Category Archives: Medicaid

Should I be Paid to Care for My Parents?

By Attorney Elizabeth Durnell

Have you ever considered paying your children to care for you?  Have you ever considered being paid to care for your parents?

There is a new trend in Nursing Home Medicaid planning, in which parents pay their children to care for them, even after they enter a Nursing Home.

In 2009, the Wall Street Journal published an article by Victoria E. Knight entitled “Relative Can Be Paid To Look After Elderly”.  Following is an exerpt from that article:

Caring for a family member is a responsibility many people bear. It can also be a source of income.

So-called "caregiver agreements" — formal contracts under which relatives are hired to care for elderly family members — have been around for a while. But with the economic downturn, more families may be open to entering into such arrangements, some attorneys and caregiver advocates say.

Financial transfers made under a caregiver agreement generally aren't considered gifts, an important consideration if an elderly person later hopes to qualify for Medicaid, the joint federal/state program that covers nursing-home care. The contracts can also provide assurances to other family members about the cost and quality of care being delivered and reward caregivers for the long hours they put in. The agreements need to be carefully crafted, and there are tax consequences.

To an aging parent, the idea of being cared for by a trusted family member may be appealing. And for those who want to stay in their own homes, or need to because they can't sell their property to fund entry into a continuing-care retirement community, hiring a relative can be a money-saving strategy.

For adult children who have more time to devote to mom or dad, such arrangements can provide a modest source of income — or at least cover expenses they incur in providing care — at a time when many families are struggling.

In recent years, caregiver agreements have grown in popularity as a Medicaid planning tool because they can reduce the size of an estate, according to Louis Jay Ulman, a senior principal at Offit Kurman, a law firm with offices in the Baltimore-Washington corridor. That's because a rule change extended the look-back period for making gifts to family members to five years from three.

If properly set up, transfers made under a caregiver agreement aren't considered gifts but rather compensation because they are payments made in return for a service, lawyers say.

Please note the beginning of the last paragraph: “If properly set up.”  There are many specific and complex legal requirements to set up these arrangements.  If done incorrectly, it could cost you and your family time, money and added risk that your loved one will not qualify for benefits as an improper transfer.  If you are interested in learning more about caregiver agreements, it is imperative you contact an Elder Law Attorney.

What Do I Do If I Receive a Letter from the Attorney General Demanding Payment for My Parent’s Nursing Home Bill?

By Daneen Cline

One of our clients, Janet*, entered a nursing home when she was 79 years old. She had been widowed for several years and her 2 children spent her assets on her care before applying for public benefits. When Janet passed away, she had been receiving benefits for only 7 months.

Within 3 months of her death her son received a notice from an attorney, acting as special counsel of the Ohio Attorney General. The notice stated that the State of Ohio was pursuing estate recovery of the $63,875 they had spent on Janet’s care.

Estate Recovery is the program that recovers monies spent by the State of Ohio on a person’s care. The concept is that they will pay for your care during your lifetime and then recover as much of the money back as possible from the estate after your death. Any individual who receives any form of public benefits and is over the age of 55 is subject to Estate Recovery.

Janet’s son wasn’t overly concerned, his mother’s assets had been limited to the amount in her checking account at the time of her death and a life estate interest in a home. He wrote a check for $642, the amount in her checking account, and sent it to the attorney. He didn’t think the life estate was an issue so he didn’t mention it. The Department of Job & Family Services had never considered it to be an asset so it never crossed his mind that the Ohio Attorney General would consider it to be an asset.

A few months passed, he never heard from the attorney again and he forgot about the entire episode. His sister and he listed the home for sale and it went under contract very quickly. Then the title company handling the sale called him, their title search had discovered a lien on the property. The lien had been placed by the State of Ohio for the amount of $63,233 as part of the Estate Recovery program. Janet’s son made a few phone calls and discovered that the lien was valid but that the amount the State of Ohio was actually due couldn’t exceed his mother’s life estate interest. In the end, a check was written to the State of Ohio for $31,000 at the property closing.

Had Janet’s son consulted with a qualified Elder Law Attorney when he was first notified that Estate Recovery against his mother’s estate had begun, he would have discovered that the State of Ohio now has the right to place liens on any interest a person holds in real estate at their death. He also would have discovered that these liens can usually be negotiated for a reduced amount.

