Michael Gilfix and Mark Gilfix recently appeared together on NBC Bay Area’s “Asian Pacific America with Robert Handa.” The episode focused on families in Asian communities with special needs, particularly those with autistic children.

They discussed the importance of Special Needs Trusts and their critical role in structuring an effective estate plan. Mark acknowledged the reluctance some Asian families feel toward seeking outside help, and said these trusts represent a “one-time, lifelong insurance policy” to protect their children’s livelihood.

Michael also talked about his book, “Special Needs Trust Creation and Management Guide,” which answers many of the most common questions parents have about Special Needs Trusts. For more information about this book, click here. (Link to www.gilfix.com/books)

Mark Gilfix also recently appeared on KTVU’s “Bay Area People.”

Mark said that because caring for autistic children is so time-consuming and expensive, parents do not understand how to provide for their children after they are gone. He pointed out that directly inheriting a parent’s assets can disqualify an autistic person from crucial needs-based programs such as Medi-Cal and Supplemental Security Income, a problem solved by Special Needs Trusts.

Mark also had the opportunity to talk about Michael’s Special Needs Trust guide. Viewers of both programs are invited to request a copy of the book here.

The segment can be seen here:
https://www.youtube.com/watch?v=jthuk-u0424

Overwhelmingly, research shows that older Americans would prefer to age at home or in other noninstitutional settings. But for aging in place to really work, a number of preparations must be made. An urgent health event can make staying at home impossible because of financial issues or practical concerns that cannot be remedied quickly enough.

According to Forbes Magazine, experts suggest that people who wish to age in their own residences begin preparing in their 50s and early 60s. Their preparations should include financial planning and possible home remodels that incorporate universal access design principles.

But thanks to technology, even families with members already in their 70s, 80s and 90s can take immediate steps to make life at home safer.

Philips has created a medication dispensing device that can be pre-loaded with up to 40 days’ worth of medication. The device gives verbal alerts when it is time for a dose, and it can telephone family members when a dose is missed. The system feeds data into an online portal that seniors and family members can view.

According to the American Association of Retired People (AARP), wearable health monitors are losing their “device stigma” as young people adopt wearables to track their own health. Companies like Lively are making devices that combine the cool of high-tech wearables with the functionality seniors need, including panic buttons, medication reminders and activity monitors.

For those willing to invest more, companies like GrandCare offer comprehensive systems that digitally connect a range of medical devices and activity detectors. GrandCare’s online health dashboard includes health data as well as video chat and shared calendars. Experts hope that systems such as these will one day eliminate the need for nursing homes or intensive in-home assistance in many cases.

Even with emerging technology, mindful financial planning and practical preparation of a residence still form the true foundation of a long-term ability to remain at home. An estate planning attorney – like those at Gilfix and La Poll Associates – can help families navigate planning issues, such as asset preservation for Medi-Cal eligibility. These and other planning tools can help families achieve peace of mind for the future.

Pioneers of Elder Law – For over 30 years, Gilfix & La Poll Associates LLP has innovated creative legal solutions to help you manage and plan the future of your estate.
To contact an estate planning lawyer visit http://www.gilfix.com/ or call 800.244.9424.

This unique kind of trust can provide for many of the supplemental needs of a disabled person without jeopardizing that person’s eligibility for vital government benefits, including Medi-Cal and Supplemental Security Income. However, few know that there are concrete benefits to setting up such a trust sooner rather than later.

Start growing now.
When parents or grandparents set up and put money into a special needs trust during their own lifetimes, it can start to grow immediately. From the time the trust is established, anyone can contribute to it – uncles, godparents, friends – creating an especially beneficial way for loved ones to contribute to your child or family member’s future.

Ensure that the trust has the most beneficial structure.
Some special needs trusts, especially those created for assets already belonging to the beneficiary, mandate that funds remaining in the trust after the death of the beneficiary must first go to pay back Medi-Cal for all expenses covered during the beneficiary’s lifetime. When a trust is set up within the parents’ lifetime, by contrast, it can be established before any assets pass on to the beneficiary. A correctly drafted third-party special needs trust need not have a payback provision.

