216 Higgins Road Park Ridge, IL, 60068 (847) 221-0154
Problem: We recommend that our clients seek to purchase long term care insurance. But, what happens if it cannot be purchased either due to unaffordable costs or underwriting prohibitions? Solution: Medicaid is the only federal governmental program that will pay for long-term care. This will require using some of your own funds in order to properly pay your way at a long term care facility, but if planned for properly, will not result in the use of all of your funds. Therefore, in order to access the Medicaid program in Illinois, one must take some of the following steps in order to become eligible. Be aware, this is a very complex area of planning, but these initial steps should be an overview of what you need to do to begin the process. You would be wise to consult with an Illinois elder law attorney who focuses in this type of asset protection work.
  1. Revise Powers of Attorney
First, revise any powers of attorney for property and health care that you currently have. Most of the powers of attorney that we see in our office, while valid, are inadequate to allow the necessary repositioning and reclassification of assets to gain eligibility to Medicaid, VA, and other governmental benefits.
  1. Contact a Physician
If the senior has mental competency issues, then perhaps contacting a physician to determine whether or not the senior has the requisite mental capacity to execute new estate planning documents is essential. It is unethical to have a senior sign anything that they don’t have the capability of understanding.
  1. Seek Guardianship
This step is a last resort, but may be necessary in some cases, if no powers of attorney can be executed due to diminished mental capacity.
  1. Revise Old Wills and Trusts
Revising old wills and trusts is also essential. Most wills and trusts are nothing but death plans. But, when you’re looking to gain eligibility for Medicaid for long-term care, the documents must reflect the authorization of handling long-term care planning matters rather than just distribution of assets and a death.
  1. Create a Blueprint
The next step, which is useful to seniors, and the family members that are supporting them, (and boomers that are beginning to ponder the long-term care journey), is to create a blueprint.  This blueprint will consist of breaking down considerations into life’s 3 main phases: preplanning, wait-and-see planning, and crisis planning. Preplanning is done when there is plenty of time to plan, waitand-see planning is done when there is a diagnosis, but you are not forced to leave home for long-term care, and crisis planning is when you must seek a higher level of care in an institutional facility of some type. Quite often, after the blueprint is done and steps one through four are completed, there is nothing further to do until the situation becomes more escalated and a higher level of care may be needed by the senior or boomer, who may migrate to a crisis planning stage.
  1. Inventory Assets
Assuming that we need a higher level of care, we need to continue the work that we did in steps one through five and take the next step, which is set up work necessary to inventory assets and get an understanding of asset ownership, beneficiary designations, and ability to convert to cash in order to pay for long-term care expenses, at least for some period of time.
  1. Seek Placement in a Facility
The next step, assuming that a higher level of care is to be delivered, is to seek placement in a facility. There are many kinds of facilities, such as, independent living facilities, assisted living facilities, supportive living facilities, and nursing homes, and continuing care retirement communities (CCRC’s). I am pleased to say that, for the most part, we see these business entities delivering good care to most of our seniors. Like any other business entity some of their business contracts are fair and others are unscrupulous. It is necessary for you to have a lawyer familiar with these types of contracts to be sure that, from a legal standpoint, whatever you are signing is acceptable. Remember, some of these contracts can require you to pay $10,000 a month and may unnecessarily impose financial liability on children and other signers of these contracts.
  1. Select a Strategy
The next task is to select a strategy which will allow the senior or boomer to legally and ethically reposition his or her asset(s).  This opens up eligibility for the Medicaid benefit in Illinois without spending down to the paltry statutory level of $2,000 of assets. Remember without further planning, Illinois expects you to rely on $2,000 for the rest of your life. This is impossible because some of our seniors enter long-term care at the age of 67 and may remain in long-term care for the next 20 years. It would be nice to have more than a mere $2,000 to buy the TVs, radios, bathrobes and slippers, hearing aids, and eyeglasses that make life more tolerable.
  1. Prepare and File the Medicaid Application
The next step is to prepare and select a time, after the implementation of all asset protection strategies, to file the actual Medicaid application, which fully documents all transactions over the last 60 months. In some cases this can be very demanding task as some seniors lose documentation and forget about transactions and assets.
