funds are used to pay the costs of the program. Individuals who are over the age of 65, and who have made Social Secuirty contributions during their working lives are entitled to benefits. Part A of Medicare pays for hospitalization, hospice and some health care. It also pays for rehabilitation in a nursing home for specific periods of time. Part B is designed to pay for outpatient hospital care and doctors’ visits. Co-payments, deductibles and monthly payments may be required for Part B.  

     If a person is hospitalized for three days under Medicare, and then goes into a skilled nursing facility (SNF), Medicare will pay pay 100% of the bill for up to 20 days in the SNF. After that, for days 21 to 100, Medicare will pay only for 80% of the cost. During this time, the Medicare recipient will be required to make a co-payment, through supplemental insurance or will pay privately.

    After 100 days, there is no Medicare coverage for a SNF. After that time, you must pay privately, pay through your long term insurance policy (if  you have one) , or qualify for Medi-Cal to pay for the SNF. The average stay in a SNF under Medicare is under 24 days. Medicare and Medi-Cal are two different programs, and are not related to each other.

     Planning for Medi-Cal qualification should be made early on, through your elder law attorney. There are qualification requirements with regard to assets, income,  spending down, gifting, and a share of cost which goes to the the nursing home. There are legitimate and legal methods through the Medi-Cal regulations to protect assets and create qualification for Medi-Cal. You may visit our web site at htt://WalnutCreekElderLaw.com, for information on how to plan for and how to qualify for Medi-Cal. The estate planning documents, including the financial durable powers of attorney and revocable living trust are usually updated to include government benefits and asset protection language. If a client loses mental capacity, and this language is not present in the estate planning documents, qualification for government benefits, including Medi-Cal, and asset protection is much more difficult.

 Written Michael J. Young, lawyoung1@gmail.com, elder law attorney in Walnut Creek, CA. www.WalnutCreekElderLaw.com mike@WalnutCreekElderLaw.com. 1931 San Miguel Dr., Suite 220, Walnut Creek, CA 94596. 925-256-0298. Mr. Young, who also advises on Medi-Cal qualification, asset protection, nursing homes and the VA Aid & Attendance qualification, serves Contra Costa and Alameda Counties in CA, including the cities of Walnut Creek, Alamo, Danville, Concord, Brentwood, Pleasant Hill, Antioch, Clayton, etc.

The surviving spouse of a wartime Veteran may be eligible for the VA Aid and Attendance Pension Benefit. This benefit can help pay the costs of in home care, board and care and assisted living facilities for the surviving spouse. We must be able to show that the surviving spouse had been married to the Veteran for at least one year, or had children by the Veteran if married less than one year.

The surviving spouse is not eligible if he/she has remarried. Also, the surviving spouse must have been living with the Veteran at the time of the Veteran’s death, unless they were separated because of  medical or military reasons. The Veteran must have a discharge from the military that is other than dishonorable.  The pension rate for the surviving spouse may be as much as $1,056 per month, or $12,681 per year. 

Each VA claim is different and unique, and there are never any guarantees that any claim will be granted by the VA. When we plan for the VA Aid and Attendance Pension benefit, we also plan for Medi-Cal at the same time. Both benefits have different qualification rules, which must be coordinated.

This blog is general in nature, is for informational purposes only and is not legal advice. You should consult an elder law attorney for your particular case, and before you proceed with any planning.

Written Michael J. Young, lawyoung1@gmail.com, elder law attorney in Walnut Creek, CA. www.WalnutCreekElderLaw.com mike@WalnutCreekElderLaw.com. 1931 San Miguel Dr., Suite 220, Walnut Creek, CA 94596. 925-256-0298. Mr. Young, who also advises on Medi-Cal qualification, asset protection, nursing homes and the VA Aid & Attendance qualification, serves Contra Costa and Alameda Counties in CA, including the cities of Walnut Creek, Alamo, Danville, Concord, Brentwood, Pleasant Hill, Antioch, Clayton, etc.

The language used in estate planning documents for asset protection and government benefits planning for the older client, is very different from the language used in regular estate planning documents. In fact, I would say that 90% or more of all revocable living trusts and financial durable powers of attorney do not contain the right language, and are defective for this type of planning, if the maker or one of the makers of the documents loses mental capacity.

