Fong Law Group

Highlights of How the Omnibus Bill Will Benefit Older Adults

The Senate and House have cleared the passage of a year-end $1.7 trillion appropriations bill that will benefit older adults on a number of fronts.

The bill, which runs more than 4,000 pages and includes a wide variety of legislation, heads to President Biden next for his signoff.

Here is a breakdown of some of the highlights that relate to supporting older Americans:

Health and Housing

• Opt to age at home – The Money Follows the Person (MFP) Program has been helping older adults age in their own home or a community setting, rather than in nursing homes, since 1972. The newly passed bill extends MFP through September 2027.
   
• Age in place safely – The omnibus bill has also doubled funding for the federal government’s Older Adult Home Modification Program from $15 million to $30 million.
  
  For seniors with limited income, this program covers the cost of simple, low-cost home modifications – such as railings and temporary wheelchair ramps – that help them age in place safely.
   
• Provide for your healthy spouse if you are on Medicaid in a nursing home – Medicaid beneficiaries who must reside in a long-term care facility but have a spouse still living at home will continue to see their healthy spouse protected from poverty.
  
  Known as spousal impoverishment rules, these protections ensure that the healthy spouse receives income while their institutionalized spouse keeps their Medicaid eligibility. These protections, which are adjusted each year, will continue to be in place until September 2027.
   
• Continue to see doctors online – Lawmakers have extended access to telehealth services for Medicare enrollees for another two years.
   
• Find affordable housing with support services – The Housing for the Elderly Program has received a billion-dollar bump in funding as well.
  
  This program seeks to aid seniors with very limited income in securing housing that is within their means while also offering supportive services such as assistance with cooking and cleaning.

Retirement Savings

• Contribute more to retirement – For older workers, the omnibus bill raises what are known as “catch-up” contribution limits for retirement savings. Taxpayers ages 60 to 63 will be allowed to contribute an extra $10,000 to their 401(k) starting in 2025.
   
• Access 401(k) funds for emergencies – If you need to take money out of your 401(k) before reaching age 59½, under certain circumstances you will no longer have to pay the 10 percent penalty fee for withdrawing money early. As of the end of 2023, you will be allowed to withdraw up to $1,000 a year for unforeseen emergencies without incurring a penalty.
   
• Wait longer to withdraw money from your retirement accounts – Previously, you were required to begin withdrawing money from your retirement plan account starting at age 72. This mandatory withdrawal is known as a required minimum distribution (RMD).
  
  As of January 1, 2023, the new bill allows you to hold off until age 73 to take funds from these types of private retirement accounts.

Protecting Spouses of Medicaid Applicants: 2023 Guidelines

The Centers for Medicare & Medicaid Services (CMS) has released the 2023 federal guidelines for how much money the spouses of institutionalized Medicaid recipients may keep, as well as related Medicaid figures.

What Are Spousal Impoverishment Rules?

Spousal impoverishment is a concern for older couples when there is one spouse who requires long-term care and applies for Medicaid.

Before the federal government enacted spousal impoverishment protections, many healthy spouses faced poverty when their partners needed long-term care. The spousal impoverishment rules are based on the idea that spouses will provide for each other.

Community Spouse Resource Allowance

In 2023, the spouse of a Medicaid recipient living in a nursing home (called the “community spouse”) may keep as much as $148,620 without jeopardizing the Medicaid eligibility of the spouse who is receiving long-term care.

Known as the community spouse resource allowance (CSRA), this is the most that a state may allow a community spouse to retain without a hearing or a court order. While some states set a lower maximum, the least that a state may allow a community spouse to retain in 2023 will be $29,724.

Monthly Maintenance Needs Allowance

Meanwhile, the maximum monthly maintenance needs allowance (MMMNA) for 2023 will be $3,715.50. This is the most in monthly income that a community spouse is allowed to have if their own income is not enough to live on and they must take some or all of the institutionalized spouse's income.

The minimum monthly maintenance needs allowance for the lower 48 states will be $2,288.75 ($2,861.25 for Alaska and $2,632.50 for Hawaii) until July 1, 2023.

In determining how much income a particular community spouse is allowed to retain, states must abide by this upper and lower range. Bear in mind that these figures apply only if the community spouse needs to take income from the institutionalized spouse.

According to Medicaid law, the community spouse may keep all their own income, even if it exceeds the maximum monthly maintenance needs allowance.

