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Long-term Health Care Planning for North Dakota Farmers and Ranchers (FE1779)

Long-term health care has become a major issue for farm and ranch families who want to transition their business to the next generation. A long-term health care plan is an essential part of any succession and estate plan to insure the business transitions as the family desires. Without a plan, the farm/ranch business is facing a potentially huge financial risk.

Gary A. Hachfeld, Extension Educator, University of Minnesota Extension

Lori Scharmer, Family Economics Specialist, North Dakota State University Extension Service


Long-term Care Terms

Long-term care: Includes a wide range of care from in-home care to the nursing home

Medicare: A federal health insurance program for people who are age 65 or older, disabled, blind or have permanent kidney failure

Medicaid: A federal program that provides health-care payments for needy people. The program is administered by each county human services department. Individuals have to comply with asset and income rules to qualify. Those will be discussed later in
this publication.

Community spouse (CS): Person/spouse who does not reside in a long-term care facility or receive Medicaid

Institutionalized spouse (IS): The person who is married to a CS and resides in a long-term health care facility. He or she may or may not be receiving Medicaid.

Long-term health care has become a major issue for farm and ranch families who want to transition their business to the next generation. A long-term health-care plan is an essential part of any succession and estate plan to ensure the business transitions as the family desires.

Long-term health care costs have skyrocketed. Without a plan, the farm/ranch business is facing a potentially huge financial risk.

Many individuals ask why long-term health-care planning is important. Including this topic in your succession planning is important for at least three reasons. First, people do not realize the probability of needing some form of long-term care in their lifetime.

Second, long-term health care is expensive and, therefore, potentially financially crippling to a farm or ranch business. Third, people have a lot of misconception about what they can do with their assets to protect them from long-term care costs. These issues will be discussed throughout this publication.

Long-term health care includes a wide range of care options. Those include care given in the home by a family member or home health-care aid, assisted living, congregate and basic care, and the nursing home.

This publication outlines what long-term care is, the statistics around the probability of needing long-term care, some of the terms involved, an explanation of the federal Medicare and Medicaid program qualification guidelines, methods of paying for long-term care and the long-term care partnership program.

Each individual has to decide how he or she will deal with long-term health-care costs if the need arises. This is a personal choice, and every individual has a different set of circumstances.

This information is not meant to imply one choice vs. another. The information contained herein is simply to outline rules around how various programs work, dispel misconceptions about various available programs, and outline some ideas to help you think about your long-term health-care planning.

Probability of Needing Long-term Care

According to several federal governmental agencies and insurance companies, the actual risk for needing long-term care is greater than 50 percent. If you have a spouse, the overall risk of one partner needing long-term care is greater than 65 percent.

Currently, one in two Americans older than 65 will have an extended nursing home stay (does not include any type of home stay). Also, one in 10 Americans older than 65 will have a nursing home stay of more than five years. The average nursing home stay is 2½ to three years. Of those people receiving long-term health care, 40 percent are under the age of 65.

For family members who perform nursing home-level care in their home, a total of 42 percent of the caregivers report the care recipient resided in the home for a period of three years or more. For the caregivers who deliver care in their home, their immune system’s ability to fight disease decreases 18 percent, on average.

The caregiver’s life expectancy decreases by three to four years, on average. The No. 1 health-care issue for caregivers is depression.

Long-term Care Costs

Long-term care costs are based upon the level of care and the care facility. Many insurance companies do a survey of annual long-term care costs. Listed here are current annual cost ranges by type of care and location for North Dakota. The data source is Genworth Financial for 2015 and the numbers listed are the median per year.

Long term costs by regions

Obviously, these numbers change each year. In recent years, the cost of long-term care has increased at a rate of 5 to 7 percent annually. Because of these costs, the issue of paying for long-term health care is far more potentially crippling to a farm or ranch business than any tax issue.

Medicare

Medicare is a federal health-care program that Americans qualify for at age 65. It is not intended to pay for long-term custodial health care.

Medicare may pay for a portion of a nursing home stay if the stay is for doctored-ordered recuperative care such as physical therapy and speech therapy.

To qualify, one must have a minimum of a three-day “admitted” hospital stay before being discharged to the nursing home. Being in the hospital for “observation” does not qualify the patient for Medicare coverage if discharged to the nursing home. The nursing home must be a Medicare-approved nursing home. Lastly, the nursing home stay has to be for doctor-ordered recuperative care.

