Ralph Robbins
Certified Financial Planner
Ralph S. Robbins, CFP©, is a licensed Certified Financial Planning Practitioner and an Accredited VA Claims Agent specializing in Eldercare Financial Planning. He works everyday helping families in crisis find creative ways to fund long-term care expenses and deal with family financial issues.
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Question
I had 24 /7 long term care in NY but I moved to FL and am getting no where. Any advice?
Have you contacted your local Area Agency on Aging? Every county in the US has one. They are often called "Aging and Disability... Have you contacted your local Area Agency on Aging? Every county in the US has one. They are often called "Aging and Disability Resource Centers" and act as a clearing house of sorts for all state and federal programs that may be able to assist her. Do a search for Area Agency on Aging in your county. Unfortunately Florida does a very poor job taking care of needy populations. Remember: You vote counts! see more
Question
How much active duty during wartime is necessary to qualify someone as a veteran?
To be eligible for VA Improved Pension the rule is the veteran must have 90 continuous days of active duty service one day of which must... To be eligible for VA Improved Pension the rule is the veteran must have 90 continuous days of active duty service one day of which must have been during "wartime" as defined by Congress. Civilian employees of military branches are not considered active duty military with some very limited exceptions. Involvement in the space program is not one of them. see more
Question
What are valid expenses that reduce income to avoid exceeding the Veterans Aid & Attendance income limit?
Foresttrees... If the veteran is eligible and qualifies for VA Improved Pension with Aid and Attendance the maximum monthly benefit for a... Foresttrees...
If the veteran is eligible and qualifies for VA Improved Pension with Aid and Attendance the maximum monthly benefit for a single veteran in 2015 is $1,788 per month.
The Veterans Healthcare Administration may also provide some nominal home care services through the Geriatric Extended Care program. This is accessed through the veteran's VA primary care physician. see more
If the veteran is eligible and qualifies for VA Improved Pension with Aid and Attendance the maximum monthly benefit for a single veteran in 2015 is $1,788 per month.
The Veterans Healthcare Administration may also provide some nominal home care services through the Geriatric Extended Care program. This is accessed through the veteran's VA primary care physician. see more
Question
What happens when you have no money to get through a large penalty period?
Most states have a hardship provision for situations such as this. Apply and report the transfers. Request a hardship exemption from the... Most states have a hardship provision for situations such as this. Apply and report the transfers. Request a hardship exemption from the potential penalty citing the provision in your state's Medicaid policy manual if possible. see more
Question
What do I do about VA Aid benefits if Mom go to rehab?
VA Improved Pension with Aid and Attendance although paid monthly is actually calculated on an annual basis. As long her expenses on an... VA Improved Pension with Aid and Attendance although paid monthly is actually calculated on an annual basis. As long her expenses on an annual basis continue to be relatively the same as when she applied there will be no impact on her monthly benefit.
The only times you are required to notify the VA of any changes are:
1. If her income or expenses change to an extent that on an annual basis her benefit would be affected (either up or down).
2. If she is in a nursing home long-term and receiving Medicaid.
3. She passes away. see more
The only times you are required to notify the VA of any changes are:
1. If her income or expenses change to an extent that on an annual basis her benefit would be affected (either up or down).
2. If she is in a nursing home long-term and receiving Medicaid.
3. She passes away. see more
Question
Anyone gotten A&A and lost other benefits?
The following is from sources available to the general public and is not offered as legal or financial advice. Consult a state agency or... The following is from sources available to the general public and is not offered as legal or financial advice. Consult a state agency or professional before making any legal or financial decisions.
The answer to your question will depend on the benefits she is seeking, those she is receiving now, and your state's income limits for those benefits.
The VA Improved Pension with Aid and Attendance is the highest level of Improved Pension awarded to those who have high unreimbursed medical expenses and is awarded on top of "Basic" Pension which is not based on medical need.
In some instances the Basic Pension component is considered countable income for benefit eligibility purposes and the Aid and Attendance portion is not because it is intended to provide for cost of care.
