hi there.

>> I'm Sadie Johnson, the host of Life Ahead and we're welcoming you here to PBS Fort Wayne.

I love this show.

Every week we try to give you some information or some education on a topic that might help you with choices you have to make in your LIFE Ahead.

And we're going to do that now as I have two attorneys in the studio with me here, we're going to be talking mainly about Indiana Medicaid and the plan for emergencies with that situation.

>> So something that many of you might have to face in the library and I encourage you to give us a call here.

The number will be on the bottom of the screen periodically in the next half hour (969) 27 twenty and certainly we welcome any questions that you have for our attorneys this evening.

>> You'll probably recognize them.

In fact, first of all, here right next to me we have Jessica Thorson.

>> She's been on our show many times.

Jessica, welcome.

>> Hello.

Nice great to be back.

You good.

Thank you.

And Janelle's been on the show a couple of times this is Janelle Sprinkel.

>> Janelle, you're excited about this topic tonight.

You're an expert in Manti.

>> So is Jessica.

But we think we can answer some questions tonight for sure.

There you go.

See between the two of them we can we can handle whatever you have to give us here and I would encourage you if you don't mind when you call in with a question to stay on the phone with us and ask them directly that way if they need to ask you something back, you're right there.

But if you're not comfortable with that, that's OK. We have somebody in the control room answering our phones there that will take your question, keep it up on the teleprompter and send it out here in the studio to me to ask you those are the rules.

>> Nothing else sounds great and we have no commercial break.

So we go straight through here for this half hour.

All right.

Let's start, Jessica, with having you tell us the difference between Medicare and Medicaid.

>> That's confusing if you don't know it is so confusing and to have them be called such a simpler name makes it even more to know.

So Medicare is an insurance plan that you get when you turn sixty five or have been on disability benefits for more than two years.

Yeah, Medicaid is a need based program that you can get really at any age depending on what your need is and what your resources are.

>> Right.

It's a program you actually have to apply for whereas sometimes with Medicare you can be an automatic thing if you've been on disability for a couple of years, can you be on both?

>> Yes you can.

OK, and Medicare Medicaid not only as a matter of of age but you said there's need and we're going to talk about what the requirements are in a minute but it could be also young people maybe with a disability get Medicaid so it gets pretty complicated what are some of the documents estate planning documents since we usually talk about estate planning that you need to even go and apply for sure.

>> So if you're applying for yourself you can kind of handle that application on your own.

But it's always a good idea to have a durable power of attorney, agent and appointment of a health care representative because if somebody needs to apply on behalf of you then they need those documents in order to actually make that application.

They would not be able to speak to the Medicaid office without that.

>> So it's really important to get those durable power of attorney and appointment of a health care representative as soon as you can.

>> So those are the that's the difference between if you apply yourself or whether you're applying for someone else, a parent or a relative.

>> Correct.

OK, got that.

OK Janelle, why should I even consider applying for for Medicaid who's eligible and what are the benefits of Medicaid?

>> Sure I mean the benefits of Medicaid and sometimes it makes a difference between whether you can afford the the care that you need or care that you need for your loved one and not it really has a a broad reach of what it can help you with from if you're at home watching to remain at home, it can help you pay for nursing hours to have someone come in and help take care of you or a loved one if you're in an assisted living facility it can also help in that situation where it puts a cap on your expense of the room that you're staying in and your care costs and then if you're in a skilled nursing facility it really can pay a bulk of it.

You transfer your income to help pay for the facility and Medicaid can come in and help pay for the rest of everything above that.

>> So it really can be a big benefit.

OK, all right.

Let's talk about the differences between regular Medicaid or if you have if you're a VA can you get VA benefits plus Medicaid?

>> Yes, you can actually you can be on both and there are some nuances about that if you have Medicaid and you are either at home getting those nursing hours we talked about or if you're an assisted living facility then you can be having the both of them and you can be getting your full benefit from VA as well.

However, if you're in a nursing home situation then your VA benefits are reduced to nine dollars because Medicaid is paying for all of your benefits above your income.

And so since Medicaid is paying for all of those bills anyway VA then drops your income or your benefit down because you already getting all those covered .

>> You know, one of the things that I think is just really wonderful I've had to guess before that I've talked about, you know, extended living whether it's, you know, assisted living or in a nursing home or in a center that has multiple types of living I guess if you will.

>> And they've assured me well I mean to me they've assured our viewers that it doesn't matter if you're on Medicaid or not if you're in an assisted living, the staff never even knows that because some people feel like oh, I won't get as good a care or whatever because the government's paying for it, not the people.

So they won't pay that much attention to me and and they've said that's not true at all.

>> Nobody ever knows except you know, the Treasurer or whomever of the facility that you're staying there on Medicaid so you get equal care.

>> That's a good thing.

