TennCare will use estate recovery on TennCare payments for long-term care.
Long-term medical care is expensive – but where does the money come from?
This week I want to talk about TennCare Estate Recovery. Over the last few blog posts, we have gone over the benefits available to those who qualify medically and financially for TennCare Choices, Tennessee’s long-term care Medicaid program. We have also discussed how we can help our clients adjust their finances so that they can qualify. This week we want to discuss how TennCare recoups the cost of providing long-term care services.
TennCare rules can be confusing
A long time ago, my friend told me that her grandmother had to give away her house because she could not afford to pay for medical care and needed to qualify for Medicaid. This is really unfortunate! Her grandmother clearly didn’t understand the rules of Medicaid. Unfortunately, people like my friend’s grandmother get bad information about Medicaid, the services that are available, and the requirements to become eligible. I wish I could have told my friend’s Grandmother that she could have kept her house. This leads me to my main point…
TennCare will not take your house while you are living in it.
However, TennCare estate recovery allows TennCare to get reimbursed for any funds that they spent on behalf of someone after that person dies. In other words, the state will eventually try to get reimbursed for the money they spent on your long-term care.
According to current TennCare rules, a single person can own a house that is worth up to $603,000, or land with a house worth over $603,000, without any concern about being ineligible for TennCare due to their home. However, you will want to talk to your attorney and financial advisor about how you may be able to continue to pay the costs of maintaining a home if you are in skilled nursing care.
How and when does TennCare get reimbursed for your long-term care?
For most of us, TennCare is not going to take your home even if you are living in a facility. Concern about your real estate should arise if you were hoping to pass your real estate to your family when you die. While TennCare will not try to get repaid for their expenditures during your lifetime, they will seek reimbursement after you pass away.
For example…
Roberta has a home worth $250,000 and no other assets. She was in a skilled nursing facility for two years and received TennCare services for which they paid $125,000. After Roberta passes away, her estate will be expected to pay $125,000 back to TennCare before the family receives any money. Since there is a house worth $250,000, the family would be expected to sell that house and give half the proceeds to the state. This process is called estate recovery.
Work with a probate attorney to resolve an estate recovery claim.
Is there any way we can keep the house in the family?
Estate recovery is something that TennCare takes seriously, and will go to great lengths to make sure that they are properly reimbursed. However, they will not take your home while you are living in it.
I want to be clear: A loved one receiving TennCare benefits while alive does not mean that Tennessee will later attempt to collect the money from YOU. The debt is not yours. If you have a loved one who passes away while on TennCare, your probate attorney will work with you to resolve that estate recovery claim so that TennCare can get reimbursed for any funds they spent on behalf of the deceased.
You can find more information through the Estate Recovery division here.
If you have a family member that was on TennCare or needs to get on TennCare, contact us at 615-846-6201. We’re here to help!
Many people have sufficient income to maintain a regular lifestyle but are unable to afford the high cost of long-term care. With the average cost of long-term care around $7,000.00 a month, it is incredibly difficult for most families to afford it, even more so after retirement. That’s why it’s a good idea to plan for qualifying for TennCare, also known as Medicaid.
Evaluate and restructure your assets to qualify for TennCare
It’s worthwhile to know how to qualify for TennCare
As we discussed in our blog last week, there are certain criteria you need to meet to be eligible for TennCare. As an elder law attorney, one of my jobs is to help families get their loved ones qualified for TennCare while maintaining resources available for the rest of the household.
One of the ways that we do this is by restructuring a family’s assets. We do this by turning resources that are countable for TennCare purposes into items that TennCare does not count as part of its eligibility assessment
This process is known in the elder law community as a spend-down. The goal of the spend-down is to make you or your loved one eligible for TennCare as far as your assets are concerned. If you are overqualified for income-based criteria, we can use a special type of trust called a Qualified Income Trust, or a Miller Trust, to reduce your income. The goal of a spend-down is to maintain the quality of life for all family members including those who need long-term care.
Bob might benefit from purchasing a quality mobility device
What is a “spend-down”?
For example…
Bob needs to go into long-term care. Bob is eligible based on his income. He makes $2,000.00 a month of social security retirement income. Bob also has a house, a car, and $50,000.00 in the bank. Bob is widowed and his children are adults.
We need to do something with at least $48,000.00 from Bob’s bank account in order to make him eligible for TennCare. His house and his car are not countable for TennCare purposes in most cases. What can we do?
