Moore and Peden

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Elder Law and Financial Planning

– Legal services with an emphasis on those issues that affect the growing aging population.

Our services include preparation of wills, living wills, powers of attorney, Qualified Income Trusts, appointment of heathcare agents, revocable and irrevocable trusts and special needs trusts.

We also provide medicaid financial planning, representation at medicaid fair hearings, assistance with medicaid applications and nursing home patient advocacy.

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Looking southeast from the Old Natchez Trace, in Maury County

Medicare

The Medicare program provides a payment source for most seniors’ medical costs. Unlike Medicaid, which is a joint Federal-State partnership for poor persons, Medicare is a federal insurance program established to provide medical care for the elderly and disabled. Medicare is divided into Part A (hospitalization, skilled nursing facility placement, home health and hospice care; Part B (physicians services, diagnostic tests, medical equipment, ambulance, outpatient, physical and speech therapy, prescription drugs and certain home care) Part C (Medicare Plus Choice Program; a collection of alternative plans) and Part D (prescription drug plan). Medicare does not provide long-term nursing home care, but will only provide skilled nursing care or rehabilitation services for up to 100 days. Part B requires the payment of a premium which is ordinarily paid by automatic deduction from Social Security benefits. Medicare has many co-payment requirements for care and deductibles from covered care. Most persons purchase a Medicare supplement policy to pay co-payments, deductibles and some non-covered items.

Medicaid (TennCare “Choices”)

Medicaid in Tennessee is now called “Choices” and is administered by the Bureau of TennCare. Eligibility is based upon both medical and financial need. Choices eligibility planning for a person facing long-term care in a nursing home is complex and requires specialized knowledge of Federal and State regulations.
We formulate Choices planning alternatives that will maximize the community spouse’s (the at home spouse) income and exempt assets while preserving Choices eligibility for the institutionalized spouse. The planning is comprehensive and consideration is given to factors such as:

  • Age and health status of husband and wife;
  • Asset transfer strategies;
  • Impoverishment;
  • Loss of control;
  • Mental status;
  • Nutrition;
  • Social isolation;
  • Supplemental needs of institutionalized spouse;
  • Possible use of Medicaid compliant annuities to adjust resources;
  • Strategies to maximize the Community Spouse Resource Allowance (CSRA) and achieve instant eligibility of the institutionalized spouse.
  • Strategies to maximize the community spouse income allowance;
  • Conversion of countable resources to non-countable resources;
  • Strategies to defeat or minimize estate recovery;
  • Spend down strategies;
  • Anti-abuse and exploitation strategies;
  • Nursing home care oversight (optional);
  • Transfer strategies between spouses;
  • Transfers for the benefit of a blind or disabled child or to a trust for a spouse and/or
  • Transfer of the home to a spouse, child under 21, caretaker, sibling with ownership interest, or adult child who lived in home and provided sufficient care to allow him/her to remain in the home;

Other needed legal documents:

  • Will
  • Durable Power of Attorney (financial)
  • Durable Power of Attorney for Health Care
  • Living Will

What is a Qualified Income Trust?

As noted above, eligibility for TennCare Choices depends on both medical and financial need. To qualify financially the applicant must have limited assets and limited income. If the applicant has monthly income above the eligibility limit, the law allows the excess income to be placed into a Qualified Income Trust, also called a “Miller Trust”.

 

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Some Definitions:

Looking east from the Old Natchez Trace

Looking east from the Old Natchez Trace

Will: A legal document that establishes how a person’s property will be distributed after their death, who will care for children or pets, and how debts or taxes will be paid, among others issues.

Living will: A legal document that outlines a person’s medical care wishes – such as whether they want to be put on life-support – when they are unable to speak for themselves.

Health care power of attorney: A legal document that appoints someone to make health care decisions for you, when you are unable to do so yourself.

Durable power of attorney: A legal document that appoints someone to make financial, health care, and other decisions for you, when you are unable to do so yourself.

Special needs trust: These trusts allow mentally or physically disabled people to inherit assets and still remain eligible for government benefits, such as Medicaid and Supplemental Security Income (SSI).

Qualified income trust: These trusts allow a person to become eligible for Medicaid nursing home coverage when their income would normally be too high to qualify.

Conservatorship: The judicial appointment of a guardian to make financial and personal decisions for someone who’s physically or mentally impaired and no longer able to handle their own affairs.

Probate: A court proceeding that takes place after a person’s death to prove the validity of a will. The process typically involves collecting the deceased person’s assets, paying off outstanding debts and taxes, and distributing property to the heirs.

 

Related Resources

Powers of Attorney, Tracy Moore, Wills, Conservatorships