The Medicaid nursing home spend-down program mandated by the government has 5-year look back provisions resulting in financial devastation of senior & elderly couples and the next generation baby boomers.
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Seventy seven million (77,000,000) middle class aging baby boomers are going to rely on Medicare as their default long-term health care policy. The Cato Institute estimates that $60 trillions of Medicare is an unfunded, unaccounted for obligation.1
The Medicare / Medicaid programs are dual eligibilities government programs for the aged, the blind, and disabled, and heavy long term care users for the poor of the poorest. Medicaid is the largest liability in state budgets having topped elementary and secondary education. For 2003, total Medicaid expenditures in most states were $267 billion. Of this, Medicaid financed nursing home care accounted for approximately $51 billion and home care $9.9billion.1
The new Tax Reduction Act of 2005 mandated that seniors spend-down all of their combined assets before the sick spouse can qualify into a nursing home. The act requires a 5-year look back for any transfers by seniors designed to deprive the state of those available resources to pay for the nursing home.
What is the Nursing Home Spend-Down?
The spend-down provision is that “you must self pay” for your nursing home care with the sale of all your personal and real assets to the point of financial devastation of your life’s savings driving you into financial destitution. Nursing home eligibility will be determined by your lack of any available resources designed specifically to punish/impoverish your healthy spouse. This means that if one spouse needs private care, the other spouse needs to spend every dollar they have before the government will help with the costs!
Why is Medicaid Estate Planning Important?
The problem with the 5-year look back provision is that the new Medicare regulations do not consider the healthy spouse. It’s a social punishment of the marriage certificate. It’s a new social discrimination based on health. Eventually seniors will be forced to choose divorce for the sake of retaining their financial dignity.
What’s happening with the Medicaid Health Care System?
The gross mismanagement of the social security system is going to force baby boomers into giving serious thought about their long-term health care. There won’t be any money by the time baby boomers reach retirement age. Health care has been escalating at an alarming pace. Government planners have figured out that they can save $10 billion over the next 5 years by increasing the look back provision from 3 years to 5 years.
What’s the 5-Year Look Back for the Nursing Home Program?
Before you qualify for the government nursing home assistance program, there is a 60 month look back to see if and when you transferred your assets for less than fair cash value or you transferred your assets into a trust system or any system of transferring your wealth for the purpose of becoming eligible for the nursing home program depriving the state of all your available resources for your long-term health care.2
The Social Change at hand on home equity
According to the National Council of the Aging, 81% of America’s 13.2 million households aged 62 and over own their own homes. Seventy-four (74%) of those seniors own their homes free and clear. Altogether seniors own nearly $2trillion worth of home equity.1 You got to hand it to the government to help you figure out how to spend it.
They want you to use the equity in your home to pay for your own long-term health care! They are going to make it super-easy for you to borrow against it or “reverse mortgage” your way to creating a new government sponsored reverse mortgage industry. Based on this perceived wealth, it will not be long before government will mandate look back provisions of 10 years for most asset transfers to 20 years for real estate property.
What’s a Reverse Mortgage?
A Reverse Mortgage (RM) is a special kind of loan which can be obtained if you are at least 62 years of age (if married, the youngest must be at least 62) and own your own home, condo, or co-op. A Reverse Mortgage (RM ) converts a portion of the value (equity) of a home into instant cash. The main feature of this program is that you need not qualify for credit to obtain this loan.
The money borrowed can be in one lump sum, monthly payment, line of credit, or any combination. The Reverse Mortgage is a non-recourse loan. There’s no personal liability to the borrower, their estate, or their heirs. The house is the only collateral and the borrower does not have to make any monthly payments; it’s the reverse, the bank pays you.
What’s wrong, is that the interest charged on the loan accrues and compounds on itself accelerating the amount of equity being removed from the home, not to mention the extravagant forced fees charged when there’s no other alternative. What’s wrong with Reverse Mortgage’s is that the financial dignity of the senior will quickly evaporate, before their very eyes.
What can you do now to avoid the Government mandated confiscation of the Medicaid Nursing Home Spend-Down program?
Good planning is done when the seas are calm; it’s often too late when the seas are stormy. It has become obvious that government has outspent their income and created more money with printing presses. As a boomer myself, I just don’t like it when big brother has plans for my earnings and accumulated wealth.
The more money you throw at them the more they want, it’s a black hole of the universe. If Government wants us to buy our own long-term health care, then why not make it tax deductible. Why on form 1040 heath care costs have to exceed 7.5% of adjusted gross income. Why not make deductions for long term care insurance 100% tax deductible, or better yet why not make it affordable.
1Source: Stephen A. Moses, Cato Institute, Policy Analysis, No. 549, Aging America’s Achilles’ Heel Medicaid Long-Term Care.
2Transferring assets at less than it’s fair cash value i.e. transferring your home to your child for $100.00 is either considered a taxable gift in excess of the allowed $12,000 annual exclusion or it’s considered a “fraudulent conveyance.” See tax form 709 for gift tax consequences, see your lawyer for how to avoid fraudulent conveyance, or call Rocco Beatrice at 888-93ULTRA (888-938-5872) for a completely FREE consultation. No sales pressure, no risk and no obligations when you call.
Call Estate Street Partners toll-free at 888-93ULTRA (888-938-5872) for solid, award-winning advice on how you can plan ahead for surefire and stable Medicaid estate planning and protection.
Rocco Beatrice, CPA, MST, MBA, Managing Director, Estate Street Partners, LLC.
Mr. Beatrice is an asset protection award winning trust and estate planning expert.
What often changes the answer
After reviewing Medicaid Nursing Home Spend-Down Program: 5-Year Look Back, many people want a clearer sense of how the answer changes once real life timing, funding, and control are added to the discussion.
What usually shapes the next step
- Timing matters because transfers and look-back rules can change what is possible.
- Funding matters because a trust has to hold the right assets in the right way to work as planned.
- Control matters because Medicaid planning works best when the structure matches the family’s actual care goals.
Where readers often continue
A practical next reading path is Medicaid Irrevocable Trust, Irrevocable Trust, and FAQ. When government rules shape the decision, many readers also review official Medicaid eligibility guidance.
