Qualifying for Medicaid - A Massachusetts Guide to Medicaid Asset Protection Techniques

I admire Roto Rooter. Few other businesses are so financially successful using a single tool - such as the spiraling drain cleaning tool. As an elder law and Medicaid attorney in Massachusetts I am starting to feel like Roto Rooter. New Medicaid regulations and qualifications have made it nearly impossible at the time of nursing home admission to protect an elder's assets. Despite the strict guidelines and pre-planning requirements of the Deficit Reduction Act and interim state and federal regulation, we are still winning the battle of family asset protection. If you are facing the spectre of paying the outrageous costs of a Massachusetts nursing home from your own funds please call Law for Life for a free telephone consultation to review your Medicaid asset protection options. Our phone number is (toll free) 877-325-6746 or 781-782-6000. We have offices throughout Massachusetts (Boston, Hingham, Wellesley, Winchester and serve the Worcester, Springfield, New Bedford/Fall River, Barnstable and Pittsfield areas through satellite and in-home appointments.

Often our only tool in Massachusetts is the Medicaid Qualifying Immediate Annuity, also called Single Premium Immediate Annuity (or SPIA). Although pooled income trusts have their place, we are not convinced that they will be available much longer as an emergency planning tool. These annuities are quite simple, the Medicaid applicant or their community spouse contributes a lump of funds to an annuity account with an insurance company and the insurance company returns the money to the annuitant over a fixed period of time consistent with their life expectancy under the HCFA life expectancy tables. When the annuitant dies then either the family or the Commonwealth of Massachusetts Division of Medical Assistance gets the funds depending very specific rules.

But there are several other options for elders and their families facing long term care financing and Medicaid qualification. There are exception for the principal residence where the nursing home resident's spouse is still living in the home. Same with siblings, minor, blind or disabled children. The other major exception is for children who are caregivers for their parents (the "caregiver exemption") in the two years prior to the elder's nursing home admission.

From an estate planning perspective and for non-real estate assets, our choices are more limited. There is the Medicaid Annuity (for which Law for Life is recognized as a Massachusetts source for the design and implementation of annuity based plans), but also the use of Special Needs Trusts that can be establish without disqualification for anyone in the Medicaid applicant's family. Disqualification for Medicaid is the term used by the Massachusetts Division of Medical Assistance (MassHealth) to describe the time period for which a Medicaid applicant or nursing home patient is ineligible for Medicaid benefits.

Of course, advance estate planning can solve a lot of these Medicaid qualification issues. If an elder client has good health, is generally under 80 years of age and has the wherewithal to pay annual premiums then Long Term Care Insurance is a great option. Premiums can be costly on a cash basis, but I have never had an elder law client that went on claim with Long Term Care Insurance complain about the benefits. The benefits are generally cash payments for home care and nursing home care. Many people call Long Term Care Insurance "nursing home insurance", but it is really much more than that as it includes a home care benefit that can be even more important to elders in need of services.

With the same foresight as an insurance applicant, elder law clients at Law for Life are often advised when they are healthy (I like to say "when you are still buying green bananas") to set up irrevocable trusts that preserve the step-up in tax basis and remove the elder law client's assets from inclusion in their resource calculation by MassHealth. The "trick" is that after setting up and funding these types of Medicaid trusts, the elder cannot qualify (or apply) for Medicaid for five years. At one time the waiting period was much shorter on transfers and trusts, but now it is a uniform five years before the trust's Medicaid protections kick in.

That's about it for asset protection and Medicaid qualification. It is imperative to speak with a competent elder law attorney such as us experts at Law for Life (our phone number is 781-782-6000 or toll free at 877-325-6746) regarding your personal situation as the regulations are very complex and change often during the year. Whatever you do, do not apply for Medicaid without speaking with an elder law attorney, no matter how much the nursing home pushes you to sign papers or an application company, such as Medi-Services encourages you to 'just get it done' - keep your pen in your pocket until you speak with an elder law attorney.

Massachusetts Consumer Guide to Medicaid Qualification - From Roto Rooter to Medicaid Annuities

I admire Roto Rooter. Few other businesses are so financially successful using a single tool - such as the spiraling drain cleaning tool. As an elder law and Medicaid attorney in Massachusetts I am starting to feel like Roto Rooter. New Medicaid regulations and qualifications have made it nearly impossible at the time of nursing home admission to protect an elder's assets. Despite the strict guidelines and pre-planning requirements of the Deficit Reduction Act and interim state and federal regulation, we are still winning the battle of family asset protection.