As an example, if we are going to protect the home from a Medi-Cal lien, because of an imminent stay in a nursing home, we may want to transfer the ill spouse’s interest in the home to the well spouse. Or, in the case of a single person, we may want to transfer that person’s interest in the home to a child. Or, we may want to liquidate the cash in value of a life insurance policy, and gift that interest to a spouse or a child.

If the person who owns the interest has lost capacity to make the transfer, the language in the trust and financial durable power of attorney, in most cases, does not allow for this type of transfer. As a result, we may have to go to court to obtain an order to reform the estate planning documents. This process can be costly.

The alternative is to do pre-planning, and have the revocable living trust and financial durable powers of attorney updated by an elder law lawyer, who practices in the areas of Medi-Cal planning, VA planning and nursing home planning. By doing pre-planning, and including the correct language in these documents, we can save costs and headaches later on.       

This blog is for informational purposes only and is not legal advice. You should consult an elder law, asset protection and government benefits attorney for your particular case, and before you proceed with any planning.

Written Michael J. Young, elder law attorney in Walnut Creek, CA. www.WalnutCreekElderLaw.com mike@WalnutCreekElderLaw.com. 1931 San Miguel Dr., Suite 220, Walnut Creek, CA 94596. 925-256-0298. Mr. Young serves Contra Costa and Alameda Counties, including the cities of Walnut Creek, Alamo, Danville, Concord, Brentwood, Pleasant Hill, Antioch, Clayton, etc. Mr. Young advises clients regarding Medi-Cal, nursing homes, asset protection, the VA Aid and attendance pension benefit, and long term care planning.

When we plan for the VA Aid and Attendance Pension benefit, we plan for Medi-Cal at the same time. Medi-Cal and the VA benefit are both asset and income based programs. Medi-Cal pays for the costs of skilled nursing facilities, minus the share of cost paid by the recipient. The VA benefit can help pay for the costs of assisted living facilities, board and care facilities, and in home care costs. Under both programs, if the applicant is “over assets”, they can spend down, gift some of their assets away, or use other legitimate asset protection techniques to obtain qualification. 

The VA Aid and Attendance Pension Benefit program does not have a “look back” penalty period. The applicant could give away $50,000 for instance, today, and theoretically be eligible for the VA benefit tomorrow. If the same applicant then went to apply for Medi-Cal, after having gifted the $50,000, there would be an eight month penalty period. Divide $50,000 by $5,698 (penalty divisor) and you have 8.775 or, rounded down, eight months of ineligibility. As a result, the applicant would not be eligible for Medi-Cal for eight months.

There are legitimate gifting and planning techniques which your elder law attorney can show you to  create fewer months of ineligibiity for Medi-Cal. Remember that Medi-Cal pays for skilled nursing, which is much more expensive than assisted living facilities. Planning for Medi-Cal and the VA Aid and Attendance Pension benefit at the same time, is good planning. Your Medi-Cal, elder law attorney can help you with this.

 Written Michael J. Young, elder law and asset protection attorney in Walnut Creek, CA. www.WalnutCreekElderLaw.com mike@WalnutCreekElderLaw.com. 1931 San Miguel Dr., Suite 220, Walnut Creek, CA 94596. 925-256-0298. Mr. Young serves Contra Costa County and Alameda County, including the cities of Walnut Creek, Alamo, Danville, Concord, Brentwood, Pleasant Hill, Antioch, Clayton, etc. Medi-Cal Attorney Contra Costa.

In the seminars presented by Walnut Creek elder law attorney Michael J. Young, www.WalnutCreekElderLaw.com, he talks about the Veterans Affairs Aid & Attendance Improved Pension Benefit, which is paid to wartime veterans or to their surviving spouses. The program is asset and income based, as is Medi-Cal. However, the two programs have different qualification rules. The VA program is often utilized to pay for in-home care, assisted living facilities and board and care facilities. Medi-Cal is most often used to pay for skilled nursing facilities.

The VA program is “non-service connected,” which means that the disability does not necessarily result from being in the service. If you are over age 65, you are deemed to be “disabled” by the VA, and you could be eligible for the lowest amount of the benefit. If you are also housebound, you could be eligible for the next higher amount. And, if you are also in need of help with various activities of daily living, you could be eligible for the highest amount of the benefit.

