Medicaid Estate Recovery Program; Protect your Home

Medicaid Estate Recovery Program (MERP) is where Medicaid will attempt to recover funds paid out for nursing home expenses by putting a lien on their home.

Here is how MERP works:

Know your nursing home residents rights. Once a person passes away, MERP can place a claim or a lien on the home, through probate court. If a person takes over payments to protect their loved one’s home when they get placed into a nursing home, they can put their own claim in against the estate. There are also several exemptions for family members that could help you protect your home.

Keeping Track of Money Spent; Elder Law

Once your loved ones are placed into a nursing home, Medicaid will not help with their home any more. All Medicaid benefits will now be paid to the nursing home. If their home is still mortgaged, it can get very expensive to keep up. Make sure you let MERP know that you are filing a claim for money spent on anything to do with that home: mortgage, taxes, insurance, maintenance, etc.

Getting legal advice; Elder Law Attorneys Cohen and Oalican, LLC., Boston, Raynham, Andover Massachusetts

Every state has different laws regarding MERP. These laws can be very difficult to understand and you could end up losing a lot of money. Find out how to handle probate when your loved ones die and MERP starts looking to recover the money they provided the nursing home. Elder law attorneys Cohen and Oalican know what the proper state laws are and will help protect your house and get through these tough times.

Medicare to Help People Quit Smoking; Medicaid Law

According to Health and Human Services, over 5 million Americans on Medicare smoke. Medicare finally created a new free program to help people quick smoking. There should be no copay or deductible for this program. Make sure your doctor will accept payment from Medicare as full-reimbursement first so that you can avoid any unexpected charges.

Quit Smoking Program Guidelines; Medicare

This new Medicare program allows two attempts per year to quit smoking. Each time you will be allowed four sessions for counseling. Doctors are told to follow guidelines formulated by the government:

1. Ask the patient questions
2. Advise them to quit smoking
3. Assess the situation and the patients willingness
4. Assist the patients attempt to quit smoking
5. Arrange a follow-up session

Also, doctors may prescribe certain anti-smoking drugs that will be covered by Medicare.

Getting Help Can Work; Elder Law Attorneys Cohen and Oalican, LLC.

Quitting smoking takes willingness and commitment. Less than 7% can quit without help, but with counseling and drugs together, these percentages go up nearly 4 times, according to the American College of Physicians. The Society for Vascular Surgery says these things WILL happen within 48 hours when a person quits smoking:

• Blood carbon monoxide level will return to normal
• Increase in taste/smell
• Decreased blood pressure
• Heart attack chances will decrease
• Drop in pulse rate
• Hands and feet body temperature will go up
• Nerve endings will grow back

Proper understanding of Medicaid law and appropriate Medicaid planning is an essential part of any plan for the future. With proper planning you can protect your home, protect your spouse, and protect your assets.

Attorneys Cohen & Oalican specialize in Elder Law; where protecting your assets and your dignity is their core mission. 

Three Important Questions for Retirement Planning; Part Two

As we talked about in part one of this series, planning your retirement is only as good as how these three things might culminate:

• How long you might live
• How well your investments might (or might not) work
• How much money you will require to live comfortably until you die

We know that those are things that not many can ever predict. There are asset protection plans that attorneys Cohen and Oalican can help you to understand. In this installment of “Three Important Questions for Retirement Planning”, we will explain more about protecting all that you’ve worked for.

How much monthly income will you need to survive when you retire?

Nobody can tell you what inflation rates, health care costs, or tax rates will do in the future. First thing you should do is decide when you would like to retire and what type of lifestyle you would be happy with. There is obviously a benefit in saving as much as possible for your retirement. If the market does well, your retirement plan and trusts will do well, but even if the market doesn’t do well, a dollar saved is still a dollar saved and a higher percentage saved is better than a lower percentage saved.

Saving, living on less and/or delaying your retirement

1. Saving. It is recommended to save at least 15% of your salary while saving. Some say 10%, but it’s all about playing it safe. There is also a hidden benefit to regular saving: when people make a habit of saving, they usually become more modest spenders.
2. Delaying your retirement. Retiring later than you regularly planned raises your monthly Social Security/Medicaid benefits. Your benefits almost double if you wait until you’re 70 as opposed to retiring at 62.
3. Living on less. How much you think you need at retirement could be a lot less than you think. You should definitely aim high with your retirement plan, but there are hobbies that you could pick up that cost less than your current hobby and you might like it even more than your current hobby. Author Ralph Warner said so well, “You'll do much better planning for retirement if you recognize that it's not all about money." 