 Of course, our one tool in Massachusetts is the Medicaid Qualifying Immediate Annuity, also called Single Premium Immediate Annuity (or SPIA). These annuities are quite simple, the Medicaid applicant or their community spouse contributes a lump of funds to an annuity account with an insurance company and the insurance company returns the money to the annuitant over a fixed period of time consistent with their life expectancy under the HCFA life expectancy tables. When the annuitant dies then either the family or the Commonwealth of Massachusetts Division of Medical Assistance gets the remaining funds depending on very specific rules.

 But there are several other options for elders and their families facing long term care financing and Medicaid qualification. There is an exception for the principal residence where the nursing home resident's spouse is still living in the home. This exception also applies to siblings, minor, blind or disabled children. The other major exception is for children who are caregivers for their parents (the "caregiver exemption") in the two years prior to the elder's nursing home admission.

 From an estate planning perspective and for non-real estate assets, our choices are more limited. Besides the Medicaid Annuity, Special Needs Trusts can also be used without disqualification for anyone in the Medicaid applicant's family. Disqualification for Medicaid is the term used by the Massachusetts Division of Medical Assistance (MassHealth) to describe the time period for which a Medicaid applicant or nursing home patient is ineligible for Medicaid benefits.

 Of course, advance estate planning can solve a lot of these Medicaid qualification issues. Generally, if an elder client is in good health,  under 80 years of age and has the wherewithal to pay annual premiums, then Long Term Care Insurance is a great option. Premiums can be costly on a cash basis, but I have never had an elder law client who had has a claim with her Long Term Care Insurance company complain about the benefits. The benefits are generally cash payments for home care and nursing home care. Many people call Long Term Care Insurance "nursing home insurance," but it is really much more than that as it also includes a home- care benefit.

 With the same foresight as an insurance applicant, elder law clients at Gosselin Law are often advised when they are healthy (or as I like to say "when you are still buying green bananas") to set up irrevocable trusts that preserve the step-up in tax basis and remove the elder law client's assets from inclusion in their resource calculation by MassHealth. The "trick" is that after setting up and funding these types of Medicaid trusts, the elder is not elegible for Medicaid for five years. At one time the waiting period was much shorter on transfers and trusts, but now, it is a uniform five years before the trust's Medicaid "protections" kick in.

That's about it for asset protection and Medicaid qualification. Whatever you do, do not apply for Medicaid without speaking with an elder law attorney, no matter how much the nursing home pushes you to sign papers or an application company, such as Medi-Services encourages you to 'just get it done' - keep your pen in your pocket until you speak with an elder law attorney. If you are facing the spectre of paying the outrageous costs of a Massachusetts nursing home from your own funds, please call Gosselin Law for a free telephone consultation to review your Medicaid asset protection options. Our phone number is (toll free) 877-325-6746 or 781-729-0313. We have offices throughout Massachusetts (Boston, Hingham, Wellesley, Winchester and serve Amherst, New Bedford, Barnstable and Pittsfield through satellite and in-home appointments.

 

Elder Law Reverse Mortgages and Legal Capacity

Getting to Sure: Legal Capacity and the Elder Lawyer in the Context of Reverse Mortgage Transactions

Introduction: Legal Capacity and the Elderly

 In general, the law presumes that all adults have legal capacity unless proven otherwise. The legal standard of proof is “clear and convincing” which means, in essence, that the law sets the bar pretty high for those wanting to prove that someone is incapable of being a legal person and, therefore, unable to be a client or enter into contractual arrangements. That being said, legal capacity is situational, as is the required degree of mental capacity, both depend on the proposed act. For example, a relatively low level of capacity is required for someone to create a valid will (individuals making a will only need to show that they understand that the document they are creating is a will), while a higher level of capacity is needed for providing informed consent to medical care. The degree of legal capacity necessary to establish a lawyer-client relationship lies somewhere between the capacity of a will-maker and that needed to give informed consent to medical care. In order for prospective clients to ethically be considered legal clients, lawyers must be able to establish that the clients have sufficient legal capacity to both become the lawyer’s client, as well as having the legal capacity to take whatever legal action the client purports to do.