Give yourself time to change the trustee(s) or remainder beneficiaries.
The administration of a special needs trust can be complicated. Many parents or guardians entrust this responsibility to a professional trustee, who can ensure proper disbursement that does not endanger benefits eligibility. Other parents select a family member. Regardless, a properly constructed third-party special needs trust can give parents the flexibility to change trustees over time as needs change.

For more than 30 years, Gilfix & La Poll Associates LLP has innovated creative legal solutions to help you manage and plan the future of your estate. To contact an estate planning lawyer, visit http://www.gilfix.com/ or call (800) 244-9424.

For a copy of Michael Gilfix’s guide, Special Needs Trust Creation and Management, visit the same website or call the number above.

The California State Assembly recently passed a new bill designed to limit Medi-Cal’s ability to recover assets from the estates of deceased Medi-Cal beneficiaries. As the law stands currently, Medi-Cal can seize a substantial portion of an estate — including a residence — to recover the benefits used to cover medical care through Medi-Cal.

But Governor Jerry Brown’s advisors are encouraging a veto of the bill in order to avoid revenue losses that would hurt the state’s budget, as reported by the Mercury News.  

Even if Governor Brown does sign the bill, the new law would limit but not entirely prohibit Medi-Cal asset recovery.

The Mercury News turned to Michael Gilfix for comment on the growing concerns surrounding Medi-Cal asset seizure.

Gilfix pointed out that whether or not the bill is vetoed, Californians can take steps to protect their estates from Medi-Cal recovery. In the article, he commented that assets, and residences in particular, can be protected through proactive estate planning.

According to the Mercury News, many older Californians who already benefit from Medi-Cal are surprised to learn that their estates, which they hoped to pass down to their heirs, are at risk.

Gilfix & La Poll helps clients plan for Medi-Cal eligibility in a way that legally protects assets to the greatest extent possible and minimizes the impact of taxes on the estate.

Pioneers of Elder Law – For over 30 years, Gilfix & La Poll Associates LLP has innovated creative legal solutions to help you manage and plan the future of your estate.
To contact an estate planning lawyer visit http://www.gilfix.com/ or call 800.244.9424.

A major concern is that such claims blindside tens of thousands of older Californians who are receiving “expanded Medi-Cal” under President Obama’s Affordable Care Act. They are shocked to learn that their estate, most typically consisting of their residence, will be essentially attacked upon their passing.

Michael Gilfix points out in the article that assets could be protected from such Medi-Cal recovery claims. “There are certain ways to transfer a home out of an estate, although this can raise tax issues,” Michael Gilfix is quoted in the article.

Clients of Gilfix & La Poll understand that the residence can be protected and that many potential tax traps can be avoided with careful planning.

Learn more by contacting Gilfix & La Poll Associates LLP at http://www.gilfix.com/contact-us/.

Long-term care planning is also important for older adults with disabilities; their numbers will also increase to roughly 21 million by 2040. By 2050, it is estimated that there will be at least 25 million people in the U.S. who are using long-term care, either at home or in an assisted living or skilled nursing facility. How will those 25 million people pay for their care?

Many of them hope to rely on Medicare or Medi-Cal, but Medicare only pays for up to 100 days of care in a skilled nursing facility after three days in a hospital, and only if that skilled care has been deemed necessary. After the first 20 days, Medicare also has a co-pay which must be met.

Simply stated, Medicare is not a meaningful source of assistance when long-term care services are needed.

The average cost of a nursing home stay in California is $250 per day. Assisted living facilities in California cost an average of $2,900 per month. Adult day services typically run at least $80 a day. Hourly home care costs run between $15 and $30 for a home health aide, who assists with activities of daily living (bathing, dressing, etc.), but is not a registered medical professional and cannot meet more than basic health care needs.

If a more skilled home care provider is needed, the cost is typically between $20 and $40 per hour.

Medicaid, known as Medi-Cal in California, can pay the cost of skilled nursing care, but only after careful planning steps are taken and eligibility is achieved.