Make improvements to his home that would improve his quality of life and access to the things that he needed in the home. This might include:
Grab bars in the shower or hallway.
A ramp into the main entrances.
Paving the driveway or expanding it closer to the door
Widening doors
Buy some things for Bob that his Medicare did not cover, such as:
Hearing aids
Dentures
Eyeglasses
Top of the line mobility devices
There may be other things that would improve Bob’s quality of life. There are things we can spend money on or convert into income. I am also going to suggest to everyone that they use the money to make arrangements for end-of-life needs if they have not done so already. Since at some point Bob’s children will need to make arrangements for his burial or cremation, paying for it now from his excess funds is a great way to make those funds unavailable for TennCare purposes and meet a future need.
Bob has peace of mind because he has plans in place for long-term care
Bob might want a Care and Savings Assessment
It’s not easy getting approved for TennCare / Medicaid, and we know it! That’s why we offer help in planning your steps to qualify. It doesn’t matter what your starting point is, we’re here to help you navigate the process with one goal: get our clients the quality of care that they need. Contact us if you would like to make plans for qualifying for TennCare.
Quite simply, TennCare is Tennessee’s Medicaid program. While the name “TennCare” has the word “care” in it, it is NOT Medicare. In order to further clarify the difference between the terms “Medicaid” and “Medicare,” you need to remember that we use “Medicare” to “care” for our elders and “Medicaid” to “aid” those, of any age, in need. Essentially TennCare is Tennessee’s brand of Medicaid. Hopefully, that little trick will help you remember the differences between each program.
Who qualifies for TennCare?
Now that you are familiar with the difference between Medicare and Medicaid, let’s discuss who qualifies for TennCare (Medicaid).
There are three qualification criteria that you must meet in order to obtain Medicaid/TennCare.
1. Medical qualification –There is a special medical test that applicants must pass in order to qualify. Usually, a care facility will handle this piece of the Medicaid application.
2. Asset qualification – A TennCare applicant who is single can only have $2,000.00 in assets before they are eligible for TennCare. Vehicles and real estate are usually exempt from the count of assets. A “Care and Savings Assessment” is a good place to start if the applicant needs help with figuring out what they have in assets and what options are available to make excess assets “non-countable” for TennCare purposes.
3. Income qualification – A TennCare applicant can only receive $2,382.00 per month (as of 2021) in order to receive TennCare. If an applicant has more than this amount in income, an attorney can resolve it through what is called a Miller Trust or a Qualified Income Trust.
Long-term care is very expensive
Why should I be concerned about long-term care services?
Unless you are a millionaire or multi-millionaire, TennCare eligibility and designation could have a major impact on your finances and your family. While you may not need TennCare now, you will want to plan as if you will need it in the future. As you may have heard us say before “we hope for the best, and plan for the worst.” Having a plan is an effective way to ensure that you will have long-term care coverage when you need it. This isn’t to say that you won’t find yourself needing TennCare much sooner than expected. When this happens we call it “TennCare Crisis Planning”.
Knowing your options makes all the difference
I don’t know where to start!
The biggest obstacle to TennCare planning is determining what to do with your assets and income; especially if there is excess in any category. There are a lot of rules and potential pitfalls that you need to look out for. Fortunately, we have some great financial planning and legal resources that can help our clients. If you have an immediate need for TennCare or want to plan for TennCare we can supply the client with what we call a “Care and Savings Assessment”. It’s a wonderful tool that helps people effectively navigate through their options.
How do we help our estate planning clients with TennCare planning?
For our estate planning clients, we like to take into consideration the possibility that you may need TennCare in the future.
For example, it is our priority to set up our client estate plans to make sure that TennCare is accessible if it is ever needed. As with many government organizations, Medicaid has lots of rules to follow and many people find that they did not know what rules they were supposed to be following until it was too late! Fortunately for our clients, we know the rules and can help you plan in advance of ever needing to apply for TennCare to cover medical care. Additionally, we create documents that make sure that someone can apply for Tenncare on your behalf. This is useful if you become incapacitated in the future.
How do we help our Conservatorship clients with TennCare?
Many of our conservatorship clients are caregivers for a loved one who requires skilled nursing to keep them safe. The average cost for this type of care is about $7,000.00 per month or more. There is usually a large gap between monthly income and fees. Our firm can navigate the TennCare application process and assure that the appropriate language is in the conservatorship order paperwork with the court so that the client may obtain the appropriate benefits for their loved one.