Medical Tests and Legal Ethics: What’s the Standard Measure of Capacity?

When dealing with elderly clients, the law’s general presumption of the client’s capacity may be inaccurate in many situations involving elderly clients. When family members (e.g. adult children), brings an aged person to an elder law attorney, in some instances they may be doing so because of some observed events or behaviors that suggest to them that the person’s mental faculties are declining. Such non-clinical observations while not determinative, they do raise the question of whether the person in question has the legal capacity. How then does an elder law attorney determine a prospective client’s legal capacity? 

According to Veda Johnson, who has been a geriatric nurse for ten years working in nursing homes and hospitals in Orlando, Florida, where the elderly population has been growing rapidly for the last ten to fifteen years, assessing the mental acuity of an elderly patient is not simple. There are several kinds of tools in the form of scales or assessments, like the Glasgow Coma Scale for example, that are used to evaluate how “alert and oriented” an elderly person might be. Unlike nurses, lawyers seeking to determine whether elderly clients have sufficient legal capacity do not have any professional tools available to them. There is no standardized procedure or even a universally accepted legal definition. And in both the medical arena and the legal field determining if a person is losing her mental faculties is never a yes-or-no question. 

Each lawyer must make an independent, holistic determination on a case-by-case basis, each time weighing all the facts and circumstances.   Some attorneys rely on their personal observation of the older person plus comments from those who spend time with the older individual. But, determining if one has legal capacity is not the same as rationally determining what makes sense to the according to attorneys’ predilections. So attorneys must be aware of keeping their own prejudices at bay when making a determination. While bizarre or inexplicable behavior can be interpreted as evidence of diminished capacity, eccentricity is not the same as incapacity. But, as one might imagine, the dividing line can be exceedingly difficult to draw. 

The Model Rules governing lawyers’ ethics nationwide are primarily aspirational, but should at least guide lawyers’ decisions about where the line falls. States may also have ethic rules on what constitutes legal capacity in the context of representing elderly clients. In Massachusetts, for example, Rule 1.14 of the Massachusetts Rules of Professional Conduct lays out what lawyers must do if they suspect that a prospective client lacks legal capacity. The rule does not specifically speak to elder attorneys; however, Comment 1 to the rule states in part, “it is recognized that some persons of advanced age can be quite capable of handling routine financial matters while needing special legal protection concerning major transactions.” Entering into a reverse mortgage transaction is more complex than contracting for other secured loans (like home equity loans, for example) so a reverse mortgage can be considered a “major transaction.” There will be times when a lawyer will conclude that a client seeking to obtain legal representation in procuring a reverse mortgage loan lacks legal capacity, but has legal capacity for other contractual matters. If this is the case, there are a few options for lawyers that allow them to represent an elderly client.

Powers of Attorney

One option is obtaining a power of attorney. There are three kinds of power of attorneys. There is the non-durable power of attorney which terminates when the person who created it becomes legally incapacitated. A durable power of attorney, on the other hand, continues to be valid even after the principal becomes incapacitated. The third kind of a power of attorney is the springing power of attorney which becomes effective only upon the happening of an event that has been designated in the terms of the document. All powers of attorney terminate automatically upon death.

It is better for seniors to create power of attorneys when they are legally competent and in good health. But, if there are already health problems, early signs of dementia or Alzheimer’s disease, one should be created immediately. By creating a durable power of attorney for finances, with gifting authority, for example, seniors can appoint someone else to handle their personal finances, including the authority to transfer your assets even after they become incapacitated.

Guardianships

Guardianships are a more formal option than powers of attorney. They involve going through a legal process in the probate courts. There are generally three types of guardianships. First, guardianship of the estate, or as it is also known, conservatorship, which is limited to substitute decision making for matters concerning the incapacitated person’s property (assets). Second, guardianship over the person, which gives the guardian control over decisions affecting the “person’s person”, such as: where to live or whether to consent to medical treatment. Third, plenary guardianship, which grants guardians the power to make decisions over both the person’s property and person. Within the context of these three forms of guardianships, most state statutes permit probate courts to appoint limited guardians; which means, as the name implies, that such guardians have no more power than is necessary to meet the needs of the persons over whom they are appointed.

