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May 2019

According to the AARP, just over half (52%) of the people in the U.S. who reach age 65 will need long-term care in their lifetime. And, with nursing home care costing about $12,000 a month, a stay in a nursing home can quickly drain the resources of even the most careful planner.

If you have researched how to qualify for Medicaid, you have learned about the five-year lookback period. The five-year lookback means that if you gift assets in the five years prior to applying for Medicaid, your ability to collect Medicaid can be delayed. So what’s a family to do if a senior has a sudden incapacitating illness such as a stroke or heart attack? How do you get help paying for nursing home care without running afoul of the law?

Fortunately, there are some ways to transfer assets that do not negatively impact Medicaid eligibility. One of those is purchasing a Single Premium Immediate Annuity for the spouse living at home (aka the community spouse). Properly structured, this annuity functions as a spend-down tool that eliminates excess countable assets, allowing the nursing home resident to become eligible for Medicaid benefits. Single premium means that the annuity is funded with one lump sum paid into it. Immediate means that payments from the annuity start immediately as opposed to some point in the future. To assure that the annuity doesn’t count as a transfer of assets, the Single Premium Immediate Annuity must be irrevocable (you can’t change your mind) and non-assignable (you can’t transfer it to anyone).

The Single Premium Immediate Annuity must be actuarially sound which means that the term of the annuity must be less than the life expectancy of the community spouse and the payments must at least equal the cost of the annuity. The annuity payments cannot exceed the life expectancy of the spouse based on Social Security tables. Single Premium Immediate Annuities cannot have balloon payments and the State must be named primary beneficiary with a child or other loved one as successor beneficiary. Additionally, a Single Premium Immediate Annuity is purchased after the date of institutionalization (DOI) but before applying for Medicaid. The date of institutionalization is the date that the spouse entering the nursing home was admitted to a hospital or nursing home for a 30-day period.

 

Example of How a Single Premium Immediate Annuity Protects Your Assets

Jim (age 80) and Sarah (age 76) have been married for over 50 years when Jim has a stroke. He survives but needs to be cared for around the clock. Sarah can’t take care of him so they reluctantly decide he needs to go into a nursing home.

Jim and Sarah have done their best to plan for retirement. At the time of the stroke, Jim has $2,000 monthly income and Sarah has $1,500 monthly income. They have a house and a car that are paid off and $250,000 in investments.

Jim’s nursing home costs $12,000 per month. Since the value of Jim and Sarah’s assets exceed the maximum to qualify for Medicaid, they will need to reduce their countable assets to become eligible. 

The first thing they need to do is figure out how much in assets Sarah can keep and how much they need to put into investments that are Medicaid compliant. The Community Spouse Protected Amount (CSPA) is the amount of assets Sarah can keep and enable Jim to be eligible for Medicaid. The maximum CSPA in 2019 is $126,420 and Jim can keep $1,600 for a total of $128,020.  Thus, Jim and Sarah are $121,980 over assets ($250,000 - $128,020 = $121,980).

After Jim goes into the nursing home and before applying for Title 19, Sarah purchases a Single Premium Immediate Annuity for $120,000 and they spend down the additional $1,980 on a prepaid funeral contract.  They name the State as primary beneficiary and their two children as successor beneficiaries.

Jim and Sarah apply for Title 19 after purchasing the Single Premium Immediate Annuity and disclose the annuity on their application. The Connecticut Dept. of Social Services (DSS) sends notice that they must name the state as beneficiary.

Now we need to figure out the payment structure of the annuity. Sarah’s life expectancy is 12.17 years (or 146 months). Sarah could pick a term of 146 months and get an annuity that pays $900 a month or Sarah could pick a term of 60 months and get an annuity that pays $2,500/mo.  If Sarah dies before the annuity term ends, the State of Connecticut will receive the remaining value of the annuity for the medical assistance paid for Jim. They pick the term of 60 months because they want to assure that Sarah outlives the term of the annuity.   By choosing 60 months, Sarah will receive more income.  

In the end, Sarah gets to keep the house, the car, her $1500/month of income and $2,500/month of annuity income. Jim pays his monthly applied income to the nursing home $2,000 - $60 personal allowance = $1,940.  In the end, Jim pays $1940 a month towards his care and the State pays for the rest of his care at the Medicaid rate the state pays nursing homes.  If Jim stays in the nursing home for 2 years, Jim and Sarah will have received a public benefit from the state that is worth $241,440 ($10,060 x 24 months = $241,440) to them.  Thus, a Single Premium Immediate Annuity can provide a substantial benefit to Jim & Sarah.

If you think that a Single Premium Immediate Annuity would help your family, give the elder law attorneys at Cipparone & Zaccaro, PC a call. 

In 2006, William Bassford executed a Trust entitled the “William W. Bassford Irrevocable Trust.”  Despite the title of the Trust, the Trust stated in Article Two that “notwithstanding anything herein contained, the Settlor explicitly reserves the following powers … (5) to revoke this Trust ….”  This Trust owned the home that William lived in along with his third wife, Frances.

