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October 2014

Transferring money to a child can cause a penalty period for a Medicaid applicant if done within the five years prior to the application.  One exception to this rule is a transfer in exchange for fair market value of services.  This exception allows a parent to pay a child for taking care of him or her. 

You may ask “Don’t family members care for each other without expectation of compensation?”  The answer is yes, in most instances, and the law presumes that a child is rendering services for a parent gratuitously.  So how can one overcome this presumption?  The arrangement must be documented in a Caregiver Agreement. The Department of Social Services (“DSS”), the Connecticut agency that administers the state’s Medicaid program, recognizes payment under a Caregiver Agreement as a legitimate expense.  If there is no written contract, DSS may consider such payment a disqualifying gift.

For many people, a Caregiver contract with a parent feels awkward.  I typically hear “My mother raised and cared for me and now it is my turn to care for her.  I shouldn’t turn the care of my mother into a business arrangement”.  This sentiment is understandable.  However, many children who care for parents sacrifice time away from a job and forego earning income they need to support themselves and their own children.  Moreover, the mother would likely need a nursing home if the child did not take care of her.  Additionally, many parents can’t afford the full cost of paying for a stranger to provide homecare.  Finally, many parents would prefer to pay a child and keep the money in the family rather than pay a stranger or nursing home.  In these circumstances, a Caregiver Agreement between the child and the parent makes perfect sense.

A written Caregiver Agreement must contain all of the necessary elements of a binding contract in order to satisfy DSS.  The agreement should set forth the full scope of services and compensation to be provided.  Moreover, it should include all of the family members who are providing any type of compensable service to the parent.  Such services could include paying bills, grocery shopping, transporting the parent to medical appointments or recreational activities, providing companionship, cooking meals, house cleaning, yard work, and doing laundry.  The agreement can specify that the payments are made weekly, monthly, or in a lump sum upon request from the service provider.  If the child is uncomfortable accepting the payments, the child could collect the compensation, then set up a bank account in the child’s name and use the money as a nest egg for the parent’s benefit.  The lump sum method provides the child the option of declining to accept payment if the parent never needs to apply for Medicaid.  If the parent applies for Medicaid, the child can request the lump sum payment and reduce the parent’s countable assets and expedite the parent’s eligibility.  Regardless of the method used, the caregiver should keep good records of all services provided to justify the payments.    

Contact us if you would like to discuss in more detail how a Caregiver Agreement can benefit you and your family.

If your spouse receives a diagnosis from a doctor that she or he has dementia or Alzheimer’s Disease, it is time to consider changing your estate plan.  Why? Because if you die and your spouse needs Title 19 (Medicaid), your family could lose most of its wealth.

Let’s take an example.  Assume you and your wife have a joint investment portfolio of $300,000 and together you own a home without a mortgage.  You have a pension from work.  You have a $100,000 life insurance policy naming your wife as beneficiary. Your current Will leaves everything to your wife and together you own most of your property jointly.

One day, you accompany your wife to the doctor and the doctor informs you that your wife has early onset of dementia.   In the middle of the night you start thinking, “Who will take care of my wife if I am gone?”  Your mind immediately thinks that your children will help.  But then you recall they have their own lives.  You decide that you must set things up so it is easier for them to help your wife after you are gone. 

You set an appointment with your lawyer and ask questions about Title 19 and Medicaid.  Your lawyer tells you that after you die your wife can only have $1,600 in assets if she needs to qualify for Title 19.  Given the average cost of nursing home care in Connecticut is $11,851 per month, after you die your wife may have to spend down all of the family’s funds on her medical care to qualify for Medicaid. 

There is a better way to set up your estate plan.   We recommend that you no longer hold your property jointly and you do not name your wife as beneficiary of your life insurance policy.  Instead, all of your joint assets are retitled in your name.  Your wife signs a deed conveying the home to you.  You meet with your financial advisor to put your investment portfolio in your name.  You talk to your insurance agent to change the beneficiary to your estate, instead of your wife. Your pension will continue to provide some support to your wife after you are gone.

You sign a Will that does not give everything to your wife.  Instead, the Will states that ½ of your property goes to an income-only trust for your wife and the other ½ goes to a trust for the benefit of your descendants (i.e. – your children and the children of a deceased child). We call it a Community Spouse Will. You name your most trusted child as Executor of your Will and Trustee of the trust for your descendants under the Will. If the trust for your wife does not provide enough funds for her living expenses, then the Trustee of the trust for your descendants can distribute those funds to your children and they can tap those funds for her care.  When your wife passes away, any balance remaining in her trust goes to your descendants.  Any balance left in the trust for descendants will go to your children. 

What does a Community Spouse Will accomplish?  If you pass away, your wife will qualify for Title 19 (Medicaid) because she does not own any property and your most trusted child will manage your property for the family’s benefit.  You will rest assured that your wife can receive the care she needs and leave something for your children.