Florida Medicaid Lawyer Presentation

Neufeld, Kleinberg & Pinkiert, PA, an elder law and personal injury litigation firm
www.ElderNeedsLaw.com
Miami-Dade Broward
(305) 931-0478 | (954) 523-8292
Elder Law
Medicaid-Planning 101
Jason Neufeld, Esq.
Jason’s Story
What is elder law?
• Elder Law attorneys handle a wide range of legal
matters – affecting an older or disabled person.
– Some that you are likely familiar with: e.g.

incapacity planning, enhanced durable powers
of attorney, advanced directives, health care
surrogate, living wills, trusts, estate planning,
probate & guardianship.
– Other areas that are more niche: e.g. long-

term-care planning, Medicaid-planning, and
special needs planning.
What is Medicaid Planning?
Five Ways to Pay for Long Term Care
• Cash / Private Pay
• Medicare (but only for max 100 days, if admitted to hospital for
at least three days)
– Day 1-20 (100%)
– Day 21-100 ($167.50/day copay – as of 2018 – a good Medicare
Supplement Policy may cover this)
– After Day 100 (you are on your own)

• VA (but only meaningful for home health/ALF care)
• LTC Insurance (less than 10% have* and getting harder to
obtain)
• Medicaid
*According to the American Association for Long Term Care Insurance
What is Medicaid?
• Medicaid is Federal/State Partnership and an
umbrella term for a variety of programs (most common is
health insurance for the destitute)
• Means Tested
– Asset Test: ≤ $2,000
– Income Test: ≤ $2,250/month (as of January 2018)
But I’m too rich to qualify for Medicaid!
Medicaid Planning
• Using federal and state rules to legally and
ethically protect assets and income for
someone who may need skilled LTC.
• Institutional Care Program (ICP)
– Applicant must be medically qualified
(unable to perform 3/6 ADLs, disabled per
SSA guidelines, dementia)
– Applicant must be financially qualified
• i.e. pass the asset test ($2,000 total) & income
test ($2,250/mo).
Ethics of Medicaid Planning
Income Test
• $2,250/month (as of January, 2018)
• If income (from all sources: e.g. SSR, pension, 401k/IRA distributions,
annuity payments, etc…) exceeds this amount, fairly easy
workaround.
– filter excess through a Qualified Income Trust
(a/k/a “Miller Trust” or d4B Trust)
• Drawback – irrevocable with Medicaid payback
obligation.
Still paying attention?
Asset Test
• $2,000 total ($3,000 for a married couple)
• But some assets are exempt/non-countable:
– Homestead (up to $572,000 equity limit as of January 2018)
• Unless married, child under 21, or disabled child of any age
– 1 automobile
– Irrevocable pre-paid funeral contract
• For everyone!
– Personal property / household goods

– Life Insurance (if face value of all policies combined does not exceed $2,500)
– Income Producing Property
– DRA compliant annuities and special needs trusts
• Virtually all other assets are countable - bank accounts,

CDs, brokerage accounts, vacation homes, IRA/401k (if not in
payout mode)
So what does an elder law attorney do?
The art of the spenddown.
Medicaid planning is really the art of turning countable assets

into non-countable resources in a way that preserves and
protects the client’s estate as much as possible, so:
1. The client is well taken care of and can live the best
possible life (Medicaid doesn’t pay for everything);
2. The client’s spouse (if no need for Medicaid) is not

forced into poverty
– CSRA
– MMMNA;
3. To increase the chance that the client has something

to pass onto their heirs.
Lookback Period – 5 years
Common Misconception: If I don’t have 5 years to plan, not
worth seeking advice of an elder law attorney.
• Problem when people try to play amateur Medicaid planner:

“Kids, all that I own is now yours….now give me my Medicaid.” or
“Let me start giving each of your $15,000/year because the IRS says it is
OK.”
• Medicaid, by federal law, must look back five years (will check with
IRS, ask for bank records, run a background check) and penalize the Medicaid
applicant for any gifts or transfers for less than FMV.
Before Discussing Medicaid Strategies
The importance of an
Enhanced Durable Power of Attorney
(one size does not fit all)
Countable  Non-Countable Assets
We are going to develop a plan that can involve a
combination of the following:
• Special Needs Trusts (pooled vs. 1st party)
• Personal Services Contracts
• Annuities
• Investments aligned with estate plan
– Rentals
– Purchase Portion of Child’s Home or Business (careful if sold)
– Utilize Lady Bird Deed
• Spend money to improve quality of life

Minimize Medicaid Estate Recovery
• Medicaid asserts a lien over probatable
assets.
• Elder law attorneys will structure the
Medicaid-plan in a way that minimizes or
eliminates what your estate will need to
payback to the state.
• Pre-Planning vs. Crisis Planning
If Pre-Planning, consider intentional gifting to an Irrevocable 5-Year Trust that
distributes income only.
- money can be distributed to family members
- creditor protected (avoids risk of outright gift: divorce,
bankruptcy, putting it all on red)
My gift to you -
• As a thank you for attending this webinar:
– Free copy of my book
– $100.00 discount off of my consultation fee if you
book an appointment within 7 days of this
webinar.
• $250.00 (instead of $350.00)
• Free consultation, if I am hired to do any work.
THANK YOU! | Questions?
JASON NEUFELD, ESQ.

NEUFELD, KLEINBERG & PINKIERT, PA
MIAMI-DADE: 305.931.0478
BROWARD: 954.523.8292
WWW.ELDERNEEDSLAW.COM | ASSISTING STATEWIDE
ELDER LAW PRACTICE AREAS

MEDICAID PLANNING
INCAPACITY PLANNING (POWER OF ATTORNEY/
HEALTH CARE SURROGATE/LIVING WILL)
ESTATE PLANNING (WILLS/TRUSTS)

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Neufeld, Kleinberg & Pinkiert, PA, an elder law and personal injury litigation firm

– Some that you are likely familiar with: e.g.

– Other areas that are more niche: e.g. long-

– After Day 100 (you are on your own)

*According to the American Association for Long Term Care Insurance

But I’m too rich to qualify for Medicaid!

Ethics of Medicaid Planning

– Personal property / household goods

• Virtually all other assets are countable - bank accounts,

Medicaid planning is really the art of turning countable assets

2. The client’s spouse (if no need for Medicaid) is not

3. To increase the chance that the client has something

• Problem when people try to play amateur Medicaid planner:

• Spend money to improve quality of life

JASON NEUFELD, ESQ.

WWW.ELDERNEEDSLAW.COM | ASSISTING STATEWIDE

ELDER LAW PRACTICE AREAS

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