1. HEFFNER &
ASSOCIATES
ELDER LAW
Mark B. Heffner, Esq. , CELA
Heffner & Associates
615 Jefferson Boulevard
Warwick, Rhode Island
401-737-1600
www.hefflaw.com
Medicaid & Medicaid Planning:
Stuff you will want to know &
tell your clients

2. HEFFNER &
ASSOCIATES
ELDER LAW
Disclaimer
•Materials are for general education and should not
be substituted for consultation with a competent
elder law attorney in your jurisdiction
•Materials presented from the perspective of Rhode
Island Medicaid regulations and practice
•Rules and practice vary significantly from State to
State (and occasionally within the same State) and
are subject to change

3. HEFFNER &
ASSOCIATES
ELDER LAW
•Practicing elder law since 1988
•CELA (Certified Elder Law Attorney) by National Elder
Law Foundation (accredited by ABA for specialization)
•Served in Rhode Island House of Representatives for 10
years
Who is this guy?
•Harvard College; Boston College Law School
•Adjunct Professor, Roger Williams University Law
School
•Friend of Tom Grennan’s

4. HEFFNER &
ASSOCIATES
ELDER LAW
What is Medicaid?
•It is not Medicare!
•Medicaid: in addition to general criteria (age, blind,
disabled) & needing a level of care, must also fall
within financial criteria (assets, income, transfer
restrictions)
•Medicare: insurance model; no asset or income
qualification requirements

5. HEFFNER &
ASSOCIATES
ELDER LAW
Why do should we (and our clients
care about) Medicaid?
•Medicare--limited long term care (LTC) coverage
20 days full payment, up to 80 additional days with
co-pay ($148/pay)
•Continues to require skilled (vs. custodial) care
•Medicare LTC coverage initially applicable if
individual has a three day prior hospital admission &

6. HEFFNER &
ASSOCIATES
ELDER LAW
Why do should we (and our clients
care about) Medicaid?
•Once Medicare ends (if it began at all), absent long
term care insurance, individual pays privately
•Rhode Island: $8516/month
• Genworth 2013 cost of care survey (
www.genworth.com/corporate/about-genworth/industry
)
•Massachusetts: $10,493/month
•Connecticut : $12,638/month

7. HEFFNER &
ASSOCIATES
ELDER LAW
Resources vs. Income
Asset available to
applicant to support,
maintenance or medical
care
Available as of the first
moment of a month
(FOM) of desired
eligibility
Anything received in
cash or in-kind that can
be used for food,
clothing or shelter
That which is received
during a month
Income received within a
month and not spent
within the month
becomes a resource as of
the FOM of the following
month

8. HEFFNER &
ASSOCIATES
ELDER LAW
Resources
Excluded (Single Person)
•Home (equity value limit:
$525K) if “intent to return”
•Household goods & personal
effects( no value limit, unless
exceptional)
•Vehicle (limit: $4500, unless
used for transportation to
medical appts)
•Life Insurance ($4000 face
limit)
•Irrevocable Burial Contract,
or funds set aside for burial
($1500)
•Funds otherwise available
(limit: $4000)
Available
EVERYTHING
ELSE

9. HEFFNER &
ASSOCIATES
ELDER LAW
Resources
Excluded (Married Couple)
•Home: no equity limitation if
residence of “Community
Spouse” (CS)
•Vehicle: if used by CS, no
limitation on value
•CS retains “Community
Spouse Resource Allowance”
(CSRA)

10. HEFFNER &
ASSOCIATES
ELDER LAW
Resources: Married Couple
What is Community Spouse Resource Allowance
Determine couple’s total joint resources as of first
moment of the month (FOM) of the beginning of a
period of continual institutionalization (POCI)
Total joint resources: combined resources of the
institutionalized spouse & community spouse, to extent of
either’s ownership interest in the resource
Maximum CSRA 2013: $115,920
Minimum CSRA 2013: $ 23,184
Community Spouse Resource Allowance (CSRA)
calculated by dividing total joint resources in half;
however, CSRA is subject (in RI) to the following
minimums and maximums

11. HEFFNER &
ASSOCIATES
ELDER LAW
Income-Generally
Anything received during a month in cash or in-kind
that can be used for food, clothing or shelter.
Recurring payments such as the following:
•Gross Social Security
•Gross Pension
•Net--according to Medicaid--rental income
In addition, “one-off” or non-monthly payments--e.g.:
•Inheritances & receipt of life insurance proceeds
•Income tax refunds
•Annual distributions from IRAs and other retirement
plans