Attorneys Cohen & Oalican specialize in Elder Law; where protecting your assets and your dignity is their core mission.

Three Important Questions for Retirement Planning; Part One

You’ve seen “retirement calculators” time and time again on different websites leading you to believe that if you were to save a certain amount of money you would be able to retire comfortably. Unfortunately that’s not always the case. Planning your retirement is only as good as your answers to three questions:

• How long might you live? 
• How well (or not-so well) will your investments work out? 
• How much money will you require to live comfortably until you die?

Your life expectancy; Elder Law Attorney Cohen & Oalican

Retirement planning would be a lot easier if you knew how long you were going to live for. That’s obviously never the case. Fortunately, there is an insurance called an immediate annuity which allows you to never run out of assets, however long you live. Of course, just like anything that sounds too good to be true, there are setbacks, so talking to an elder law attorney would be a smart idea.

Your asset protection plan; Boston, Raynham, Andover Massachusetts

To stay on track with your asset protection plan you must always monitor your investments and adjust to market changes. You may have to save more and/or work longer than you originally thought when you first started thinking about your retirement plan. Attorneys Cohen & Oalican specialize in helping you protect your home and protect your spouse.

To be continued…

Medicaid Planning; New Free Medicare Checkup

We can't say this enough times: Medicaid planning is not an easy thing to do. Until January 1st, 2011, the only routine exam Medicare covered was the “Welcome Exam”. This exam is only for brand new beneficiaries. Now, a new annual wellness visit has been established under the Affordable Care Act. This free Medicare checkup was a big step in Medicaid Law, but can be very misleading.

How to get your free Medicare wellness checkup; Boston, Raynham, Andover Massachusetts

William Schmitz, a retired engineer from Maine, was upset when he found out Medicare Law had defeated him once again and denied his claim when he went for what-he-thought was a free physical. “When I asked the doctor’s office what had happened, they clued me in that I was mistaken about the difference between Medicare’s wellness exam and a physical”, William said.
In order to get this free check up, don’t just set up an appointment for a physical. Specifically ask for the free Medicare wellness visit, billing code G0438. Medicare does not cover the cost of a physical.

Medicare wellness visits and doctors; Elder Law Attorneys Cohen & Oalican

As always with Medicare planning: be cautious and double-check with your doctor. All doctors do not have to offer these Medicare wellness visits. Also, Medicare does not have the authority to tell a doctor what services to offer. If the beneficiary’s doctor will not perform this check up, the beneficiary has the right to go to another doctor. It is always good to choose a trustee to get the proper help you need with Medicaid planning.

Attorneys Cohen & Oalican specialize in Elder Law; where protecting your assets and your dignity is their core mission.

Alternatives to Nursing Homes as Nursing Home Populations Swell With Younger Patients - Part 2

 

One of the main reasons cited for this movement of younger people into nursing homes are the budget cuts most states face in Medicare and Medicaid.  In the long term, it is more cost efficient to care for a younger person in their home with part time caretakers.  However, in the short term, this is a more expensive way of treating patients, as the caregivers need to be hired and trained.  In the budget crunch most states are experiencing, short term funding takes priority over long term spending.   Younger people are being moved into nursing homes earlier, as in the short term, this is a more economically viable way of treating them.

According to a study by the AARP Public Policy Institute, the cost of at home care is about a third the cost of providing care in a nursing home or institution.  Many states, however, simply do not have the funding for at home care in their Medicaid programs.

One of the most telling quotes about the movement of younger people to nursing homes is:

“Over the past 20 years, federal laws and policies have established a civil right to get long-term care at home. But NPR's investigation found that is only sporadically enforced.

More than 60 percent of what states spend on long-term care for the elderly and disabled goes to pay for people — like Michelle Fridley — to live in a nursing home. The amount spent on home-based care has grown steadily, but not nearly enough to meet the need. Nationwide, there are some 400,000 people on state waiting lists for home-based care, double the number 10 years ago.”

