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Can A Trust Help You Plan for Long-Term Care?

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October 17, 2023 •  Emily Hicks Law, PLLC
Long-term care costs can wipe out savings for retirement. Here's how a trust can help you plan for long-term care costs.

Navigating Medicaid Planning and Irrevocable Trusts for Long-Term Care: What You Need to Know

Long-term care, particularly in the form of nursing home expenses, can pose a significant financial challenge for retirees and those nearing retirement. The high costs associated with long-term care, often running into thousands of dollars per month for extended periods, can keep many individuals awake at night, worrying about how to afford it. In such situations, the absence of long-term care insurance can be a regret, leaving retirees to explore alternatives like Medicaid.

Medicaid, a federal-state entitlement program, can provide a fallback option for long-term care. However, to qualify for Medicaid, individuals must meet strict asset thresholds, often limited to no more than $2,000 in countable assets in most states. This limitation can create financial hurdles, but some planning strategies, such as creating irrevocable trusts, can help individuals navigate the complex landscape of Medicaid and long-term care financing.

Understanding Irrevocable Trusts for Medicaid Planning

Irrevocable trusts are a valuable tool in Medicaid planning, allowing individuals to protect some of their assets from being counted towards the Medicaid eligibility threshold. The fundamental idea is to transfer assets into an irrevocable trust at least five years before applying for Medicaid. Medicaid, under its rules, does not consider these assets when determining eligibility, provided the planning is executed correctly.

However, creating an irrevocable trust for Medicaid planning must be done with care and precision. If executed incorrectly, it can jeopardize Medicaid eligibility and disrupt financial plans, including tax considerations.

When to Start Medicaid Planning with Irrevocable Trusts

A common question in Medicaid planning is, "When is the right time to start?" According to experts, individuals interested in Medicaid planning should consider initiating the process in their mid-to-late 60s or early 70s. The timing is crucial because of Medicaid's lookback period, which is typically five years for both nursing home and home care. Any transfer of countable assets made within the preceding five years of applying for Medicaid can result in a penalty period, during which individuals have to cover their care costs using other means.

Transferring assets in one's mid-to-late 60s or early 70s increases the chances of satisfying the five-year lookback period, statistically speaking, and avoiding a penalty period. Additionally, most 60-year-olds are often hesitant to part with their assets, making this age range more practical for Medicaid planning.

Advantages of Using Irrevocable Trusts

While there are alternatives like outright gifts to children or other beneficiaries, irrevocable trusts are often the preferred choice for Medicaid planning. Several advantages make trusts a better option:

  1. Asset Protection: Irrevocable trusts prevent beneficiaries from squandering the assets, protecting them from potential misuse.
  2. Creditor Protection: Trusts shield assets from the claims of beneficiaries' creditors, safeguarding them from financial vulnerabilities.
  3. Divorce Protection: In the event of a beneficiary's divorce, assets in the trust are not considered marital property, preventing former spouses from claiming a share.

The Design of the Irrevocable Trust

Creating an irrevocable trust involves careful design, considering the conflicting objectives of Medicaid and IRS rules. The goal is to have Medicaid exclude the assets transferred to the trust while allowing the IRS to consider them as still owned by the individual for tax purposes. Achieving both goals is possible by granting the settlor a limited power of appointment to change the beneficiaries of the trust.

This action does not affect the gift to the trust for Medicaid purposes but prevents a completed gift from occurring for tax purposes, enabling a basis step-up at death. However, the rules governing irrevocable trusts can vary among Medicaid agencies, necessitating a thorough understanding of the specific agency's approach to such trusts.

The Role of a Comprehensive Team

Medicaid trust planning is a complex process that requires collaboration among professionals. An attorney experienced in elder law and Medicaid planning, a financial planner, and a CPA often form a comprehensive team to ensure the planning is executed correctly and does not adversely affect the individual's financial and tax plans.

In some cases, individuals may choose to place their primary residence in the irrevocable trust, which can preserve the Sec. 121(a) gain exclusion while allowing them to live in the home for the rest of their lives. However, if the trust is not meticulously designed, it can lead to unintended consequences, including tax issues and liquidity problems.

In summary, Medicaid planning with irrevocable trusts can provide a valuable strategy for individuals concerned about affording long-term care. However, this planning requires careful execution and the expertise of a well-rounded team to ensure it aligns with an individual's goals and financial situation while securing Medicaid eligibility.

Reference: Journal of Accountancy (October 9, 2023): Long-term-care planning using trusts

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