The rule is that if the Aid and Attendance award would only have been received because medical expenses consume all of the claimant's income, the entire award is supposed to be reported by the VA to state agencies as comprised totally of Aid and Attendance and therefore no portion countable as income for benefit eligibility purposes. Needless to say, the VA does always report benefits according to the rule and it can be very difficult to obtain correct reporting.
If your mother has Original Medicare, with or without a Medicare supplement, and is receiving low income SSI related benefits such as Extra Help with prescription drug coverage or assistance with Part B Medicare premiums and/or deductibles and co-pays, then the Aid and Attendance Pension benefit may have an impact on her receipt of those benefits.
If, however, she is receiving her Medicare benefits (including prescription drugs) through a Medicare Advantage plan (HMO) the only low income SSI benefit that might be affected would be Part B premium assistance if she is indeed otherwise eligible for it. The VA award, depending on the amount, will in all likelihood offset the value of these benefits.
Your profile says you live in Kentucky. If the help she is receiving now is a Medicaid program, or if she is applying for Medicaid Home and Community Based Services or Medicaid nursing home benefits in that state, the VA Aid and Attendance benefit may have an impact on her eligibility as the income cap in Kentucky (the maximum income a Medicaid applicant can have to be eligible) is $2,199 per month GROSS (in 2015). Therefore her Social Security plus the maximum Aid and Attendance award of $1,149 per month (in 2015) might put her over the income cap. This can be cured, however by creating a Qualified Income Trust (QIT). Kentucky does not offer a template for this trust and you will have to contact an attorney or obtain free legal services in your area to have it drafted.
If receiving Medicaid benefits this MUST be done in the same month she receives her first check from the VA.
I would suggest starting by contacting the state or county agency through which she is currently receiving benefits and determine the nature of those benefits and see if they can answer how a VA award will impact those benefits. You will then be armed as to what to expect when a VA Pension benefit is awarded.
I would then suggest you do a search for a County Veteran Service Officer and/or Veteran Service Officer in your area and speak with same about applying for VA Improved Pension. To obtain the maximum award of $1,149 per month all of her income will have to be consumed by unreimbursed medical expenses (household expenses are not counted as a medical expense). If she pays you all her income as her caregiver she would qualify. You will have to document this in the application and show evidence that this is the case.
I am sorry this is all so complicated but it can be successfully navigated with persistent advocacy and the proper guidance whether obtained from state agencies and/or a professional in private practice. see more
The answer to your question will depend on the benefits she is seeking, those she is receiving now, and your state's income limits for those benefits.
The VA Improved Pension with Aid and Attendance is the highest level of Improved Pension awarded to those who have high unreimbursed medical expenses and is awarded on top of "Basic" Pension which is not based on medical need.
In some instances the Basic Pension component is considered countable income for benefit eligibility purposes and the Aid and Attendance portion is not because it is intended to provide for cost of care.
The rule is that if the Aid and Attendance award would only have been received because medical expenses consume all of the claimant's income, the entire award is supposed to be reported by the VA to state agencies as comprised totally of Aid and Attendance and therefore no portion countable as income for benefit eligibility purposes. Needless to say, the VA does always report benefits according to the rule and it can be very difficult to obtain correct reporting.
If your mother has Original Medicare, with or without a Medicare supplement, and is receiving low income SSI related benefits such as Extra Help with prescription drug coverage or assistance with Part B Medicare premiums and/or deductibles and co-pays, then the Aid and Attendance Pension benefit may have an impact on her receipt of those benefits.
If, however, she is receiving her Medicare benefits (including prescription drugs) through a Medicare Advantage plan (HMO) the only low income SSI benefit that might be affected would be Part B premium assistance if she is indeed otherwise eligible for it. The VA award, depending on the amount, will in all likelihood offset the value of these benefits.
Your profile says you live in Kentucky. If the help she is receiving now is a Medicaid program, or if she is applying for Medicaid Home and Community Based Services or Medicaid nursing home benefits in that state, the VA Aid and Attendance benefit may have an impact on her eligibility as the income cap in Kentucky (the maximum income a Medicaid applicant can have to be eligible) is $2,199 per month GROSS (in 2015). Therefore her Social Security plus the maximum Aid and Attendance award of $1,149 per month (in 2015) might put her over the income cap. This can be cured, however by creating a Qualified Income Trust (QIT). Kentucky does not offer a template for this trust and you will have to contact an attorney or obtain free legal services in your area to have it drafted.