Frequently attorney’s like our firm, that specialize in caring for the elderly, and those that have long term care needs, must be engaged to support a patient’s right to at home care.  In 1999, the right to at home care was clearly established in the Supreme Court, in the “Olmstead Case”.   In that decision, the Supreme Court stated that the unnecessary institutionalization of people with disabilities is  a form of discrimination.

 

To be continued…

How to Protect Your Home if You Are Admitted to a Nursing Home - Part 3

Medicaid Lien

There is also the distinct possibility of Medicaid putting a lien on your home to compensate for the expenditure on your treatment. If you sell your home while still living, the lien would have to be satisfied by reimbursing the state for the amount spent on your medical care. The only cases where you can claim exemption from this rule is when a spouse, or a minor, disabled or blind child, or a sibling with equity share in the property, is living in your home.

Recovery of Estate

As stated earlier, only if a spouse, a minor, blind, or disabled child, or a sibling with a share in the property inhabit the house, can you be exempted from the state claiming it as recompense for your Medicaid expenses of your nursing home treatment. If the spouse of dependent family member move out or dies, the state can again try to claim the property.

There are some situations however, when the value of a home or property can be protected against recovery by Medicaid. These are:

• If you or your spouse owned the home as tenants by the entirety.
• If the house is in the name of your spouse and you have given up your interest in it.
• If the house is in the name of an irrevocable trust.
• If any family member is eligible as a ‘care-taker child’.’ This is applicable when a daughter/son looked after you prior to your admittance to a nursing home and has no other place to live in. The person can then avoid a Medicaid claim on the house after your demise.

It is advisable to have a detailed discussion with an attorney regarding this ‘care-taker child exception’ and whether it can be applicable for any family member in your case. Considering the many legalities and other policy matters involved, the attorney can guide and help you to protect and retain your home and property, against all claims by the state and Medicaid.

For further information visit Cohen & Oalican,LLP Boston Elder Law and Estate Planning Attorneys, Also serving Andover and Raynham Massachusetts

How to Protect Your Home if You Are Admitted to a Nursing Home - Part 2

Part 2

Transfer of your home

The legal transfer on ownership of your home to your children or any other family member may incur a Medicaid penalty, which would affect your eligibility for Medicaid for a certain period of time. It is best to talk to an attorney to find out all the legalities regarding your wish to transfer your property ownership to someone else, before you do it.

There is no penalty involved if you transfer ownership of your home, to the following:

1. To your spouse.

2. Any child of yours who is under 21 years of age, or visually or physically challenged.

3. Into a trust that is formulated for the sole benefit of a disabled person under 65 years of age. This could be for the Medicaid applicant as well, under certain circumstances.

4. A brother or sister of the owner, who has lived in the same home for one year prior to the admission of the applicant in the nursing home and also has an equity share in the property.

5. A child who has been a caregiver and is the offspring of the applicant, who has lived in the same house for a minimum period of 2 years. He/she must have taken care of the applicant during that period to avoid admission to a nursing home.

You may consider selling off your home at the current market value, but you may find yourself ineligible for any Medicaid benefits. You may end up utilizing the money from the sale of your home, for your medical treatment.


For advice with your Medicaid Planning, contact Cohen & Oalican,LLP Boston Elder Law and Estate Planning Attorneys, Also serving Andover and Raynham Massachusetts

How to Protect Your home if You Are Admitted to a Nursing Home - Part 1

How to Protect Your Home if You Are Admitted to a Nursing Home


When you need to obtain Medicaid coverage for your future medical treatment and care, it is not necessary to sell your home. However, if the house is in your sole name, the state may claim your house legally after your demise. When you claim Medicaid to pay for medical treatment in a nursing home, it is possible that the state may try to recover the cost of the benefits provided, by placing a lien against your home. This is termed ‘estate recovery’ and the house you own may be the only item of considerable value left after your demise, given the terms and conditions of eligibility for Medicaid.

So there is a distinct possibility of the state filing a legal claim on your property and home after your demise. It is in your interest therefore, to consult an attorney to get complete information and find out how to protect your home, as soon as you need to be admitted to a nursing home for your medical treatment. Some states have implemented the Deficit Reduction Act of 2005, whereby the home is not looked upon as an asset for the terms of eligibility for Medicaid, if the equity value is less than $500,000. In some states, the equity value limit is $750,000. You can retain your home and property with no limit on the equity value, if your spouse or
any other dependent family members live there.


