1. MEDICAID: HOW TO MANAGE THE COST OF STAYING IN A NURSING HOME Alzheimer's Association-West Michigan P. Haans Mulder Cunningham Dalman, P.C. 321 Settlers Road Holland, MI 49423 (616) 392-1821 phmulder@holland-law.com

2. Background Grew up in Holland Attorney and Partner at Cunningham Dalman, P.C. Masters in Tax, CFP®, and specialize in estates/elder law and business planning Serving the Holland area since 1900

3. Background Cunningham Dalman, P.C. is located in Holland and has been serving the greater Holland/Zeeland since 1900 We have 14 attorneys specializing in all areas of the law Serving the Holland area since 1900

4. Overview Discuss the Medicaid process Talk about the Medicaid eligibility rules Cover recent new developments and changes in the Medicaid rules Serving the Holland area since 1900

5. What is Medicaid? State and federal program that pays for medical treatment (including nursing home care) Oftentimes confused with Medicare Serving the Holland area since 1900

6. When does Medicaid apply? Must be in a nursing home or be in certain counties that have the MI Choice Waiver program Waiver program provides care in a person’s home and may cover residential facilities Serving the Holland area since 1900

7. Who does Medicaid apply to? Applies to people who are 65 years or older, blind, or disabled Must satisfy the medical requirements (have level of care assessment done) Must meet income and asset tests Serving the Holland area since 1900

8. Who does Medicaid apply to? You cannot have enough income to pay the monthly cost of staying in a nursing home ($6-7,000 in this area) Cannot earn more than $2,022/month for the MI Choice Waiver program Serving the Holland area since 1900

9. Who does Medicaid apply to? Asset test requires that a single person cannot have more than $2,000 in countable assets Can keep your home (it’s not in your trust) and a vehicle Serving the Holland area since 1900

10. Who does Medicaid apply to? Asset test allows a married couple to keep their home (again, if it’s not in a trust), a vehicle, and one-half of their other assets Serving the Holland area since 1900

11. Where do you apply? Apply for Medicaid at the Department of Human Services (DHS) DHS offices are located in each county Apply to the county office that the nursing home is located Serving the Holland area since 1900

12. Example Clients were husband and wife Drafted an estate plan for them A couple years later, the wife’s health declined significantly and had to go to a nursing home Serving the Holland area since 1900

13. Example She didn’t stay in a hospital for three days so Medicare didn’t cover any of the stay at the nursing home They had a house, vehicle, and investments Serving the Holland area since 1900

14. Example Could keep the house (because it was properly owned) and their vehicle Without any Medicaid planning, they would have had to spend down one-half of their investments Serving the Holland area since 1900

15. Example Drafted a trust that allowed them to protect all of their investments (as opposed to just half) This provided peace of mind to the husband Serving the Holland area since 1900

16. New Developments-House If the house is in your trust, it becomes a countable asset If it’s in your individual name, it will go through probate Probate could subject your house to the Medicaid lien Serving the Holland area since 1900

17. New Developments-House Don’t have enough cash to pay the costs of maintaining the house House can be rented to pay these costs Evaluate whether it’s economically feasible Serving the Holland area since 1900

18. New Developments-Long Delays Process normally took 45-60 days State of Michigan budget cuts have led to long delays This becomes very problematic if the Medicaid application is denied Serving the Holland area since 1900

19. New Developments-Technology New computer system has caused problems Make sure to understand what the Medicaid notices really mean Serving the Holland area since 1900

20. Questions…… Serving the Holland area since 1900

21. Thank You P. Haans Mulder Cunningham Dalman, P.C. 321 Settlers Road Holland, MI 49423 (616) 392-1821 phmulder@holland-law.com www.holland-law.com Serving the Holland area since 1900