If receiving Medicaid benefits this MUST be done in the same month she receives her first check from the VA.
I would suggest starting by contacting the state or county agency through which she is currently receiving benefits and determine the nature of those benefits and see if they can answer how a VA award will impact those benefits. You will then be armed as to what to expect when a VA Pension benefit is awarded.
I would then suggest you do a search for a County Veteran Service Officer and/or Veteran Service Officer in your area and speak with same about applying for VA Improved Pension. To obtain the maximum award of $1,149 per month all of her income will have to be consumed by unreimbursed medical expenses (household expenses are not counted as a medical expense). If she pays you all her income as her caregiver she would qualify. You will have to document this in the application and show evidence that this is the case.
I am sorry this is all so complicated but it can be successfully navigated with persistent advocacy and the proper guidance whether obtained from state agencies and/or a professional in private practice. see more
Question
What financial assistance/resource is available for paying for care of a serious level Alzheimer's patient/lov...
The following is not to be considered legal or financial advice. It is offered only for educational purposes from sources available to the... The following is not to be considered legal or financial advice. It is offered only for educational purposes from sources available to the general public.
First, you might want to consider applying for your wife's Social Security retirement benefit. She will lose 20% of her maximum benefit but it appears this may appreciably help with family finances. Social Security Disability may not be helpful because there is a two year wait after benefit approval to receive Medicare. By that time she will already be 65 and otherwise eligible (presumably).
Second, if you or she are not a veteran, the only public benefit for long-term care will be Medicaid (Medi-Cal in your state). If your financial circumstances are such that she qualifies financially you do not necessarily need an attorney to apply. You do, however, want to make sure that your estate planning documents, e.g., Wills, Powers of Attorney, Health Care Surrogacy, etc. are up to date...you want to make sure you have the power to make decisions for her when she is unable to so for herself and that she is not the beneficiary of any resources that may disqualify her from Medi-Cal if she were receiving benefits and you were to predecease her. You do not necessarily need an expensive elder law attorney to prepare or amend these documents – I’m sure there are plenty of local attorneys that provide such estate planning services at very reasonable fees (though I would never discourage you or anyone from consulting an elder law attorney).
The other advantage to applying early for her Social Security retirement benefit is that if she is placed in a nursing home environment under Medi-Cal you will receive a portion of her Social Security benefit under "Spousal Impoverishment" rules. (In CA the Community Spouse - the spouse not receiving Medi-Cal – may, in 2015, retain a minimum of $1.966.25 of the couple's combined income).
In addition to nursing home coverage, Medi-Cal provides home and community based services that may help with home care and assisted living expenses.
The best place to begin your search for all programs that may be of assistance is your local Area Agency on Aging. Every county in the U.S. has one and they act as "clearing house" for all programs, state and federal, that may be available to your wife. They will be of tremendous help. Do an internet search for the agency in your county. see more
First, you might want to consider applying for your wife's Social Security retirement benefit. She will lose 20% of her maximum benefit but it appears this may appreciably help with family finances. Social Security Disability may not be helpful because there is a two year wait after benefit approval to receive Medicare. By that time she will already be 65 and otherwise eligible (presumably).
Second, if you or she are not a veteran, the only public benefit for long-term care will be Medicaid (Medi-Cal in your state). If your financial circumstances are such that she qualifies financially you do not necessarily need an attorney to apply. You do, however, want to make sure that your estate planning documents, e.g., Wills, Powers of Attorney, Health Care Surrogacy, etc. are up to date...you want to make sure you have the power to make decisions for her when she is unable to so for herself and that she is not the beneficiary of any resources that may disqualify her from Medi-Cal if she were receiving benefits and you were to predecease her. You do not necessarily need an expensive elder law attorney to prepare or amend these documents – I’m sure there are plenty of local attorneys that provide such estate planning services at very reasonable fees (though I would never discourage you or anyone from consulting an elder law attorney).