Cohen & Oalican,LLP Boston. Elder Law and Estate Planning Attorneys, Also serving Andover and Raynham Massachusetts

Cohen & Oalican answer: Can enrollment in Medicare Part B be delayed without having to pay a higher premium?

Can enrollment in Medicare Part B be delayed without having to pay a higher premium?

Enrollment in Medicare Part B can be delayed without paying a higher premium under certain circumstances. If you or your spouse was employed and had group health plan coverage through the union or your respective employer and therefore did not enroll in Medicare Part B when you were first eligible, you can sign up for it during a Special Enrollment Period. You can sign up for Medicare Part B:

• While you still have health plan coverage provided by your employer or group plan coverage offered by the union, during your period of employment or that of your spouse

• In the eight-month period after the health plan coverage given by your employer or union ends or your employment ends, whichever happens first

The rules for Special Enrollment in Medicare Part B are also applicable if you have any disability and are working, or if you have health plan coverage provided by an employed member of your family. If you enroll for Medicare Plan B during the Special Enrollment Period, the effective date for commencement of coverage differs depending on when you enroll:

1. If you are covered by the group health plan or you enroll in Medicare Part B in the first month after the group health plan coverage ends, the coverage provided by Medicare Part B would begin on the first day of the month of enrollment. If you wish to postpone the coverage, you can designate the starting date to the first day of any of the three months immediately following the enrollment.

2. If you enroll any time during the remaining seven months of the Special Enrollment Period, your coverage under the Medicare Part B will begin the month following your enrollment.
If you are unable to enroll in the Medicare Part B during your Special Enrollment Period, you cannot enroll again until the next General Enrollment Period, which is scheduled on January 1st through March 31st of each year. If you enroll during this period, you may have to make a higher premium payment for the Medicare Part B health coverage, since you had the opportunity to enroll earlier and chose not to.

For more information on enrollment, please contact Social Security Administration at 1-800-772-1213.

Make sure you will be protected, call Cohen & Oalican, LLP to discuss your Medicaid Plan.

Medicare coverage for Nursing Treatment, Long-Term Treatment and Expert Nursing Care

What is the amount of coverage that the current Medicare plans offer for nursing home treatment, long-term treatment and expert nursing care?

Normally, Medicare does not offer any help for long-term treatment and care. Treatment on a long-term basis is referred to as “custodial care,” as it can be carried out in various forms and locations. Long-term treatment and care can be rendered at a nursing home, another location in the community and even at home.

Personalized care, which cannot be categorized as skilled care, includes supportive service for daily activities like bathing, eating and other general support which does not fall under the category of skilled medical treatment. Therefore, Medicare will not pay for this type of care.

Medicare offers monetary help only for treatment, classified as vital and proficient medical or nursing care. If you are ill and need constant care under the eye of trained medical personnel who will have the responsibility for your remedial care, you would fall into this category.

Trained medical personnel like doctors and nurses managing your treatment differ from the long-term care given at home or elsewhere by your family members or care-givers. Medicare will only pay for treatment given at a medical facility by qualified and experienced staff.

To make sure you will be protected, call Cohen & Oalican, LLP to discuss your long-term care and Medicaid Plan.

Cohen & Oalican : New Health Care Law and Medicare

Cohen & Oalican answer:

Will the new health care law have any influence on my current benefits and coverage from Medicare?


You may rest assured that there will be no adverse impact on your current Medicare coverage due to the new health care law. On the contrary, this new law signed by the President ensures increased access to health insurance and provides considerable improvements to current policy, thereby providing enhanced protection for you and your family through Medicare coverage plans.

While you may keep your current plan intact, the President’s new law improves Medicare coverage exponentially. For example, the new law ensures the gap in prescription drug coverage (otherwise known as the “donut hole”) will close gradually by 2020. Each year, Medicare recipients will be offered new savings under the law. In 2010, a one-time rebate of $250 will be offer to Medicare recipients This amount will be given to those Medicare recipients who are not already receiving extra help to pay for prescribed medicines. You do not have to submit any personal information to obtain this check like bank account numbers, Social Security details or even Medicare coverage details. If anybody calls you regarding this $250 check and asks for any information, we advise you not divulge any personal facts.