If the individual meets these three criteria, Medicare will pay for up to a maximum of 100 days. Medicare pays 100 percent of the cost for the first 20 days for doctor-ordered care. For days 21 through 100, Medicare pays all but the daily co-pay, which currently is $152 per day (number changes frequently). The daily co-pay has to be paid for by the patient. For days 101 and beyond, Medicare pays nothing, regardless of circumstances.

During the 100-day period, Medicare will stop paying if the patient’s condition does not show improvement or the doctor ceases to order recuperative care. Once day 101 arrives, Medicare stops paying. The bottom line: Medicare will not pay for an extended long-term health-care stay in a nursing home.

Veterans Benefits

To qualify for Veterans Affairs (VA) benefits, you often must meet specific asset and income requirements, much like Medicaid. You must have wartime service of at least 90 days and one day of wartime service to qualify. Note: Wartime service dates are determined by Congress, not by actual dates of a war. In addition, you must have a service-connected (SC) disability to qualify.

To be placed in a VA community living center (VA nursing home), you would require nursing home care for a service-connected disability, be rated as having a 60 percent SC disability and be unemployable or you have a combined SC disability percentage of 70 percent or more and require nursing home care for the condition.

A second alternative would be placement in a contract nursing home based upon space and availability.

This is a very complex area and proper planning must be done to qualify. See an elder law attorney, as well as your county veteran services officer.

Medicaid

Medicaid is a federal program that assists with health-care payments for the needy. Medicaid pays for custodial/skilled long-term care stays in qualified facilities.

To qualify for Medicaid in North Dakota, the individual has to be a resident of North Dakota. In addition, the individual must meet several financial eligibility requirements. Those include maximum asset ownership amounts, asset spend-down rules, asset transfer requirements and income rule requirements. All of these rules must be met before an individual is eligible for Medicaid.

Asset Ownership Limitations

An individual cannot own more than a maximum of $3,000 worth of assets to qualify for Medicaid in North Dakota. If the husband and wife are applying for Medicaid, that limit is $6,000, or $3,000 per person. Any assets over that amount, with some exceptions, would be subject to spend-down rules, which will be discussed later in this publication. Each person can have a pre-paid burial fund of no more than $6,000 in addition to the $3,000 asset limit amount.

Asset Assessment Process

If the Medicaid applicant has a spouse, the couple’s assets will be assessed through a process referred to as asset assessment. This takes place the first date the spouse entered into long-term care or stayed for 30 continuous days. This stay may have been years ago or the date the person entered the care facility for the first time.

The asset assessment process determines the IS share of assets, the CS share of assets and which assets are subject to spend-down rules.

Assets are divided 50/50 between spouses. The CS is allowed to keep certain assets called excluded assets (discussed later). The CS also has an asset allowance amount he or she can keep in addition to the excluded assets. The current minimum is $23,844 and the maximum is$119,220 (2015). The asset allowance amount changes Jan. 1 of each year.

Once assets have been assessed, they are deemed “available” and “excluded.” The IS can keep $3,000 worth of assets, but any assets in excess of that amount are subject to spend-down rules.

Available assets are assets that are counted against the asset limit ($3,000 per person in North Dakota) when establishing eligibility. They also are subject to spend-down rules, meaning they have to be liquidated or spent on medical care for the IS to become eligible for Medicaid. Available assets include:

• All cash accounts regardless of ownership (does not matter if the account is in one spouse’s name only, and prenuptial agreements have no bearing on this)

• Jointly owned cash accounts unless an actual contribution by the joint owner (other than your spouse) can be proven

• Any investments accounts, stocks, bonds, CDs, etc.

• Land, livestock, machinery and grain inventories (some exceptions are detailed later in this publication)

• Boats, four-wheelers, snowmobiles, campers, cabin and timeshares

• Gift cards, debit cards, pre-paid credit cards, in-store credits

• Disqualified transfers: sale of land or any other asset for less than fair market value if done within 60 months of application for Medicaid

Note: Any retirement accounts of either spouse are not included in the asset assessment process. However, before one or both spouses are eligible for Medicaid, the retirement accounts must be annuitized. (See more details later in this publication.)

