The One Big Beautiful Bill: What NC Residents Need to Know About Long-Term Care Changes

The landscape of long-term care benefits in North Carolina is shifting dramatically with the implementation of the "One Big Beautiful Bill." This legislation introduces several key changes that could significantly impact how you or your loved ones access crucial healthcare services when they're needed most.

Most notably, the bill establishes a flat home equity cap of $1 million for Medicaid eligibility. For homeowners who have built substantial equity over decades – particularly in urban areas with higher property values – this could create unexpected barriers to receiving necessary care. Fortunately, several protective measures remain available, including convertible trusts, irrevocable Medicaid asset protection trusts, and traditional life estate deeds, but timing is critical. These strategies must be implemented outside the five-year look-back period to be effective.

The legislation also introduces more frequent eligibility redeterminations (now semi-annual rather than annual) and reduces the retroactive coverage period from 90 days to just 30 days. This shortened window makes immediate action essential when facing a healthcare crisis. Waiting even a few weeks to begin the application process could result in thousands of dollars in uncovered expenses that previously would have been retroactively covered.

Despite these challenges, proactive planning remains your strongest defense. By putting protective measures in place before they're needed, you can avoid sacrificing your home or other assets due to a long-term care situation that's no fault of your own. The tools available haven't changed – but the urgency of implementing them has increased substantially.

Ready to protect what you've worked so hard to build? Call us at 1-888-999-6600 to schedule a free consultation. Let's develop a strategy that shields your assets while ensuring you maintain access to the care you may need in the future.

Episode Transcript

Greg McIntyre (00:00):
The one big beautiful bill and how it
affects long-term care benefitsin North Carolina.
Let's get into it.
My law partner, brenton Begley,wrote a summary yesterday on
the one big beautiful bill andhow it affects long-term care
benefits.
You can find that on our blog.
On our site.

(00:20):
We've got a ton of resourcesthere mcelderallcom slash blog.
Our site.
We've got a ton of resourcesthere mcelderallcom slash blog
Great article.
I'm going to hit the high pointson this bill and long-term care
benefits.
So the benefit that pays forskilled nursing care in North
Carolina a couple of in-homecare programs PACE and CAP,
pacing cap will be affected, butreally only in specific ways.

(00:47):
There's a flat home equity capof one million dollars.
That means if you have over onemillion dollars equity not the
value of your home, but equityin your home then you're not
going to be eligible.
So the way you avoid that is byusing tools like convertible

(01:09):
trust that we offer orirrevocable Medicaid asset
protection trust to move yourhome into that trust but still
have your trustee, which couldbe a trusted child, for example.
Maintain control of that homein the trust and keep that
maintained for your use ofbenefit for the rest of your
life.
And then you have beneficiarydesignations from the trust

(01:30):
where you're passing it, say, tothe children.
So planning ahead is importantthere with your home, always has
been.
Another thing is putting, say,a life estate deed on that home
ahead of time.
A traditional life estate deedcould be done as well.
So that's a tool that could beused as long as it's done
outside of the look back periodfor that benefit, which is five

(01:52):
years.
So there's some absoluteplanning tools there that are
just readily available for usthat we use now and we won't.
Nothing will change there.
But four you should really beaware of that.
If you might have or beapproaching a million dollars in
equity in your house and ifthat's the case, especially in

(02:12):
urban areas, then you should.
You know where home valuesmight be higher and equity might
be higher.
If you've been paying amortgage down for 30 years, you
should really pay attention tothat and we should sit down and
talk about that and plan ahead.
There's semi-annual eligibilityredeterminations.

(02:35):
I've seen that before.
Anyway, most departments do itannually but semi-annual.
We handle recertificationswhich are not super burdensome,
but anything dealing with agovernmental agency can be
complex.
Along those lines.

(02:56):
There's the suspension ofenrollment, simplification rules
.
This was really, I think, setto be implemented more than
anything.
But you know we handle thoseapplications from the beginning
and recertifications, and theycan be complex to put together.
However, we have a wholedepartment that's dedicated to

(03:18):
doing that and it's a greatdepartment led by Mary Kells,
who's phenomenal in that area.
And just you know we handlethat for clients anyway.
So no change there for us,aside from perhaps more frequent
certifications.
So no change there for us,aside from perhaps more frequent
certifications.
And then there is a short andretroactive coverage period.

(03:39):
This is one of the main points.
Previously, the long-term care,medicaid benefit, paying for
skilled nursing care, whichlet's call it nursing home care,
or two in-home care programs,pace and CAP they would pay back
to retroactively, say for afacility, up to 90 days.

(04:02):
So we'd get someone financiallyin shape to qualify, put in the
application and then they'd payback up to 90 days.
Now they've shortened that,they'll pay back up to 90 days.
Now they've shortened thatThey'll pay back up to 30 days.
It's just more important thatwhen you have a crisis, when you
or your spouse does, or someonein your family, that we sit

(04:22):
down quickly and determine so,because time matters there.
The quicker we can get thateverything moving along and
putting the application and getto a point of financial
qualification, the longerthey'll pay back, okay.

(04:44):
Or the more chances or morelikelihood that we'll get the
30-day payback and max out thatperiod okay.
The 30-day payback and max outthat period Okay.
So that's very important aswell.
Long story short, there's someslight effects to long-term care
benefits, not affectingeveryone.
However, as I've always said,planning ahead helps put you in

(05:18):
the driver's seat, helps youavoid these types of conflict.
It's just more important thanever to sit down and plan ahead
to make sure you don't sacrificeyour home or other assets
because of a long term caresituation.
You know, a nursing home orassisted living situation that's
no fault of your own.
In addition, we still have thesame tools applied to the new

(05:41):
bill that applied to the oldthat we use legally so, but the
timing is a bit different.
So just want to make sure,especially if you're you know,
if you have a home that couldbuild over that million dollars
in equity, let's get that in aMedicaid asset protection trust,
in an irrevocable trust, putthat in a safe and lock the door

(06:01):
to make sure it's safe.
Or let's look at deep planning,like traditional life estate
needs on that home.
I'd offer a free consult to sitdown and talk about it.
If you want to look at planningahead, look at getting your
affairs in order, because younever know what changes in the
law might do to your eligibility.
So you want to take advantageof the planning just period and

(06:25):
plan ahead.
You can give us a call at1-888-999-6600 to take advantage
of that free consultation andlet's sit down and talk about
protecting what you've worked solong and hard for.