The new health care law would also help reduce the costs of preventive services from the year 2011 moving forward.

If you have further questions please contact Cohen & Oalican LLP, elder law attorneys in Boston, Andover and Raynham.

Cohen & Oalican : New Health Care Law and Presciption Drugs

Cohen & Oalican answer:

Does the new health care law have any provisions to deal with the coverage gap in prescription drugs?

Medicare’s drug coverage was inadequate for approximately 8 million people in 2007. Most Medicare plans have a prescription drug coverage gap or “donut hole” , which forces you seniors to pay out of pocket for your prescription medicines to a certain limit before the plan will begin to cover medication costs. Coinsurance, private payments and annual deductible amounts are all taken into account for each plan’s limit within the coverage gap, however, even these high costs do not always translate to cost savings for many Medicare recipients.

2010: Coverage Gap Rebate of $250

In March, the President signed a new health care law, which offers discounts and savings for seniors during the coverage gap period. The rebate is designed to assist Medicare recipients with prescription drug costs while in the donut hole.

Here’s how it works—Beginning in 2010, Medicare will send you a check for $250 as a one-time payment, three months after the end of the quarterly period when you reached your prescription drug coverage limit. It is important to note that the coverage gap rebate only applies to Medicare recipients who are eligible for the drug coverage and are not currently receiving assistance from another source. Seniors should also be advised that no personal information has to be provided to receive the rebate check, like the number of your bank account, your Social Security number or your Medicare information. If you are contacted by regarding the rebate payment who asks for personal information, please do not divulge any
essential or pertinent facts about yourself. For more information about the coverage gap rebate check, call the designated location dealing with your particular plan.

If you have further questions please contact Cohen & Oalican LLP, elder law attorneys in Boston, Andover and Raynham.

PROTECTING YOUR HOUSE FROM THE COST OF NURSING HOME CARE Part 7 Conclusion

Cohen & Oalican, LLP : PROTECTING YOUR HOUSE FROM THE COST OF NURSING HOME CARE Part 7 of 7




Conclusion

Our clients worked extremely hard their entire lives saving for their retirement and to pass along a little something for their children. Often, their home is their “nest egg” representing a life time of hard work and savings. The best way to protect your home is to plan ahead. Given the State’s tightening budget, it has become even more difficult to obtain Medicaid eligibility and protect your home. For your own peace of mind, it’s more important than ever to hire an experienced Elder Law Attorney to create a comprehensive Asset Protection Plan to preserve all that you have worked for.

Consult with one of the attorneys at the offices of Cohen & Oalican, LLP for more information on Medicaid and Estate Planning.

This series has been brought to you by Cohen & Oalican LLP, Elder Law Attorneys Boston, Raynham, Andover

PROTECTING YOUR HOUSE FROM THE COST OF NURSING HOME CARE Part 6 Bring on The Medicaid Lien

Cohen & Oalican, LLP discuss: PROTECTING YOUR HOUSE FROM THE COST OF NURSING HOME CARE Part 6 of 7



Bring on the Medicaid Lien


In certain situations, it may make more sense to apply for Medicaid and let the Medicaid lien accrue against the house. Let’s consider a client who has $100,000 and a house worth $400,000. They spend down their funds in a year or so after entering a nursing home. At that point they have two choices. First, they could sell the house and pay privately for their care until the funds are spent down. If the nursing home costs $10,000 a month this will take about three years or so. Another option would be to apply for Medicaid once the funds are spent down. Remember, Medicaid will not count your house as an asset in determining eligibility if you indicate on your application that you intend to return home. Once the application is accepted, Medicaid will place a lien against the house and when the individual dies, the family will have to pay back Medicaid for benefits provided during that person’s life. You may be wondering where is the benefit in this strategy? The benefit lies in the fact that when you repay Medicaid you are paying them based on what Medicaid pays the nursing home which is typically between 60 and 60 percent of the private pay rate. In other words, if you let the lien accrue you would pay back Medicaid at a rate of $7,000 a month compared with the $10,000 a month that you would have paid privately if you sold the house. Of course, if you receive Medicaid benefits over many years, the lien may exceed the value of the house and there would be no benefit to the family. (It’s important to note that regardless of the size of the lien, Medicaid is only entitled to the value of the house.) One other drawback to this strategy is that the Medicaid applicant cannot use their own income to pay for the house expenses (taxes and insurance). The only way to cover this cost is either to rent the house or for other family members to pay the bills.