The other advantage to applying early for her Social Security retirement benefit is that if she is placed in a nursing home environment under Medi-Cal you will receive a portion of her Social Security benefit under "Spousal Impoverishment" rules. (In CA the Community Spouse - the spouse not receiving Medi-Cal – may, in 2015, retain a minimum of $1.966.25 of the couple's combined income).
In addition to nursing home coverage, Medi-Cal provides home and community based services that may help with home care and assisted living expenses.
The best place to begin your search for all programs that may be of assistance is your local Area Agency on Aging. Every county in the U.S. has one and they act as "clearing house" for all programs, state and federal, that may be available to your wife. They will be of tremendous help. Do an internet search for the agency in your county. see more
Question
If my aunt is already receiving a spousal VA death benefit, why does she have to provide all the forms to get...
Silverstallion.... As you may know there are two survivor cash benefit programs: Service connected DIC (aka "compensation") and... Silverstallion....
As you may know there are two survivor cash benefit programs: Service connected DIC (aka "compensation") and non-service connected Improved Pension. Both have a basic benefit and a higher Aid and Attendance benefit. You may apply for both but you cannot receive both simultaneously. The claimant has the choice of the higher benefit.
If you qualified for both this year, you would be better off with DIC as it would provide a higher award (plus other possible benefits not available with Pension). see more
As you may know there are two survivor cash benefit programs: Service connected DIC (aka "compensation") and non-service connected Improved Pension. Both have a basic benefit and a higher Aid and Attendance benefit. You may apply for both but you cannot receive both simultaneously. The claimant has the choice of the higher benefit.
If you qualified for both this year, you would be better off with DIC as it would provide a higher award (plus other possible benefits not available with Pension). see more
Question
If my aunt is already receiving a spousal VA death benefit, why does she have to provide all the forms to get...
If you are referring to VA Improved Pension benefits understand that there are actually three "levels" of Pension benefit. ... If you are referring to VA Improved Pension benefits understand that there are actually three "levels" of Pension benefit. Starting with the lowest benefit they are:
1. Basic Pension
2. Housebound
3. Aid and Attendance.
An award is issued as "Improved Pension (Basic) with Housebound" or "Improved Pension (Basic) with Aid and Attendance).
It may be she is receiving one of the lower benefit levels which does not require the same evidence that the Aid and Attendance level does. see more
1. Basic Pension
2. Housebound
3. Aid and Attendance.
An award is issued as "Improved Pension (Basic) with Housebound" or "Improved Pension (Basic) with Aid and Attendance).
It may be she is receiving one of the lower benefit levels which does not require the same evidence that the Aid and Attendance level does. see more
Question
Is an irrevocable trust a good idea?
The following should not be considered legal advice and is offered for educational/informational purposes only: Issues surrounding second... The following should not be considered legal advice and is offered for educational/informational purposes only:
Issues surrounding second marriages and heirs can be complex and contentious and it is important that the parents come to agreement as to the disposition of their assets (not the heirs) and that proper documents then be drawn to effectuate those desires.
That being said, most spouses want the surviving spouse to have use and enjoyment of the other's assets until the demise of the surviving spouse at which point assets are divided among the heirs.
Typically this is done via the creation of a revocable trust(s) the testamentary terms of which become irrevocable at the demise of the grantor. It can also be done via Wills which then fund a trust as previously mentioned.
Medicaid considerations:
Two cautions:
1. Transfers to an irrevocable trust are subject to the famed "5 year look back" with respect to Medicaid eligibility.
2. Some states do not consider a primary residence held in a revocable trust to be an exempt asset for Medicaid eligibility purposes.
Lastly, some states have stringent "Spousal Elective Share" statutes which prevent a surviving spouse from being disinherited - usually stipulating that a minimum percentage of the entire estate be available to the surviving spouse - including those held in a revocable trust.
A competent estate planning attorney will be helpful in exploring options. see more
Issues surrounding second marriages and heirs can be complex and contentious and it is important that the parents come to agreement as to the disposition of their assets (not the heirs) and that proper documents then be drawn to effectuate those desires.
