This presentation describes the current Medicaid eligibility rules and shows various techniques that permits individuals and families to preserve assets in the face of crushing long-term care costs

1. Elder Law and Medicaid Richard J. Shapiro, J.D. Mindy Menke, J.D. Blustein, Shapiro, Rich & Barone, LLP 90 Crystal Run Rd., Suite 409 Middletown, New York 10941 (845) 692-0011 www.mid-hudsonlaw.com

5. Medicaid Income and Resource Levels 2009 © 2009 Richard J. Shapiro

10. The Look-Back Period © 2009 Richard J. Shapiro

12. The Penalty Period © 2009 Richard J. Shapiro

14. Calculation of the Penalty Period The total value of all uncompensated transfers divided by the average monthly cost of nursing home care as established by New York State © 2009 Richard J. Shapiro

17. Rules Protecting the Community Spouse © 2009 Richard J. Shapiro

27. IRT Trustmaker(s) Transfer $ + house? Subject to 5-year look back Trustees (often one or more children) Principal distributions to class of beneficiaries? INCOME NO PRINCIPAL C1 C2 Protective trust Protective trust Capital gains exemption preserved if house sold (Subject to limited power of appointment) Trustmakers may replace trustees (after 2 nd death) Powers of Appointment? © 2009 Richard J. Shapiro

29. Elder Law and Medicaid Richard J. Shapiro, J.D. Mindy Menke, J.D. Blustein, Shapiro, Rich & Barone, LLP 90 Crystal Run Rd., Suite 409 Middletown, New York 10941 (845) 692-0011 www.mid-hudsonlaw.com © 2009 Richard J. Shapiro