Excluded assets are assets that are disregarded at the time of application unless the applicant does not have a spouse; assets are sold or converted. Unavailable assets include:

• Personal residence to a maximum value of $552,000 each (2015)

• Land totaling 160 acres and contiguous to the personal residence

• One motor vehicle of any value used by the applicant

• Personal effects, wearing apparel, household goods and furniture

• Property that is essential to earning a livelihood

• Property that is not saleable without creating an undue hardship

• Gifted assets if gifted 60 months prior to Medicaid application

• Pre-paid burials to a maximum of $6,000 per person; is available to both spouses

• Value of assets in life estate

• Value of mineral acres

• Qualified retirement fund accounts (before approval of one spouse for Medicaid, accounts must be annuitized)

• Annuities that are excluded based upon Medicaid rules (more details later in this publication)

• Indian trust and restricted lands

The following assets must remain identifiable and not comingled with other assets to be considered excluded assets:

• Insurance indemnity payments

• Home-replacement funds from the sale of a home for replacement

• Educational scholarships, grants (excluded for a nine-month period)

• Federal income tax refunds (excluded for 12 months)

• State income tax refunds (excluded for nine months)

• Indian per capita and/or judgment funds issued after Oct. 19, 1973

Asset Allowance Rules

If one spouse enters the nursing home, the CS is allowed a given amount of assets calculated via the asset assessment process. The amount of additional assets above the excluded assets is determined by federal Medicaid rules and is referred to as the community spouse asset allowance. This number changes each year on Jan. 1.

The assets are unavailable and can include items from the available list outlined earlier in this publication. They remain unavailable until the CS dies or enters the nursing home, upon which time the assets become available assets for Medicaid if the IS remains in the nursing home at the death of the CS.

If land, machinery, livestock and other farm/ranch assets are involved and the CS is living on the farm/ranch and is operating the farm/ranch (actually doing the work), the assets become excluded as long as the CS is operating the farm/ranch. The amount can be in excess of the asset allowance amount applicable.

If the CS is living on the farm/ranch but not operating the farm/ranch, the assets are limited to the excluded assets as outlined earlier and the maximum asset allowance amount applicable.

If the CS chooses to keep land as the asset allowance amount, any additional land above the excluded 160 acres and the land allocated to the asset allowance amount must be offered for sale. This has to be done for the IS to qualify for Medicaid.

If the CS has land in addition to the excluded 160 acres, he or she must charge full fair market value rent for those acres. The rent is included as income and subject to Medicaid income rules.

Income Rules

The CS, under current Medicaid rules, is allowed to keep all the income in his or her name. In addition, the CS is allowed a minimum monthly income amount of $2,267 for 2015. This number changes each Jan. 1. If the CS does not have enough income in his or her name only to meet the $2,267 per month amount, he or she is allowed to keep some of the IS’s income to reach the minimum monthly income amount.

Asset Spend-down Rules

To qualify for Medicaid, the applicant cannot own more than $3,000 worth of assets plus a pre-paid burial fund of no more than $6,000. If the applicant has assets and wants to qualify for Medicaid, he or she must spend down (liquidate) those assets to no more than $3,000 to qualify.

In the following example, John and Jane still are farming/ranching. John had a major health issue and is forced to enter the nursing home. Jane remains on the farm/ranch but does not operate the farm/ranch. Assets were evaluated and allocated based upon the asset assessment process and asset allowance rules. Jane chose to use her asset allowance to keep an additional 60 acres of land. Following is the example results:

John and Jane's Assets

The bottom line in this example is that for John to qualify for Medicaid, he would have to spend down (liquidate or spend on care costs) the $5,301,525 on his side of the ledger to no more than $3,000. Owning more than $3,000 worth of assets would make John ineligible for Medicaid.

Having to spend down that amount of assets places the farm/ranch family and the farm business at huge financial risk. The result could mean the farm/ranch business no longer can continue.

In addition, if John and Jane were farming with a son or daughter and that child was using the buildings, even though they are excluded assets to Jane because she is living on the farm/ranch, she would have to charge the farming heir fair market rent for those buildings.

If John and Jane were not farming with a child but the buildings were being used by someone else, Jane also would have to charge fair market value rent for the buildings.

Jane also has to charge fair market value rent on the 60 acres of land she kept as her asset allowance amount. In addition, she is not allowed to own any additional assets. That means she cannot have a checking or savings account, for example. Owning one or both would put her over the $119,220 maximum asset allowance amount.

Gifting Assets

A huge misconception many people have is that if I give away all my assets before I have to go into the nursing home, the assets will be protected and I can go onto Medicaid to pay for my long-term nursing home costs. That is not true. The Deficit Reduction Act of 2005 changed the rules for Medicaid.