It is absolutely nothing.

Yeah, OK. All right.

Let's go back to you.

Jessica is there income limit for Medicare Medicaid?

>> There is an income limit and that number fluctuate every year.

>> It gets adjusted every year kind like hi.

It's just like Social Security.

So I did not know yeah.

>> As your Social Security kind of does that cost of living increases so does the income limit.

OK so for twenty twenty three it's around 27 hundred dollars OK and so there are a lot of people who are actually over that amount but there are workarounds for it so do mean workarounds so there is a way to kind of reduce your your income and it's by using what's known legally as a qualified income trust but a lot of people know it as a Miller Trust Miller Trust and it's just because that's the first person who ever created this particular type of thing.

>> And so what this type of trust does is it puts the income in that is over that 27 hundred dollars.

So if you had say three thousand dollars in income you would put three hundred dollars into this each month to bring your income below.

>> So is that a regular trust.

>> It's an of savings is irrevocable.

It's an irrevocable trust.

It is truly a trust but it is a special type of trust and so it is very similar in nature to a health savings account in the sense that it is geared towards medical expenses.

It is geared toward helping pay for your care costs so that Medicaid is paying for less of them.

And so you need to contriute each month to your care cost is what this is about.

>> But then it keeps you from being an eligible possibly for Medicare, right?

>> Exactly.

A good workaround in many people.

OK, that makes sense.

>> I don't like that theory.

How about in terms of qualifying financially?

>> Is there a limit you can or cannot make and what if you have a spouse that still works working but you have to go into assisted living?

>> How do you figure that financially?

>> So when it comes to the income that is something that a lot of elder law attorneys are going to spend a lot of time talking about because it can adjust your what's being earned in the home and how you're budgeting your maybe your rent or your mortgage or your utilities.

>> Yeah.

So a lot of times we will spend an entire meeting just talking about this this particular issue because if you have a spouse who has their own income, whether it's from an earned employment or if it's their own pension or their own Social Security, they're getting interest or dividends or something.

>> Correct.

We really have to kind of do a calculation to determine what type of income is going to stay in the home and what type of income needs to be paid as a liability to a nursing home facility or assisted living depending on the situation.

>> And so yes, there are all kinds of requirements and change every year.

Yes, yes.

>> In addition to, you know, Medicaid eligibility or or income limit changing so you have to be on top of this.

>> Got it.

OK, all right.

>> We have some phone calls that are beginning to come in and I appreciate them.

And again for the rest of you (969) 27 twenty is our phone number here.

>> Carmen just called in and she said we were told we need to sell my grandmother.

>> Oh, this is this is going to be a typical question.

I think we were told we need to sell my grandmother's home for nursing home services.

Is there a way to avoid this?

I hear that probably more than anything else in terms of Medicaid and nursing homes that they think they need to sell the home.

>> True.

Not true.

Who can help?

And that's kind of a loaded question because it depends on a lot of factors.

Depends on is she in a nursing home right now or are you just planning for it?

>> Does she have other assets?

We need to look at the whole of the picture.

Right that that question comes up a lot because people are very, very sentimental.

They want to protect the home.

Right.

Especially if it's a farm or something else that's been in the family for a long time.

Sure.

And so we often seek to protect the home.

That's usually one of our number one things that we're trying to do.

So I would never say yes or no just based on that one question.

It's looking at the entirety of the picture what the care costs costs are, what the timeline is.

But we would do our best to make sure that we try to work around and try to do other steps and strategies to protect that house.

>> I mean do you find, Jessica, that that's something people come in with that I don't want to say myth because there is some truth to it.

>> But but that concept that we're going to lose our home, we're going to lose our home, it is probably the most common question in elder law attorney is going to get when somebody is talking about Medicaid because it is maybe it's the house that they built 50 years ago together and they not only do they have to sort through all of those memories but then to lose something that's been so important in their lives it is definitely the number one question.

>> And so most elder law attorneys are going to work to try to save the best that they can.

>> But the sooner you can have a conversation about that the better because the you know, the more information we have, the more complete picture and the earlier we can talk about it, the more options hopefully we can present.

>> OK, all right.

Now Janelle, I'm going to ask you this another thing I hear so often is that five year look back that they're going to look back at your financial situation for the last five years and see if you've started gifting away things so that your actual income or assets look to be lower.

>> Good idea.

Not a good idea.

What's the situation with that?

>> Well, because we know that it exists because we know that they are going to look back for that standard.

I mean every day everywhere they can look back into financial records for five years.

>> Yes.

Yes.

And they are looking for exactly what you said.

Have you been giving big chunks of your assets away because we've talked about income there is an income limit but there's also an asset limit that you have to be below some people without having a strategy in place think OK, well I'm going to gift my house so I'm going to gift some money to my kids thinking well if it's not in my name I'm OK. And that is where Medicaid will say well we're going to take a look and see if you've done that.