That being said, most spouses want the surviving spouse to have use and enjoyment of the other's assets until the demise of the surviving spouse at which point assets are divided among the heirs.
Typically this is done via the creation of a revocable trust(s) the testamentary terms of which become irrevocable at the demise of the grantor. It can also be done via Wills which then fund a trust as previously mentioned.
Medicaid considerations:
Two cautions:
1. Transfers to an irrevocable trust are subject to the famed "5 year look back" with respect to Medicaid eligibility.
2. Some states do not consider a primary residence held in a revocable trust to be an exempt asset for Medicaid eligibility purposes.
Lastly, some states have stringent "Spousal Elective Share" statutes which prevent a surviving spouse from being disinherited - usually stipulating that a minimum percentage of the entire estate be available to the surviving spouse - including those held in a revocable trust.
A competent estate planning attorney will be helpful in exploring options. see more
Question
How are assets figured for Medicaid eligibility if 1 IRA is owned by SNF spouse, 1 IRA and 1 mutual fund is ow...
How an IRA is treated as an asset varies by state. Some do not count the principal if the IRA is in monthly distribution. Others will not... How an IRA is treated as an asset varies by state. Some do not count the principal if the IRA is in monthly distribution. Others will not count the IRA principal if the IRA distribution also includes principal. Yet others will count the IRA as an asset and the only way to protect it without causing a potentially large tax event is by annuitizing the IRA. see more
Question
How are policies owned by each spouse totaled, then split, if one seeks SNF/Medicaid yet the cash, face or Ter...
Girlscout...double check with the provider as to the nature of the policy. There is no such thing as a "term policy with cash... Girlscout...double check with the provider as to the nature of the policy. There is no such thing as a "term policy with cash value". Perhaps you are confusing terminology? A term life insurance policy has a death benefit and premium, that's it...they do not accumulate a cash value (kind of like a savings account) as do other forms of life insurance.
When applying for Medicaid long-term care benefits Medicaid is only concerned with life insurance policies that have a cash value. This cash value may be considered an asset for Medicaid eligibility purposes.
How the premium was/is being paid has no bearing on Medicaid's treatment of the policy. see more
When applying for Medicaid long-term care benefits Medicaid is only concerned with life insurance policies that have a cash value. This cash value may be considered an asset for Medicaid eligibility purposes.
How the premium was/is being paid has no bearing on Medicaid's treatment of the policy. see more
Question
How are policies owned by each spouse totaled, then split, if one seeks SNF/Medicaid yet the cash, face or Ter...
Term policy has no cash value and therefore is not a countable asset for Medicaid eligibility purposes. If non-Medicaid spouses predeceases... Term policy has no cash value and therefore is not a countable asset for Medicaid eligibility purposes.
If non-Medicaid spouses predeceases Medicaid spouse and Medicaid spouse receives death benefit they may be disqualified for benefits ($2,000 asset limit).
You may wish to consider changing the beneficiary of the whole life policy.
Irrevocable cremation policies are not countable assets for Medicaid eligibility purposes. see more
If non-Medicaid spouses predeceases Medicaid spouse and Medicaid spouse receives death benefit they may be disqualified for benefits ($2,000 asset limit).
You may wish to consider changing the beneficiary of the whole life policy.
Irrevocable cremation policies are not countable assets for Medicaid eligibility purposes. see more
Question
I am the Fiduciary for my Mother's VA account. Can I reimburse myself/my spouse a reasonable rent for her to s...
The VA will allow Pension benefits to be used to pay reasonable room and board to live in the caregivers home. Contact the Fiduciary Hub... The VA will allow Pension benefits to be used to pay reasonable room and board to live in the caregivers home. Contact the Fiduciary Hub that initially appointed you fiduciary and tell them you wish to adjust the manner in which the benefit is being applied. They will send you the requisite paperwork. Make sure you keep an excellent paper trail for the next visit from the Fiduciary Hub representative.