 The veteran must have been discharged from the U.S. armed forces, with anything but a dishonorable discharge. Also, the veteran must have served 90 days continuously in the military, one day of which had to be during a war time. The periods of war are as follows:

•  WWI: April 6, 1917 through November 11, 1918
• WWII: December 7, 1941 through December 31, 1946
• Korean War: June 27, 1950 through January 31, 1955
• Vietnam War: August 5, 1964 through May 7, 1975
• Persian Gulf War: August 2, 1990 and continuing

The VA application, if prepared by someone other than the veteran, must be prepared “pro bono,” that is, without charge, and by someone who is accredited by the VA. An elder law attorney who is accredited by the VA is best equipped to help you with the planning and application for the VA benefit. He would also prepare an integrated long term elder care plan for you, that would take into account all of your assets, plus the VA and Medi-Cal benefits.

 Caveat: Beware of non-attorney individuals and organizations who offer to help with the VA applications. First check to see if they are accredited by the VA, which is required by federal law.  Also know that VA applications are prepared pro bono, that is, without charge. You may be advised by an organization to gift all of your assets away in a large gift, which can create immediate eligibility for the VA program, but ineligibility for Medi-Cal for a long period of time. Medi-Cal and VA have different rules. Finally, if the person or organization who wants to help with the VA application wants to sell an annuity to you as part of the process, you most certainly should get a second opinion.

This blog is for informational purposes only and is not legal advice. You should consult an elder law attorney for your particular case, and before you proceed with any planning.

Written Michael J. Young, lawyoung1@gmail.com, elder law attorney in Walnut Creek, CA. www.WalnutCreekElderLaw.com mike@WalnutCreekElderLaw.com. 1931 San Miguel Dr., Suite 220, Walnut Creek, CA 94596. 925-256-0298. Mr. Young serves Contra Costa and Alameda Counties, including the cities of Walnut Creek, Alamo, Danville, Concord, Brentwood, Pleasant Hill, Antioch, Clayton, etc.

VA BENEFITS MAY COVER THE COST OF AN ASSITED LIVING FACILITY OR IN HOME CARE

www.WalnutCreekElderLaw.com. As we discussed in previous Elder Law Today newsletters, the Veteran’s Administration provides a wonderful pension benefit for those individuals who served at least one day during a period of wartime and are now disabled due to non-service connected reasons (aging related issues,  Alzheimer’s, Parkinson’s, multiple sclerosis, and/or other physical disabilities).  This pension, referred to as “Aid and Attendance Allowance”, may pay  the long term care provided in an assisted living facility, or in-home care.  

The “Aid and Attendance” (A and A) benefit is available to a veteran who is disabled and requires the aid of another person to perform the personal functions required in everyday living.  A veteran can show they are eligible if they have a substantial need for assistance with the activities of daily living.  Such activities include bathing, dressing, meal preparation, etc.  A veteran would also qualify for this pension if they can show they need the attendance of another person in order to avoid the hazards of his or her daily environment.  The need for assistance does not have to be permanent.

 Under this program, a veteran can receive up to  $1,644.00 per month or $19,736 per year in benefits, and a widowed spouse can receive up to $1,056.00 per month of $12,681 per year in benefits.  The applicant must be “permanently and totally disabled” under the VA rules.

The vet does not need to be helpless under the rules. He only needs to show that he is in need of aid and attendance on a regular basis. Someone who is housebound or in an assisted living facility and over the age of 65 is presumed by the Veterans Administration to be in need of Aid and Attendance.

Eligibility for the program is based on the income and assets of the veteran. In determining income, deductions are allowed for unreimbursed medical expenses (UMEs). In home care workers are an allowable deduction, provided that some medical or nursing services are provided. Also, the cost of an assisted living facility, or a portion thereof, can be an allowable medical deduction against gross income. 

 In addition, a family member can provide in-home care for a veteran who is applying for aid and attendance.  In order to meet the disability criteria, the care services provided by an unlicensed relative must be prescribed by a health care professional (ex. doctor, RN, LPN or licensed physical therapist) and the professional must consult with the unlicensed relative caregiver at least once a month (in person or by telephone) to monitor the regimen.  In addition, there must be a valid care contract in place and the caregiver must be receiving no more than fair market value for services he or she is providing.

