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Caregiver Agreements and Considerations.

Caregiver agreements are often used in the Medicaid context so that a family member can be paid for their services to a loved one and the payment would not be considered a gift.

In the Medicaid context, payments to family members are considered to be a gift for love and affection, unless there is a clear agreement written prior to services being rendered, preferably signed by the parent receiving the care as well as the child giving the care.

The caregiver agreement will set forth all of the terms of the transaction, including what services will be provided, where will they be provided, how will they be provided, and other typical contract languages.

The significance of this agreement is that the Department of Human Services (DHS) will look at the transaction as an arms-length transaction between third parties and not among family members.

This means that the payments to the child will not be considered a gift, and, therefore payments will be allowed to be counted as a “for value” transfer as part of a legitimate spend-down and not a gift that will trigger a penalty period for Medicaid purposes.

The biggest question that arises in regards to caregiver agreements is what the parent should pay for services. This is often a very difficult question because there are certainly competing interests at stake. For the parent receiving the care, they genuinely would like to pay full market value and as much as they can without there being a penalty created. This will legitimately reduce the value of their estate, but benefit the child who is providing services for their care on a daily basis.

On the other hand, if there are other children who are not providing the care they often feel slighted or that the other sibling is receiving more than their fair share.

This is very difficult because the children who are not providing the care want the amount to be paid to be the least amount possible to potentially raise the amount that will be left for them and their siblings to share.

However, if the parent does not spend down their assets legitimately, the money can be lost to long-term care costs, and there may not be anything left for anybody.

This inheritance rub is one of the most difficult things involved with a family caregiver because of the potential conflict that it may create among the family members.

At the end of the day, fair market value is generally set in, in this context, by what other professionals and people are charging for similar services. As long as you can stay within the realm of what others are charging for similar services, the Department of Human Services will not raise a red flag. However, that does not mean that other children or other family members may not question the motives of their family member providing the services and the amount of the payment.

We believe it is important to have all parties abreast of the information and informed so that we can potentially avoid unwanted conflict in the future. We always advise the advice of a professional to assist with these potential implications, and ensuring that the agreements are written properly to comply with DHS and Medicaid standards.

If you are looking for advice in regards to estate planning, please call our office at 717-845-5390 or click the link here and we will contact you.

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Why to use Bellomo & Associates for Medicaid Instead of Doing it Yourself

When it comes to filing an application for Medicaid, the process can be quite daunting.  Hiring a professional at Bellomo & Associates can relieve the pressure on everyone. 

To qualify for Medicaid, you must be determined both medically and financially qualified.  To be medically qualified, you must be assessed by the County Area Agency on Aging and the family or Nursing Home physician.  Becoming financially qualified is the tricky part.  For Community Based Services your monthly income cannot exceed the yearly income limit established by Pennsylvania. For skilled Nursing Home Care your income needs to be below the Cost of Care for that facility.  In addition, you must provide statements for the previous five years for all accounts, verify all transactions over $500, and document all closed accounts. 

How can we help preserve excess assets if you sell the home or car, or even if you transferred or gifted assets?   This is done by a process that follows the rules for Medicaid qualification.  We will review the financials and determine what can be done to get Medicaid approval. 

A single person can have one house, one car, and up to $2,400*,  or possibly as much as $8,000* depending upon their income,  in all accounts.  If you have resources within those limits but have transferred assets for less than Fair Market Value or given a gift over $500, you will not qualify.  You are penalized and must pay privately during this period.  We can help determine the penalty period and establish how the payments to the skilled nursing care will be paid. 

A married couple can have one house, one car, and assets are divided in half with the maximum protected at $130,380* for the Community Spouse, this is the Resource Allowance.  As of 2021 the Community Spouse’s retirement accounts are exempt from the Resource Allowance calculation.  If you file for Medicaid and have assets over the established Resource Allowance, you will be denied Medicaid, and will need to spend the excess over that amount, then refile.  Most likely the excess will be paid to the Nursing Home or private care.  This is another time way Bellomo & Associates can help protect assets and assist in obtaining financial eligibility for Medicaid.

Bellomo & Associates can potentially assist in qualify a single person that has excess assets, has previously made gifts and perhaps even leave a legacy for their beneficiaries. We can also protect the excess assets for the Community Spouse so that the Community Spouse can maintain the same lifestyle and the family legacy.  Requesting help from the team at Bellomo & Associates will ease the process and help preserve what you worked so hard to earn.  

If you are interested in learning more about Medicaid crisis planning, please call our office at 717-845-5390, or click the link here to RSVP to our upcoming workshop to learn more about it.

 

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Meet the Team: Deb Pingel

Deb Pingel a Wisconsin Native joined our team in 2020. Customer Service has been instill in Deb for her whole life. From babysitting, helping elderly through church, to customer service, Deb is in the front of the line to help others. Most recently she managed the online shopping at a local grocer, helping get groceries for the customers that were not comfortable shopping during the pandemic. Having a history of Medicaid Planning on the annuity side will bring another great dynamic to the Medicaid team. Deb loves being a wife, mother to her children as well as her fur babies. Deb received her Degree from UW-Milwaukee in Science and Arts.

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Meet the Team

Introducing Sharee Bishop

Hello!  I am Sharee Bishop and work remotely from Ebensburg as a Medicaid Coordinator.   After I retired from the Commonwealth of Pennsylvania working 25+ years in a County Assistance Office as a long-term care caseworker, I joined Bellomo and Associates in June 2019.

I enjoy working with families requesting Nursing Home Care or Waiver Services.  I understand the stress created when asking for help for a loved one.  And I know that gathering documents can be very overwhelming.  My goal is to alleviate that stress and work closely with the family towards approval of Medicaid benefits.

In my personal time, I enjoy reading and spending time with family.  I am an avid Pittsburgh Penguins fan; but also, watch football and college wrestling.

 

Introducing Lisa Wolfe

I am Lisa Wolfe and began working in client services with Bellomo & Associates over a year ago.  I am now assisting in both the Probate and Medicaid Departments.  I enjoy assisting clients and strive to give them the best possible client experience.  In my free time I like to cook and to try new recipes.  I also enjoy listening to classical music, especially when it is performed by my daughters.

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Meet the Team: Christine Oyler

Christine Oyler joined Bellomo & Associates, LLC in April of 2016 in the Medicaid Department.  She graduated from York College of Pennsylvania with a Bachelor of Science Degree in Nursing.  Christine’s previous work experiences consist of working as an RN in Labor & Delivery, a LTC facility with adults that have neuromuscular disorders and as an Infection Control Practitioner.

Christine shares Bellomo & Associates belief that education empowers people to make the best choices for themselves and their families and this is why she loves providing workshops educating individuals on Medicaid.  She loves being able to help assist others through the Medicaid process. Christine loves spending time with her family.  She also enjoys taking daytrips and traveling, especially to the beach and Disney World!

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