  1. Prepare for the Post Application Audit
The next step is to prepare for the post application audit by the State of Illinois staff members and be ready to file an appeal in the event the state objects to anything you have presented in the application. Also be ready on an annual basis to respond to the state’s request in what is called their annual redetermination process (REDE). Summary: I hope this gives you a simplistic view about how to qualify for Illinois Medicaid while using Medicaid asset protection strategies. Most clients are trying to preserve some assets and they are entitled to do so as a matter of exercising their civil rights as long as they do this legally and ethically. This planning is not done by wealthy individuals, as they can pay their way through any costs associated with long-term care. Rather, this planning is best done by middle class individuals who have worked to accumulate some savings only to find that the cost of long-term care make their life’s work disappear in no time. Our goal, as asset protection attorneys for the middle class, is to allow seniors to gain access to the Medicaid program. Although this requires clients to use some of their own assets for their cost of long-term care, it also enables them to preserve some of their assets.  Therefore, in their senior years, after a lifetime of work, they are entitled to some dignity and some resources to make a life in a nursing home more livable. Anthony B. Ferraro BS-MSTax-CPA-JD
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  As we have written in the past, for many years estate planning was driven primarily by estate tax minimization. Now with the estate tax exemption at $5.43 million per person, there are very few middle class individuals that need to worry about federal state tax and their estate plan. Does that mean that no estate planning is necessary for the middle class? Absolutely not. Instead, with this freedom from the need to focus on the estate tax planning, there are plenty of opportunities and resources to focus on matters that are far more important than taxes. Listed below are the areas that deserve more attention and have not received enough focus in the past. Middle class taxpayers can start focusing on the following areas:
  1. Creditor Protection:
Creditor protection can focus on the individual client and also the following generation to fulfill the client’s wish to leave a financial legacy. For example, in planning for the next generation, parents work very hard to deliver a financial legacy. But what happens when, upon their death, their children are embroiled in a divorce, a bankruptcy, or a lawsuit with a large damages claims brought against them? Therefore, no matter how hard you have worked to leave wealth for your children, that wealth can evaporate in a moment based on the uncontrollable events that take place in your children’s lives.
  1. Selection of Fiduciaries:
Selecting someone to act in matters pertaining to powers of attorney for property, powers of attorney for health, trustee selection, or executor selection, all bring with them a host of pros and cons. Do you know what the pros and cons are? You should before you start making those important appointments in your documents. Have you spoken to a trust company that may do a better job than family members?
  1. Income Tax Impact is Now Front and Center:
Now that the estate tax is less of an issue for most middle class taxpayers, taxpayers can rightfully start focusing on other matters of importance. For example, on income tax basis step-up (or step-down) issues for purposes of future sales of appreciating property. Also, consider reducing the so-called 3.8% Medicare surtax on investment income such as dividend, interest and capital gains.
  1. Second Marriage Planning:
Proper attention must be given to matters pertaining to second marriages and threading the needle between providing for the new spouse while still leaving a financial legacy for children from the prior marriage. There a lot of good options, some funded by financial products, that can be valuable in situations such as this.
  1. Business Succession Planning:
Trying to equalize inheritances associated with cases where some children are involved in a family business but others are not requires, again, threading the needle in a way in which multiple parties with diverse interests can be made to feel that they were dealt with fairly.
  1. Long-Term Care Planning:
With advances in medical science allowing many of us to live longer and healthier lives, the question becomes how to plan for not only what happens when we die, but, what happens if we don’t die, until living a long life, but with the devastating expense of long term care? While the simple answer is for you to obtain long-term care insurance, it is not the only answer. As a matter of fact, due to increasing premiums and difficult underwriting standards, many people will have to look for other solutions in planning for long-term care. Related to the area of long-term care planning are matters pertaining to special-needs planning, matters of elder abuse, related financial services (especially dealing with Social Security elections), IRA and 401k retirement elections, and Medicaid asset protection planning against long-term care costs. So, for the middle class, estate planning remains alive and well. The focus has changed from estate taxation into other, and in my opinion, more important matters.      
