Julie Jason

Beyond the issue of how to deal with the emotional and medical issues, is the question of how a family can afford the cost of care at home, or a long-term stay at an assisted living or nursing center facility. 

Some individual’s costs are covered in full or in part through long-term care insurance; Medicare and private health insurance does not cover long-term care.  (Nursing centers may give discounts for services rendered to people who have long-term care insurance, according to Susan Welsh, Director of Admissions, Nathaniel Witherell Rehab and Nursing Center of Greenwich.)      

If the family simply does not have adequate assets, income or insurance to pay for a long-term stay, Medicaid may be the only answer.  Medicaid (Title XIX) is the federal/state safety net for the indigent.  

To qualify in Connecticut, you (the “institutionalized individual”) may not have more than $1,600 in assets, according to Connecticut’s Office of Policy and Management (OPM).    If you are married, your spouse (the “community spouse”) can only have up to $109,560 (the “Community Spouse Protected Amount” (CSPA) ).  The CSPA is updated every year, according to Mag Morelli, president of CANPFA, the Connecticut Association of Not-for-profit Providers for the Aging.   (Go to www.canpfa.org for a wealth of resources.)

If you are married and you have more assets between you ($1,600), and your spouse ($109,560), the excess is “considered available” to you, the institutionalized individual.  That means that you have to use the excess to pay for your nursing care, even if those assets are titled in your spouse’s name (there are some exceptions, such as your house).  Income limits also enter in the picture. 

When learning about the Medicaid program, keep in mind that married couples have to figure out how the community spouse can support him or herself.   Protection of spousal assets is permitted under the program, according to Welsh, and couples in particular need to determine to how conserve those assets.   Every situation is different. 

You won’t really know whether you are a candidate for Medicaid until you explore your personal situation. You can get a start on how to qualify for Medicaid by doing some research on your own.  (Go to the Connecticut Department of Social Services (DSS) website at www.dss.state.ct.us.)   

To do the subject justice, however, you’ll need to consult with an elder law attorney.    

If a spouse is facing the possibility of needing long-term care, time is of the essence in seeking out an elder law attorney, said Nina A. Kohn, Associate Professor of Law, Syracuse University College of Law.  “There are a number of legal strategies that can be used to protect the community spouse’s income and assets, and a qualified attorney can provide very valuable guidance as to how to proceed.   
The good news is that federal law provides significant protection to prevent the spouse of nursing home residents from becoming destitute, but the benefit and effect of those protections can depend on the structure of one’s financial and legal arrangements.”

Attorneys Richard Fisher and Sam Starks, who practice locally agree:  you want to address potential planning issues today, not tomorrow.    Richard Fisher is with the Stamford law firm of Cacace, Tusch & Santagata and Samuel Starks is a sole practitionner in Stamford.    

Here is what you can expect the elder law attorney to help you with:

• Review your concerns and address planning issues.
  
  
• Review family assets and income.      
  
  
• Assess whether the family is a candidate for Medicaid.  If so, address opportunities to protect the community spouse’s assets and income.  For example, Fisher explains that a family may want to improve the home and pay off outstanding debt while maintaining eligibility for Medicaid. 
  
  
• Review assets transferred during the five-year Medicaid look-back period.  Medicaid can recover assets that were divested within five years, according to Paul Moretti, attorney and legal expert on www.justanswer.com. 
  
  
• Assess other planning opportunities, such as trusts.  For example, the “Miller Trust,” names Medicaid as the beneficiary, explained Moretti.  The trust benefits you during your lifetime;  Medicaid gets the remainder after your death.
  
  
• Help apply for Medicaid and file appeals if necessary.  The Medicaid application process is rather involved and lengthy requiring records covering a five year period, explained Vic Bible, President of IFFS Eldercare Consultants.  
  
  
• Prepare appropriate documents.  “ It’s really helpful to a family if the individual has appointed a family member as a health care representative and durable power of attorney for financial matters,” said Starks.      
  

If you are the son or daughter or grandchild, consider what a reader, Dan Greco, shared with me:     “One father can take care of 10 kids, but 10 kids can’t take care of one father.”   When you’re raising kids, parents focus on the children’s needs, education, and teaching them how to live.  When the parents come to the age when they need assistance, without planning, there is no organized way for the family to care for the parent.  You can change that by doing some research and planning.               

For more information on Greenwich Hospital’s Center for Healthy Aging, you can call (203) 863-4373 or visit the Greenwich Hospital’s website at www.greenhosp.org (search for “healthy aging”).  

You can research nursing centers by going to www.medicare.gov (search for “Nursing Home Compare”).  

For more information on long-term care insurance, check out the Connecticut Partnership for Long Term Care, which is administered by OPM.  For more information go online to www.ct.gov and search for “Connecticut Partnership”).   Look for a list of approved insurers that qualify purchasers to protect some assets from Medicaid eligibility limits.  You can also call 1-800-547-3443 to receive a packet of information.  

To read Part 3 of this series, click here.