Consult with one of the attorneys at the offices of Cohen & Oalican, LLP for more information on Medicaid.

This has been Part 6 in a series of 7, brought to you by Cohen & Oalican LLP, Elder Law Attorneys Boston, Raynham, Andover

PROTECTING YOUR HOUSE FROM THE COST OF NURSING HOME CARE Part 3

Cohen & Oalican, LLP discuss: PROTECTING YOUR HOUSE FROM THE COST OF NURSING HOME CARE Part 3 of 7

The Transfer Penalty and the Look-Back

If you give away your assets it will make you and your spouse ineligible for Medicaid benefits for up to five years. When you apply for benefits, Medicaid reviews five years of bank statements in order to identify any disqualifying transfers. This is known as the “look-back period.” Any transfers that happened before the five year period are protected and do not have to be reported to Medicaid. However, if you apply for benefits during the look-back period, Medicaid imposes one month of ineligibility for approximately every $8,000 you give away. In addition, the clock does not start “ticking” on the ineligibility period until you are in a nursing and have spent down your assets.

The easiest way to explain the transfer rules is by way of an example. Let’s assume Mrs. Smith transfers her condo worth $320,000 to her grandson on March 15, 2010. On April 15, 2011, Mrs. Smith suffers a stroke and is admitted to a nursing home. Assume she spends down her assets below $2,000 as of August 2011. Because she would be applying during the look-back period, Medicaid would impose thirty two (32) months of ineligibility ($320,000 ÷ $8,000 = 32 months). The transfer penalty would not start until August 1, 2011 and would end in April 2014.

Keep in mind, that the rules are different for married couples. If a husband is in a nursing home with a wife living in the community, Medicaid allows the husband to transfer their home to the healthy spouse, without imposing any ineligibility period. The house is then completely protected from the husband’s nursing home costs (even after the wife’s death.) Although, planning can be more complicated for a single person there are several options available to protect the house regardless of whether you are married or single.

Consult with one of the attorneys at the offices of Cohen & Oalican, LLP to create your personalized Medicaid plan.

This has been Part 3 in a series of 7, brought to you by Cohen & Oalican LLP, Elder Law Attorneys Boston, Raynham, Andover

PROTECTING YOUR HOUSE FROM THE COST OF NURSING HOME CARE Part 2

Cohen & Oalican, LLP discuss:


PROTECTING YOUR HOUSE FROM THE COST OF NURSING HOME CARE

Part 2 of 7

Noncountable does not mean Protected

A home with equity of less than $750,000 is considered a noncountable asset. Without proper planning, at death the State will have a lien against your house and Medicaid will seek reimbursement for benefits provided. On the other hand, there are steps you can take to avoid a Medicaid lien and protect your home, saving hundreds of thousands of dollars.

Although the risk of a Medicaid lien is very real, the good news is that Medicaid will not force you to sell your house if you enter a nursing home. As long as a Medicaid applicant indicates on their application that they intend to return home, Medicaid will not force the sale of the house. This is a subjective question and it does not matter whether there is any realistic chance that the person actually will be able to return home.

Many people think the best way to protect their home is to give it outright to their children. Although this may sound like the simplest solution -- it may be the worst choice. Transferring a home outright to children can result in large capital gains taxes. Secondly, things can happen to children that can place the house at risk. What happens if a child gets divorced, is sued or has creditor problems? Seniors have been literally forced out of their own home as a result of ‘gifting’ their house to their children. There are several strategies available which will protect the house from Medicaid but also protect your right to live in the house. However, before you consider transferring your house, you have to understand the Medicaid transfer rules.