The State of Ohio has led the nation in monies recovered through the Estate Recovery Program. They are very good at it and are becoming increasingly aggressive. This isn’t a program that is going to go away, so it is important to consider the ramification of estate recovery in any asset preservation plan you may have.

*(names are not real)

The 800-Pound Piano: Medicaid Estate Recovery in Ohio

By Dan Vu

As the attorney handling our firm’s estate recovery cases, I am often asked, “How long does the State have to collect on my parent’s estate?” or “Isn’t there a statute of limitations for the State to recover these assets?” The answer will many times surprise them. The Ohio Attorney General, who administers Ohio’s estate recovery, has maintained that they have no statute of limitations and that they can collect on a parent’s non-probate estate FOREVER.  And for those of you who have seen the movie The Sandlot, I am sure you mouthed that slowly with me.  Yes, forever. The Ohio Attorney General argues that even ten years after a Medicaid recipient has passed away, the State could recover from the beneficiaries any amount distributed to them from the Medicaid recipient’s estate.

To make a clarification, this is for the Medicaid recipients NON-probate estate. For their probate estate, there is a definite time period for the Attorney General to submit a claim. For assets in probate court, the Attorney General must make a claim or lose their claim against those assets. However, for those who have had some estate planning done, most if not all of their assets avoid probate. This is done for many good reasons. On the other hand, this places an 800-pound piano hanging over the beneficiaries’ heads forever. This strikes most people as patently unfair. And in my opinion, it is unfair. For the rest of us, we have a certain time period to settle on our affairs. For example, if you hit my car and I wait 10 years to sue you, I will be laughed out of court! But for the Ohio Attorney General, when they sue a beneficiary years after the Medicaid recipient has passed, the only one laughing will be the Attorney General.

All of this can be upsetting, but don’t stop reading. There is some good news! The trend in Ohio has been to rectify these unfair and unjust laws that allow the State to collect on a debt indefinitely.  The Ohio Legislature passed House Bill 390. This bill set a statute of limitations for the Ohio Attorney General to collect on certain tax debts. This was a major blow to the Ohio Attorney General’s revenue recovery office. No longer could the Ohio Attorney General wait 10 years before making its first attempt to collect on an alleged tax debt. The same needs to happen for Ohio’s Medicaid Estate Recovery Program. But if this does not occur because of legislative action, the courts may be doing it themselves.

In the Eight Appellate District in Ohio, the Ohio Attorney General has recently lost a very important case. In this case, In re Estate of Centorbi, the Court held that the Ohio Attorney General has one year to present an estate recovery claim. That means the Ohio Attorney General must send out a letter notifying the beneficiaries of its Medicaid recovery claim within one year of the Medicaid recipient’s death. This is a major victory for beneficiaries. No longer will they be blind sided by a Medicaid claim years after the Medicaid recipient has passed. Of course this is not a full victory yet. This ruling is only binding in the Eight Appellate District of Ohio. It certainly is a persuasive precedent in other districts, but each district will have the final say until the Ohio Supreme Court ways in. In light of this, I personally asked the Assistant Attorney General managing Ohio’s Estate Recovery Program whether he would willing to abide by that ruling elsewhere in Ohio. Surprise, the answer was … NO! Furthermore, this ruling is not a complete victory because it does not address the fact that the Attorney General still has forever collect on a claim once it is timely made. So Ohio still has a lot further to go in this regards. But the trend has started in both the legislature and in the courts. Lets hope it continues.

If you receive a letter from the Ohio Attorney General, call our office for a free consultation.

Worried about taking care of aging parents?

Over half of all Americans say they worry about taking care of their aging parents. Katie Couric says both parties should sit down and have an honest talk about the future.

Navigating Medicare and Medicaid options are mind-numbing and helping our parents live out their lives can be completely overwhelming. Don’t bare the financial burden of your parents medical expenses. A consultation with an Elder Law attorney can help you and your parents plan for the future.

You Don’t Have to Spend Down Your Life Savings to Pay for a Nursing Home

By Attorney Elizabeth Durnell

Screen shot 2009-12-17 at 1.27.42 PMA few weeks ago, Judy and Gary came into the office to discuss how to pay the nursing home bill they are anticipating for Judy’s father, George.  George has been slowing down and can no longer be cared for at home.  George’ doctor is recommending they place him in a nursing home.   George’s estate is close to $300,000, and he worked a lifetime to build it.  He wants it to go to his family, not the State of Ohio.