William had three adult children: Andrew, Zelda and Jonathan.  The children’s mother died many years ago.   William later married Frances and their marriage lasted for 33 years until he died.  Sometime before William died, he suffered from several illnesses which included severe anxiety and depression, post-traumatic stress disorder from his service during World War II, mild to moderate dementia, impaired hearing and frequent urinary tract infections.  As a result of his health issues, William was hospitalized at a residential psychiatric facility.  In October of 2011, Frances filed an application for the appointment of an involuntary conservator of her husband’s person and estate.  Following a hearing, a Connecticut Probate Court appointed her to be her husband’s conservator.

On June 25, 2012, William’s trustees (who were two, long-time friends of his) conveyed the home that he lived in, from the Trust to William, so that the Trust no longer owned the property.  The property was now owned by him.  He also revoked the “Irrevocable  Trust” on this date.  William did this in conjunction with a new Will that he executed on May 7, 2012.  In this Will, he left various items of personal property to Andrew and Zelda, as well as to some of his grandchildren.  He also left $1.00 to his son Jonathan.  The remainder of his estate was left to Frances, his wife of 33 years.   William died on February 19, 2014.

After his death, his children petitioned the Probate Court where they asked the Court to construe the Trust.  The children sought a decree from the Court which declared that the Trust was irrevocable.  If the Court agreed with the children, that would invalidate the trustees’ conveyance of the property from the Trust to William.  It would also invalidate William’s revocation of his own Trust.  The Probate Court found pursuant to Article Two of the Trust, that the Trust was revocable and that William was capable of receiving title to his home.  The Court made this finding despite the fact that William was conserved by his wife.  The children then brought an appeal to the Connecticut Superior Court.  Among the issues on appeal were whether the Trust was irrevocable and whether the revocation of that Trust was improper.

During the trial in the Superior Court, the Court looked to the facts surrounding the revocation of the Trust.  On June 14, 2012 – months after Frances was appointed by the Probate Court to conserve her husband – William was hospitalized at a psychiatric facility.  Although the medical records revealed that he was feeling anxious, depressed, confused and that he reported suicidal ideations, he was also alert and oriented as to person, place and time.  After his admission, his attorney visited him at the facility.  She brought her husband with her to act as a witness.  The attorney testified that she spoke to William for about 20 minutes that day and that he was alert and not confused.  She told him that upon his discharge from the facility, his written Trust revocation was ready for his signature.  The attorney testified that William was eager to sign the revocation because he felt that the new Will that he signed approximately one month before, would not have the effect that he desired unless the Trust was also revoked.  She also testified that she reviewed the provisions of the Trust with him, specifically the provision which gave him the right to revoke the Trust.  One week later, William signed the written revocation of his Trust before his attorney.

The Superior Court concluded that William had a thorough discussion with his attorney and that he thought about the revocation of his Trust for over three months before his actual revocation.  Taking these facts in conjunction with the preparation of his new Will, the Court determined that William’s desire to complete his estate plan had not wavered or changed in all that time and that he was not confused about the revocation in any way. 

As part of the process of creating his estate plan, William was also evaluated by a psychiatrist.  In late April of 2012, William met with him for a formal clinical interview.  Prior to this interview, the psychiatrist reviewed William’s medical history.  At trial, he testified that while William had dementia, his particular dementia was progressing slowly.  In addition, the psychiatrist testified that William had memory deficits and episodes of delirium during those times when he suffered from urinary tract infections.  Nevertheless, William’s treatment history proved that when he was treated for his urinary tract infections, he returned to lucidity quickly and functioned at a stable level.  Ultimately, the psychiatrist testified that in his professional opinion, William possessed the cognitive ability to know the nature and extent of his assets and how he wanted to dispose of them.

The Court also found that prior to his execution of the revocation, William directed his attorney to contact the trustees of his Trust, to let them know what he desired.  William’s attorney sent both of them a letter advising the trustees that he wished to revoke the Trust and that he wanted title to the property to be conveyed to him.  The letter also directed the Trustees to personally confer with William’s psychiatrist regarding his capacity to execute his Will.  The trustees testified that upon receiving this letter, they spoke to his psychiatrist.  They also testified that they visited William after he was hospitalized.  Both of them testified that he appeared to be his normal self and that he was able to carry on an intelligent conversation with them about his wishes.  Finally, the trustees testified that after this visit, they signed the written revocation themselves.

The Superior Court concluded that William was not confused or uncertain about what he was doing but rather, that he independently determined to proceed with the revocation of his Trust and the conveyance of his property.  Thus, he had the mental capacity legally required to effectuate this transaction.  This decision was subsequently appealed to the Connecticut Appellate Court.  The name of the case is Bassford vs. Bassford, 180 Conn.App. 331 (2018).  On appeal, that court examined the record, as well as the briefs and arguments of the parties and concluded that the judgment of the Superior Court should be affirmed.

In Bassford, three separate courts concluded that the “revocation” language of the Trust was clear and that despite how the Trust was titled, this was a revocable Trust.  In addition, the Court found that under the facts of this case, an involuntarily conserved person could revoke his Trust. 

The facts of this case are unique.  Many lawyers would argue that William’s Trust was poorly drafted, insofar as the ambiguity it created for William and his family.  The lesson from Bassford is that the language of a trust is more important than the title.  At Cipparone & Zaccaro, we exercise extreme caution when drafting Trusts.  If you would like to talk to us about preparing your estate plan, please don’t hesitate to give us a call.  We’ll take great care to put together a clear, thoughtful estate plan for you so you can avoid this kind of litigation.