Joint Ownership Arrangements

Powers of attorney and guardianships are not the only ways of making sure that an older person will have a mechanism in place for taking care of financial affairs when that person is no longer able to do so. Joint ownership arrangements can also be used. The specific forms include joint tenancy, tenancy in common and, for married couples, tenancy by the entirety. The types of joint ownership arrangements have many characteristics in common. One such feature is what happens when one joint owner dies - the other owner automatically assumes ownership and control of what was owned in common. Creating a joint tenancy can be quite simple. Adding a new signature on a bank account or changing a deed on real estate may be sufficient; no special forms are needed. But, creating a joint tenancy can have complex financial, tax and legal consequences, thus, it is probably advisable to consult a lawyer or financial professional for advice before creating one. 

Revocable Trusts

Another alternative to guardianship is creating a revocable trust to hold the older person’s (a.k.a. settlor’s or grantor’s or trustor’s) assets. The trustee of the trust might be a close friend or relative or perhaps a bank’s trust department or some other financial institution. The trust may be structured with the settlor as the sole trustee or in conjunction with another trustee who will take over completely if the settlor is no longer willing or able to handle financial matters. By definition, a revocable trust can be modified as long as the settlor is legally capable of making that decision. If the settlor becomes legally incapacitated, and there’s no alternate settlor, then the trust becomes irrevocable and only terminates upon the settlor’s death.

Reverse Mortgage Transactions and Legal Capacity

Like lawyers, lenders serving seniors 62 or older who do not have the legal capacity to enter into a reverse mortgage transaction can do so with the person or entity appointed in a durable power of attorney or with a court order guardian. Under the federal home mortgage program, HECM and HUD, guardians and attorneys-in-fact or agents named in durable powers of attorney (together referred to as legal representatives) may execute the legal documents incident to a reverse mortgage transaction, provided that they have the authority to do so by court order or per the terms of the power of attorney contract. Part of any reverse mortgage transaction also involves counseling. The law requires that seniors receive counseling before they obtain a loan. Legal representatives can and must request counseling. Whether counseling sessions are between, counselors and legal representatives or counselors and seniors directly, the reverse mortgage counseling code of ethics requires that all counseling sessions, by HUD-approved HECM counseling agencies be confidential in any event.

Reverse mortgages depend on borrower eligibility and living arrangement so it may be harder for a trust or joint owner of a property to become a borrower in a reverse mortgage loan. The trust, for example, would have to be structured in a way that left the 62-year-old prospective borrower/settlor as owner of the property to be mortgaged and the home must also be the settlor’s primary residence. As far as joint ownership, both owners would have to be reverse mortgage eligible. Thus, using revocable trusts or joint ownership as mechanisms to protect seniors at risk of losing legal capacity has some drawbacks. An elder lawyer and financial professional can help seniors and their families decide what options are best for them.

Getting to Sure in an Unsure World: A Charge for Elder Lawyers

Representing elderly clients involve many unique issues for legal and financial professionals. Assessing legal capacity is one of those issues. Many elder attorneys have developed intake forms that include questions which are useful in assessing the legal capacity of prospective clients (as well as run-of-the-mill questions about finances and ownership.) Asking what seems like simple questions like “What day is it today?” as well as questions about medications can be good when trying to decide: (a) does this person have the required legal capacity become a client; and (b) can this person enter into a major transaction like a reverse mortgage? At the end of the day the answers provided may merely help lawyers become more sure (or less certain) about the prospective client’s legal capacity, but at least lawyers would be doing their part in “getting to sure” about that client’s mental capacity as a legal matter.

Gosselin Law provides comprehensive elder law, estate planning and reverse mortgage services.  These services include Medicaid applications; emergency elder law matters; real estate transactions; guardianship; estate tax matters; wills; trusts; Medicaid annuities; Annuity planning for Medicaid; Medicaid trusts; special needs planning and related areas.  Gosselin Law can be reached at 781-729-0313 or toll free 877-325-6746.  Serving Massachusetts and New Hampshire.