Here’s the problem:  Judy and Gary understand that an individual must have less than $1500 in assets to have their benefits paid.  Judy and Gary are worried that they must spend down all of George’s money for his care before Medicaid will begin to pay the bill, or they must keep George at home until all of his money is spent.

This is a common misconception in nursing home planning: you have to spend all your money before Medicaid will pay.

The main focus of my work at Cooper Elder Law involves nursing home planning.  I often meet with the families of clients who will need to make gifts in order to qualify for Medicaid benefits and share the same worries as Judy and Gary.

The good news is, there is hope for these families.  When a person makes a gift during the “look-back period,” which is the five years before a person is admitted to a nursing home, the person is placed on a Restricted Medicaid Coverage Period.  During the Restricted Period, Medicaid will not pay for the person’s room and board at the nursing home.  So, for George, this does not mean that he can’t live in a nursing home, it only means that he must pay privately for his care until the Restricted Period is over.

The Restricted Medicaid Period does not mean that you must pay for all expenses out of your pocket.   Medicaid may cover services such as emergency room visits, ambulance services, hospital stays, surgery and anesthesia, if medically necessary.  Medicaid may also pay for medical equipment such as wheelchairs, hospital beds, orthotics and prosthetics, diabetic supplies, canes, walkers and crutches, lifts, colostomy supplies and oxygen supplies.  Finally, although there are some limitations, the following services are available as well: doctors visits, lab testing and x-rays, occupational therapy, speech therapy, physical therapy and hearing services.  Prescription drug coverage may also be provided by Medicare Part D.

If you or a loved one develops a condition that may mean a nursing home is in your future, you should consult with an elder law attorney who can help you understand the rules that apply to Medicaid.  This is not a good choice for do-it-yourself.  You need to understand the complex rules that Medicaid has developed in order to protect the work of a lifetime.

Putting the Medicaid “look-back period” in to perspective

By Attorney Renee Fox

As many of you know in order to qualify for Medicaid and have the State pay for your nursing home stay as a general rule a single person must spend down their assets to a meager $1,500 plus a car. Further, they will “look-back” five years from the date of your application to see if you have made any gifts or transfers to others. If so, that will be counted as part of your assets.

Recently, I sat in on a question and answer session with a newly married couple in their late fifties. This was a second marriage for both of them.

The discussion with our newly weds was centered on protecting their assets should they go into a nursing home.  Skeptical Husband dismissed the notion that this was even important at this time in their lives. He had a large estate and stated he would just private pay the nursing home out of his pocket if anything happened to him (but he was convinced nothing would happen because he was young and healthy). Seeing that Ohio’s average monthly cost for nursing homes is over $6,000, I thought this was a pretty bold statement. Happy Wife, on the other hand, had a much different take on the subject. She felt her home, worth a few hundred thousand dollars, was certainly worth protecting from Medicaid and was something that needed completed now. She wanted it done now so that her five year “look-back” clock would start ticking now should catastrophic illness strike.

Medicaid_June 2009-thumb-320x240You may be wondering how these newly weds could be on such totally opposite pages? Well, here is the difference. Wife had lost her first husband to illness. Also, she herself had a battle with colon cancer. She recognized that illness and disease could strike at any time and render you incapacitated. She understood that even at a young age, it was not too soon to protect her home. If she set up that trust today her five year clock for “look-back” would begin running. Husband had not had any such experience and had a completely different perspective.

My advice is to be proactive; it is never too early to think about how you can protect your stuff!  Call us when you’re ready.

Attention: Medicare Beneficiaries Medicare Premiums, Deductibles and Copayments for 2010

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  • Basic Part B premium: $110.50/month (was $96.40) (But most beneficiaries will not pay this increase due to a “hold-harmless” provision in the Medicare law prohibiting Part B premiums from rising more than that year’s cost of living increase in Social Security benefits. Part B deductible: $155 (was $135)

  • Part A deductible: $1,100 (was $1,068)

  • Co-payment for hospital stay days 61-90: $275/day (was $267)

  • Co-payment for hospital stay days 91 and beyond: $550/day (was $534)

  • Skilled nursing facility co-payment, days 21-100: $137.50/day (was $133.50)

Premiums for higher-income beneficiaries:

  • Individuals with annual incomes between $85,000 and $107,000 and married couples with annual incomes between $170,000 and $214,000 in 2010 will pay a monthly premium of $154.70.