So if you've done that they assess a penalty against you.

Well, really meaning once you already are a proof for Medicaid then depending on how much of that gifting existed and there is a number and it's somewhere I just usually round about seven thousand dollars what I just calculate in my head but no, that changes every year for every seven thousand increment that you've given away after you are approved on Medicaid then you have one additional month of paying full price for every million dollars that is you're having to pay full price for assisted living or nursing home or wherever you are.

>> Oh interesting.

Yeah.

So any way or any way you can not have that happen Jessica so there are ways to avoid it but does involve planning so not after you're already in a facility it can be when you're in a facility I think that's another common myth is that that people think that OK well we're already in the facility.

We just need to to spend everything down.

There is still some planning that can be done but the sooner you get with an attorney to talk about it the better.

Yeah.

So there is planning that can be done but it's got to be done under the advice of an attorney.

Otherwise you can run into a situation where you thought you were doing the right thing and maybe you created a little bit more complicated situation or maybe you're you're making a decision based on what you heard last year or a neighbor told you or a relative as you ladies have suggested, a lot of things change every year the parameters.

So you know, it may maybe old information that you're basing that on.

>> Can you spin down all of your assets, Jessica?

Right.

Yeah.

Janelle to make your income look lower you can that's one of your options.

You can always pay full price until you have under that asset limit and then you can can apply.

Now a lot of people come to an attorney because they prefer not to spend down all their assets.

It's it's very a nice idea to think about.

Well, I want to protect some of those assets and and that's when we come up with a strategy and we say well you can gift it in certain cases to certain people so we know where you can put some of your money depending on the timeline.

We know if we are going to use an irrevocable trust.

>> There's lots of different things we can do so that you can avoid spending all of it down if if you don't want to.

>> Yeah oh so many decisions to me.

OK, Jessica, I'm going to let you give everybody some really good advice.

You always suggest about planning what should people be doing or planning if they think that sometime in the next five years, three years, two years they might need some assisted living?

>> What should they be doing?

First and foremost get a great list of your documents and your assets documents and assets so so so we're not we're talking about actual money.

>> Yes.

And property.

Yes.

What else?

>> So truly make a good list of checking accounts, savings accounts, savings bonds, certificates, investments.

Is it an IRA or is it an annuity IRA do you have individual stock certificates as well as a brokerage account that has stocks bonds within it?

So really understanding that OK, if I have an Ameriprise or a Charles Schwab account, is that really then made up of four or five accounts or is it just one account and really understanding who owns it between you and your husband if you are married or if you if you've added a child on is that joint ownership or do they just have permission to access the account or be a signer on the account?

>> So not only knowing where the accounts are, the type of account they are and who owns it is valuable information.

What also helps is knowing beneficiaries because that comes into play for some of our some of the planning we want to still honor if we can save funds we want to still honor what your wishes were that the money or asset goes to a beneficiary.

>> Correct.

And so truly it takes time to gather all of that information so I do the best you can to keep that running list.

But if if you haven't been doing that for sure, if you're starting to think somebody needs home health care or assisted living because Medicaid can help with those things, the sooner you can kind of get yourself organized knowing those assets the better you off you will be OK. >> All right.

So planning, planning, planning and planning and and get your ducks in a row.

>> I don't know if that's a legal term but I like it.

>> OK, let's go back to you, Janelle.

>> You know, we talked about whether or not we can spend down all of our assets.

Is it too late to apply for Medicaid benefits if you're already in a nursing home or your spouse's?

>> No, not at all.

>> Never too late.

It's never too late now you know, as Jessica mentioned, we always would prefer that you an earlier sure.

>> The earlier you come in the more assets you have that you haven't already spent towards paying for that facility.

So if you've been in there a while, you've been spending down your assets to provide for that care but there's still some there and we can help you navigate you apply for Medicaid ,we can navigate do we protect these?

Do we stand down?

What's our strategy?

So it's never too late to just ask a question how can this help?

What can you do to help me?

And you know we can we can definitely help in any of those situations whether you're already in and your spouse is out or whether you're both in or however the situation is that's always it's always helpful to come and talk to an elder law attorney.

>> Well, that's good to know because I think a lot of people may be under the misconception or misperception whichever it would be that you know, once you're already in a facility it's truly a done deal.

No.

>> So not the case at all.

OK, all right.

What type of documents then are needed to apply for Medicaid?

>> Let's say it's your first first time around.

What's that like?

So it is a daunting list.

I won't I won't lie.

It is a lot of things to prove who you are.

>> So it's things like birth certificates maybe marriage certificates or death certificate really you need all of those you need all those things Social Security cards, photo I.D.

insurance card.