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1. The Problematic Situation You represent the personal representative of an estate where the decedent made one person their joint tenant on real property, accounts, stocks, or other assets. It becomes clear upon reading the decedent’s will, which was prepared after the creation of the joint tenancy accounts, that the decedent did not actually intend for the co-tenant to take a 100% beneficial interest in the property at the decedent’s death. Rather through the prior conversations with the co-tenant and others, the decedent was merely trying to avoid the probate process and wanted to assign the responsibility for the re-distribution of the jointly owned assets to one person: the surviving joint-tenant. Unfortunately, the decedent may not have realized or may have forgotten that when the first co-owner of joint tenancy property passes away, the surviving joint tenant takes title to 100% of the legal and beneficial interests in the jointly owned property. This may create an unintended consequence where the surviving joint tenant wishes to “normalize” the inherited assets and redistribute them among the beneficiaries stated, for example, in the decedent’s will. The unintended consequence is that the surviving joint tenant will incur gift taxes (and possible estate taxes if the interest passed is large enough), upon distributing the inherited assets to the intended beneficiaries. One possibility for mitigating the burden on the surviving joint tenant is to argue that the assets were in fact held in a “resulting trust.” 2. Illinois Law Under Illinois law a resulting trust can be created by operation of law when property is transferred to a person who did not pay for the property, and it is implied that that person hold the property for the benefit of another person. Resulting trusts should not to be confused with “constructive trusts,” even though they are both judicially imposed “trusts.” A constructive trust arises when a wrongdoer party has taken title to property rightfully owned by another. That party is then ordered to transfer the property back to the rightful owner. In a resulting trust, however, the party vested with the mistakenly inherited assets (for example a surviving joint tenant) is acting like a mere trustee,  and did not commit any wrongdoing to obtain title to the property. Under Illinois law, a resulting trust is a trust created by operation of law based on the intent of parties.[i] Resulting trusts arise when property is bought with the money of one person, but the title is taken in the name of another.[ii] The creator of the resulting trust must not intend to give the recipient a present interest.[iii] Illinois law further provides that although there is a presumption that transfers between family members are gifts, the presumption can be overcome by showing the intentions of the family members.[iv] If the property was (1) purchased solely with the creator’s own funds, (2) the recipient did not contribute to the taxes, management, or maintenance for the property, or (3) the property was put in joint tenancy for the purpose of probate avoidance, these factors contribute to overcoming the presumption of a gift.[v] The recipient’s understanding of the arrangement is also a factor that Illinois courts consider.[vi] If the recipient believed that she had no present interest in the property that, along with the other factors, contributes to the court’s finding a resulting trust.[vii] When a resulting trust is established, the recipient has title to the property in name only and is acting instead as a trustee.  (Emphasis added).[viii] 3. Practical Applications So, what are the practical applications of the use of the resulting trust? The first application relates to the elimination of potential gift taxes when the unintended sole beneficiary, the surviving joint tenant, wishes to reallocate or redistribute the assets to the true intended beneficiaries of the decedent’s estate as expressed.  In these cases, I think it may be possible to make a resulting trust argument to the IRS.  I think the resulting trust argument would apply specifically in cases where the personal representative of the estate was listed as a joint owner on assets belonging to the decedent, despite the fact that the personal representative did not contribute any of their own money towards the purchase of the assets, nor did the personal representative assist in their maintenance or pay any of the taxes on the property. This application and argument is further bolstered by evidence that the decedent (a relative) who passed away had expressed during his lifetime that he did not want his estate to go through probate, but merely wanted the personal representative to handle distributions to other family members, for example, in a well-executed will subsequent to the creation of the joint tenancy. We all know that gratuitous transfers will be viewed as gifts from the transferor, thereby either causing gift taxes to be paid or, at a minimum, creating a charge against their lifetime exclusion amount, assuming that the gift exceeds the annual exclusion amount.  