Interactive Long-Term Care Planning Decision Tree: Workshop Breakdown

When evaluating long-term care strategies for clients, the lawyer must ask a series of questions to understand the issues and variables to consider in planning. Every client has their own unique needs, requiring valuable insight from an experienced attorney. Fraser Trebilcock attorney Melisa M. W. Mysliwiec will be sharing key information with other attorneys in Michigan to help them better serve their own clients in long-term care planning. The presentation, titled “Interactive Long-Term Care Planning Decision Tree,” will be delivered to members of the Institute of Continuing Legal Education’s Elder Law Certificate Program on Friday, September 17, 2021.

 The seminar will assist attorneys in identifying the critical information they can collect at the initial client meeting, and explore the issues and variables to consider in Medicaid-focused strategies and how they can impact the options available to their clients. Attorneys will learn using real-world scenarios and going through the decision tree step by step from start to finish.

Melisa, along with Rosemary Howley Buhl, Arthur L. Malisow, Charles S. Ofstein, and Amy Rombyer Tripp, will answer questions and provide advice on each step of the decision tree to have attendees walk away with a completed decision tree that they’ll be able to use as a model in their practice.


Attorney Melisa Mysliwiec

If you would like to talk with an attorney about putting legal plans in place, contact attorney Melisa M. W. Mysliwiec. Melisa focuses her work in the areas of Elder Law and Medicaid planning, estate planning, and trust and estate administration. She can be reached at mmysliwiec@fraserlawfirm.com or 616-301-0800.

Completing the Medicaid Application: Workshop Breakdown

Maneuvering through the numerous rules and regulations of Medicaid can often be a stressful time for families. The application itself seems straightforward, but every client has their own unique needs, requiring valuable insight from an experienced attorney. It’s with that in mind that Fraser Trebilcock attorney Melisa M.W. Mysliwiec will be sharing key information with other attorneys in Michigan. The presentation, titled, “Completing the Medicaid Application: A Hands-On Workshop,” will be delivered to members of the Institute of Continuing Legal Education‘s Elder Law Certificate Program on Friday, June 28, 2019.

This seminar will provide attendees with a case study and supporting documents, in which they will be able to work through in groups from start to finish. A completed sample Assets Declaration and Medicaid Application for Patient of Nursing Facility will be given as well for attendees to review and understand what is included and why.

Melisa, along with Rosemary Howley Buhl, Arthur L. Malisow, Terrence G. Quinn, and Charles S. Ofstein, will answer questions and provide advice on each step in the process to ensure attendees walk away with a completed sample Medicaid application they’ll be able to use as a model in their practice.


Attorney Melisa Mysliwiec

If you would like to talk with an attorney about putting legal plans in place, contact attorney Melisa M. W. Mysliwiec. Melisa focuses her work in the areas of Elder Law and Medicaid planning, estate planning, and trust and estate administration. She can be reached at mmysliwiec@fraserlawfirm.com or 616-301-0800.

Planning Strategies and Divestments in Medicaid Planning: A Workshop

Navigating through the many rules and regulations of Medicaid can often be a stressful time for families. The application process itself can be one of the biggest hurdles to overcome, as well as the post-planning that occurs after Medicaid eligibility is obtained. It’s with these difficulties in mind that Fraser Trebilcock attorney Melisa Mysliwiec recently shared key insights with other attorneys in Michigan on how to help families maneuver through the challenging aspects of Medicaid. The presentation, titled “Hands-On Medicaid Part II: Planning Strategies and Divestment”, a follow-up to last year’s workshop, was delivered following the Institute for Continuing Legal Education’s 4th Annual Elder Law Institute, on Friday, September 14.

The seminar provided attendees with a case study about a husband and wife, second marriage for both, navigating the post-planning that is required during the presumed asset eligibility period after the husband obtained Medicaid eligibility to help pay for his long-term nursing home care. Subsequently, attendees were face with a change in circumstances; the husband died and the wife requires long-term nursing home care. Sample income and financial statements were provided and the attendees worked through a sample spend down and completed a Medicaid Application.