The new spousal impoverishment numbers (except for the minimum monthly maintenance needs allowance) take effect on January 1, 2023.

Home Equity Limits

In 2023, a Medicaid applicant’s principal residence will not be counted as an asset by Medicaid if the applicant's equity interest in the home is less than $688,000. States have the option of raising this limit to $1,033,000.

Pros and Cons of a Medicaid Asset Protection Trust

A Medicaid Asset Protection Trust (MAPT) is one option a person may consider to protect their assets from Medicaid and nursing homes or long-term care.

A MAPT is an irrevocable trust created during your lifetime. The primary goal of a MAPT is to transfer assets to it so that Medicaid will not count these assets toward your resource limit when determining whether you qualify for Medicaid benefits.

However, creating an irrevocable trust comes with a certain lack of control over the assets you transfer to this trust. Before making such a significant decision, consider some pros and cons to see if this long-term care strategy is right for you.

Benefits of a MAPT

1. You Can Still Benefit From the Assets of a MAPT

Although transfers of assets to a MAPT cause you to relinquish your ownership and control of them, the finality of the arrangement is not as harsh as it sounds.

In creating a MAPT, you select a person (trustee) who manages the trust assets for your benefit. So, if you transfer investment accounts to the MAPT, you can still receive the income generated from these investments. If you transfer your home, you can still live there. In exchange for giving up control of your assets to a MAPT, your assets no longer count against you for Medicaid eligibility purposes.

2. Your Assets Are Safe From Medicaid and Other Long-Term Care Creditors

Once your assets are in a MAPT and other criteria are met, Medicaid can’t seize them or ask you to spend them down to pay for your nursing home or long-term care costs. These assets also are not subject to Medicaid’s estate recovery program.

As a result, your heirs can benefit from the assets without the interference of Medicaid or liens it could otherwise file against your estate after you pass.

3. You Can Choose Your Beneficiaries

A MAPT also functions as an estate planning tool. This is because you can designate who receives what remains of the trust upon your passing. The beneficiaries you choose will receive the assets per the terms of the trust agreement, and the chances of a probate court getting involved are diminished.

In addition, you may be able to retain what is called a “limited power of appointment.” This allows you to change who the beneficiaries of the MAPT will be, should your wishes or family circumstances change.

4. Assets Are Protected From Your Beneficiaries’ Creditors

Even though you can designate a MAPT’s beneficiaries now, those beneficiaries do not have full access to the trust’s assets because of how it is structured. This also means their creditors do not have access to it. And, if your child is a beneficiary and is going through a messy divorce, neither does their spouse. You can also designate how bequests to beneficiaries can be used.

5. Protection From Capital Gains Taxes

A properly drafted MAPT preserves the full capital gains tax exclusion on the primary residence (currently $250,000 per spouse). Later, when a person’s beneficiaries sell the home, it would be valued at the market price at the date of gifting and not at the original purchase price. This can avoid or significantly minimize the capital gains tax that your heirs may owe.

Drawbacks of MAPTS

1. Timing Is Everything

For a MAPT to function as intended, it needs to be created in advance to avoid the Medicaid lookback period. In most states, this is five years for nursing home or institutional care. In some states, there may also be a lookback period for community Medicaid care (home aides, local programs, etc.).

If less than five years have elapsed since you created your MAPT, you may still be responsible for some or all of your long-term care costs until sufficient time has passed.

2. Income From MAPT Is Countable by Medicaid

Although assets in a MAPT may not be “countable” by Medicaid toward your resource limit, these assets may still generate income. If this income is payable to you, it may cause you to exceed the income limit permitted in your state.

If this happens to you, you may have other options, such as utilizing a pooled income trust, or may decide you will contribute partially toward your care.

3. Giving Up Control Is Non-Negotiable

A trust will not qualify as a MAPT if you retain control other than the limited power of appointment that may be permitted in your situation. You must accept that a person you select to act as trustee will manage the trust, distribute funds and income from the trust, and also be the effective owner of the assets.

In addition, creating a MAPT but not transferring assets to it is ineffective. You need to fully commit to the concept for it to benefit you.

4. Setting Up a MAPT Is Costly

Creating and implementing a MAPT is a complex legal task requiring many hours of work and expenditures made on your behalf. In addition, because MAPTs are tied to individual state and federal laws, the expertise of a qualified Medicaid attorney is essential.