Thus, we believe that by arguing for a resulting trust, we will be able to spare the surviving joint tenant from incurring the unwanted gift taxes, or perhaps estate tax at death, by gratuitously re-conveying the assets received through joint tenancy to the intended beneficiaries described in the decedent’s will that a decedent may subsequently have prepared after creating the “temporary” or “convenience-type” joint tenancy asset with the surviving joint tenant. A second application may arise in the handling of matters pertaining to the elderly. One may use the resulting trust argument to posit to the state Medicaid agencies that an asset held by a Medicaid applicant is not a “countable asset” because it is being held merely in a resulting trust. Of course, some practitioners of Medicaid eligibility law will argue: “Why not just make a complete return of the asset prior to application?” The implication of this argument is that the asset will be out of the Medicaid applicant’s estate; thus, no problem with ineligibility. Generally, I would agree with this line of argument, but, there are some assets that cannot be returned at least on a timely basis. Sometimes Medicaid eligibility is something that is required immediately with greater urgency because of lack of other funds. Furthermore, practitioners of Medicaid eligibility should be aware of the potential counter-argument by the State Medicaid agency that indicates that any asset held by the Medicaid applicant that is available, but is instead disclaimed or transferred without compensation, will result in a possible penalty for uncompensated transfers. While practitioners are well aware of this prohibition, the essence of the resulting trust argument is that the Medicaid applicant was never intended to be in possession of this asset or countable resource in the first place, thus creating the resulting trust and thus eliminating the need for a disclaimer or a compensated transfer. 4. Conclusion In conclusion, one hopes that both the IRS and Illinois state Medicaid agency can see and agree to practical applications and usage of the resulting trust argument: 1) for avoidance of IRS imposed gift taxes on the re-distribution of assets inadvertently held by the surviving joint tenant taxpayer who erroneously came into title through joint tenancy, and 2) in the avoidance of having a State Medicaid agency consider an asset inadvertently acquired by operation of law to be a countable asset for Medicaid eligibility purposes and thereby delaying or preventing the eligibility that a senior needs. [i] Suwalski v. Suwalski, 40 Ill. 2d 492, 495 (1968). [ii] Id. [iii] In re Estate of Wilson, 81 Ill.2d 349, 355 (1980). [iv] See In re Estate of Koch, 297 Ill. App. 3d 786, 789 (1998) [v] Ludwig v. Ludwig, 413 Ill. 43, 52 (1952). [vi] Id. [vii] Id.  [viii] In re Estate of Koch, 297 Ill. App. 3d at 789.
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During your stay in a hospital, your doctor and the staff must work with you to help plan for discharge from the hospital.  Your input is an important part of creating a comprehensive plan for what happens after you leave the hospital setting and enter long term care.  The following questions come from a document called “Your Discharge Planning Checklist” from the Centers for Medicare and Medicaid Services.  We recommend using this and other checklists in working with the hospital’s staff before discharge. During your stay in a hospital, your doctor and the staff must work with you to help plan for discharge from the hospital. Your input is an important part of creating a comprehensive plan for what happens to you after you leave the hospital setting and enter long term care. The following questions come from a document called “Your Discharge Planning Checklist” from the Centers for Medicare and Medicaid Services. We recommend using this and other checklists in working with the hospital’s staff before discharge. The following questions are important considerations as you prepare to leave the hospital:
  •  Where will you receive care after discharge?
  •  Who will be helping you in the transition from the hospital to long-term care?
  •  What is the current status of your health? What can you do to improve it?
  •  What potential problems should you be aware of with regards to your health? Is there someone you could call if these problems do arise?
  •  Do you need medical equipment (like a walker)?
In addition, we strongly recommend doing the following in preparation for discharge from the hospital:
  •   Create “My Drug List” to write down any prescription drugs, over the counter drugs, vitamins, and herbal supplements that you need to take, along with the dosage and other pertinent information.
  •  Ask for written discharge instructions and a summary of your current health status. Bring this information, along with your complete “My Drug List” to follow up appointments.
  •  Talk to a social worker or a representative from your health plan to determine what your insurance will cover and how much you will have to pay.
  •  Talk to an elder law attorney if you do not know how your long term care will be covered:
        -Long Term Care Insurance? Not many people have it.
