Trying to plan your North Carolina estate? Get the answers you need to protect your family.

It might be easy to think that filing for Medicaid assistance for nursing home care is as simple as completing the Medicaid application forms, but that is just the start of a time-consuming process that often takes several months.

Working with an attorney can be critical to the success of your application.  Here are a few reasons how working with our office can be beneficial:

• We make sure that the client is actually eligible and is filing the application at the correct time.  Due to budget cuts, most county Medicaid offices are understaffed and it can take several months for them to review and approve or deny your application.  Thus, it is critical to make sure that you are eligible.  Otherwise, if the applicable is denied several months after filing it, that’s several months of lost coverage—potentially resulting in tens of thousands of dollars being owed to the nursing home.
   
• We know what documentation is required to support an application so that we can help assemble and file as thorough an application as possible to reduce delays with application approval.
   
• Unlike the nursing home, our duty is to act in your best interests.  The private pay rate at most nursing homes is significantly higher than the Medicaid reimbursement rate (the amount that the government pays them for a patient that is approved for Medicaid).  Thus, it’s not really in the nursing homes best interest to help you get your application approved as quickly as possible.
   
• We conduct a full application “audit” prior to submitting the application to Medicaid.  We review all of the bank statements and supporting information as if we were as caseworker from the Medicaid office to look for any “red flags” that might slow down or jeopardize the application.  If we find any, we’ll work with you to get them properly documented to ensure that your application gets approved as quickly as possible.
   
• While your application is pending and after the application is approved, you are still responsible for paying a “Patient Monthly Liability,” i.e., your share of the nursing home bill.  We’ll calculate this amount for you to make sure that you don’t fall into arrears while the application is pending.

 

Spend-Down and Eligibility Planning

If it is determined that you are not yet eligible for Medicaid, then we can assist you with a Medicaid spend-down plan to achieve Medicaid eligibility.  There may be separate legal fees to create a Medicaid spend-down plan.  As part of the plan, we’ll discuss various Medicaid exemptions and allowable expenditures until assets are reduced sufficiently to qualify for Medicaid.  Legal fees for Medicaid spend-down planning and/or assistance with preparing and filing the Medicaid application are allowable Medicaid spend-down expenses. 

Pre-Filing of the Application

Our process begins with working with you to gather the supporting documents for the Medicaid application.  When appropriate, we are happy to contact banks and financial institutions on your behalf to gather supporting financial information (though some banks will charge a fee for this service). While we will do what we can to reduce the burden on you of tracking down information, we will need your involvement in tracking down records such as important biographical information (e.g., birth certificates and similar), but we work with you to try and make this as easy as possible.  We’ll provide you with a thorough checklist of information needed.

Our office will then conduct a pre-submission “audit” of the application materials and supporting documents to ensure that the client is eligible, that we’re filing at the correct time, and if there are any potential “red flags” in the financial statements, that we have the supporting documents for them.  We’ll also calculate the Patient Monthly Liability for you and instruct you regarding how to pay the nursing home while the application is pending.

Filing of the Application & Advocating for Eligibility

Once we file the application, we will handle all follow-up and interaction with the Medicaid office until the application is processed.  Due to budget cuts, many Medicaid offices are understaffed, so the Medicaid application review process can take several months.  During this time, we will follow up on your application status to ensure that it was properly received and filed, that is has been assigned to a caseworker, and what the status of the application processing is. 

While the application is pending, we’ll answer any questions that might arise from the Medicaid office regarding the application.  We’ll also continue to work with you if any questions arise on your end.

We are well versed on the Medicaid manual and the various eligibility rules and exemptions.  When we file your application, we include supporting documentation specifically citing the various sections of the Medicaid manual that allow for certain exemptions to ensure that the application is processed in a timely manner and that you receive the exemptions that you are entitled to.

During the Medicaid application process, it is common for the Medicaid office to send “Requests for Information.”  These letters come with strict deadlines and it is critical to comply with them.  We docket all deadlines, ask for extensions when needed (however the number of exemptions is limited), and work diligently to gather the information requested and submit it in a timely manner.

Review of Medicaid Approval

When the Medicaid application is approved, we’ll review the approval letter to ensure that the Patient Monthly Liability was properly calculated.  We’ll also advise you regarding how to ensure that you maintain ongoing Medicaid eligibility and don’t do something to jeopardize your Medicaid status. 

Additional Information on North Carolina Medicaid Assistance for Nursing Home Care:

Download a free copy of Jackie Bedard’s book, The Ultimate Guide to Paying for Nursing Home Care in North Carolina, to learn the nursing home and Medicaid secrets you need to know to avoid going broke in a nursing home and leaving your family penniless.

