The document discusses veterans benefits, estate recovery, and updates to Medicaid rules. It summarizes the VA's Aid and Attendance benefit for veterans, including eligibility requirements and asset protections. It then explains Medicaid eligibility and estate recovery, emphasizing the use of trusts and ladybird deeds to protect the family home. Recent changes are noted, such as houses in trusts now counting as assets and shorter deadlines to respond to Medicaid applications.

1. THE ONLY THING CONSTANT IS
CHANGE ITSELF: VETERANS
BENEFITS, ESTATE RECOVERY AND
UPDATES TO THE MEDICAID RULES
P. Haans Mulder, JD, MST, CFP®
Cunningham Dalman, P.C.
321 Settlers Road
Holland, MI 49423
(616) 392-1821
phmulder@holland-law.com

2. Background
• Haans is a partner and has a Masters in
Tax, CFP®, and specializes in estates/elder
law and business planning
• Cunningham Dalman, P.C. has been
serving the greater Holland/Zeeland area
since 1900
Serving the Holland area since 1900

3. Overview
• Cover the VA’s Aid & Attendance benefit
and its eligibility rules
• Discuss the Estate Recovery program
• Finish with new developments under the
Medicaid rules
Serving the Holland area since 1900

4. Veteran’s A&A Benefit
• Single veterans are eligible for up to
$1,732 per month
• Veteran with a spouse is eligible for up to
$2,054 per month
• Surviving spouse is eligible for up to
$1,113 per month
Serving the Holland area since 1900

5. Veteran’s A&A Benefit
• The benefit will cover in-home as well as
care in an assisted living facility
• Obtaining the benefit in someone’s home
can be difficult unless there are
significant medical expenses
Serving the Holland area since 1900

6. Veteran’s A&A Benefit
• The veteran must have served 90
consecutive days of active duty and at
least one day during a war-time period
• The veteran must have also received
discharge other than dishonorable
Serving the Holland area since 1900

7. Veteran’s A&A Benefit
• Program has an income and asset test
• Can either have low monthly income or
medical expenses that exceed income
• Must have not more than $80,000 of
countable assets (single or married)
• Is often much less
Serving the Holland area since 1900

8. • The veteran can establish an irrevocable
trust and gift “excess” assets to it
• There is no “look-back” period
• The veteran’s child is often the trustee
and all of the children are the beneficiaries
of the trust
Serving the Holland area since 1900
Veteran’s A&A Benefit

9. • If the veteran needs the gifted funds, the
trustee can take a distribution from the
trust (because he or she is the trustee
and a beneficiary)
• The trustee can then gift it back to the
veteran
Serving the Holland area since 1900
Veteran’s A&A Benefit

10. Medicaid and Estate Recovery
• 40% of people 65 years and older will
stay in a nursing home
• Average cost to stay in a local nursing
home is $7,500-$10,000/month
Serving the Holland area since 1900

11. What is Medicaid?
• State and federal program that pays
for medical treatment (including
nursing home care)
• Oftentimes confused with Medicare
Serving the Holland area since 1900

12. When does Medicaid apply?
• Applies principally to care in a nursing
home
• Applies to people who are blind or
disabled
• Must pass the income and asset tests
Serving the Holland area since 1900

13. Who does Medicaid apply to?
• Under income test, you cannot have
enough income to pay the monthly
cost of staying in a nursing home
($7,500-$10,000 in this area)
Serving the Holland area since 1900

14. Who does Medicaid apply to?
• Under assets test, a single person can
only have $2,000 in countable assets
• Can keep your home (if it’s not in your
trust) and a vehicle
• All other assets are countable
Serving the Holland area since 1900

15. Who does Medicaid apply to?
• Asset test allows a married couple to
keep their home (again, if it’s not in a
trust), a vehicle, and one-half of their
other assets
Serving the Holland area since 1900

16. Estate Recovery
• It applies to assets that have to be
probated (has the potential to include
all assets)
• The only assets that are typically left
are: bank account, personal property
(including vehicle), and
the house
Serving the Holland area since 1900

17. How do you protect against
estate recovery?
• The most effective way to protect the
house is with a “ladybird deed”
• A trust or individual’s are named
beneficiaries on the deed
Serving the Holland area since 1900

18. How do you protect against
estate recovery?
• The house remains an exempt asset
during the Medicaid recipient’s life
• The costs and hassle of probate are
avoided
• The State can’t recover
against it
Serving the Holland area since 1900

19. Some other things to be
aware of
• When a single person is on
Medicaid, he or she can keep the
house
• However, he or she will not be able to
use Social Security and other income
to pay the house expenses
Serving the Holland area since 1900

20. Some other things to be
aware of
• This typically means that a child or
beneficiary must pay these expenses
• Children should protect their right to be
reimbursed by executing and recording
a mortgage against the house
Serving the Holland area since 1900

21. Some other things to be
aware of
• This gives a child’s reimbursement
claim higher priority than the State of
Michigan’s estate recovery right
• A child will get paid when the house
sells
Serving the Holland area since 1900

22. Some other things to be
aware of
• You should make sure the Medicaid
recipient has signed a financial power
of attorney
• That way, the agent can execute the
mortgage
Serving the Holland area since 1900

23. New Developments-House
• If the house is in your trust, it becomes
a countable asset
• If it’s in your individual name, it will go
through probate
• Don’t just leave it in an individual’s
name if you are single
Serving the Holland area since 1900

24. New Developments-House
• Don’t have enough cash to pay the
costs of maintaining the house
• House can be rented to pay these
costs
• Best option is rent to a family member
and then “sublease” it
Serving the Holland area since 1900

25. New Developments-Short
Deadlines to Respond
• Have spoken in prior years about long
delays
• Now the issue is that the State of
Michigan is pressuring case workers to
respond quickly
Serving the Holland area since 1900

26. New Developments-Short
Deadlines to Respond
• It’s a significant problem because you
may not have enough time to respond
• If the application is denied, you likely
don’t have a basis to appeal
Serving the Holland area since 1900

27. Questions……
Serving the Holland area since 1900

28. Thank You
P. Haans Mulder, JD, MST, CFP®
Cunningham Dalman, P.C.
321 Settlers Road
Holland, MI 49423
(616) 392-1821
phmulder@holland-law.com
www.holland-law.com
Serving the Holland area since 1900