        -Private Pay? This can cost over $8,000 a month!
        -Medicare? Does not cover long term care in a nursing home or assisted living facility.
        -Medicaid? This covers long term care, but you must take planning steps to qualify based on your assets and income.
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For your information, Anthony B. Ferraro was elected President of the Illinois Chapter of NAELA, the National Association of Elder Law Attorneys. Congratulations to him.
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For years, estate planners have done what is considered traditional estate planning. They drafted plans primarily concerned with minimizing future estate tax liability and gave minimal attention to income tax consequences. This was perfectly fine years ago when the estate tax was much more severe than the potential for income tax. This was attributable to relatively high estate tax rates, low estate tax exemption that was not indexed for inflation, and comparatively low capital gains rates. Recently, however, Congress has tinkered with the tax system in a huge way. Accordingly, the income tax impact of estate planning is taking on greater significance. More attention is directed towards the importance of income tax basis considerations in estate planning due to the narrowing between the estate tax rates and the income tax rates. In fact, in most estates worth less than $10.5 million, estate taxes are no longer an issue. Now, income taxes loom large, primarily because of the lack of attention on the income tax basis (i.e. cost or adjusted basis) of capital assets. The bad news for most middle-class taxpayers is that for years they’ve been fed a steady diet of estate tax minimizing wills and trusts. Worse yet, they hang onto these outdated documents for many years, thinking they are done with their estate planning and not wanting to be bothered. Sadly, these old documents will no longer serve their intended purpose: estate tax minimization. While there will be no estate tax savings with these documents, because very few middle-class taxpayers will ever pay estate tax, the documents will unnecessarily increase income taxes for their heirs upon the liquidation of any assets. Bottom line:  the game starts anew. Let’s focus on income tax minimization for most taxpayers and forget about estate tax minimization. Unless your estate is worth $10.5 million or more as a couple (or $5.34 million as a single person), your biggest risk is overpaying income taxes due to inattention to income tax basis planning in your wills and trusts.  Don’t make that mistake. Review your documents today.
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You know the kinds of wills I’m talking about. The husband leaves everything to the wife, the wife leaves everything to the husband, and after they both die, everything goes to the children. This works well for situations in which the spouses are healthy one day and deceased the next. However, as most of us know, life doesn’t usually happen that way anymore. Some research indicates that 69% of individuals over 65 will require some kind of long-term care in their lifetimes. Thus, many spouses worry that if they predecease a disabled spouse who is currently in a nursing home or will require long-term care at some point in the near future, there will be insufficient funds available to provide for the institutionalized spouses’ needs. This is an especially relevant concern for expenses that are not covered under Medicaid, like a care manager, private nurse, single room, and certain therapies or drugs. Another concern is that the availability of funds from “I love you” wills and trusts will disqualify the surviving ill spouse from eligibility for Medicaid benefits. As you know from prior articles, Medicaid is the only long-term-care governmental program in the United States. Medicare does not cover long-term custodial care. To solve this problem many of our clients rely on a “testamentary trust:” a trust built into the will of each spouse. For many estate planners, this is counterintuitive because much estate planning occurs within the context of a revocable living trust. In order to preserve access to Medicaid eligibility without requiring that the surviving spouse spend down the assets and lose the chance to maintain a “rainy day fund,” creating a testamentary trust in the will of the pre-deceasing spouse is essential. What this means is that around age 55, you have to completely revise your wills and trusts to accommodate a different paradigm of thought. The thinking process is no longer what happens if I die? Rather, the question is what happens if I don’t die and live a long time with expensive long-term care. The new paradigm requires a new estate plan. If you consider yourself middle-class (meaning that your net worth will be significantly impacted by the cost of long-term care for you and/or your spouse) and are over age 55, I suggest that you revise your estate plan to reflect this newer paradigm as soon as possible.