Who's Your Daddy? - Elder Law Qualifications and Paternal Diminuitives

 
I have just come to another milestone in my life. My oldest son (10) decided that he will no longer be calling me "Daddy", but that I am forever more to be referred to as "Dad." As school kids are wont to do, my son was teased by a classmate for calling his parents "Mommy and Daddy". To conform to the bully's wishes my son just made me middle aged. I'm Massachusetts most recent middle aged lawyer father. I was a twenty something and had been enjoying my thirty somethings when this came out of the blue. In my elder law practice I am asked by prospective clients about what is and what is not elder law. Some fifty somethings ask whether they can 'qualify' to use my services for a trust or a will, while some octogenarians don't feel old enough to seek services meant for the elderly, after all "they're old people." What it all comes down to is that age is a state of mind. I tell my elder law clients that how old you think you are is so much more important than how old you are according to your birth certificate. If you need assistance with Medicaid or a will or trust you just need legal help, it's not a question of being elderly. When you need Medicaid or an estate planning attorney you can call me (781-729-0313) and, you can call me 'Daddy'.
 

Trusting Trusts

One of the most misunderstood words in the legal profession is trust. I am talking about a trust, the legal document. Many people can describe to me what a trust does ("it avoids taxes", "it keeps things secret", "it allows me to tell my son what to do with my money", "it manages my money", etc.) Few people actually see the essence of what a trust is, and what it is not.

Black's Law Dictionary defines a trust as "a right of property, real or personal, held by one party for the benefit of another." Or, "an obligation arising out of a confidence reposed in the trustee or representative, who has the legal title to property conveyed to him, that he will faithfully apply the property according to the confidence reposed, or, in other words, according to the wishes of the grantor of the trust." Well, that's a lot of help. I like to think of trusts as nothing more than "instructions". The person making the trust instructs the trustee to do something for the benefit of another person (the beneficiary). Try the exercise of replacing the word 'trust' with the word 'instructions' and I think you'll see how simple it can translate legal jargon. Trusts are really the modern equivalent of wills a generation ago. They are affordable, flexible, can avoid probate, reduce will contests and protect your family from a myriad of legal problems. Some types of trusts can even help you qualify for Medicaid as part of a comprehensive Massachusetts elder law plan.

Although trusts come in many different flavors and styles, the core element is protection of assets and ease of management. Some countries, most notably France, have no legal identity for trusts. Even the term 'trust' can't be easily translated into French, because there is no legal equivalent. As a result it can be very difficult for trusts to acquire property in France or otherwise conduct business as they are not recognized as separate legal entities. Although the concept of a trust may exist in other countries as a practical matter trusts are only used by the super rich and powerful. During the middle of the 20th century, as U.S. banks and trust companies became more competitive to offer services to a burgeoning (upper) middle class that came about after World War II, trusts became more available. In sum, a good written set of instructions left in the hands of a good person is your best defense against an unwanted outcome upon your incapacity or death. Trusts fit the bill. Let one of Law for Life's experienced trust and estate planning attorneys help you with your personal trust planning. Call them at Gosselin Law at 781-729-0313.

Estate Planning - Is Your Trustee Trustworthy?

How did wealthy Aunt Sally's bequest of $500,000 a year to help stray cats end up going to The Foundation for the Preservation of Home Brewers after she was gone? She had both a will and a trust explicitly spelling out her wishes that were supposed to be followed in perpetuity.

Stewardship is a lost art. As an estate planning attorney I am charged with preserving my clients' intents through various documents, such as wills, trusts and charitable foundations. I guide clients on selecting experienced, competent and reliable fiduciaries. I follow through to know that my clients' estate planning trusts are funded before death to avoid unnecessary probate administration.

A recent New York Times piece reminds me how important it is for me, an estate planning attorney, to see that my clients' wishes are preserved, not perverted by the corporate greed that pervades the corporate estate and trust administration industry.

The Times article shows how many irrevocable trusts, charitable trusts and private foundations are administered by stingy corporate trust giants more interested in collecting fees than serving the wishes of those no longer here. Why give the money to charities? It will only reduce trust fees.

But that is not even the worst part. According to the Times, the wishes of clients are often changed to reflect the wishes of the administrators. The charities specified in the trusts are replaced by charities chosen by administrators as more appropriate. Generous gifts become less so, or even disappear. Why?