Good long-term care sidesteps complete reliance on federal support. A person’s plans may include long-term care insurance, which covers care typically not covered by “regular” health insurance, Medicaid or Medi-Cal. Long-term care insurance helps cover care for someone who cannot perform at least some of the activities of daily living — bathing, dressing, restroom use, eating and moving from chair to bed and back again.

If you are considering a long-term care policy, know that not all insurance agents are aware that you will need a policy that covers both in-home and assisted living care for at least three years (and longer, if possible).

There are multiple long-term care policy options, including policies that provide life insurance benefits if long-term care coverage is never needed. Consult with your estate planning attorney to determine what policy best fits your estate needs for the future.

Pioneers of Elder Law – For over 30 years, Gilfix & La Poll Associates LLP has innovated creative legal solutions to help you manage and plan the future of your estate.
To contact an estate planning lawyer visit http://www.gilfix.com/ or call 800.244.9424.

To qualify for Medi-Cal when an individual is in a skilled nursing facility, she can have no more than $2,000 in “countable” assets. The residence is an “exempt resource,” which means that its value is not counted in determining eligibility. This means that a person can be in a skilled nursing facility, receive Medi-Cal benefits so that Medi-Cal pays the cost of nursing home care, and still retain ownership of the residence. This is a colossal mistake.

When a Medi-Cal recipient dies, the state of California has a right to get its money back. If the Medi-Cal recipient still owns or has any interest in a residence, the state can assert a claim against the property to recover all Medi-Cal benefits that have been paid. This could be $5,000 or it could be $400,000.

In virtually every situation, the residence can be protected. We typically recommend that the residence be transferred into a very sophisticated irrevocable trust. This transfer does not interfere with Medi-Cal eligibility. The house is therefore protected from the Medi-Cal estate recovery claim. There is also a “stepped-up basis” at the time of death so that the property can then be sold without exposure to capital gains tax.

This is a classic case of “having your cake and eating it too.” It is all a matter of good planning.

Pioneers of Elder Law – For over 30 years, Gilfix & La Poll Associates LLP has innovated creative legal solutions to help you manage and plan the future of your estate.
To contact an estate planning lawyer visit http://www.gilfix.com/ or call 800.244.9424.

The legislation included the CLASS Act, which was designed to address this specific concern. That part of the legislation was ill conceived and actuarially impossible. Critics mentioned this at the outset. Actuaries in the federal government came to the same conclusion shortly after the Act was passed. Accordingly, it was abandoned.

This means that we maintain the status quo as we think about paying and planning for the cost of skilled nursing care, in particular.

As a client of our office, you know that we can take many steps to be certain that assets are protected and that Medi-Cal eligibility can be achieved, when appropriate.

Pioneers of Elder Law – For over 30 years, Gilfix & La Poll Associates LLP has innovated creative legal solutions to help you manage and plan the future of your estate.
To contact an estate planning attorney visit http://www.gilfix.com/ or call 800.244.9424.

Meanwhile, resources for healthcare have never been more easily available. A number of free or extremely affordable preventive health tests and screenings are now being provided to seniors under the Affordable Care Act. In some cases, these services may require a small co-pay, but many do not, and all are offered without any insurance deductible for seniors.

For example, doctors who participate in Medicare are now offering a free annual wellness exam. Use this opportunity to work with your primary care physician on a 12-month wellness plan. If you have just enrolled in Medicare, you will receive a “Welcome to Medicare” exam at no cost, as well. Physicians are using it as a preventative baseline check to help plan out an ongoing wellness approach with their new patients. Other services provided for free under the Affordable Care Act include smoking cessation services, bone mass measurements, flu shots, Hepatitis B shots, abdominal aortic aneurysm screenings, and medical nutrition therapy services.

Take advantage of these opportunities to keep up with your heath maintenance. That means getting an annual flu shot and staying current on all immunizations. Go in for regular dental cleanings and medical checkups. Keep an eye on your blood pressure and cholesterol levels; the levels may seem like a small part of your overall health, but healthy blood pressure and cholesterol numbers mean a lowered risk for stroke and heart disease.