12. HEFFNER &
ASSOCIATES
ELDER LAW
Income-Single Individual
All gross income must be used for cost of care, minus:
$50/month personal needs allowance; and
$Pro-rata monthly payment of Medicare supplement
insurance (e.g. Blue Cross Plan 65)

13. HEFFNER &
ASSOCIATES
ELDER LAW
Income-Married Applicants
Community Spouse Allocation (“spousal slide over”) may be
allowed as additional deduction from IS income. Two
factors:
•CS gross income; and
•Amount of spousal allowance, consisting of
Income of CS,--whether regular (e.g. Social Security), or
periodic (e.g., inheritance) is not a factor in eligibility of
institutional spouse (IS), except in following calculation
•Basic monthly allowance to CS (currently $1,891.25); and
•If there are shelter expenses, and if so whether standard
shelter allowance or excess shelter allowance

14. HEFFNER &
ASSOCIATES
ELDER LAW
Transfers of Assets
Post-DRA’05, any transfer occurring on or after
February 8, 2006 is subject to five year lookback period
Q: What types of transfers fall within lookback period?
A: Uncompensated (UV) transfers--i.e., those for which
fair market value (FMV) not received by applicant or the
applicant’s spouse
Penalty period (P): period of time--expressed in months--
for which Medicaid LTC benefits are denied as result of a
UC, calculated as follows:
P=UV/C (average cost of a private resident in a NF)
Ex: Applicant’s spouse “sells” summer cottage with FMV
of $100K to child for $25K.
UV ($75K)/C ($8,643)=P(8.68 months)
Note: “C” varies from State to State, changes
periodically

15. HEFFNER &
ASSOCIATES
ELDER LAW
Resources: Transfers--Exceptions to Imposition of P
•Applicant’s spouse;
P (penalty period for LTC services) not created if:
•Applicant’s son or daughter who (a) was residing in
home for at least two years prior to the parent’s
institutionalization, and (b) can demonstrate that he or
she provided care which prevented parent from entering
an institution for the two year period
Asset transferred is principal residence & transferred to:
•Applicant’s child under age 21, or child who is blind or
totally and permanently disabled
•Applicant’s sibling who has an equity interest in the
residence and resided there for at least one year
immediately prior to the institutionalization of the
applicant

16. HEFFNER &
ASSOCIATES
ELDER LAW
Resources: Transfers--Exceptions to Imposition of P
•Applicant’s spouse, or to another for the sole benefit of
the spouse, or from the spouse to another for the sole
benefit of the spouse;
P not created if:
Asset transferred is other than a principal residence and
transferred to:
•Applicant’s child who is blind or totally and permanently
disabled, or to another for the sole benefit of such child,
or to a trust established for the sole benefit of such child
•Trust for sole benefit of an individual who is under age
65 and is permanently and totally disabled

17. HEFFNER &
ASSOCIATES
ELDER LAW
Resources: Transfers--Exceptions to Imposition of P
•Individual can prove his/her intention was to receive fair
market value or other valuable
compensation/consideration
P not created if:
•Applicant’s can prove transfer was exclusively for some
purpose other than to qualify for MA
•Asset is returned to applicant (in whole or in part)
•Asset transferred for fair market value or other valuable
compensation/consideration
•Denial of LTC payment would work an undue hardship

18. HEFFNER &
ASSOCIATES
ELDER LAW
Estate Recovery
•Federal and RI law require recoupment on funds spent
on MA for individuals age 55 or older
•Recovery initiated by State’s filing a claim in probate
court (in RI):
•State may create lien against decedent’s real estate by
filing notice of statement of claim in land evidence
records
•State is priority creditor under many probate statutes
•If probate estate not initiated by recipient’s fiduciary,
State as a creditor can initiate the opening of probate
under probate statutes

19. HEFFNER &
ASSOCIATES
ELDER LAW
Mark B. Heffner, Esq. , CELA
Heffner & Associates
615 Jefferson Boulevard
Warwick, Rhode Island
401-737-1600
mheffner@hefflaw.com
www.hefflaw.com
National Elder Law Foundation
www.nelf.org
Provides interactive state map of Certified
Elder Law Attorneys (CELA) in each state