ICLE 4th Annual Elder Law Institute

Melisa, along with attorneys Rosemary Howley Buhl, Howard H. Collens, Erin L. Majka, and Terrence G. Quinn, answered questions and provided thorough advice on each step in the process. The well over 100 attendees were able to walk away with a completed sample Medicaid Application and supporting documents.

In addition to presenting on this topic on Friday, Melisa also moderated the plenary sessions of ICLE’s 4th Annual Elder Law Institute on Thursday, September 13. These sessions covered a broad range of topics that allowed attendees to walk away with critical updates and detailed insights in the area of guardianships and conservatorships, government benefits, and use of protective orders in the realm of disabilities planning and elder law.


Attorney Melisa Mysliwiec

 

If you would like to talk with an attorney about putting legal plans in place, contact attorney Melisa M. W. Mysliwiec. Melisa focuses her work in the areas of Elder Law and Medicaid planning, estate planning, and trust and estate administration. She can be reached at mmysliwiec@fraserlawfirm.com or 616-301-0800.

Should You Consider Long-Term Care Insurance?

Alzheimers (800x800)It is very difficult to predict whether you or a loved one will one day need long-term care insurance. A diagnosis like Alzheimer’s disease or another dementia can drastically change your life and your financial plans. With an estimated five million Americans currently diagnosed with the disease, and a new diagnosis every 66 seconds, Fraser Trebilcock attorney Melisa M. W. Mysliwiec says it’s important to plan ahead.

“We don’t know if we’re going to get Alzheimer’s or anything like that. I think the best thing is to have your team of advisers. 30’s, 40’s, 50’s, is a good time to meet with an attorney, get estate planning documents put in place so there’s someone to act on your behalf if you become unable to,” Melisa said in an interview with WILX News 10’s Ann Emmerich.  Other important advisors to have on your team include a financial planner, accountant, and insurance agent.

These critical estate planning documents include: durable powers of attorney and patient advocate designations. You’ll also want to closely review assets and your financial plans with a financial planner when considering an investment in long-term care insurance. Long-term care insurance isn’t for everyone and a financial planner can assist in making that determination.  This is especially important, Melisa says, because even if you decide to buy long-term care insurance, the plan you choose will affect how much the insurance covers.

“There’s a big difference between getting a hundred dollars for help with care at home, versus paying privately in a nursing home which might be $250 or $270 dollars a day. So you really want to look at how much you can get per day and then there’s usually a cap on how many years it will pay out, too,” she said.

On average, people with Alzheimer’s live ten years with the disease, or longer, according to the Alzheimer’s Association. This means that families are left to pay for additional medical and living expenses for prolonged periods of time. So not only does the disease progressively devastate the health of the patient, it also takes a financial toll on families.

To read more about long-term health insurance, and hear one woman’s personal struggle with paying for her husband’s care after he was diagnosed with Alzheimer’s disease, read News 10’s full story here.

It’s important to note that even if you have long-term care insurance, you may ultimately have to rely on Medicaid. Recent rule changes could affect how much you receive from Medicaid without any penalties. Melisa explains why your caretaker agreement should be Medicaid-compliant, even before you decide to apply for Medicaid, in this blog.

If you have more questions about putting together a plan in case you or a loved one are diagnosed with Alzheimer’s disease, attorneys Melisa Mysliwiec and Paula M. Manderfield will be presenting on Alzheimer’s Legal and Financial Planning on Wednesday, March 8 at MSU Federal Credit Union’s East Lansing Branch, from 6-7:30 p.m. Advance registration is requested.