  • Individuals with annual incomes between $107,000 and $160,000 and married couples with annual incomes between $214,000 and $320,000 in 2010 will pay a monthly premium of $221.

  • Individuals with annual incomes between $160,000 and $214,000 and married couples with annual incomes between $320,000 and $428,000 in 2010 will pay a monthly premium of $287.30.

  • Individuals with annual incomes of $214,000 or more and married couples with annual incomes of $428,000 or more in 2010 will pay a monthly premium of $353.60.

Rates differ for beneficiaries who are married but file a separate tax return from their spouse:

  • Those with incomes between $85,000 and $128,000 will pay a monthly premium of $287.30.

  • Those with incomes greater than $128,000 will pay a monthly premium of $353.60.

For more information please visit www.ohioinsurance.gov, www.medicare.gov or call our office at 800-798-5297.

Taken in part from ElderLawAnswers.com”

Monopoly and the Game of Life

In 1934, Charles B. Darrow of Germantown, Pennsylvania, presented a game called MONOPOLY to the executives at Parker Brothers. Like many American at the time of the “Great Depression,” Mr. Darrow was unemployed, and simply created the game as an escape to amuse himself and pass the time. With the help of a friend who was a printer Mr. Darrow sold 5,000 sets of the game at a Philadelphia department store before he gained the attention of Parker Brothers in 1935. The game is now the leading proprietary game in the United States, sold in 80 countries, and published in 26 different languages.


The game is so popular because it is catches the American spirit of hard work and Capitalism, and allows folks from all different walks of life to prove that in the right circumstance and with a little luck they can be a champion of industry. The object of the game as defined by Parker Brothers is “to become the wealthiest player through buying, renting and selling property.” At the beginning of the game each player visits the Banker and the Banker gives them $1500.00 divided through various denominations. The challenge is to then grow that $1500.00 into a small fortune.


One of the reasons that I enjoy playing Monopoly is that it presents you with realistic challenges similar to what I now face as a working parent. As a youngster I was always convinced that if I could win the game of Monopoly I would also be successful as an adult. For me, the tensest time of the game is the beginning because you basically start with nothing. The $1500.00 that the banker gives you is seed money and your early decisions are critical because there is no room for error.


In a recent family game I was the banker and began by giving each player their $1500.00. It was my 70 year old mother who immediately complained that I had not given her enough money. I was forced to consult the rule book and proved my mom wrong. Her response was “how in the world do you expect me to survive, or have any fun with just $1500.00.” It then struck me that she was saying the same thing that thousands of other seniors in Ohio are saying who are not playing the game of Monopoly but embattled in a medical crisis.


In Monopoly you start with $1500.00 and in the State of Ohio if you unfortunately get the wrong illness and go to a Nursing Home for care you will end up only $1500.00. I always felt Monopoly dealt with most challenges I would face prior to my retirement. You can buy things, sell things, pay rent, charge rent, pay income taxes, mortgage property, open businesses, get free parking, and even go to jail. But the one glairing exception is that even the game of Monopoly doesn’t deal with illness or the catastrophic cost associated with a long term care situation.


Each day seniors in Ohio are forced to spend down their entire life savings including their home before the State of Ohio will lend any financial assistance. The worst part is that the rules of Monopoly are clear but the rules associated with Medicaid are not. The need to spend down before receiving assistance is not the complete story. In most cases a complete spend down can be avoided. The problem is that you must get good competent advice from your advisors. There is one law for the informed and another law for the uninformed. The more you understand the rules of Monopoly the better you will become at playing the game. Ohio is well informed how the rules work to their advantage and the public needs to do the same. A good advisor will asses the entire situation which includes the benefit of a healthy spouse, the children who are disabled or who serve as care givers, the types of savings accumulated, as well as the types of income generated through work history or savings. I would encourage every senior or person close to retirement to visit with an attorney who practices in the area of Nursing Home planning and who is familiar with the continuing care benefit programs available, whether they are available through the State of Ohio or the Veterans Association.