Be sure to consult with one of the attorneys at the offices of Cohen Oalican, LLP to create your Medicaid plan

This has been Part 2 in a series of 7, brought to you by Cohen & Oalican LLP, Elder Law Attorneys Boston, Raynham, Andover

Protecting your house from the cost of nursing home care - Part 1

Cohen & Oalican discuss Part 1 of 7

PROTECTING YOUR HOUSE FROM THE COST OF NURSING HOME CARE



Introduction

For must of us, our home is our most valuable asset. “Value” refers both to how much money you would receive if you sold your house but perhaps more importantly, value describes the emotional attachments we hold for the place we live and raise our families. When we first meet with our clients we typically ask what they are most worried about. The overwhelming majority tell us that they want to protect their home. “I don’t want to lose my house, if I go to a nursing home” is an often repeated refrain.

There is a great deal of confusion regarding what will happen to your house if you enter a nursing home. Some people have the good fortune of being wealthy enough to pay privately for their care. Although when nursing homes typically cost $100,000 a year, most of us are not that lucky. Others had the foresight to buy long-term care insurance. However, most of our clients are not wealthy enough to pay for their care and they either cannot afford insurance, or are not qualified. The remaining choice is Medicaid.

The first basic rule of nursing home Medicaid eligibility is that an applicant, whether single or married, may have no more than $2,000 in "countable" assets in his or her name. "Countable" assets generally include everything you own, except for your home (if it is located in Massachusetts and it has equity less than $750,000). Everything else,(second homes, retirement savings, life insurance) is counted and may have to be spent down before you can obtain eligibility. Although Medicaid will consider your home to be a noncountable asset it is important to understand that does not mean your home is protected.

This has been Part 1 in a series of 7, brought to you by Cohen & Oalican LLP, Elder Law Attorneys Boston, Raynham, Andover

Durable Power of Attorney and Health Care Proxy - FAQ Part 3

12. When does a health care proxy take effect?

A health care proxy takes effect only when you require medical treatment and are unable to communicate your wishes concerning your treatment.

13. What if I become able to communicate my own decisions?

If you become able to express your wishes at any time, you will be listened to and the health care proxy will have no effect.

14. Who should have a copy of my health care proxy?

Your agent should have the original document. You should have a copy and your physician should have a copy with your medical records.

15. How can I get a health care proxy?

Contact an attorney at Cohen & Oalican, LLP who is skilled and experienced in this area.

Durable Power of Attorney and Health Care Proxy - FAQ Part 2

Durable Power of Attorney and Health Care Proxy - Part 2


6. What kind of records should I keep?

It is very important that you keep good records of your actions under the power of attorney. That is the best way to be able to answer any questions anyone may raise. The most important rule to keep in mind is not to commingle the funds you are managing with your own money. Keep the accounts separate. The easiest way to keep records is to run all funds through a checking account. The checks will act as receipts and the checkbook register as a running account.

7. Can I be compensated for my work as attorney-in-fact?

Yes, if the principal has agreed to pay you. In general, the attorney-in-fact is entitled to “reasonable” compensation for his or her services. However, in most cases, the attorney- in-fact is a family member and does not expect to be paid. If you would like to be paid, it is best that you discuss this with the principal, agree on a reasonable rate of payment, and out that agreement in writing. That is the only way to avoid misunderstanding in the future.

8. What is a health care proxy?

A health care proxy is a document executed by a competent person (the principal) giving another person (the agent) the authority to make health care decisions for you if you are unable to communicate such decisions yourself.

9. Why have a health care proxy?

In case you ever become incapacitated, it is important that someone has the legal authority to communicate your wishes concerning medical treatment. This is true especially if you were to disagree with family members about your treatment. By executing a health care proxy, you ensure that the direction that you have given your agent will be carried out in the event of such disagreement.

10. Who should I appoint as my agent?

Since your agent is going to have the authority to make medical decisions for you in the event you are unable to make such decisions yourself, it should be a family member or friend that you trust will follow your wishes. Before executing a health care proxy, you should talk to the person that you want to name as your agent about your wishes concerning medical decisions, especially life sustaining treatment.

11. Should I have a medical directive (Living Will)?

A medical directive provides your agent with instructions on what type of care you would like. If you wish, you may include a medical directive in your health care proxy. It may include specific instructions concerning the initiation or termination of life sustaining treatment or a more broad statement granting general authority for all medical decisions that are important to you.


Please contact Cohen & Oalican, LLP Boston, Andover and Raynham, for further information.