You should expect that this expertise comes at the cost of several thousand dollars or more. However, your potential savings could be exponentially greater for you and your family. For this reason, the price is often well worth it.

5. Potential Effects on Care

It’s important to realize that while the MAPT strategy is designed to preserve assets and wealth, it assumes that a person will rely on Medicaid to pay for a portion of their care. However, Medicaid does not cover all facilities. For example, many assisted living facilities are not licensed as assisted living programs and only accept private pay residents. Thus, relying on Medicaid could affect the choice and quality of care a person may receive.

The pros and cons discussed above are not exhaustive, and there may be other ones that apply to your situation. Investing in a MAPT is a highly fact-specific process, and MAPTs are not suitable for everyone.

You should speak with your attorney to discuss how a MAPT may affect other benefits you receive, your overall estate plan, its tax consequences, and whether it is right for you.

What You Need to Know About Medicaid’s Personal Needs Allowance

Seniors who rely on Medicaid and live in nursing homes receive a personal needs allowance — a monthly stipend the Medicaid recipient can use to pay for needs that Medicaid does not cover. Medicaid restricts the amount of the allowance and how it is used. If recipients do not use all the money they received in a month, they may risk losing their coverage.

What Can I Buy with My Personal Needs Allowance?

The items a Medicaid recipient can buy with their personal needs allowance are limited to things that Medicaid does not cover. A recipient can buy vitamins, hair care, snacks, clothing, and other personal-use items. However, since the nursing home facility is required to cover toiletries, the personal needs allowance generally cannot be spent on those types of items.

How Much Money Do I Get for My Personal Needs Allowance?

The Medicaid personal needs allowance has not adjusted for inflation for more than 30 years. In the 1980s, the federal government increased the Medicaid personal needs allowance to a minimum of $30 per month, which has not increased since. The monthly amount Medicaid recipients receive for their expenses varies from state to state. For example, in California, Medicaid recipients get $35 per month while senior citizens in Alaska receive $200 per month.

Am I Allowed to Manage My Personal Needs Allowance Funds?

The recipient may manage their funds. Those who are unable to manage their own money can have a guardian or the nursing home take charge of their personal needs allowance.

If the nursing home where the recipient resides manages their personal needs allowance, the facility must provide an accounting for how it spent the money. Medicaid prohibits the nursing home from using the money on anything that Medicaid provides.

Guardians can manage the recipient’s personal needs allowance on their behalf. The guardian is held to the same standards as the nursing home where the recipient resides and so must provide an accounting, usually some itemization of expenses.

What Happens If I Don’t Spend the Entire Allowance in a Month?

A recipient is not required to spend their entire allowance each month. Sometimes the money accumulates. However, recipients should be careful if they regularly do not spend all the money. Any money from the personal needs allowance a recipient does not spend is deemed an asset. Medicaid limits the value of assets that recipients are allowed to have, and if the recipient accumulates more assets than allowed, they may lose Medicaid eligibility. The Medicaid asset limit for 2022 is $2,000 in most states.

Savings for Seniors: Lower Medicare Part B Premiums in 2023

For the first time in more than 10 years, Medicare Part B enrollees will see some of their costs decline. In an announcement issued by the Centers for Medicare and Medicaid Services (CMS), the agency outlined changes to the premium, deductible, and co-payment amounts for numerous Medicare costs taking effect in 2023.

• Medicare Part B basic monthly premium = $164.90 = Savings of about $62 for the year
   
• Medicare Part B annual deductible = $226 = Savings of $84 for the year
   
• Other amounts, meanwhile, will rise slightly in 2023:
   
  • Medicare Part A deductible = $1,600 (up from $1,556)
  • Co-payment for hospital stay, days 61 to 90 = $400 per day (up from $389)  
  • Co-payment for hospital stay, days 91 and beyond = $800 per day (up from $778)
  • Co-payment for skilled nursing facility, days 21 to 100 = $200 per day (up from $194.50)

Note that beneficiaries with higher incomes pay higher monthly premiums. For further details, read the news release from CMS.

If you wish to make changes your coverage, Medicare’s Open Enrollment Period will take place October 15 through December 7. 

Comparing Traditional Medicare and Medicare Advantage

Recent research by the Kaiser Family Foundation examined the differences between traditional Medicare and Medicare Advantage. While people in either program were similarly satisfied with their care and overall care coordination, some distinctions became apparent.