The game of Monopoly ends when you are declared bankrupt which means you owe more than you can pay to another player or the bank. Ohio has adopted the rules of Monopoly and will only assist you when you owe more than you can pay to the Nursing Home. Dealing with the unexpected high cost of Nursing Home care is often viewed as a loser’s game, but like Monopoly not every situation has to end in bankruptcy. Get advice and know the rules. We can help you protect yourself and your loved ones.


Please continue to explore our website for information regarding one of our monthly informational workshops, or call our office to schedule an appointment for a complimentary consultation with one of our attorneys in regards to your personal situation.

Enjoy your IRA so Ohio doesn’t!

A family recently visited our office to find out how to pay for home health care.

George and Sarah* have been married for 55 years. Sarah suffers severe rheumatoid arthritis that is so severe she must use a walker. To make matters worse, she recently fell and broke two ribs. George is doing his best to keep Sarah at home, but at age 79, Sarah’s care is beginning to take its toll on him. George is trying to find home health care aides to assist him with her care. He does not want to put Sarah, the love of his life, in a nursing home.

At wits end, George visited a local County Agency to inquire about benefits for Sarah. They informed George that although Sarah qualified for care medically, he had too much money to qualify. The county suggested that George spend down his retirement account to $20,000 and buy a new car to replace his 5-year-old car and he should qualify.

George asked what we could do to help. He told us that it would be very difficult to maintain his quality of life if he only had $20,000, and perhaps the thought of a new car would be appealing if he were sixteen years old, but his Buick only had 37,000 miles on it – he liked it just fine.

We began with a review of their assets using the same criteria the County used. They have a nice home, the 5-year-old Buick Century, a few CDs, and a large retirement account from George’s former employer.

In reviewing George’s dilemma, we determined that if we would create income, or a pension, with his retirement account – one he could not outlive – he would qualify for benefits and keep his Buick. We knew that if George turned his lump sum IRA into a guaranteed income stream, the State of Ohio would look at this as income, not as an asset; this income would be George’s and therefore not counted in determining Sarah’s eligibility for benefits.

We converted George’s IRA to income so that he could maintain his lifestyle while qualifying Sarah qualified for Home Health Care benefits the following month. We are happy to report that George is able to keep Sarah at home, right where they want her to be.

*(not their real names)

Blood from a Turnip: An Estate Recovery Case Study

By Daneen Cline


One of our clients, Janet*, entered a nursing home when she was 79 years old. She had been widowed for several years and her 2 children spent her assets on her care before applying for public benefits. When Janet passed away, she had been receiving benefits for only 7 months.

Within 3 months of her death her son received a notice from an attorney, acting as special counsel of the Ohio Attorney General. The notice stated that the State of Ohio was pursuing estate recovery of the $63,875 they had spent on Janet’s care.

Estate Recovery is the program that recovers monies spent by the State of Ohio on a person’s care. The concept is that they will pay for your care during your lifetime and then recover as much of the money back as possible from the estate after your death. Any individual who receives any form of public benefits and is over the age of 55 is subject to Estate Recovery.

Janet’s son wasn’t overly concerned, his mother’s assets had been limited to the amount in her checking account at the time of her death and a life estate interest in a home. He wrote a check for $642, the amount in her checking account, and sent it to the attorney. He didn’t think the life estate was an issue so he didn’t mention it. The Department of Job & Family Services had never considered it to be an asset so it never crossed his mind that the Ohio Attorney General would consider it to be an asset.

A few months passed, he never heard from the attorney again and he forgot about the entire episode. His sister and he listed the home for sale and it went under contract very quickly. Then the title company handling the sale called him, their title search had discovered a lien on the property. The lien had been placed by the State of Ohio for the amount of $63,233 as part of the Estate Recovery program. Janet’s son made a few phone calls and discovered that the lien was valid but that the amount the State of Ohio was actually due couldn’t exceed his mother’s life estate interest. In the end, a check was written to the State of Ohio for $31,000 at the property closing.

Had Janet’s son consulted with a qualified Elder Law Attorney when he was first notified that Estate Recovery against his mother’s estate had begun, he would have discovered that the State of Ohio now has the right to place liens on any interest a person holds in real estate at their death. He also would have discovered that these liens can usually be negotiated for a reduced amount.

The State of Ohio has led the nation in monies recovered through the Estate Recovery Program. They are very good at it and are becoming increasingly aggressive. This isn’t a program that is going to go away, so it is important to consider the ramification of estate recovery in any asset preservation plan you may have.

*(names are not real)



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