One change was the look-back period for gifting when applying for Medicaid. When applying for Medicaid, not only do you have to do an asset assessment and comply with income rules, you must comply with asset transfer rules as well. Those rules state that when applying for Medicaid, you need to disclose any and all gifts given within 60 months of the date of application. A gift includes the obvious outright gift, but it also includes a sale of assets for less than fair market value (FMV); this is referred to as a disqualifying transfer. The difference between the FMV and the sale price constitutes the amount of the gift.

If a gift is made within 60 months of application for Medicaid, a formula is used to calculate the penalty period. That formula is based upon two numbers. First is the amount of the gift. Second is the statewide average payment to skilled nursing facility, or SAPSNF, number. The SAPSNF number is North Dakota’s estimate of the cost for a month’s stay in the nursing home. The current number is $7,595 and that number changes every July 1.

Let’s assume you make a gift of $50,000 and 49 months later you need to apply for Medicaid. The penalty period would be calculated by dividing the gift amount by the SAPSNF number, or in this example, 6.58 months.

In addition to the 60-month look-back period change, the Deficit Reduction Act of 2005 changes when the penalty period begins. Using the gifting example, the Medicaid applicant would have to spend down assets to no more than $3,000. Once Medicaid application is made, the 6.58-month penalty period would begin.

The bottom line is that doing no planning and relying on Medicaid for your long-term health-care costs will not work unless you plan to spend down your assets. This could mean liquidating the farm/ranch business you wish to transition to the next generation.

Retirement Accounts

Before either spouse can be approved for Medicaid, all retirement accounts of both spouses must be annuitized. An annuity can be an excluded asset if it meets the following criteria:

• The annuity is irrevocable and cannot be assigned to another person

• The issuing entity is an insurance company or other commercial company that sells annuities as part of the normal course of business

• The annuity provides for level monthly payments

• The annuity will return the full principal and interest within the annuitant’s life expectancy and has a guaranteed period that is equal to at least 85 percent of the annuitant’s life expectancy

• The Department of Human Services is irrevocably named as the primary beneficiary of the annuity following the death of the applicant and the applicant’s community spouse, not to exceed the amount of benefits paid by the applicant or spouse, or a disabled child survives the applicant and spouse, and any payments from the annuity will be provided to those individuals

Note: The community spouse must irrevocably name the Department of Human Services as the primary beneficiary of the annuity following his/her death. However, the institutionalized spouse can name the community spouse, or a minor or disabled child.

If the annuity does not meet the previous criteria, it is considered an available asset. If the annuity is taken as an income stream, it is considered income and would be subject to the Medicaid income rules described earlier.

The CS would keep all income in his or her name only. If the CS falls short of the minimum monthly income amount of $2,267 (2015), he or she would get to keep some of the income from the IS’s annuity to reach the $2,267-per-month income limit. All other annuity income would go to the nursing home to cover the IS’s care costs.

If the annuity is taken as a lump sum, it would be considered an available asset just like assets such as a checking account, savings account or an investment account subject to the spend-down rules outlined earlier.

Asset Recovery

Let’s assume one spouse enters the nursing home. The person’s income is not enough to cover his or her nursing home care costs, so someone applies for Medicaid on his or her behalf. The person complied with all the spend-down rules, as well as all income and asset rules, so he or she qualifies for Medicaid.

The CS eventually dies, followed by the IS. Once both spouses have died, the Department of Human Services (DHS) will begin asset recovery. DHS will file a claim against the couple’s estate and recover the value of all care costs provided the couple or the value of their estate, whichever is less.

Other Medicaid Rules

The Medicaid applicant can transfer assets to a qualified, disabled family member (spouse or child) and still qualify for Medicaid. The assets have to be placed into a special-needs trust for the care of the disabled family member. The trust would have to have a trustee who is someone other than the disabled family member.

Once the IS has been approved for Medicaid, the CS cannot gift away assets without making the IS ineligible for Medicaid. This would include gifts of, say, $100 to grandchildren for Christmas, birthday, etc.

Many times, the CS goes south for the winter. This is acceptable and does not cause an issue because the CS is not living in the home on the farm/ranch. It is referred to as a “temporary absence.”

Each year, DHS completes an annual review of the IS file. The purpose of this review is to determine if the CS has gifted any assets or made any disqualified transfers. Any of these occurrences would make the IS ineligible for Medicaid for a period of time based upon the formula outlined earlier.

