A presentation made by certified elder law attorney Mark Heffner during the Rhode Island Spring Education Conference, presented by the Greater New England Chapter of the National Multiple Sclerosis Society.
These slides cover powers of attorney, irrevocable trusts, revocable trusts (a.k.a., "living trusts"), estate planning, myths and facts about Medicare, how Medicaid is different from Medicare, planning techniques for Medicaid and more.
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Adapting: Financial Planning for a Life with MS
1. HEFFNER &
ASSOCIATES
ELDER LAW
Mark B. Heffner, Esq. , CELA
Heffner & Associates
615 Jefferson Boulevard
Warwick, Rhode Island
401-737-1600
mheffner@hefflaw.com
www.hefflaw.com
Estate Planning & Public Benefits
for Individuals with MS
2. HEFFNER &
ASSOCIATES
ELDER LAW
Disclaimer
•Materials are for general education and should not
be substituted for consultation with a competent
estate planning attorney in your state
•Materials presented from the perspective of Rhode
Island
•Rules and practice vary significantly from state to
state and are subject to change
3. HEFFNER &
ASSOCIATES
ELDER LAW
Lifetime Planning: Health Care
Decisionmaking
Advance Directive
Durable Power of
Attorney for Health
Care
Living Will
Selection of Agent
Selection of Successor Agent
4. HEFFNER &
ASSOCIATES
ELDER LAW
Lifetime Planning: Financial
Decisionmaking
Joint accounts: Be careful!
Durable Power of Attorney for finances
Determination of
Powers to provide
Again, selection
successor Agent
Selection of Agent (aka,
“Attorney in fact”)
Ex: Gifting and Estate
planning?
5. HEFFNER &
ASSOCIATES
ELDER LAW
Lifetime Planning: Financial
Decisionmaking
Revocable Trust, aka,“Living Trust”
Avoids/Reduces “Push-Back” of Institutions
with use of Durable Power of Attorney
Selection of Trustee & successor Trustee
critical
Still need Durable Power of Attorney for
finances
No utility for asset protection planning.
Instead, need…….
6. HEFFNER &
ASSOCIATES
ELDER LAW
Lifetime Planning: Financial
Decisionmaking
Irrevocable Trust
Properly structured, assets titled to
Irrevocable Trust protected from spend
down for Medicaid eligibility
Assets transferred subject to 5 year
lookback period
Loss of direct control over assets
transferred
7. HEFFNER &
ASSOCIATES
ELDER LAW
Planning for post-death
Will—requires probate
Selection of Executor—same person
generally as agent under financial DPOA
Revocable & Irrevocable Trusts—if “funded”
will avoid probate for those assets
Note: Need to check beneficiary
designations (IRAs, life insurance, annuities),
joint titling, as generally “trump” Will or
Trust provisions
8. HEFFNER &
ASSOCIATES
ELDER LAW
Public benefits available for long-term
care: Medicare
Myth: Individuals with MS & other chronic
illnesses requiring LTC not covered by
Medicare
Fact: Individuals eligible for Medicare are
entitled to an individualized assessment of
their need for services vs. generalized
assumptions based on diagnosis
Examples of services which could benefit
individuals with MS include PT, OT, Speech
therapies.
9. HEFFNER &
ASSOCIATES
ELDER LAW
Public benefits available for long-term
care: Medicare
Myth: PT, OT, Speech therapies unavailable to
MS patients because condition is chronic
and not likely to improve
Fact:Therapies are available if services are
skilled and medically necessary to maintain
individual’s condition and prevent
deterioration
“Improvement” or “restoration of prior
functioning” not the test—rather that skilled
services are required to maintain current
level of functioning & prevent deterioration
10. HEFFNER &
ASSOCIATES
ELDER LAW
Public benefits available for long-term
care: Medicare
Nursing home benefit under Part A--limited
long term care (LTC) coverage 20 days full
payment, up to 80 additional days with co-
pay ($160/pay)
Medicare nursing home benefit requires a
three day prior hospital admission
In contrast to…..
11. HEFFNER &
ASSOCIATES
ELDER LAW
Public benefits available for long-term
care: Medicare
Coverage for long-term home care benefits
are available provided:
Physician signs plan of care
Patient is homebound
Patient requires PT or speech therapy, or
intermittent skilled nursing home care
Home care provider is Medicare-certified
Potentially unlimited in duration
12. HEFFNER &
ASSOCIATES
ELDER LAW
What is Medicaid?
•It is not Medicare!
•Medicaid: in addition to general criteria (age, blind,
disabled) & needing a level of care, must also fall
within financial criteria (assets, income, transfer
restrictions)
•Medicare: insurance model; no asset or income
qualification requirements
•Substantial state to state variations
13. HEFFNER &
ASSOCIATES
ELDER LAW
Resources
Excluded (Single Person)
•Home (equity value limit:
$543K) if “intent to return”
•Household goods &
personal effects( no value
limit, unless exceptional)
•Vehicle (limit: $4500, unless
used for transportation to
medical appts)
•Life Insurance ($4000 face
limit)
•Irrevocable Burial Contract,
or funds set aside for burial
($1500)
•Funds otherwise available
(limit: $4000)
Available
EVERYTHING
ELSE
14. HEFFNER &
ASSOCIATES
ELDER LAW
Resources
Excluded (Married Couple)
•Home: no equity limitation
if residence of “Community
Spouse” (CS)
•Vehicle: if used by CS, no
limitation on value
•CS retains “Community
Spouse Resource Allowance”
(CSRA)
15. HEFFNER &
ASSOCIATES
ELDER LAW
Transfers of Assets
Any transfer occurring on or after February 8, 2006 is
subject to five year lookback period
Q: What types of transfers fall within lookback period?
A: Uncompensated (UV) transfers--i.e., those for which
fair market value (FMV) not received by applicant or the
applicant’s spouse
Parent gives adult children each $10,000
Uncompensated transfer: $30,000
16. HEFFNER &
ASSOCIATES
ELDER LAW
Medicaid Planning Techniques
Highly individualized—one size definitely does not fit all!
• Spenddowns—debts, taxes, burial contracts.
Non-crisis, or “pre-crisis” planning techniques include:
• Make transfers, incur five year lookback period
• Specialized annuities—married couples only
“Crisis planning” techniques include:
• “Reverse half a loaf” planning
• Many more opportunities exist for married couples;
however still “never too late” for single individuals
• Transfers—must be mindful of tax implications,
creditors—grantor Irrevocable Trusts useful device.
17. HEFFNER &
ASSOCIATES
ELDER LAW
How to get started
Arrange for consultation with competent
elder law attorney
Preparation: provide elder law attorney with
individual family, financial and health
information
Initial meeting should be hour-hour & a half
Expect fee for initial consultation
18. HEFFNER &
ASSOCIATES
ELDER LAW
National Elder Law Foundation
www.nelf.org
Locating competent elder law attorney
Certified Elder Law Attorney
Provides interactive state map of Certified
Elder Law Attorneys (CELA) in each state
19. HEFFNER &
ASSOCIATES
ELDER LAW
Mark B. Heffner, Esq. , CELA
Heffner & Associates
615 Jefferson Boulevard
Warwick, Rhode Island
401-737-1600
mheffner@hefflaw.com
www.hefflaw.com