 

There are many gun owners who worry about what will happen to their firearms and magazines when they die or become incapacitated. If you become incapacitated, a typical revocable living trust may require the sale of your firearms or transfer to an ineligible individual or one who does not understand the additional laws and restrictions relating to the ownership, transfer, and use of firearms. Similarly, when you die, firearms need to be transferred properly and only to those who are legally able to be in possession of them. While a traditional trust can be used to purchase NFA firearms, there are many problems with using a traditional trust and therefore only a NFA Gun Trust should be used. For more detailed information, please contact our office at 919.443.3035.

Elder law is a growing field of law that deals with the issues faced by the fastest growing segment of the U.S. population, seniors. With the goal of Asset Protection, this area of law combines parts of Long Term Care Planning, Veterans Benefits, Special Needs Planning, Medicaid Planning, Estate Planning, Senior Estate Planning, and Trust or Probate Administration.

The difference between ordinary and extraordinary is “a little extra.” We decided early on that we would provide our clients with an exceptional and complete experience. That’s how our Vision Method came to be.

Free Public Seminars

Many of our clients first get to know us by attending one of our free public seminars held at our office to learn more about estate planning. While attendance at our seminars is not required, we regularly receive feedback from attendees that they felt like it was well worth the investment of time and helped them feel better prepared for their first appointment.

Your Vision Meeting

Your first one-on-one appointment with our office is called a Vision Meeting. One of our friendly Client Welcome Specialists will assist you with scheduling your Vision Meeting and walk you through how to prepare for your meeting.

Preparing for Your Vision Meeting

In preparation for your Vision Meeting, we’ll ask you to complete a one-page Vision Meeting Form and return it to us a week before your scheduled Vision Meeting along with any prior estate planning documents that you may have. You’re welcome to enclose any additional notes, financial statements, or information that you think will be beneficial.

The Vision Meeting Form asks for some basic information such as your name and age, whether you’re married or have children, whether you have prior planning, and a rough snapshot of your assets. This information is critical for a number of reasons:

• Different assets are handled differently upon your death so this helps us assess potential probate issues or similar concerns;
• Helping us identify potential capital gains tax, income tax, or estate tax issues so we can discuss applicable planning options;
• Different assets are treated differently for purposes of government assistance such as veterans’ benefits or Medicaid for nursing home care—we use this information to help assess long-term care planning options; and
• Different types of assets have varying degrees of asset protection from lawsuits, creditors, or nursing home expenses so this can help us asses your potential exposure to these concerns.

Your information is reviewed by our legal team and our Estate Planning Manager. Our legal team prepares several illustrations for your Vision Meeting to help spot challenges and opportunities such as:

• Estimates of the size and composition of your estate that would be subject to probate expenses and taxes, and which of those expenses are avoidable;
• If you’re age 50 or older, illustrations relating to future long-term care costs;
• If you have more than $500,000 in pre-tax retirement plans, “stretch out” illustrations to illustrate that with planning and tax strategies to maximize the retirement plans which could be worth millions to your beneficiaries.

If you have prior planning documents that you submit with sufficient time to review in advance of your Vision Meeting, a member of our legal team will complete an Estate Planning Document Review Checklist that highlights some of the most common issues that we see on a regular basis.[1]

What happens during the Vision Meeting?

A Vision Meeting is when we get to know more about you and your family—the things that aren’t easily conveyed on paper. What keeps you up at night? What hopes and dreams do you have for your family?

Through conversation and a series of thought-provoking questions, we help guide you through the process of figuring out your “vision” for your planning—what is really important to you? What do you want your plan to accomplish?

We’ve worked hard to strip out as much of the legal “mumbo jumbo” out of this meeting as possible and discuss in plain English—what do you want for your and your family’s future?

Based on your goals, our Estate Planning Manager will review planning options with you that align with your identified goals.

The fees for our plans are based upon the type of planning and the value and complexity of the planning. Rest assured that our fees are not based on the size of your estate, but rather, are directly based on the type of planning needed to meet the specific goals that you identify during the Vision Meeting. All of our foundational planning options are offered on a flat fee basis so they’ll be no surprises.

Advanced Wealth Protection Planning is handled on a case-by-case basis and often starts with foundational planning, but may also include hourly billing to perform a more in-depth tax or asset protection analysis, or the planning may be broken into stages (e.g., begin with in-depth wealth protection analysis followed by a separate implementation stage) with separate fees for each stage.

When is a Vision Meeting not appropriate?

A Vision Meeting is not intended to be a legal consultation for specific legal advice. If you are looking for specific legal information or advice, we do offer standalone legal consultations for a consultation fee.