Why Your Caretaker Agreement Should Be Medicaid-Compliant, Even If You’re Not on Medicaid

Trusts & Estates - Fraser TrebilcockUnder current Medicaid policy, what you don’t know about care contracts might actually hurt you.  The definition of what is considered a care contract under Medicaid policy is broad.  Currently, any arrangement under which an individual is paying for health care monitoring, medical treatment, securing hospitalization, visitation, entertainment, shopping, home help or other assistance with activities of daily living is considered a personal care contract.  Further, any arrangement which pays for expenses such as home/cottage/car repairs, property maintenance, property taxes, homeowner’s insurance, heat and utilities for the homestead or other real property of the client’s is considered a home care contract.  These are the types of things that allow individuals to age in place and remain in their homes as long as possible, as opposed to entering a nursing home.

The reason Medicaid’s care contract policy will harm those who don’t know about it is all payments made to caregivers for any of these types of services within 5 years of applying for Medicaid benefits will be considered a divestment for purposes of Medicaid eligibility unless a Medicaid-compliant caregiver contract was in place.  Divestments are defined as transfers for less than fair market value.  Divestments result in a penalty period during which Medicaid will not pay for an individual’s costs for long-term care services, home and community-based services, home help, and home health.

Most people do not anticipate entering a nursing home or needing long-term care Medicaid benefits.  Even so, they are expected to know when and if this will occur, and they need to know at least 5 years in advance so that they can take the necessary precautions with respect to personal care and home care contracts, or face penalty.  No one has a crystal ball that views 5 years out; therefore, the best practice is to establish Medicaid-compliant caretaker contracts for all personal care and home care contracts to ensure no penalty is assessed in the event that long-term care Medicaid is needed in the future.

Additionally, this policy applies equally to arrangements with both relatives (anyone related by blood, marriage or adoption) and non-relatives (including third-party commercial providers).

For a personal or home care agreement to be considered Medicaid-compliant (i.e. not be considered a transfer for less than fair market value [i.e. divestment] for purposes of Medicaid), each of the following must be met:

  1. The services must only be performed after a written legal contract/agreement has been executed between the client and provider.
  2. The contract/agreement must be dated, notarized, and signed by the provider and the client, either individually or by the client’s agent under a power of attorney, guardian, or conservator, provided that the person signing for the client is not the provider or the beneficiary of services.
  3. No services may be paid for until the services have been provided (there cannot be prospective payment for future expenses or services).
  4. At the time that services are received, the client cannot be residing in a nursing facility, adult foster care home (license or unlicensed), institution for mental diseases, inpatient hospital, or intermediate care facility for individuals with intellectual disabilities.
  5. At the time that services are received, the client cannot be eligible for home and community based wavier, home health, or home help.
  6. The contract/agreement must show the type, frequency and duration of such services being provided to the client and the amount of compensation being paid to the provider.
  7. Payment for companionship services is prohibited.
  8. At the time services are received, the services must have been recommended in writing and signed by the client’s physician as necessary to prevent the transfer of the client to a residential care or nursing facility.

Note, also, that there is a presumption that relatives who provide home and personal care services do so for love and affection only.  Payment for home and personal care services to relatives creates a rebuttable presumption that the payment was a transfer for less than fair market value (i.e. a divestment).  Therefore, even if a Medicaid-compliant caregiver contract is in place for services provided by a relative, if and when Medicaid is applied for, the Department of Health and Human Services will determine fair market value for such services by comparing the contract price to other area businesses which provide such services.  If the relative’s rate was greater, it will very likely be considered a divestment.  For this reason, it would be wise to compare a relative caretaker’s cost of services to other providers in the area in advance to be sure the rate is similar.  Additionally, it is recommended that the documentation gathered is retained in case fair market value is contested in the future.

Questions? Contact us to learn more.


Mysliwiec, Melisa

Fraser Trebilcock provides counsel on all matters relating to the legal planning for care and support of those needing Medicare and Medicaid. Attorney Melisa M. W. Mysliwiec focuses her work in the areas of Elder Law and Medicaid planning, estate planning, and trust and estate administration. She can be reached at mmysliwiec@fraserlawfirm.com or 616-301-0800. You can also click here to learn more about our Trusts & Estates practice.

 

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Continue reading Michigan’s Medicaid Estate Recovery Program