If the CS and IS had entered into a contract for deed (CFD) on land, the CFD would not have to be offered for sale if it was initiated more than 60 months prior to application for Medicaid. If initiated within 60 months of application for Medicaid, the CFD asset value would be the remaining payments due, and that amount would be an available asset.

Suppose the parents have placed their farm/ranch assets into a life estate. They farm/ranch with their son. The son marries and builds a second home on the farm/ranch site. Dad ends up having to enter the nursing home and becomes the IS. Mom is the CS. The CS either eventually goes into the nursing home or dies while the IS still is in the nursing home. Once that happens, the farm/ranch son must charge fair market value rent for the parent’s house on the farm/ranch site unless another qualified family member lives in the house. The rent goes to the nursing home for the IS’s care cost.

Assets placed into an irrevocable trust 60 months prior to applying for Medicaid are not subject to asset assessment and spend-down rules. However, this often does not work in North Dakota, so be cautious and seek the help of an elder law attorney.

Placing assets into a life estate can provide some protection for long-term health-care costs. As long as land is placed into a life estate prior to the 60-month look-back period, neither the life estate portion nor remainderman portion is looked at as having any asset value.

The only thing DHS looks at is that the life estate individual receives fair market rent if the land is rented to a tenant. If the land is put into a life estate within 60 months of the application for Medicaid, the entire value at the time of the transfer is considered a disqualifying transfer and will result in a penalty period.

Financing Long-term Health Care

As described, Medicare does not pay for extended long-term health-care costs. To qualify for Medicaid, you have to spend down a considerable amount of assets in addition to abiding by income and asset transfer rules. Your medical insurance and disability insurance will not pay for your long-term health-care costs.

However, you have other options for financing your long-term health-care costs. Those choices include family care; self-insure; self-pay; gift away all assets to a child, for example, and wait 60 months to apply for Medicaid; place all your assets into a life estate; place your assets into a special-needs trust if you have a special-needs family member; or purchase long-term care insurance.

Family Care

The issues and challenges of family care were discussed earlier. In addition to the toll on the caregiver’s health and the costs to family finances, fewer children are residing near those needing long-term care. Also, more women are in the workforce, and they have tended to be the caregiver in the past. The complexity of medical or nursing needs of the family member may make it unrealistic for family members to provide care at home.

Divorce is a huge issue, which makes caring for parents difficult. Lastly, people are living longer, so they require care for a greater length of time. All these issues can make family care a less than desirable option for many families.

Self-insure

To self-insure means to set aside enough money to pay for your long-term health care if needed. This option has at least three issues. One, where is the money going to come from? It no doubt means liquidating assets.

Two, how much money am I going to need? The average stay in a nursing home is 2½ to three years. However, records show that a person spent 29 years in the nursing home due to Alzheimer’s disease.

Three, what is my backup plan if I run out of money and I am still in the nursing home?

Self-pay

To self-pay means paying your own expenses for long-term health care. Unless you have substantial assets other than the farm/ranch assets, self-paying will place your farm/ranch business at risk. In addition, this method can place a strain on family relationships and finances.

Gift All Assets to Child and Wait 60 Months

This approach involves gifting all but $3,000 of your assets to one of your children, for example, and relying on him or her to pay all your living expenses for 60 months, then applying for Medicaid if you need to go into a long-term health-care facility. This approach is an option but may not be very feasible.

Life Estate

Placing assets into a life estate can afford some protection from long-term health-care costs. Assets would have to be placed into the life estate and 60 months would have to pass before applying for Medicaid to make this work.

Special-needs Trust

Placing assets into a special-needs trust will protect assets from long-term health-care costs. You need to have a qualified family member who has special needs to qualify for this trust provision.

Long-term Care Insurance

Purchasing long-term care insurance (LTCI) is a method of paying any long-term care costs. LTCI has two basic types of policies: standard and hybrid. The standard LTCI policy pays strictly for long-term care costs. The hybrid LTCI policy is a new product that combines life insurance with the ability to pay for long-term health-care costs.

When purchasing LTCI, you will need to make some decisions regarding the type of coverage. Items include the number of years of coverage, the length of the elimination period or the time before the insurance starts to pay, inflation protection, the facilities you want covered in the policy and the payoff period. This should be done in consultation with your insurance agent.