Traditional Medicare’s Strengths

Traditional Medicare is a federal health insurance program for adults 65 and older and individuals with disabilities. Medicare Part A covers hospital fees, Part B applies to medical expenses, and Part D involves prescriptions.

The Foundation reviewed 62 studies released since 2016. The research findings revealed the following:

• Beneficiaries of traditional Medicare were more likely to receive cancer care in higher-quality hospitals.
• They also tended to get superior care in skilled nursing facilities and home health agencies compared with their Medicare Advantage counterparts.
• Traditional Medicare recipients may be less likely to have problems related to expenses.

Findings on Benefits of Medicare Advantage

Medicare Advantage is an alternative to traditional Medicare. It offers plans encompassing Part A hospital fees, Part B medical expenses, and Part D medicine. In some cases, the cost of Medicare Advantage can be lower, but not always. Privately owned companies contract with Medicare to provide Medicare Advantage.

According to the study:

• Some research indicated that Medicare Advantage had slightly better preventive services, providing increased access to routine health checkups, screenings, and vaccinations.
• Patients with Medicare Advantage were more likely to have a consistent health care provider.
• Medicare Advantage had lower hospital readmission rates, received more information during care transitions, and had more favorable experiences getting prescription drugs.

Switching Rates

The researchers looked at the rates at which people switched programs as a way of understanding program dissatisfaction. Medicare Advantage had a higher switching rate relative to traditional Medicare. Yet both had a low turnover, possibly suggesting that people tended to be satisfied with both programs.

Switching from Medicare Advantage to standard Medicare was more common among:

• people of color
• residents of rural areas
• those eligible for both Medicare and Medicaid
• individuals who experienced a health impairment that affected their daily functioning

Cost Issues

Beneficiaries of traditional Medicare reported higher rates of cost difficulties than enrollees in Medicare Advantage. Yet recipients of conventional Medicare with supplemental coverage had the lowest rates of expense complaints overall.

Seek Professional Guidance

Since each plan’s benefits and drawbacks can depend on individual circumstances, consider speaking to your elder law attorney before enrolling. They can explain the differences between these programs and help you plan for retirement.

What Are Medicaid Asset Protection Trusts?

Medicaid imposes strict rules on how much money and assets an applicant can have. To qualify for Medicaid, you must fall under the asset limit, which is $2,000 in most states.

Even with greater than $2,000 in assets, however, you may be able to get on Medicaid by establishing a Medicaid Asset Protection Trust (MAPT). When you put your assets in a MAPT, Medicaid will not count the money in the trust toward its resource limit.

Using Medicaid Asset Protection Trusts to Transfer Assets

After you create a Medicaid Asset Protection Trust, you no longer own the assets within it, allowing you to qualify for Medicaid following the five-year lookback period. People who are currently healthy but plan to go on Medicaid in the future might choose to use this Medicaid planning strategy.

It is essential to understand that MAPTs are irrevocable: Once you make the trust, you cannot change your mind and take those assets back. Your trust must be irrevocable for you to qualify for Medicaid because it means that you no longer own or control these assets.

In contrast to MAPTs, many types of revocable trusts, such as family trusts, are often ineffective in preparing for Medicaid. Having the power to revoke your trust would allow to retain control over your assets, and Medicaid would count the contents of your trust as part of your resources.

Creating a Medicaid Asset Protection Trust

Three parties are involved in a MAPT: the grantor, the trustee, and the beneficiary. When you make a trust, you become the grantor, the person who places assets into the trust. The trustee manages the trust, and the beneficiary — or beneficiaries — will receive your assets.

If you want your MAPT to ensure you qualify for Medicaid, you must name someone other than yourself or your spouse as the beneficiary. Designating yourself as the beneficiary would mean giving yourself assets, which Medicaid would count toward its asset limit.

You can, however, select your children or parents as beneficiaries. Using a MAPT, you can also make sure they get those assets when you pass away.

What Can You Place in a Medicaid Asset Protection Trust?

As part of your Medicaid planning strategy, you can place many types of assets in a MAPT, including:

• Checking and savings accounts
• Stocks and bonds
• Mutual funds
• Certificates of deposit
• Real estate that is not your primary residence
• In most states, your home

Although many states allow you to place your home in MAPT so that it will not count toward Medicaid’s resource limit after five years, Medicaid regulations vary by state. In Michigan, for example, placing your home in a MAPT will not prevent it from counting toward the asset limit.