If you or someone you know is a Veteran receiving care in an assisted living facility, or at home, please encourage them to file a claim for this benefit. It would be prudent to seek the guidance of an experiended elder law attorney who is accredited by the VA.

 CAVEAT: When planning for this VA benefit, you should also plan for Medi-Cal benefits and coordinate all of this with your elder law estate plan at the same time. An elder law estate planning attorney, who is also accredited by the VA, is best equipped to help you with this planning. When seeking help for this VA benefit, always ask if the person helping you is accredited by the VA.  

 The following are some additional requirements for eligibility:

 a. Be a veteran who served at least 90 days of active duty.

b. At least one day of active duty had to be during wartime: WWII – 12/7/41 to 7/25/47 – Korea – 6/27/50 to 12/31/55 – Vietnam – 8/5/64 to 5/7/75;

c. Does not need to have been in combat;

d. Discharged other than dishonorably;

e. Income less than $1,644 per month, once out-of-pocket medical expenses are considered.

f. Net worth less than approximately $50,000 for singles or $80,000 for couples.

g. Gifting of assets is allowed with no look-back period, but must be coordinated with Medi-Cal planning and gifting, which does have a look-back period.

 If you or someone you know is a Veteran receiving care in an assisted living facility, or at home, please encourage them to file a claim for this benefit. It would be prudent to seek the guidance of an experiended elder law attorney who is accredited by the VA.

Elder Law Today is written by Michael J. Young, Attorney at Law, 1931 San Miguel Dr., Ste. 220,  Walnut Creek, CA 94596. This information is for general informational purposes only, and does not constitute legal advice. For specific questions, you should consult a qualified attorney. MIKE@WALNUTCREEKELDERLAW.COM

For additional information, such as upcoming seminars, past newsletters, and to listen to an interview with attorney Michael J. Young, visit  www.WalnutCreekElderLaw.com.

Office: (925)-256-0298

UPCOMING SEMINARS BY ELDER LAW ATTORNEY MICHAEL J. YOUNG:

Dates: Fridays, January 8 and 22, from 2:00 to 3:30 p.m. at the Law Offices of Michael J. Young, in the Channell Room. For reservations call 925-256-0298.

VA AID AND ATTENDANCE BENEFITS

            The VA Aid and Attendance pension benefit program is provided by the Veterans Administration to veterans and their surviving spouses. This benefit helps to pay for in-home care, assisted living facility and nursing home costs. There are income and asset requirements for qualification. When we plan for the VA Aid and Attendance benefit for our senior clients as part of their long term care plan, we also plan for Medi-Cal benefits at the same time. If this  planning is not coordinated and done carefully by an elder law attorney, you may become eligible for the VA Aid and Attendance benefit, but ineligible for Medi-Cal for a long period of time.

             You should see a senior law attorney who is accredited by the Veterans Administration to give advice on the Aid and Attendance program, and who is accredited by the VA to file an application for this benefit on behalf of his clients. The senior law attorney is required to make the application on a pro bono basis on behalf of his clients. Beware of individuals and organizations who appear somehow to be connected with the Veterans Administration. Many times they are annuity salespeople, and are certainly not accredited by the Veterans Administration. They make their living by selling annuities. Annuities may at times be a valuable tool for asset protection, but should not be the focus of long term care planning. In addition, the use of an annuity may be a “time bomb” as far as Medi-Cal eligibility is concerned. The annuity salesman may help create eligibility immediately for the VA Aid and Attendance pension benefit by the use of an annuity, but may create long periods of ineligibility for Medi-Cal. Always ask if the person who is offering to give you advice on the Aid and Attendance benefit has been accredited by the Veterans Administration.  They must  be accredited to file for an application for the VA Aid and Attendance benefit and to give specific advice with regard to the application. If they are not so accredited, they will most likely be in violation of the law.   

             To be eligible for the benefit, the veteran must have been honorably discharged from the service. The veteran must have also served one day during a wartime period, and must have been in the service during a wartime period for 90 continuous days. Also, it is not a requirement that the veteran saw combat, or that he was injured.

            By Michael J. Young, Elder law attorney in Contra Costa County.