For example, when we receive phone calls from a concerned spouse or adult child who wants to discuss long-term care issues for his or her loved one, we may suggest that a legal consultation would be a better place to start rather than a Vision Meeting.

Similarly, a Vision Meeting is not for making specific decisions about your plan such as who will get what and who will serve in specific roles. The purpose of the Vision Meeting is to help you identify your goals and what type of planning fits your needs. After your Vision Meeting, you will have a separate Design Meeting with an attorney to discuss the who, what, where, when, and how of your planning. Your design lawyer will confirm that you have selected the right planning for your goals and will provide guidance to help you shape the plan.

Don’t worry. Our friendly Client Welcome Specialists will help you figure out if a Vision Meeting is a good place to start or if a legal consultation may be a better option.

Wrapping Up the Vision Meeting

At the conclusion of your Vision Meeting, your Estate Planning Manager will discuss planning options with you based upon your goals and the process involved to implement your plan.

The Estate Planning Manager will then review our Privacy Policy and Engagement Agreement with you, and will assist you with scheduling your Design Meeting with one of our Estate Planning attorneys. Please know that we do require a deposit to schedule your Design Meeting so that we can begin preparing for your Design Meeting. The Client Relationship will discuss this with you in detail.

Our Guarantee

Our plans even come with a guarantee! The state bar won’t allow us to guarantee a specific outcome for your plan, but we are committed to making sure that our services meet our clients’ expectations. That’s why we offer the following guarantee:

We promise you will receive competent legal services, to the best of our abilities. At any time between now and 60 days after your Signing Meeting, you are not completely satisfied with our services, we ask that you, 1) please tell us immediately, and 2) give us an opportunity to make it right. If we cannot make it right, we will refund 100% of your fee.

While it is rare, from time-time-time, based on additional information disclosed during your Design Meeting, your attorney may recommend changing the type of planning that you selected. If that’s the case, your attorney will discuss the reason for the change to the plan, and with your agreement, your Engagement Agreement and fee will be adjusted accordingly.

After the Vision Meeting

See CFEPVisionMethod.com to read more about Carolina Family Estate Planning’s Vision Method for estate planning.

Secrets of How to Choose a Will or Trust Lawyer

We’ve all seen them: Lawyer ads. They all seem to brag about the same tired things—decades of combined experience, promises of “free consultations,” and how much the “care.” So what?

You owe it to yourself and your family to do your research before you do your estate planning. The reality is that most people don’t know how to compare law firms. It’s easy to just think that you “just need a Will” and that all Wills are the same, but that couldn’t be further from the truth. Get the insider secrets you need to know before hiring a law firm for your will or trust. Inside this guide, you’ll learn a simple six-step process for choosing your attorney so you can have peace of mind that you’ve made the best decision for you and your family.

To get started, download our guide, How to Choose a Will or Trust Lawyer, or call our office at 919-443-3035 to schedule a Vision Meeting and we’ll mail you a copy with your Vision Meeting confirmation.

 

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[1] Please note that the Estate Planning Document Review is not intended as specific legal advice. Because it is performed before your Vision Meeting, we do not have enough specific information about your goals to offer formal legal advice. The Estate Planning Document Review is intended to highlight common planning issues you may wish to explore further such as dated or out-of-state documents and similar.

The three documents you need are: Advance Health Care Directive, Financial Power of Attorney, HIPAA Forms. Call our office to find out how to get these documents at 919-443-3035.

Yes. You will need to fill out and return the Estate Planning Worksheet and the Estate Planning Family Worksheet. Please be sure to return the worksheets to our office one week prior to meeting so that we can prepare for your appointment. Instructions on how to return the worksheets to us are printed on the Worksheet. Fillable PDF Worksheets can be found under the Getting Started tab on our website.

“Get Ahead of the Curve: 1 in 10 Americans is called “sandwiched” because they’re caring for aging parents and their youngsters.  But they’re not planning ahead”

 

http://www.newser.com/article/23e752b33eb34e4684dc1517a9ab6b25/healthbeat-poll-finds-generation-caught-between-kids-and-aging-parents-worried-about-own-care.html

Social Security 

Social Security is a federal program providing retirement, disability, and survivor benefits to wage earners and their spouses, former spouses, widows, widowers and children.  Eligibility for benefits under the program are based up on the wage earner’s work history.  The amount of the monthly Social Security benefit is based upon a number of factors including the number of years worked and the amount of earnings during those years.

Medicare

Medicare is a federal health insurance program that provides health care benefits to the following: (1) persons age 65 and older; (2) individuals with certain disabilities that are under the age of 65 years; (3) disabled children of certain wage earners; (4) individuals with permanent kidney failure. 