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Remember that a Revocable Living Trust is like a door or an open box; things can come both in and out. The next type of trust that I want to explain is the Irrevocable Living Trust (IRLT). The irrevocable living trust differs from the revocable living trust (RLT) because once something is put into the IRLT, it is permanently there. Imagine that instead of a door that can be opened in an RLT, an IRLT is like a door that has been permanently locked. If you decide to put all of your assets in an irrevocable living trust and you need to get to them one day, you will have a big problem. Another way of putting it is is that it is like a box that can be locked. You’re probably asking yourself “well, why would anyone want to use an irrevocable living trust then?” The truth is, an IRLT is commonly used because it has asset protection, while an RLT does not. So, since many of us want some control over our assets, IRLTs and RLTs are generally created to work simultaneously. One example of a commonly used IRLT is a Medicaid Asset Protection Trust (MAPT). This special type of trust is used by people who need or will need to pay nursing home costs, but want to protect some their assets from being spent-down. In order to utilize this type of trust though, you must have enough money to potentially private-pay for long-term care during the entire 5-year penalty period. But sometimes, you can use this strategy and not have to be able to private pay for 5 years! Stay tuned to explore more options. -Anthony B. Ferraro
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Attention! Many of today’s Americans are under the assumption that VA Benefits only apply to servicemen and women who were injured or disabled while serving.  VA Benefits do largely apply to those men and women; however, there are also other VA benefits available to wartime veterans who are senior citizens currently paying for long-term care.  Wartime veterans have earned this right simply by serving our country, even if they were not injured during their time of service. Note, wartime veterans and their spouses who do not have disabilities as a result of serving are eligible for the Special Monthly Pension benefit when they are 65 and older, permanently disabled and unable to work, homebound, or in need of regular aid of another person.  The Special Monthly Pension benefit is based on the need for financial assistance, so there are income and asset limitations. If any of the above situations apply to you, I recommend getting the necessary paper work ready in order to prove you qualify for such benefits.  This may require a doctor’s visit or paperwork from the nursing home or assisted living facility stating that you or your loved one is permanently disabled. -Anthony B. Ferraro
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Financial institutions like banks are now demanding up-to-date documents when dealing with both powers of attorney and revocable living trusts. This impacts Medicaid and long term care. If you have a power of attorney for property, it probably says that your loved one can act on your behalf as your agent.  But because Medicaid has very complicated rules, someone acting on your behalf may need to make changes to the way your assets are held.  Typical power of attorneys or property do not allow your agent to make changes to your estate plan or create other documents that can protect you and your healthy spouse from going broke because of long term care costs. One thing many traditional estate planning attorneys are doing for married couples is creating a joint revocable living trust, which often transforms itself into an irrevocable trust when one spouse becomes disabled.  Once this happens, the healthy spouse would not be allowed to make changes in the way the assets are held; thus forcing the healthy spouse to spend an excessive amount of assets to care for the ill spouse before he or she can qualify for Medicaid.  This is something we elder law attorneys want to prevent from happening. Nobody wants to be out of money.  Our job as elder attorneys is to help you receive quality healthcare and preserve your options.   Thus, your plan should be updated to ensure absolute solvency if possible, legally and ethically.  This includes a power of attorney that allows your agent to be able to take very special actions to protect you and your loved ones financially. Please contact me today if you would like me to review your current documents to make sure you have the protection you deserve. -Anthony B. Ferraro
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Hopefully by now you understand the basics on what a trust is, so we are going to look at one of the most common types of trusts, the Revocable Living Trust.  The easiest way to remember what exactly this is by remembering that “revocable” means you can change your mind, so like the meaning of the word, you can make changes to the trust. A revocable living trust is like a door.  Things go in and things go out.  For example, if today you open a checking account, it can go in the trust.  Another few months go by, and you open a savings account.  Then you decide to buy some stock in your favorite company.  You can put it all in the name of the trust. But what if you need to take something out of the trust?  That’s why it’s a good thing that this kind of trust is like a door!  You can take an asset out if you need to. Additionally, if you suddenly pass away, so long as your trust has written instructions to your successor trustee, your family should not have to go through probate after you die because your trust is holding all of your assets securely. Remember though, that this is not the only kind of trust available to you.  Revocable living trusts do not have any asset protection, and that may be something you need if you need long-term care, for example. More on other types of trusts to follow. -Anthony B. Ferraro
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