>> So it's really sort of just kind of basic identification type of documents but then a lot of people will come into one myth that they've heard is well I've heard Medicaid goes back three months and so what that really means is if I were to apply in the month of August, Medicaid will ask for proof of my assets for the last three months they're looking to see if we were eligible for anything else to see if we did any transactions to hurry up and get us ready for Medicaid.

And so yes, they're going to ask for financial statements three months prior to when you apply what's the difference between that and a five year look back?

>> Well, so with the five year look back when you apply you are asked very specifically have you made any transfers OK in the last five years?

>> Yeah.

And so you are required to disclose those things they if you have they're then going to ask follow up questions and and want documents to prove those things.

>> I see.

OK, all right.

Not confusing at all but the thing is you have to tell the truth or you have to pay that penalty which might be a whole month's care.

>> Yeah yeah.

More or more yes.

Yes.

We've had people who have generously given money to a child for not not to hide assets, not to get ready for Medicaid and not for any of those reasons but just to provide them to help buy a car or they're down on their luck whatever the reason is which is just lovely and you can do that.

>> But Medicaid will still hold that look at.

>> Yes, yes.

Yes.

So it is nice to have a strategy before you do something that if it has happened which it has in many cases it's not it's not a stop to you applying for Medicaid.

It's just something that we we work in to the strategy and work around.

>> And so our strategy is is kind of a key word here and we don't mean doing anything illegal.

Oh no.

Because you know, your guide your clients are in that way but it's it's just finding I don't want to say loopholes.

>> That's not correct.

>> What's a good word which is accurate?

Well, we're working within within the rules and the regulations and so to your advantage of crossable, correct?

>> Yeah.

And in some cases it's just helping someone through it and you see there's lots of answers and it changes and it depends on someone's assets.

So it's just having someone who is knowledgeable in that area navigate you through.

Right.

And not everybody is I mean most people unless they've already been through it don't understand it themselves.

>> Right.

And as you've heard our attorneys say that things change regularly whether it's you know, an asset financial Limmud or laws that might change what happens if you don't want Medicaid at all?

>> What should you be doing anything special?

We'll start with you, Jessica.

>> So if you never want to go on Medicaid and I understand that unfortunately some people have no choice in that but the sooner than you start planning for those expenses the better.

So I would be working with a financial advisor to make sure that I was thinking of those care costs.

There are a lot of really good products out there.

There is still long term care insurance and there's lots of variables to that.

Perhaps you were a veteran and you're not fully aware of what benefits are available to you through through the those are a lot.

A lot yeah.

And so really truly trying to think about how you can self pay and plan for those expenses if you don't if you don't want to end up on Medicaid.

>> Got it.

OK any any good advice is nearing the end of our show that she'd like to share Janelle with our viewers again that might counteract any myths that people generally have.

>> Yes actually and this is back to the question that we got about saving the home because a lot of times we are ask and this is even outside that penalty maybe it's we still have more than five years and the question is should I did my house to the kid?

>> Oh, right.

Right.

And it sounds like a great idea, right?

You're getting it out of your name five years go by.

You know that doesn't count towards your penalty the problem there's a couple of problems to that and it's the biggest one is that it's no longer your house so you can't control that.

You can't sell it when you want to.

You're because it's not your home you don't get the homestead exemption and that reduces your state taxes.

>> So you're your own real estate taxes go up but then if your children are gifted that house during their lives they have to pay capital gains when they sell it to them.

That's different than if they had inherited it.

So it raises your taxes, it raises their taxes and it can create a penalty.

You're in the five years and then you don't own your home.

So if you can't mortgage it or get a line of credit or any other thing you would do if you owned the home.

>> So there's a lot of negatives to doing it.

It sounds like it.

We have another phone call I want to get to you very quickly.

I'll leave this for you to answer Jessica again just in about a minute if you want called in and she says what if you already have Medicare?

Why do you have to even consider Medicaid?

>> You may never need to consider Medicaid but when you may need to consider Medicaid is if you're needing home health care because Medicare will only pay for home health care for a short period of time.

Medicare generally has no or limited benefits for long term care in a nursing so they'll pay for rehab for a period of time.

Most people know of the hundred days but beyond that Medicare won't pay for that room and board at a nursing home and there is no Medicare benefit for assisted living.

>> Oh OK. >> So so if you are to be just maybe so many days of care after surgery or something when you're released from the hospital you can go to a facility with Medicare helping.

>> Yes.

Yes.

I hope that helped you want and so then that's the answer.

You know you don't have to if you feel like you're in a good situation financially.

>> Well, I hope that you've all learned some significant things I have here as we've been talking about Medicaid and Medicare and next of course we'll have a new topic a new guest.

>> Meanwhile, Jessica Genel, thank you for being with us.

You're staying healthy and stay safe and I'll see you next week