 Mr. Young’s office is located at 1931 San Miguel Dr., Ste. 220, Walnut Creek, CA 94596. His office number is 925-256-0298 and e-mail is LawYoung1@gmail.com. You may visit his website at www.WalnutCreekElderLaw.com  Mr. Young serves senior clients in Contra Costa and Alameda Counties. He also has many senior clients in Brentwood, Antioch, Concord, Alameda and surrounding communities. His long term care plans for seniors helps families prepare to pay for nursing home costs and preserve assets. He also helps his clients apply for Medi-Cal and the VA Aid and Attendance Pension benefit. You may see Mr. Young’s “Nuts and Bolts” Guide to Veteran’s Benefits at the following link. www.walnutcreekelderlaw.com/GuideToVeteransBenefits.html

             For Medi-Cal eligibility, the single applicant must have no more than $2,000 in non-exempt assets in her name. If you just give away your assets, without proper planning, and you want to enter a nursing home, you may create a period of ineligibility for Med-Cal. The ineligibility period begins at the date of the transfer.

             Medi-Cal presently has a 30 month look back period, and they use a divisor of $5,698, which is known as the average private pay rate (APPR). This figure is used to determine the period of ineligibility. So for example, if you transfer $20,000 to a family member, and divide that figure by $5,698 you will have 3.5 months of ineligibility. This is rounded down to three months of ineligibility from the date of the gift. If this gift is made in November, 2009, the applicant would be ineligible for November and December of 2009, and ineligible for January, 2010. She would be eligible in February, 2010.

            If $200,000 is transferred to another individual, (divided by $5,698), 35 months of ineligibility is created. However, Medi-Cal presently has a 30 month look back period. So, after 30 months have passed from the date of this transfer, the applicant would be eligible for Medi-Cal.

             There are also acceptable and legal methods for transferring assets, among family members for instance, which create fewer months of ineligibility. An elder law attorney familiar with nursing home and Medi-Cal eligibility can advise you on these matters.

            By, Michael J. Young elder law attorney in Walnut Creek, CA.

            Mr. Young is an elder law attorney who practices in the east bay. His office is in Contra Costa County, located at 1931 San Miguel Dr., Ste. 220, Walnut Creek, CA. Mr. Young has East Bay elder law clients who live in such towns as Brentwood, Antioch, Concord, Alamo, Walnut Creek, etc.  Many of his clients are concerned about how they will pay for their nursing home costs. Mr. Young prepares long term care plans for his clients, which may include utilizing Medi-Cal and the Veterans Administration Aid and Attendance Benefit for wartime veterans. www.WalnutCreekElderLaw.com  Lawyoung1@Gmail.com 925-256-0298

For Medi-Cal qualification, the community spouse (well spouse) is allowed to have $109,560 (in 2009) in non-exempt, or countable assets. This is called the Community Spouse Resource Allowance, or CSRA, which increases yearly based upon the Consumer Price Index.

Only non-exempt assets are counted for the CSRA. As a result, IRA’s in the name of the well spouse, which are exempt, are not counted. Also not counted are a car, the house, household goods and jewelry in the name of the well spouse, plus the $109,560. Once the ill spouse is eligible for Medi-Cal, any assets acquired by the well spouse will not affect eligibility of the ill spouse. So, an inheritance received by the well spouse after the ill spouse is qualified, will not affect eligibility of the ill spouse.

In addition, under California law, the well spouse can keep all of her income. In addition, she is allowed to have what is called a minimum monthly maintenance needs allowance of income (MMMNA) of $2,739. If she is under that amount, she can receive a portion of her ill spouse’s income, to bring her up to that amount. 

The impoverished spouse statutes state that if the $109,560 CSRA, and/or the $2,739 MMMNA are insufficient for the well spouse to live on, she can file for an administrative hearing or file a petition with the court to have these amounts raised.

 By Michael J. Young, elder law attorney in Contra Costa County. Our offices are located at 1931 San Miguel Dr., Ste. 220, Walnut Creek, CA 94596. (925) 256-0298. Please visit our website at www.WalnutCreekElderLaw.com

 Michael J. Young, elder law attorney advises clients in Walnut Creek, as well as surrounding  towns such as Danville, Concord, Brentwood and Antioch.