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Contact Information:
William B.C. Pittenger
8595 Meadow Hill Drive
Frisco, TX 75034
972-335-9473
972-335-0073 (Fax)
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Here is some of our most requested information concerning Medicaid, nursing homes and protecting your future.

When considering qualification for Medicaid for nursing home care there are a number of issues.

Asset Test: Exempt and nonexempt assets; a house is exempt, car is exempt, certain household furniture is exempt, prepaid funeral in trust account is exempt, $2000.00 cash is exempt; The TDHS employee will speak about "spend down" rather than discuss any other steps or techniques to keep more of your assets.

Asset Transactions: Don't be confused - the laws that protect your assets can be confusing. Here are a few things to consider:
- Do get legal help in making any transfers as disqualification from Medicaid could occur for up to 60 months or more if assets are transferred. Penalty periods have to be carefully assessed in making transfers.
- Certain transfers are not illegal and can help if done right.
- Creation of trusts may be the wrong move.
- The creation of a trust may be useful for the benefit of a special needs person.
- Selling a house may be a real mistake as it is an Exempt Resource.
- Specially drafted Powers of Attorney can be a strategy to avoid Estate Recovery.
- The advice to "spend down" until you reach minimal assets may or may not be accurate or needed.
- The advice that the Protected Resource Amount (the "PRA") for the at-home spouse is limited to a certain figure may not be correct; steps can be taken to expand the PRA.

Income Transactions: Disqualification because of too much retirement and social security income can be overcome by a Qualified Income Trust (known previously as a Miller Trust). This is a special type of trust used solely to overcome Medicaid disqualification based upon too much income. We prepare these a few months preceding qualification for nursing home. There are specific rules of how to operate these trusts.

Disqualification from Medicaid After Entering the Nursing Home: Inheriting money from your spouse or anyone else can push you over the limit where you then will have to spend down those assets or do other planning, to be able to re-apply for Medicaid. Wills between spouses need to be altered to avoid this type of result. Planning of your spouse and other family members should be done to avoid this problem, and in some cases a "special needs trust" could be used to enhance the quality of life of the nursing home individual.

Allowing money to accumulate in the bank account past the allowable amount can result in disqualification, like allowing Social Security money to build up in the account rather than pay it over to the nursing home where it should have been timely paid.

Single Persons Planning: The above discussion has application in part to the single person. Some of the options of expanded PRA for a spouse, would not be available to protect assets. For a single person however, the Qualified Income Trust is useful and the use of transfers carefully done can reduce the amount which has to be paid as "private pay" to the nursing home, thus spending down the assets. The proper use of exempt assets is helpful. The proper handling of a homestead residence as an exempt asset and utilizing a trust is helpful also.


In summary, there are a number of considerations and possible planning steps which can be used to greatly help reduce the loss of funds, but is has to be done right considering the extensive regulations in this area of the law. In addition, the regulations issued in the Medicaid field may affect planning which has been done, thus it is important to check back with the elder law attorney to determine if any changes in the law have taken place. After an elder law plan is in force, we do not review them or send updates to our clients, as the legal work terminates and our legal representation ends upon execution of the plan. You may want to calendar ahead concerning any changes and contact the attorney regarding a review session at a reasonable cost to see if the plan should be altered.