How do we help clients with TennCare Crisis planning?
For those who have never considered the cost of long-term care until they or a loved one need to enter a nursing facility, the cost of care is likely to come as a shock- and an unaffordable, but necessary, expense. This is when we can step in with what we call “crisis planning,” meaning that you need a plan and you need a plan now.
In these cases, we are able to look at the household financial situation of the person needing skilled care, as well as the family situation overall, and come up with a plan for how to best use existing resources and get them qualified for TennCare benefits to pay for the nursing home bills. This process called our “Care and Savings Assessment”, is one of the most rewarding things that we do! It allows us to help people get the care that they need while still providing a quality of life for themselves and their families.
If you are concerned about accessing TennCare benefits for long-term care, contact our office for a complimentary initial call using our online calendar here.
Last week I provided a handy list of preventative measures to help you avoid financial scams. But what do you do about the tricky people in your life who want to take your money? Half of all abuse comes from someone the victim knows. This means friends, paid caregivers, and professionals you depend on. While I’m not advocating for you to be untrusting of those around you, I am telling you that it’s important to pay attention to the red flags.
You should ask yourself: Is there anyone in my network that might want to take my money or anyone that “feels” that I owe them money? Here’s a list of the red flags to look out for:
Is your new friend really a friend?
Do I have new friends who are overly helpful?
Look out for the con artist. These tricksters will use coercion, flattery and manipulation. How can this happen to you? I’ll paint you a picture:
Let’s say you have recently met someone who is really interested in helping you around the house or with errands. Your new friend is charming and really interested in knowing you and being around you. Over time you start to trust this person and maybe even depend on them for your day-to-day activities. In the end, you do things you wouldn’t normally do such as gift-giving, especially after they tell you about all of the difficulties in their life. How nice of you to just “give” your low-mileage car to that nice new friend of yours! You think your new friend is being helpful. Nope! They are grooming you to take advantage of your kindness.
Is anyone resentful or angry about helping me?
Pay attention to those who are resentful or angry about any requests to help out with caregiving. This is the type who feels that they are “owed” something for their efforts. This mentality leads to all kinds of abuse such as abandonment, starvation, denial of care, physical harm or threats to place you in a nursing home. Additionally, the abuser may steal your money, pay for things with your credit, take your valuables, or make you sign things you don’t agree with or understand.
Am I my caretaker’s golden goose?
There are people out there who are really down on their luck and are desperate enough to hold you hostage in exchange for caretaking. Unfortunately these caretakers see you as a golden goose and have no problem using caretaking on a quid pro quo basis.
Have you ever read the book “Misery”? The story is of a woman who discovers that her favorite author has crushed his leg in an accident. She “cares” for him but ultimately holds him hostage, afraid for his life, unless he writes a novel for her. This horror novel is an extreme example of an abuser who holds their victim hostage. While the story is far-fetched, it’s not usual for us to rely on our friends and families for certain things during different times of our lives. An abusive caregiver could hold you hostage or tie their efforts to what you can do for them in ways that aren’t appropriate. It’s clear to see how you can easily lose control of your finances in these circumstances.
Beware the unethical professional who wants to work with you “exclusively”.
Do my hired professionals really have my interests at heart?
Beware professionals who are unethical. While most professionals will be honest with you, unfortunately we can’t say the same about everyone out there. Some “sketchy” professionals will intentionally confuse older adults in order to take advantage of them. These professionals could be your banker, accountant, financial advisor, doctor, or even lawyer (yes, we know the jokes too!). It could be anyone who has a professional relationship with you. These criminals are more than happy to help you line their pockets via forgery, lying, coercion, and misrepresentation.
On the September 24, 2021 episode of the true crime podcast Criminal episode “Family Money,” journalist Phoebe Judge investigates the case of two bankers who siphoned off millions of dollars from their grandmother after she entrusted them with her accounts. Because she trusted them and they also held a formal relationship as her bankers, they were able to move money out of her accounts and make investments that only benefited themselves- not her. This situation demonstrates how all three of our situations listed can work together, especially for people who you think would NEVER take advantage of you. And for most people that’s the case. But it never hurts to have a second or third set of eyes on things if it seems like something might be amiss.