The Affordable Care Act does not address the cost of long-term care, nor does Medicare pay for skilled nursing facilities ($5,000 – $10,000). To cover such costs, Medi-Cal is the only governmental source of assistance.

What else can seniors do to take charge of their health and enjoy their later years? Numerous studies have shown that keeping an active interest in intellectual pursuits slows the development of dementia or other types of cognitive decline. Take up a new hobby or learn a new skill. Work on puzzles, brain teasers, crossword puzzles. Take music lessons, or learn a new language. Even things as simple as taking an interesting class at a community center or brushing up on math can make a huge difference in brain activity.

Be sure to get regular exercise. It may be walking every day, or biking on the weekends, or taking an exercise class at the gym most mornings. Focus both on leisure activities which are enjoyable and physical activities which get you moving; you do not have to put too much of a strain on your body. Get outside, get active and have fun.

For Medi-Cal planning assistance, talk with a knowledgeable attorney who can guide you through the maze.

Pioneers of Elder Law – For over 30 years, Gilfix & La Poll Associates LLP has innovated creative legal solutions to help you manage and plan the future of your estate.
To contact an estate planning lawyer visit http://www.gilfix.com/ or call 800.244.9424.

Indeed, annual premiums have doubled and even tripled in a few short years. Twenty percent annual increases are expected.

The real question focuses on, “What to do about the cost of long-term care?”

If you have sufficient resources, long-term care insurance is still an alternative to consider. Do not, however, do so blindly. You can calculate the cost over a twenty-year or thirty-year period. You could put those funds aside to pay for the cost of long-term care if you are very disciplined and have tenacity, patience, and fortitude.

This alternative, in other words, is to “self insure.” Rather than put $200,000 into the hands of a long-term care insurance company, set that money aside, ideally in a tax favored account, and use it when you need it.

The other alternative is Medicaid, known as Medi-Cal in California. Medi-Cal is a needs-based program. The Wall Street Journal indicates that it is “a government health program for poor people.” This is a gross misstatement.

For an individual to qualify for Medi-Cal, for example, she can have no more than $2,000 in countable assets. Federal law provides that a residence is an exempt resource, which means that its value is not counted when determining eligibility. There is a cap in most states of $750,000 on the value of an exempt residence if the individual is in a skilled nursing facility, but the point remains.

For a married couple, there is no cap on the value of an exempt residence when one spouse is in a nursing home. The spouse living at home can retain at least $115,000 in her name if her institutionalized spouse is in a nursing home and receiving Medi-Cal/Medicaid benefits.

Moreover, numerous planning steps can be taken to protect assets and qualify for Medicaid. While this is by no means an ideal outcome, it is the only alternative to losing all of your money in far too many cases.

The message is that you must think about this eventuality – the need for long-term care services at home or in a facility – and plan accordingly. If you do not have long-term care insurance, do not expect the government to come to your assistance unless you plan for Medicaid. Medicare does not pay the ongoing cost of nursing home care.

We understand these options and these rules intimately. We have been helping people plan for almost thirty years with consistent success. You must learn about your options.

Pioneers of Elder Law – For over 30 years, Gilfix & La Poll Associates LLP has innovated creative legal solutions to help you manage and plan the future of your estate.
To contact an estate planning lawyer visit http://www.gilfix.com/ or call 800.244.9424.

There are more than one million elderly people in the state who have been working with this dual system. Gov. Jerry Brown has said that he estimates at least 500 million dollars will be saved by combing the two. The concern, of course, is that combining the two systems may simply be untenable. This new, managed care system will have to oversee the federally funded Medicare, plus the state-federal Medi-Cal, as well as social services.

The new system will be put into place after October 1 of this year as part of a three-year experiment in the Orange County area. For someone who is sick, dealing with three separate administrative entities, with multiple insurance plans and services can be overwhelming. Hopefully this new system will make managing care as painless as possible.

If you have concerns about your long-term care or managed care plans, please do not hesitate to contact the attorneys at Gilfix & La Poll.