Benefits and Drawbacks of Medicaid Asset Protection Trusts

Medicaid Asset Protection Trusts offer several benefits to individuals planning to apply for Medicaid:

• MAPTs preserve generational wealth, safeguarding assets for family members.
• After you pass away, the state cannot take your assets from your beneficiaries to reimburse them for your long-term care, as MAPTs avoid probate.
• Since nursing home fees can be exorbitant, MAPTs can save your family money, as they let you qualify for Medicaid once the lookback period has ended.

The drawbacks of MAPTs include the following:

• Once you establish a MAPT, you forfeit the control and use of your assets. If you need money, you will not be able to draw from the trust.
• The fees associated with preparing a MAPT can be costly, ranging from $2,000 to $12,000.

Speak with your attorney to learn about how using a Medicaid Asset Protection Trust could help you plan for your future.

Can a Nursing Home Hold Friends or Family Members Responsible For a Resident's Care?

If your loved one is entering a nursing home, you may worry whether you could be liable for their care. Under federal law, a facility cannot require a family member or friend to co-sign an admission agreement and take on personal liability. However, nursing homes around the country still try to do so, and often these matters end up in court.

What can you do to prevent this from happening to you? It starts with educating yourself on what is and is not allowed.

A law known as the Federal Nursing Home Reform Law prohibits a nursing home or facility from requiring or asking for a financial guarantee from a third party. Federal regulations regarding Medicare and Medicaid have similar restrictions.

These laws and regulations state that a home cannot have a resident’s family member or friend co-sign an admission agreement to take on financial liability. However, a nursing facility may obtain the signature of the resident’s agent, who has access to the resident’s income or assets, agreeing to use these resources to pay for care. Still, this agreement may not impose personal financial liability on the agent.

Review Before You Sign

If you are assisting a loved one with entering a nursing home, you should carefully review all the admission paperwork before you sign it. Many facilities have unscrupulous practices of using admission agreements that violate federal law or regulations.

You do not have to sign or “volunteer” to sign a financial guarantee that makes you personally responsible. It is incorrect if a nursing home claims a guarantee is necessary because the federal law only applies to Medicaid-eligible individuals. Nursing homes are also not allowed to condition admitting or keeping a person on receipt of a third-party guarantee.

Today, the most common tactic used by nursing homes is an admission agreement that obligates the signor as an agent with supposed control over the resident’s money. These agreements stipulate the agent will apply these resources to the nursing home expenses and apply for Medicaid on the resident’s behalf. Often, the person signing this document doesn’t know how to handle this situation, does not have this control, or makes mistakes in the resident’s Medicaid application, causing coverage to be denied.

What follows may be a lawsuit by the nursing home, claiming the agent violated their duties in the agreement and must pay the care costs. Courts have gone both ways on whether these agreements are enforceable, and the agent’s conduct often influences a court’s decision. Egregious conduct can lead to courts ruling in favor of the nursing home. An example is where an agent used the resident’s money for luxury items or other people’s expenses rather than their loved one’s care.

Plan Ahead As Much As Possible

The best action is to plan before nursing home care is necessary. This can put you or your loved ones in a position to be ready to apply for Medicaid should the need arise. At the same time, an aging individual can do proper asset protection planning and avoid look-back periods creditors could otherwise exploit against the resident or an agent.

However, this is not always possible for many older adults and their family members. Individuals who will take on the responsibility of being an agent should understand what this entails and seek the advice of your elder law attorney before starting the admission process.

How Much Long-Term Care Insurance Should You Purchase?

Long-term care insurance helps you prepare for financial costs associated with aging, such as nursing home care, assisted living, or in-home care. Yet long-term care insurance policies vary widely in terms of the amount of coverage and how long the protection lasts.

The Average Costs of Care

The 2021 Genworth cost of long-term care survey provides national median monthly costs for the following:

• Nursing home care = $9,034 (private room); $7,908 (semi-private room)
• Adult day health care = $1,690
• Assisted living = $4,500
• Homemaker services = $4,957
• Home health assistance = $5,148

Whether you have a health condition that you know will require care in a skilled nursing facility or prefer to prepare for unexpected medical events, you may consider purchasing a certain amount of long-term care insurance to account for future care.