There are different parts of Medicare to help cover specific services:

Medicare Part A

Part A provides coverage for inpatient hospital stays, limited coverage for rehabilitation in a skilled nursing facility after a hospital stay, hospice care, and some home health care. For most Medicare beneficiaries, there is no monthly premium for Part A

Medicare Part A does not cover your full bill.  Here is what you are responsible for out-of-pocket for a hospital stay (as of 2017):
Deductible of $1,316 for each benefit period
Days 1-60: $0 coinsurance
Days 61-90: $329 coinsurance per day
Days 91+: $658 coinsurance per each "lifetime reserve day" after day 90 (up to 60 days over your lifetime)
After lifetime reserve days have been used: All costs

For Medicare Part A to cover skilled nursing care, you must first have a qualifying hospital stay of at least 3 days in inpatient status prior to being discharge to the skilled nursing facility for care. If you had a qualifying hospital stay before ending the skilled nursing facility, then here is what you are responsible for out-of-pocket (as of 2017):
Days 1-20: $0 for each benefit period
Days 21-100: $164.50 coinsurance per day of each benefit period
Days 100+: All costs

Common Mistake: 
Do not make the mistake of assuming that Medicare will pay for your nursing home care. Medicare covers very little if any, of the nursing home bills of most seniors. If your nursing home stay is not preceded by a 3-day inpatient stay, then Medicare will not cover any of the nursing home bill. Even if your nursing home stay was preceded by a qualifying hospital stay, as you'll see from the figures above, coverage is for a very limited period of time.

Medicare Part B

Part B provides coverage for certain doctors' services, outpatient care, medical supplies, and preventative care. Most Medicare Part B beneficiaries pay for the Part B coverage via a monthly premium that is deducted from their monthly Social Security benefits. For 2017, the standard part B premium amount is $134. However, some will pay less than this because a cap on the premium since it increased more than the Social Security cost-of-living-adjustment, while others may pay a higher amount if they have higher income.

For Part B, you pay a deductible of $183 per year. After you have met your deductible, then you generally will pay 20% of all Medicare-approved services covered by Part B.

Medicare Part C

Part C, also known as Medicare Advantage Plans, is a type of Medicare health plan offered by a private company that has a contract with Medicare to provide your Medicare Part A and Part B services. Most Medicare Advantage Plans offer prescription coverage. While there are certain benefits that must be included, each Medicare Advantage plan can charge different out-of-pocket costs and have different rules for you get your health care services.

Medicare Part D

Part D adds prescription drug coverage. To get coverage, you must join a plan run by an insurance company or a private company approved by Medicare. The plans can vary in cost and which drugs are covered.
 

Medicaid

Medicaid is program for low-income and needy people. It provides coverage to children, the aged, and/or disabled, and others who are eligible to receive assistance. It is derived from federal law, but is administered by the each respective state, thus the rules for North Carolina may vary a bit from rules in other states.  The program is funded by both federal and state funds.  There are various Medicaid coverage programs for different populations. The most common coverages that we see in our office are for seniors needing help with their nursing home care or individuals with special needs that need assistance.

To read more about Medicaid coverage for nursing home care in North Carolina, check out The Ultimate Guide to Paying for Nursing Home Care in North Carolina authored by Cary elder law attorney, Jackie Bedard.

No, this is a common misconception, but Medicare does not cover the cost of long term nursing home care.  Medicare is an insurance program that provides health care benefits to persons who are over the age of 65, or are blind or disabled.  For recipients, it is basically their primary form of health insurance.  But what many seniors fail to understand is that Medicare does NOT pay for long-term care expenses!


Part of the reason for the confusion is that Medicare does pay for rehabilitation.  If a senior on Medicare has a hospital stay of at least three days and then is admitted to a Skilled Nursing Facility for rehabilitation, Medicare will pay for the care—for a while anyway.  Medicare will only pay for the rehabilitation for a maximum of 100 consecutive days.  Plus, once those days are used up, they’re gone for good. 

Did you notice that I said a “maximum” of 100 days?  That’s because it’s actually based upon how well the patient responds to the rehabilitation.  The patient must experience some improvement.  If the patient’s health is not improving, Medicare may decide that the condition is long-term and benefits will be cut off—even if you haven’t reached 100 days yet. 

Another thing that most people don’t realize is that Medicare only fully covers the first 20 days, after that there is a daily deductible of about $140 per day!  So a 100 day stay could still end up costing you over $11,000!  [If you have a Medicare Supplemental Insurance policy, it might help cover some or all of the difference though.]

Contrary to popular believe, Medicare pays very little of the cost of nursing home and long term care expenses.  The most common forms of payment are either private pay (from your own savings and/or proceeds from a long term care insurance policy) or Medicaid.