Category Archives: Medicaid

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


  • 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, or call our office at 800-798-5297.

Taken in part from”

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)

Keeping the Family Farm …

By Attorney Thom L. Cooper

In our practice we have a number of farm clients. A consistently high priority for these clients is making sure that the farm stays in the family. Typical characteristics of our farm clients: (1) They have worked hard all of their lives and plowed most of the profits from the farming operation back into improvements, equipment and purchasing additional ground. (2) They tend to be asset rich and cash poor. (3) They are good businessmen with respect to their farming operations. (4) They have also given a great deal of thought about how the farm should be passed to their heirs.
HOWEVER, one of the things many farmers rarely consider is the impact to the farm of a catastrophic health situation, like a nursing home stay. Many times our farmers have heard that the farm is “an exempt asset” and therefore not subject “sale” or “spend down”.
While it is true that the farm is an exempt asset if it is associated with the home, the farm is not protected from Ohio Estate Recovery Liens. Estate Recovery Liens are placed on a farm for the amount the government pays for any nursing home care or in-home medical care and related services. For example, if the farmer’s wife would go into a nursing home and the government pays $6,000 per month for four years for her care, a $288,000 lien is attached to the farmer’s property.
There are ways to avoid these liens but preplanning is essential now more than ever. If you are interested in learning more about how to make sure your farm is not subject to one of these liens and stays in your family, you are invited to come in for a free consultation where we will discuss the techniques available to save your farm.

Case Study: Gifting Done Wrong

By Daneen Cline

Louise is 78 and has been a resident in a nursing home for 18 months. Her daughter, Pat, has spent all of Louise’s assets to pay for her care and knows that she now must make a medicaid application for her mother. The nursing home provides Pat with the application form and a list of documents she will need, but she must attend the face to face interview with the caseworker at the Department of Job & Family Services. She assembles the required documents, meets with the caseworker and is surprised to find that she is pleasant, seems to understand the situation Louise is in and wants to help. After the caseworker gathers all the information about Louise’s assets she asks about any asset transfers Louise made in the past 5 years. Pat tells her that almost 3 years ago her mother gave each of her 4 grandchildren $30,000 as a gift. At the end of the appointment the caseworker told Pat that her mother was financially eligible for public assistance but the gifts she had made were considered to be improper transfers and because of them, the State of Ohio wouldn’t pay her nursing home bill for 24 months.
As a result, Pat was forced to move Louise to the County Home with the cost being covered by Louise and her daughter Pat.
Louise made one of the most common mistakes there is, she gifted money without knowing what the consequences would be if a health situation occurred. Public Assistance regulations do allow for gifting, but there are penalties associated with them. To gift assets successfully it is important to know what those penalties are and how and when they will be applied. Before gifting is done, a qualified Elder Law Attorney should be consulted to implement a plan that takes into consideration the possibility of a health crisis as well as one that conforms to the necessary regulations.

Ohio House Speaker Advocates Nursing Home Planning

In a June 4, 2009 Cleveland Plain Dealer Article, Ohio Speaker of the House Armond Budish advocates that Ohioans utilize nursing home planning to save their assets. Budish likens nursing home planning to tax planning as a way for seniors to save their assets. Budish states that, “It puts a greater burden on the government, but there is nothing wrong with doing it because the law allows it. . . . Congress recognized that people shouldn’t lose their savings before being covered by Medicaid and that’s why it created the options to move assets. People should be able to avail themselves of the protections that Congress has set up.”

Read full article

If you would like to follow Speaker Budish’s advice to preserve your assets, our firm can help.

The attorneys at The Thom L. Cooper Co. have the experience and expertise to answer all of your questions relating to Elder Law and Estate Planning, including:

- Will I outlive my money if I need nursing home or assisted living care?
- How can I get veterans benefits or other benefits to pay nursing home costs / assisted living costs?
- Do I need long-term care insurance?
- How can I avoid paying too much in taxes?
- What are the best ways to preserve my assets?
- How can I leave the most to my children and grandchildren without losing control of my finances?

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