Pioneers of Elder Law – For over 30 years, Gilfix & La Poll Associates LLP has innovated creative legal solutions to help you manage and plan the future of your estate.
To contact an estate planning lawyer visit http://www.gilfix.com/ or call 800.244.9424.

Share Care
In some families, a combination of paid care and family (unpaid) care can be a great help. A visiting nurse or home health aid can stop by daily to check on the senior; family members can also come by and meet some needs. When more care is needed or it becomes too financially or emotionally cumbersome to cover care this way, consider sharing the care by pooling resources. Perhaps the senior could move into a living arrangement with someone else in a similar situation. The potential companionship and support of roommates cannot be overstated. Both families can then share the family care efforts and hire one aid to come by for both seniors, which will significantly reduce the cost.

Reducing Living Costs
Another option is moving your loved one to a less expensive living arrangement. Reducing the amount paid for housing, food and utilities may give you the room you need to pay for in-home care. Or, consider moving them closer to a family caregiver, who can oversee a large portion of the care needed.

Collage Care
Patch-working different types of care is as simple as using more expensive care for some things and less expensive care for other issues. If your senior needs just a few hours of skilled in-home care for only a small portion of the day – bathing, transferring from bed, etc – and mostly needs companionship and simple meal preparation, you may be able to connect with the community to have a local volunteer, such as a high school student, that could come to the home. You may also be able to hire a college student through their campus employment office to run errands at a considerably lower rate than an adult caregiver would charge.

Adult Daycare
Adult daycare is another option; it has been shown to greatly reduce caregiver burnout for family members. Adult daycare can be anything from one or two hours a week to full days. Adult daycares typically provide a shuttle service, meals and socialization for people of different physical and cognitive levels. They often also provide services specially designed for people with Alzheimer’s or other forms of dementia, and can be significantly less expensive than in-home care. While Medicare does not pay for adult daycare and while California’s Medi-Cal program does not, some state Medicaid programs do, as does long-term care insurance. Is your loved one a veteran? The Department of Veterans Affairs (VA) offers adult daycare centers for vets who qualify.

The key is learning about options and planning accordingly.

Pioneers of Elder Law – For over 30 years, Gilfix & La Poll Associates LLP has innovated creative legal solutions to help you manage and plan the future of your estate.
To contact an estate planning lawyer visit http://www.gilfix.com/ or call 800.244.9424.

Rural areas could suffer in states that opt against Medicaid expansion.

The goal of Medicaid expansion under the Affordable Care Act is supposed to cover more of the working poor and balance out cuts that were made to already-struggling hospitals. However, Republican-led states have been opting out or holding out, while outlying areas in states like Tennessee may be the most severely impacted.

(Related: DOMA Increases Medicare Costs For Same-Sex Married Couples)

Partners for Healing in Tullahoma, Tenn., offers care exclusively to the uninsured workers — and there’s a number of them in the town of 18,000 — with a number of studies indicating that rural Americans are more likely to have low-wage jobs, and no insurance.

Kentucky Democrat Governor Steve Beshear announced that he will expand Medicaid coverage and nearly cut the state’s uninsured population in half. The expansion will extend coverage to adults earning up to 133 percent of the federal poverty line, providing public health assistance to more than 300,000 people.

(Related: Google’s Plan for ‘Digital Afterlife’)

Those pushing for Medicaid expansion credited GOP lawmakers for putting forth a House bill for discussion. Senate Republicans met behind closed doors to discuss the plan but failed to reach a consensus.

(Related: How Much Will Medicaid Cost in the Future and Why: Federal Projections)

A health advocacy group has developed a compromise proposal in hopes of ending the debate in California of how to expand Medi-Cal. Health Access California proposes a time frame and percentages for the state and countries to share $1.4 billion in savings when Medi-Cal coverage is expanded next year. State and county officials have been playing tug-a-war with how the windfall should be divided.

Read more: http://www.kaiserhealthnews.org/Daily-Reports/2013/May/10/medicaid-expansion.aspx

Christopher J. Berry is a Michigan elder law attorney Dedicated to helping seniors, veterans and their families navigate the long-term care maze. To learn more visit http://www.michiganelderlawattorney.com/ or call 248.481.4000