Evaluate which services you expect to need. Although many individuals need nursing home care, others can avoid nursing home costs by combining assisted living services with in-home care or day health services.

How to Calculate Your Monthly Benefit

Most policies provide between $2,000 and $10,000 of funds per month. To estimate how much long-term care insurance you will need:

1. Review how much you can expect to spend on long-term care.

2. Subtract the cost of services from the amount of money you can budget toward your long-term care expenses; the remainder is the amount you need long-term care insurance to cover.

Suppose you have a monthly income of $2,500 and plan to move into an assisted living facility that costs $4,500 per month. In that case, you will need a minimum of $2,000 per month in long-term care insurance to cover the cost of assisted living.

In addition to determining how much coverage you need each month, think about how long you want your plan to last. Long-term care insurance that lasts longer can be relatively more expensive, yet it provides increased protection.

The Department of Health and Human Services states that most people need long-term care by age 65. The majority of people need care for two years, but 20 percent require care for longer than five years. Most people should obtain at least two years of coverage and contemplate purchasing additional coverage.

Medicaid Planning

As you plan for your future, consider purchasing long-term care insurance that protects you for five years if you intend to apply for Medicaid. Since the Medicaid lookback period is five years, you may transfer your assets to your family and begin to spend down your assets so that you can qualify for Medicaid after your five-year coverage ends. After five years on private insurance, you may be able to transition to Medicaid.

The amount of long-term care insurance you buy should fit your unique circumstances. 

Speak with your attorney to learn more about preparing for your future with long-term care insurance.

Miller Trusts Can Help You Qualify for Medicaid

Many seniors find themselves in need of Medicaid to pay for their long-term care but are surprised to learn that their modest monthly income may disqualify them. The reason for this is that Medicaid is a “means-tested” benefit. In other words, you must not have income exceeding certain thresholds in order to qualify and receive Medicaid benefits. For example, in New Jersey, the monthly income limit for nursing home or community-based services is $2,523 for individuals and $5,046 for married couples.

Medicaid expects all of an applicant’s monthly income, besides a monthly personal needs allowance and Medicare premiums, to go toward nursing home costs. So, what if you have more income and other expenses? A Miller Trust may help you resolve this dilemma.

A Miller Trust is a Medicaid planning tool that can assist you in meeting the income limits and qualifying for Medicaid. Unlike other planning tools, Miller Trusts do not have specific disability or age requirements.

How Does a Miller Trust Work?

If your income exceeds Medicaid’s income limit, you can deposit the amount of your excess income into a Miller Trust – also referred to as a “qualified income” trust. Once it is deposited into this trust, it is not counted as income by Medicaid. However, to qualify, a trust must be irrevocable, which means you cannot cancel or change it. Once you put money into the trust, you cannot get it back directly. However, the trust can pay certain expenses on your behalf.

A Miller Trust is a good option for any Medicaid applicant needing long-term care services, whether at home, in their community, or in a skilled nursing care facility. This trust is created by the applicant, a guardian, or a person with a properly drafted power of attorney. A trustee is chosen to manage the trust and the income deposited. Anyone other than the Medicaid applicant can serve as a trustee.

Once the trust is set up, the trustee establishes a bank account to receive excess income from the Medicaid applicant. The income can only be used for certain expenses. For example, it may be used to pay the personal needs allowance of an individual in a nursing home, Medicare premiums, bills not covered by Medicaid, or supplement costs of a nursing home.

Another requirement of a Miller Trust is that the applicant’s state Medicaid agency will be the beneficiary of any remaining funds in the trust upon the death of the Medicaid applicant. The amount the state receives is limited to the total value the state paid in long-term care on behalf of the applicant. Any amount remaining after this payment may go to a person the applicant chooses.

Medicaid Income Cap

You should be aware that not every state allows Miller Trusts as a method to qualify for Medicaid. Currently, only about 25 states, known as “income cap” states, permit it. Other states do not impose an income limit for nursing home care, and so there is no need for a Miller Trust in these locations. For example, in Massachusetts, you would pay all your income, minus certain deductions, to the facility, and Medicaid would pay the remaining cost.

Before creating a trust, it is important to speak with an elder law attorney to ensure this option is right for you. If you live in a state where this is not allowed, there may be other options, such as pooled income trusts, which serve a similar purpose.

For guidance in Medicaid planning, consult your attorney.