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July 9, 2025 • 15 mins
This week, Todd Lutsky explains the process and qualifications to determine medicaid eligibility, when to get the clock started, changes coming to medicaid, and state-to-state differences.
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Speaker 1 (00:00):
This is Ask Todd on the Financial Exchange Radio network.
If you have an existing estate plan or in the
market for one, Todd Lutsky is here to answer your
questions and help you plan for a later life. Ask
Todd is presented by Cushing and Dolan, serving Massachusetts and
New England for more than thirty five years, helping families
with estate and tax planning, medicaid planning, and probate law.

(00:22):
Visit Cushingdolan dot com. Now here's Todd Lutsky.

Speaker 2 (00:27):
We are now joined by the one and only Todd
Lutsky from the law firm of Cushing and Dolan. Phone
lines are open because the segment is Asked Todd. Where
you get to Ask Todd your estate planning questions live
on air right now. Eight eight eight to zero five
two two sixty three. That is the number to call
to ask Todd your estate planning questions. We usually have

(00:48):
time for two to three of these, so get callin early,
get calling often to make sure you get your question
answered by Todd. That number is eight eight eight to
zero five. I have two two six three. Again, that
number is eight eight eight two zero five two two
six three, And we do have limited space on the
phone lines, So get calling now, mister Lutsky. How are

(01:11):
you doing today?

Speaker 3 (01:12):
I am never better and you I'm okay, ish, just
okay ish. Well, I had a doctor's appointment yesterday.

Speaker 2 (01:19):
Yeah, how'd that go? Doctor asked why I drank the
break fluid break fluid? Told him I couldn't stop.

Speaker 1 (01:26):
That.

Speaker 3 (01:26):
What makes sense?

Speaker 2 (01:26):
It wasn't a good appointment. Wasn't a good appointment, Todd.
I want to talk to you a little bit about nursing,
home planning and being able to qualify for Medicaid. When
you look at how Medicaid examines assets and incomes of
a family, what do they look at in order to
determine eligibility.

Speaker 3 (01:48):
So it's a little different for a single person versus
a married couple.

Speaker 2 (01:53):
Let's start with a single person then, so.

Speaker 3 (01:54):
The single person is a little easier because pretty much
everything is countable. Let's start with that. But then let's
try to back off assets. So you got this big pile.
In order for an individual to become eligible for Medicaid,
you need to have two thousand dollars. That doesn't seem

(02:15):
like a lot of money, no, So however, if you
have a house, it's your primary residence, and most people do.
They can check a box on the application that they
intend to return home and as long as the value
of that home is less than about a million, thirty
three thousand dollars. It very varies right around there, goes

(02:36):
up and down and a it's it was your primary
residence and it's located in Massachusetts. If you're applying in
mass it'll be non countable. Yeah, but leanable. Okay, so
they're gonna put a lean on it, but at least
that won't prevent you from It won't count towards your
two thousand dollars limit. All the rest of the money,

(02:58):
if you have no other no other estate, all the
rest of the money is accountable. How do I get
rid of it?

Speaker 1 (03:03):
What?

Speaker 3 (03:04):
Can't give it away? It's too late, You have a
five year waiting period. So the only thing you could
do there is think about buying a Medicaid annuity if
you need one, right to take those dollars. It's a
special annuity. Can't do this on your own, and you
follow the annuity rules that do provide a payback to
the state in case the annuity doesn't expire by the

(03:25):
time you do. You convert those assets into an income stream.
So if I had a five hundred and two thousand
dollars of assets, I would have to take five hundred,
leaving the two. Buy the annuity for five hundred, pays
out over my life expectancy based on a table, and
then I get this stream of income. Well, that income

(03:46):
goes to the nursing home, but the five hundred thousand
went away. Now it looks like I'm worth two thousand
dollars and I'm immediately eligible for Medicaid provide it. However
that it does have a payback provision in case I die.

Speaker 2 (03:59):
Talk with Lotski from Cushing and Dolan. If you've got
a question to ask Todd about your estate plan. Phone
lines still have space on them at eight eight eight
to zero five two two six three. That number again
is eight eight eight to zero five two two six three. Todd,
What about the situation for a married couple, how does
that differ?

Speaker 3 (04:19):
Yeah, so take the same situation, and I'm not and
i haven't discussed rental property or vacation homes. I'm just
assuming a home and money. Those are the two assets, okay,
which is mostly.

Speaker 1 (04:29):
What people have.

