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Debunking the Myths
By Dr. David Edward Marcinko; MBA, CPHQ™, CMP™
By Thomas A. Muldowney; MSFS, CLU, ChFC, CFP® CMP™
By Hope Rachel Hetico; RN, MHA, CPHQ™, CMP™
Some advisors, doctors, clients, patients and elders may believe that one way of avoiding the consumption of their assets, which they will use for nursing home care, is by transferring their resources into trusts. By putting their assets in trusts, elders and others believe that these assets will not be exposed to unwanted use and will be protected from claims by nursing home providers.
OBRA 1993 and DRA 2005
However, federal and state laws have severely reduced the use of trusts for this purpose; OBRA ’93 provided many of these restrictions. DRA’05 reduced it even more. Under this and earlier legislation, corpus and income of an inter vivos (a living trust) or self-settled trust are deemed to be resources of the grantor (and his or her spouse) even if the terms of the trust give full power of income and principal distribution to the trustee. (If any person creates a trust, even one that is irrevocable, that provides income to the original grantor, the trust is considered a grantor trust and will not work as an asset protection trust against the claims of lawful creditors – such as Nursing homes or medical providers.)
Eliminated Trusts
Furthermore, certain trusts, including those in which the beneficial interest terminates when the beneficiary becomes institutionalized (conversion trusts) and those that require remaindermen approval for distributions of principal to the lifetime beneficiary (condition precedent trusts), have been eliminated as asset protection trusts.
Approved Trusts
Other trusts have been expressly approved. These include supplemental care trusts for disabled individuals not yet age 65, income assignment trusts for people affected by state income caps, and pooled fund accounts managed by nonprofit corporations.
Ancillary Benefits
The OBRA legislation also appears to have continued to make it possible to create irrevocable trusts in which the grantor retains only the income and the trustee has no discretion to distribute principal. By eliminating a trustee’s discretion to distribute principal, these trusts effectively protect the trust assets from being deemed legally available to the grantor for nursing home costs. Only the mandated income payments could legitimately be considered by state social service agencies.
The Advisor’s Role
Therefore, a financial planner of advisors can recommend “income-only” Medicaid qualifying trusts to those clients who wish to dispose of assets in order to qualify for Medicaid. The client can establish such a trust and receive its income. The income in excess of a personal needs allowance, determined on a state-by-state basis, and must be spent on medical costs. If the income amount is less than the client’s medical needs, the balance of the medical cost will be paid by Medicaid (unless the client lives in an income “cap” state). The trust corpus will not be available, as it has, in effect, been given away. The client’s purpose to protect principal has been carried out. DRA’05 extends the look-back to sixty months.
Assessment
So even income only trusts are under scrutiny if they were established as a means by which a grantor expected to qualify for Medicaid. Thus, if an income only trust is established, it must be established long before the application for Medicaid and before the 60 month look-back period.
Conclusion
And so, your thoughts and comments on this Medical Executive-Post are appreciated.
Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com or Bio: www.stpub.com/pubs/authors/MARCINKO.htm
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“You Say Hello – I Say Goodbye”
[By Dr. David Edward Marcinko; MBA, CMP™
]
Isn’t it ironic that Citigroup just announced the merger of its Smith Barney brokerage into Morgan Stanley’s – a first step to jettisoning the “financial supermarket” business model that former CEO Sandy Weill developed in 1998 when he led he merger of Travelers with Citibank? Of course, I say, Requiem in Pace!
The Glass-Steagall Act
According to the www.HealthDictionarySeries.com, the merger circumvented the Depression-era Glass-Steagall Act that separated commercial and investment banking and helped pave the way for the banking behemoths that have been crumbling during the recent Wall Street credit crisis.
What is Was – How it Worked
The Glass-Steagall Act of 1933 established the FDIC and included various banking reforms, some of which were designed to control speculation. Most well known was Regulation Q, which allowed the Federal Reserve to regulate interest rates in savings accounts. Regulation Q, of course, was repealed in 1980. Any remaining provisions that prohibited banks from owning other financial companies were repealed on November 12, 1999, by the Gramm-Leach-Bliley Act, when it was signed into law by President William J. Clinton.
Never a Fan of GLBA
Glass Steagall was put in place after the great depression to prevent what exactly is happening now. It was a Chinese wall between investment houses and retail banks. Never a fan of the GLBA, I wrote and lectured against it for more than a decade, to the catcalls and hisses of financial advisors and brokerage industry veterans everywhere – so strong were financial industry lobbyists, and Sandy Weill of my hometown of Baltimore, MD.
Conclusion
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Filed under: Alerts Sign-Up, Breaking News, Insurance Matters, Investing, Op-Editorials, Portfolio Management, Risk Management | Tagged: banking, Bill Clinton, Citibank, CitiGroup, commercial banks, FDIC, Glass Steagall Act, Gramm-Leach-Bliley Act, investment banks, Morgan Stanley, Regulation Q, retail banks, Rukeyser, Sandy Weill, Smith Barney, Travelers | 10 Comments »
Information for Advisors
By Dr. David Edward Marcinko; MBA, CPHQ™, CMP™
By Thomas A. Muldowney; MSFS, CLU, ChFC, CFP® CMP™
By Hope Rachel Hetico; RN, MHA, CPHQ™, CMP™
According to the “Dictionary of Health Insurance and Managed Care”, www.HealthDictionarySeries.com geriatric care managers (GCMs) and case managers (CMs), including those working with licensed agencies, often develop an initial assessment; design and implement plans; investigate and identify available LTC resources; supervise aides and LTC services; coordinate family support consistent with its resources; and accommodate client needs, preferences, and budget. GCMs and CMs may be the most important contact with many elders on a regular basis, because they are generally familiar with available private and public resources.
Long Term Care Plans
An LTC plan that includes the coordination of all services (legal, medical, social, financial, and so on) has to be developed, implemented, monitored, and modified as necessary. Low-cost or medically insured services should be incorporated into the care plan when available and appropriate. The GCM is usually the best person to coordinate these services.
Private LTC Management and Insurance
Private LTC management has become an industry. The industry is fragmented, but it is starting to operate on a national scale. Services for elders are available from diverse sources. GCMs often run their own licensed agencies or care-management companies. CMs work in licensed private agencies and for government, not-for-profit, and religious agencies.
Assessment
But, the question remains, is there a real need for LTC insurance, or are there better economic and societal ways to deal with this financial issue?
Conclusion
And so, your thoughts and comments on this Medical Executive-Post are appreciated.
Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com or Bio: www.stpub.com/pubs/authors/MARCINKO.htm
Our Other Print Books and Related Information Sources:
Practice Management: http://www.springerpub.com/prod.aspx?prod_id=23759
Physician Financial Planning: http://www.jbpub.com/catalog/0763745790
Medical Risk Management: http://www.jbpub.com/catalog/9780763733421
Healthcare Organizations: www.HealthcareFinancials.com
Health Administration Terms: www.HealthDictionarySeries.com
Physician Advisors: www.CertifiedMedicalPlanner.com
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