Most people truly want to help. Trust your gut!
In conclusion
I know these are scary things to think about, and we generally don’t want to frighten our readers, but planning is important. And in this day and age, where so many scammers are out there not only online, but also those who may be coming into your home, it’s important to have a plan to protect yourself. If you need help creating a plan to protect yourself or a loved one, click here to schedule a call with us.
Last week I discussed the types of scams used to take your money! This week I want to share with you some methods that can help you beat the scammers at their game.
The first step in protecting yourself from scammers is to crawl under a rock… I’m just joking! But seriously, scammers are everywhere and target everyone. But the easier it is to find your information, the easier it is for them to contact you. Here are some things you can do today:
Opt out of “people” search engines. Here are the basic steps for opting out of people search engines: – First: Do an internet search on yourself. Where is your information listed? – Next: Find your listing on each website. Once you have the listing, write down the URL or ID number. – Finally: Use the IRL or ID for your listing and enter them into the opt out pages for each search engine.
Here are a few of the people search engine links to get you started:
While it may take a little time and effort, it is beneficial to your sanity to request your information be taken off of these websites!
Unsubscribe from email listings whenever possible. If you find you are suddenly getting emails for a business or organization you didn’t sign up for, simply label it “Junk” and move on. Your email provider will take care of the rest.
Do a privacy check up on your social media accounts. Set high limits on security and privacy on your social media accounts. Don’t let strangers message you. Unfriend anyone you don’t personally know.
The next step in fortifying your finances is to be overly cautious when talking to people you don’t know.
Don’t answer phone calls from numbers that are not programmed into your contacts. If it’s important, they will leave you a voicemail. If you accidentally answer the phone and you have no idea who is calling, don’t say anything other than normal pleasantries such as “hello” or “oh, that’s interesting”. Have a “refusal” script handy near the phone. It’s perfectly okay to say “I have to go now…” and simply hang up.
Create a “secret word” – The easiest way to protect yourself from a telemarketing or grandparent scam is to create a secret word. A secret word is a “code word” or phrase that only your loved ones will know. If the caller doesn’t know the secret word, then they don’t know you.
Follow the proper channels for communicating with government services. The IRS, Medicare, and Social Security will never call you! Nor will any correspondence be an emergency! There’s too much bureaucracy for urgency. For example, if the IRS wants to get in touch, they will send an official letter. That guy on the phone telling you that you owe past taxes and will go to jail is not from the IRS- he’s a scammer! And finally, never give your Medicare or Social Security information over the phone unless you initiated the phone call directly to the agency.
And finally here are some other very smart ways to stop scams:
Never click on a link within an email. I know this is a hard and fast rule, but the extra time it takes to navigate to a website outside of your email is worth your financial safety.
Don’t rush into making major financial decisions. Shop around and do your research before altering your home mortgage, making major home repairs, or changing your investments. Review all contracts until you are comfortable that you understand what you are required to do, what the other party must do, and what happens if something goes wrong. And finally, don’t hesitate to have someone else review your important documents.
Subscribe to a fraud monitoring plan. If you don’t want to fuss around with monitoring your credit or data on the web use a credit monitoring subscription instead. Companies such as LifeLock and EverSafe offer paid subscriptions that monitor your information and alert you to suspicious activity.
Set up safeguards at the bank. If someone else assists you with making purchases, consider giving them a credit or debit card with pre-set limits. Additionally, make sure your caregiver is being paid a fair wage and has fair amounts of time off- this will reduce the financial pressure on them to steal.
Create a trust. Creating a trust is a great way to have control over what happens to your assets, especially if you become incapacitated. Trusts aren’t easy to change and provide rules and limitations over who has access to your assets.
If possible, hire a team. Life is much less complicated when you have a professional accountant, financial advisor, and attorney on your side. Leave the legal and financial details to the people who keep up to date on the current federal rules and regulations.
And most importantly: Do not become isolated. No one gets through life alone. We all need a village to help more or less at certain stages of life. Just like you would have a neighbor keep an eye on your house during vacation, having a support system keeping an eye out for you is always a good thing. And you can do the same for them!
I hope this list has motivated you to reassess your financial security measures. There are so many actions that you can do today! Which one are you going to do first?
If you’re looking for an attorney who focuses on Elder Law, please don’t hesitate to reach out. It costs nothing to schedule a 15 minute consultation with the team at GALS!
