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.
For the past year and a half, I have done almost all of my holiday gift shopping online. Which is great- until I need to return something. For those of you who read the blog and our newsletter, you know I love to share my life hacks, so I wanted to introduce you to my favorite new local business, noted. Thanks to entrepreneur Alexis Jones, I’ve been able to return items on a tight deadline and clear out items I’ve had in a donation pile for far too long, without even leaving my house!
With the holiday gift giving season upon us, no doubt there will be a flurry of returns soon. Noted, returns with heart stands by its name and agreed to share some ideas that your gift recipients won’t want to return. But in case you do need to make a return, say goodbye to those post-holiday return lines, misplaced gift receipts, and lack of time. Create a way to make this holiday season a success for you and all those around you by scheduling your return with noted.
-April
It’s Beginning to Look Like Return Season – A Holiday Gift Giving Guide for 2021
Christmas shopping is right around the corner, and that is just another way of saying “yikes!” Just kidding! I’m not saying that Christmas shopping is exactly bad. We all know Black Friday is its own fun experience. What I’m bashing is gift receipts, return policies, and disappointed looks from family and friends.
When I was in elementary school, there was a holiday gift shop at school with gifts ranging from $1 to $5, and I WISH we could bring that back. However, that is not an option.
With the holiday season approaching, everyone works to find that oh-so-perfect gift for the people around them and sometimes we’ll come up a little short. I figured now’s the time to enlighten y’all on some alternative ways to shop for others without the stress! Not to mention avoiding those crazy Black Friday hours AND lines.
This the season for gift giving and giving back to the community. Photo by Annie Spratt on Unsplash
Holiday Gift Card Galore
You see the word gift card and immediately want to shut me down. Give me a chance to explain. Please. No, gift cards are not a cop-out. Over the years, it has become a thing that if you give a monetary card, that one barely knows them or is playing it safe. Hello? If you pick the store that you KNOW an individual loves most, how is that something to be upset about?
For the last 6-7 years, my grandma has given us a can of pringles (family tradition for 15+years) then hand selects a gift card tailored to each grandkids taste. This can range from Target to Fandango, and even car washes!
Just as much thought and effort go into this as hand picking a wrapped present. This is a gift that genuinely can make anyone around you feel loved and understood, as long as effort still goes into it. Do not just gift everyone a Walmart one and call it a day. Take a bit of time to think it through. Not to mention, you can purchase gift cards online and eliminate in-person shopping altogether. Plus, the pressure to go out to busy stores and drive through the snow hunting for weeks straight is eliminated.
A gift card almost guarantees that the person gifted the card will be able to find the perfect thing they want. Expect a joyful thank you note following the holidays sharing with you what they purchased. You know the expression. Think smarter, not harder.
Gift a Dinner Date this Holiday Season
A personal favorite of mine during the holidays is giving the gift of a meal. To be honest with y’all, I enjoy gifting more than receiving because the awkward “oh thank you” after receiving an underwhelming gift is really hard for me to fake. I cannot imagine how hard it is for others when you miss the nail.
That is why I started to treat those in my life to a meal out. No one is ever going to turn down a meal. To make sure the meal happens, I usually include a card and a couple restaurant options. This is not just a short-term present but an experience. You can share the season with someone who means something to you. The whole shebang. Pick up the person you gifted. Dress for the occasion and make sure they understand money is no option. (If you are the one being gifted this, maybe don’t order lobster). Encourage them to order a cocktail or a glass of wine, and especially dessert!
Okay, so return season, right? This is a gift that is IMPOSSIBLE to give back. Sure, I suppose the gift receiver could not follow through so YOU need to be intentional about this meal. A flawless way to avoid the uncomfortable gift received vibe, do not overlook a nice meal, and a way to steer clear of return season.
Support a family owned restaurant and gift a relaxing evening to someone you love! Photo by Zoe on Unsplash
Full Family Fun
Gift cards and dinner dates work great for those one-on-one scenarios, but what about a couple options for the whole family. My parents often gifted us one gift from Santa that we would share. One year it was the Wii, and another year a BB gun. This year, my mom called me and asked what I would be doing in the afternoon on December 26th. She did not give me any details, but she planned something for my whole family to go out and do. It is an experience!
Nashville has so many activities in the area that are not only family geared, but also an affordable price for a family gift. A few that come to mind include, a tour of the Grand Ole Opry, Music City Hall of Fame, and The Nashville Zoo, which I made an effort to see when I came to town last May.
Find a day over the kid’s holiday break, to pull everyone away from their electronics, toys, and the television. Load them into the van and keep it all a surprise! Spend the morning or afternoon exploring a new part of town or a store they love. End the outing with a family favorite ice cream shop! If it’s still cold out, hit up a place with the best hot chocolate with whipped cream and chocolate sauce on top.
Not every gift has to be unwrapped, so this is a great way to show the family the memories are priceless. There is excitement in unwrapping gifts, so if you want to let the kids know in advance the trip they are going on, here’s a tip. Print a picture of where you are taking them or a receipt. Fold it up into tiny pieces and place it in a box. Wrap the box up with holiday paper after that! Repeat the process until you are convinced it will take them long enough to open it up. Yeah, this is a bit silly, but it keeps the present unwrapping fun intact.
The Most Wonderful Time of the Year
The holiday season is like no other. Birthdays are one thing but gifting in December is on a whole other level. The pressure of giving correctly is never-ending. The possibilities of a gift card, dinner dates, and an experience are simple ways to clean up that fear. None of these are things anyone would ever want to return!
We’ve been talking about Medicare for a few weeks now, but we haven’t gotten to the how-tos yet. That’s about to change. Today we dig into how you actually enroll in Medicare.
To sign up for Part A, go to the Social Security Administration’s Medicare portal here. It will be helpful to set up an account for when you come back to sign up for Part B or when you are ready to begin receiving retirement benefits.
If you are signing up for Parts A and B, the process is the same. You’ll sign up through the Social Security Administration’s website. Remember that if you enroll for Part B, your premiums will either be deducted from your Social Security retirement payment or you will receive a bill. The 2021 Part B premium is $148.50 for most people.
If you are looking for a Medicare Advantage plan, Part D, or a Supplement (Medigap) plan, you will want to compare plan options using a plan comparison service. There are insurance brokers like Kendall Chanley and Harry Perret here in town who can help you compare options and narrow things down. Once done, they will get you signed up. These services are free to you and it’s nice to have one agent who can help you each year.
If you prefer to do things yourself or just want to do some exploring, Medicare.gov will allow you to find plans in your area and narrow them down based on what you are looking for and price ranges. I recommend filtering plans by the star ratings (four or above) and then whether you are looking for dental, vision, and prescription medicine access.
Once you make it through your first enrollment period at age 65 (ideally), you’ll be eligible for open enrollment each year from October 15th through December 7th. You may also have options to select coverage during a special enrollment period if you lose other coverage.
Applying for Medicare isn’t nearly as scary as it sounds, but it does require advanced planning and research. You don’t want any deadlines sneaking up on you! Personally, I love using reminders on my calendar well in advance of any deadlines that I have. Maybe one to begin research, one to call an expert, one to compare plans, one to sign up….all before your birthday or November.
What’s your plan for Medicare enrollment? Head to our Facebook page to share your plans in the comments!