If you plan to check into LTCI, you need to gather a number of items before going to meet with your insurance agent. Those items include:

• Date of birth

• Any and all health conditions in the past 10 years

• Any hospital stays in the past 10 years and if so, for what reason

• Medications: drug name and dosage (amount and frequency)

• Current height and weight

• Current/past tobacco use

You will need two or three visits with your insurance agent before you are ready to sign the insurance agreement. Evaluating several insurance company policy offerings may be in your best interest. Many times, this can be done through a single insurance agent.

The key is to ask lots of questions before you make a decision. Be sure you know what you are buying and that you understand all aspects of the insurance policy.

Long-term Care Partnership Program

As part of the Deficit Reduction Act of 2005 signed into law on Feb. 8, 2006, a program referred to as the Long-Term Care Partnership Program was authorized. North Dakota, as well as several other states, have enacted the program.

If you purchase a long-term care insurance policy that qualifies for the Long-Term Care Partnership Program, the insurance will pay for your long-term care costs while protecting an equal amount of assets from Medicaid rules in the event you have to apply.

Example: Helen is 58. She purchases a qualified Long-Term Care Partnership Program policy with five years of coverage worth a $922,337 pay-out in 20 years. Helen enters the nursing home in 20 years and starts using the LTCI and eventually uses up the pay-out amount. Her daughter goes to DHS and applies for Medicaid. The case worker notes that Helen had a qualified Long-Term Care Partnership Program policy worth the $922,337. Helen’s only asset is farm/ranch land worth $1.95 million. Because Helen purchased the qualified LTCI policy, $922,337 of the farm/ranch land value is protected from the Medicaid spend-down requirements. Helen can spend down to the $3,000 on the lesser amount to qualify and the rest of the farm/ranch land is not subject to the Medicaid rules.

To qualify for the Long-Term Care Partnership Program, a policy must meet several requirements. They are:

• Coverage must be for a North Dakota resident

• The insurance agent selling the policy must be certified to sell Long-Term Care Partnership Program policies (eight hours of initial certification training, four hours of training every other year thereafter to remain certified)

• Issue age: certain issue ages require a given level of inflation protection. They are: under age 61— compound inflation protection; age 61 to 75 — some level of inflation protection (simple or compound); and older than 76 —
no inflation protection required.

Note: Standard LTCI policies may qualify for the Long-Term Care Partnership Program. Hybrid LTCI policies
will not.

One additional point about LTCI is that of portability or applicability in another state if the policy is purchased in North Dakota. If you purchase a policy in North Dakota but then move and retire in, say, Arizona, you will need to check to see if the policy will be accepted in Arizona.

Additional Resources

Many resources are available to help you in getting background information on the topic of long-term health-care planning. You simply can search the Internet for long-term care and find many helpful items. If you look for Medicaid information on the Internet, make sure the information you locate is specific to North Dakota. Each state’s rules are a bit different. Make sure the information is current. Rules change quickly and often. A few are listed here:

www.completelongtermcare.com

www.longtermcare.gov

www.genworth.com

www.johnhancockltc.com

This is only a very short list and not meant as an endorsement of any specific company.

In addition, you can get help from the following individuals:

Janet Helbling
North Dakota Department of Human Services, Bismarck, ND
(701) 328-1065

Susan Johnson-Drenth
certified elder law attorney
Attorney at Law, JD Legal Planning PLLC
Fargo, ND
(701) 364-9595

This is only a very short list and not meant as an endorsement of any specific person or firm.

If long-term health-care planning is an issue for you, see an elder law attorney for information specific to your situation.

Summary

Individual long-term health-care planning must be based upon a solid personal estate and business transition plan. This is particularly true when you have a business involved that you may want to pass to the next generation.

Components of your estate and business transition plan must include a will or revocable living trust, power of attorney, health-care directive, HIPPA authorization (listing of people you grant access to your medical records), proper asset ownership, all associated contracts and agreements, and a business transition plan. All these things, together with your personal long-term health-care plan, will enable you to achieve your goals for the future.

This publication is a simplistic overview of long-term health-care planning. As you can tell, the topic is extremely complicated. When you begin to plan for this area of your life, seek the help of an elder law attorney. That is someone who focuses his or her law practice on the area of long-term health-care issues and Medicaid planning.

Finally, once your plan, including the personal estate plan and business transition plan, is complete, share your plans with your family. Doing so will inform family members of your intentions and your wishes. This action may prevent a family feud upon your death. It also allows the family to do planning for the future.

Caution: This publication is offered as educational information only. It is not intended to offer legal advice. If you have questions on this information, contact an elder law attorney.

November 2015

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