I have many clients who are using funds in this manner and it is perfectly acceptable. see more
I have many clients who are using funds in this manner and it is perfectly acceptable. see more
Question
Can money be taken from a loved one's bank account to go towards a larger home so that they can live together...
The following is for educational and informational purposes only and should not be considered legal advice. Consult appropriate... The following is for educational and informational purposes only and should not be considered legal advice. Consult appropriate professionals.
Relationship issues aside, be mindful of possible asset transfer consequences with respect to qualifying for Medicaid if it is required in the future.
In general, an agent operating under a Power of Attorney must be acting in a "fiduciary capacity" for the principal. In other words, acting in the best interest of the person who granted the power. If the document permits the activity you are proposing there should be not problem.
With respect to potential Medicaid benefits, simply using father's money to build a new property that is not titled to him could be an issue as it would be considered an uncompensated transfer and therefore create a penalty period before Medicaid benefits will be available.
The uncompensated transfer issue may be solved by father purchasing what is known as a "life estate" in the new property giving him the right to live there for the rest of his life. He must then live in the property for at least one year for the transfer not to be considered subject to penalty.
Rules vary by state. An appointment with an elder law attorney would be beneficial. see more
Relationship issues aside, be mindful of possible asset transfer consequences with respect to qualifying for Medicaid if it is required in the future.
In general, an agent operating under a Power of Attorney must be acting in a "fiduciary capacity" for the principal. In other words, acting in the best interest of the person who granted the power. If the document permits the activity you are proposing there should be not problem.
With respect to potential Medicaid benefits, simply using father's money to build a new property that is not titled to him could be an issue as it would be considered an uncompensated transfer and therefore create a penalty period before Medicaid benefits will be available.
The uncompensated transfer issue may be solved by father purchasing what is known as a "life estate" in the new property giving him the right to live there for the rest of his life. He must then live in the property for at least one year for the transfer not to be considered subject to penalty.
Rules vary by state. An appointment with an elder law attorney would be beneficial. see more
Question
Can my daughter and I keep my Mom's funds remaining in the accounts after she passes without a penalty?
Yes. Assets held jointly passes to the other joint tenants upon death. No probate. No gift/estate taxes if under $5.43 million. What kind... Yes. Assets held jointly passes to the other joint tenants upon death. No probate. No gift/estate taxes if under $5.43 million. What kind of "penalty" did you think there might be? see more
Question
We are applying for MA coverage for my Mother, if penalized, who pays for the continued care until they begin...
If indeed a penalty is imposed every state has "hardship" provisions in their rules which will allow benefits to be received if... If indeed a penalty is imposed every state has "hardship" provisions in their rules which will allow benefits to be received if lack of care would adversely impact the health and safety of the applicant. This would be the "fall back" position.
Application of the hardship provision may require an appeal after an initial denial. see more
Application of the hardship provision may require an appeal after an initial denial. see more
Question
I'm the DPOA for my Mother. Can I make the decision that she needs caregiving in a facility, ie. Board & care...
A Power of Attorney is usually written to provide for the ability for another to assist with financial and contractual matters only. ... A Power of Attorney is usually written to provide for the ability for another to assist with financial and contractual matters only. Sometimes provisions regarding healthcare are included but most often a separate document, a Health Care Surrogate or Proxy is created to handle these matters.
It is unlikely, but some documents require a determination of incapacity before an agent can act.
Savinggranny, offered great advice in terms of reviewing your mother's documents and enlisting professional support as opposed to traveling the legal route first.
You might also consider a geriatric psychologist or care manager to create a relationship with your mother and help her make appropriate decisions.
Contacting APS should be your last resort. see more
It is unlikely, but some documents require a determination of incapacity before an agent can act.
Savinggranny, offered great advice in terms of reviewing your mother's documents and enlisting professional support as opposed to traveling the legal route first.
You might also consider a geriatric psychologist or care manager to create a relationship with your mother and help her make appropriate decisions.
Contacting APS should be your last resort. see more
Question
How does shield a residence affect nursing home options?
mallory...it is also the reason OJ Simpson moved here!
Would an advance on a reverse mortgage heloc be counted as an asset for Medicaid?