Why indeed. The trust industry in the United States got its big start in Boston over 200 years ago with the First National Bank of Boston in 1784. The bank was chartered to serve the banking needs of ship captains, mainly whalers and Far East Traders.

Often the ships would be gone for over a year at a time while the captains' families stayed behind in Massachusetts. As a result, Boston trust lawyers and trust companies were charged with preserving and protecting the wealth of the merchant fleet. Massachusetts developed a great body of trust law, that to this day is unrivaled in any other state.

Silent among those laws is a clear definition as to what a reasonable action would be by a trustee. Certainly the trustees must act reasonably. But because most estate planning attorneys draft trusts with the broadest of fiduciary powers, theses same discretionary powers are often the tool of self serving corporate trustees. The cure? For one, clear language is a good start. I am a strong advocate among the Massachusetts Bar for clear language in all estate planning documents.

Our law firm is partial to English, as opposed to legaldygook, for all our estate planning documents. If you cannot understand the plain meaning of a document after carefully reading it once, it is not clearly written. Secondly, we are proponents of using co-trustees or trust protectors on all trusts and foundations. In this way, there are checks against outrageous unrestrained abuse of power by trustees as outlined in the Times article.

Last, and most important, we provide for removal of the trustee in all of our trust planning, should that trustee fail to perform fiduciary duties. Provisions are made that such a trustee can be replaced by one willing and able to do the job consistent with the language of the trust and the wishes of the client. 

Gosselin Theory of Relativity

 

Practicing in the area of probate law in Massachusetts exposes me to so many good people. Well, most all of my clients and their families are good. It's their relatives that cause all the problems. Over several years of practice I have developed a set of baseline rules for dealing with people in probate cases; I like to call it the Gosselin Theory of Relativity. It boils down to this "friends for pleasure, strangers for business and relatives for no good reason at all." Let me share with you some true to life stories (with the names changed to protect the innocent).

Many years back I had written the estate plan (will and trust) of a then elderly woman of substantial means in the area North of Boston. "Mrs. Jones" had two children. "Elsa" was a loving daughter. She visited Mrs. Jones often and was her confidante and companion as Mrs. Jones' health declined. Elsa was more or less the model daughter. "Aurelius" was a greedy, lying, conniving germ of a man that was born to Mrs. Jones but took a wrong turn on the way out of the nursery. Mrs. Jones only saw him when he was on the lam or looking for a "loan." She never turned him away, but had a plan for him at her death. You see, her estate planning made provisions for Elsa, Elsa's children, even Aurelius' children - but it left nothing to Aurelius. Mrs. Jones, as is common, asked me to keep her papers for safekeeping, only telling Elsa and Aurelius that should something happen to her that they should contact me. Aurelius lived in a Mid-Atlantic state and drove through the night to reach my office at 8:30am.

He was waiting with his car idling for me to come in to work. "Are you Mrs. Jones' lawyer? She died yesterday. She was my mother. I want to know what I'm getting in the will." I knew this day was coming. My instructions were clear from Mrs. Jones that I was to give Aurelius any and all notices required under the probate law of Massachusetts, but nothing more. "You must be Aurelius," I said like any good lawyer who only asks questions fully knowing the answer before they are spoken. "I am so sorry to hear about your mother, she was a kind and thoughtful woman. Your mother's property was held entirely in a trust, her will is of no consequence, the trust is a private document and if there is any reason to contact you in the due course of its administration I will contact you, won't you confirm your address?" I succinctly responded.

After a variety of profanity, Aurelius stomped away. Wouldn't you know that when I called Elsa to inform her that I had met Aurelius her response to me was "Mr. Gosselin, why are you sorry about mother? She is right here with me." I'll be coming back to the theme of greed over the coming weeks, it is an unfortunate necessity of being a probate lawyer. [Housekeeping: I just want to let all of you know that this blogging thing is more time consuming than I ever imagined. So, please excuse short posts or gaps of time, it's my goal to produce a new blog every 3 days or less. Also, my webmaster tells me to make sure I use "magic" words in my blog, like probate, real estate, lawyer, elder law, Massachusetts, Boston, etc.", but I promise to use these terms in their proper context and from time to time to create blogs with no words like probate, elder law, Medicaid, estate planning, Massachusetts, real estate. :)]