Speaker 3 (04:30):
Sure, And so with a married couple, it's a little different, right,
It's it's actually a little easier because with a married
couple you have again everything starts off as accountable, but
the home is different. The home if the community spouse
is living there and it's located in Massachusetts, there is

(04:50):
no value limitation. Remember we talked about the value limitation
for the single person. Remember if that home that the
single person had was worth a million five, hard stop,
they're not eligible for medicaid. That's a toughie. However, for
a married couple, if your primary residence is worth a
million five or two million or whatever it is, doesn't
matter as long as this community spouse is living there,

(05:13):
non countable, non leanable. What I would recommend, though, is
that you take to jointly owned property and convey it
to the survive, to the healthy spouse. Don't leave it
own jointly, because if I leave it owned jointly, it's
possibly going to be you know, I could die out
of order, and then it goes back to the surviving,
the health the six spouse who's in the nursing home.

(05:34):
All the rest of the money, same deal. It's all
at risk, except the community spouse gets about one hundred
and fifty four thousand dollars give or take of money
that she can reach in and take out of that
pot of money, and that'll be non countable along with
the house. Everything else countable unless you transfer it to

(05:55):
the healthy spouse, which you can do because that's a
permissible transfer, no five year waiting period, and then the
healthy spouse buys that same annuity that we talked about
for the single person. And like magic, you're on Medicaid.

Speaker 2 (06:07):
Talk with Todd Lutsky from Cushing and Dolan. If you've
got a question for Todd, we do still have room
on the phone lines at eight eight eight to zero
five two two sixty three. We are going to take
a quick break right now, but when we come back,
we're gonna get to your questions with Todd. That phone
number is eight eight eight to zero five two two
six three. One last time, it's eight eight eight two

(06:29):
zero five two two sixty three.

Speaker 1 (06:32):
Ask Todd with Todd Lutsky every Wednesday at ten thirty
only here on the Financial Exchange Radio Network. You're listening
to Ask Todd with Todd Lutsky on the Financial Exchange Radio.

Speaker 2 (06:46):
Network, talking with Todd Letski from the law firm of

(07:12):
Cushing and Dolan Todd. We talked about, you know, the
assets that are potentially at risk and income streams that
are potentially at risk in the event that you have
a long term care situation. Yeah, given all of that
money that could be at risk, at what age does
someone need to start getting their estate plan in order
for potential long term care situations? You know?

Speaker 3 (07:34):
I would say I just as a general rule, I say,
you know, sixty and over. If they come in and
they and they are talking about doing long term care planning,
I would say, you know, sixty and overs is a
time in which I'm going to at least ask the question,
because you know, it takes five years to protect stuff.
And I know we've been talking about last minute planning

(07:56):
a minute ago, but if you want to avoid that problem,
it does take five years. So you know, if I
can have this in my rear view mirror by the
time I'm sixty five or seventy, why not.

Speaker 2 (08:07):
Is there downside to doing it sooner than that. Let's
say that you're fifty five and you say, hey, should
I start getting you know, things in order for potential
long term care situations? Is there a problem with going
that route?

Speaker 3 (08:21):
Well, I mean when you're when you're younger, you probably
have younger children. You might not want them serving as
trustee yet. You know, you might need more access to
the assets to pay for college, or you know, mortgages
exist on houses. So yeah, there can be some issues
when you're when you're younger that you might just not

(08:41):
be ready for that irrevocable trust. You haven't quite settled
down yet.

Speaker 2 (08:46):
So so let's go forward. Now, Let's say that someone
is approaching a nursing home situation where you know their
health is failing, spouse can't keep them at home, or
maybe they're just not you know, maybe they don't have
a spouse. How does qualifying for medicaid to cover the
cost of that nursing home actually work? Like, what are
the steps that are involved in being able to say

(09:09):
I'm going to have Medicaid cover the cost of this
long term care situation.

Speaker 3 (09:13):
So this is more back to that last minute idea, right.
You know, if you've not planned, if you have planned,
there's always going to be some assets that are sort
of kicking around that you have to deal with. And
so the process itself is pretty arduous. I mean, you
basically come in, you explain how all the assets are owned.
You decide what assets are countable, what assets are not.

(09:36):
Like a house we talked about might not be countable,
you know, perhaps a rental property is not countable if
it's making money, if it's generating income essential self support,
but leanable. So you have to rearrange all the assets
to find out what's countable and what's non countable. Once
you do that, and you've met the financial requirements of

(09:58):
eligibility again, for a married couple, that would be one
hundred and fifty four thousand dollars ISSH for the healthy spouse,
two thousand for the six spouse, and one home. So
when you meet that eligibility requirement, now you can begin
the application process. But the application process is going to require,

(10:19):
you know, five years worth of bank statements, five years
worth of brokerage statements, birth certificates, social Security card, three
years worth a tax returns, on and on.

Speaker 2 (10:30):
There's a list. So it's not a simple and easy process,
is what you're telling me.

Speaker 3 (10:35):
No, not, in fact, we do it all, but you've
got to help me, help you by providing that support
for everything I put on the application. Then you file,
Then you wait thirty days for them to sniff it
over and come back and say, you know what, we
need more stuff. And then you have thirty days to
get that more stuff. And then you wait another thirty

(10:56):
days and if all has gone well, you should get
a letter of eligibility retroactive back to the day we
said you were financially eligible, the day we proved that
you were financially eligible for medicaid. So it's a process,
but it's one worth going down that road if you
can save these assets. So, folks, we're talking now a

(11:17):
little bit about what to do last minute. We just
talked about the application process itself, which is time consuming
and a little arduous, but again, the lawyers do most
of the work. However, what do we do last minute
to make sure these assets aren't taken? And that's what
this guide is all about. Whether you're married or single,

(11:40):
the rules are different, right, So how you treat assets
that are accountable non countable? You know, think about a home,
a vacation home, a rental property. What about life insurance,
what about annuities four oh one k's. They're all treated differently,
And there's even some information in here about how you
can transfer some of these assets last minute without the

(12:02):
five year waiting period. So don't just write the check, Folks,
call and get the guide last minute Medicaid eligibility techniques
to save it. It's for people who have planned and
people who have not planned eight six six eight four
eight five six nine to nine or Legal Exchange Show
dot com again eight six six eight four eight five

(12:26):
six nine nine or Legal Exchange Show dot com.

Speaker 2 (12:30):
Todd as you're, you know, trying to navigate that situation,
and you know, let's say that again, you've got a
medicaid situation or a nursing home situation rather that you're
trying to qualify for medicaid on Are there any differences
from state to state and how that works in terms
of qualifying or is it largely the same between most

(12:52):
most states Depending on where people are listening.

Speaker 3 (12:53):
Right now, I'm gonna say that largely it's the same
because it's a federal statute that is implemented by the state.
But they are not all the same, right Like, for example,
in Massachusetts, the value of a home when we talked

(13:13):
about a single person, the value of the home was
when the state passed the medicaid laws in twenty oh six,
they said, a home will be considered non countable unless
the value exceeds seven hundred and fifty thousand dollars or
five hundred thousand dollars depending on where you live, right,

(13:35):
because certain states have higher value real estate than others.
So they put that option in there, and the state
got to pick which value they used, and of course
those were indexed for inflation. So that's why we're at
a million plus in Massachusetts today. So Massachusetts opted for
the seven hundred and fifty valuation, whereas many other states

(13:57):
that didn't opt for that, five hundred was enough to
make it non count because they're most of the values
of the of the real estate in that state were lower,
and so that that would be it. That would be
a difference. But but generally the rules are are pretty
pretty uniform, Todd.

Speaker 2 (14:13):
I know that with the latest reconciliation bill that just
passed Congress and was signed by the President, there are
some changes to Medicaid that happen as we go out
a couple of years from now. Do any of those
impact Medicaid coverage of nursing home costs?

Speaker 3 (14:30):
Yeah, the good news is not not really, except interestingly enough,
this valuation on the home thing right. They've now decided
to make it uniform and make the value one million
dollars on the house going forward.

Speaker 2 (14:46):
Across the board.

Speaker 3 (14:47):
I'm still digesting the bill as we speak, but it
it it appears to me that it's that it's going
to be across the board. The thing I'm waiting on
is is it going to remain index for inflation? And
and then the question is if you're already at a
million one like we are in mass is it going
to fall back to a million or do we stay
at a million one and go forward? These are some
things that we need to work out. But nevertheless, folks,

(15:11):
that's what I have for today.

Speaker 2 (15:13):
Mister Lutsky, thank you so much for joining us.

Speaker 3 (15:15):
Always a pleasure.

Speaker 1 (15:17):
This has been Asked Odd on the Financial Exchange Radio network.
Ask Todd with Todd. Lutsky has been presented by Cushing
and Dolan, serving Massachusetts and New England for more than
thirty years, helping families with the state and tax planning,
Medicaid planning, and probate law. Call eight hundred and three
nine three four thousand and one or visit Cushingdolan dot com.
The views expressed in this segment are solely those of

(15:37):
Cushing and Dolan Armstrong advisor. He does not provide any
legal or tax advice. Please consult with your illegal or
tax advisor on such matters. Cushing and Armstrong do not
endorse each other and are not affiliated.
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