The Penalty Period

[Penanger]

I am the community spouse and it is likely my husband will need nursing home care within the next 5 years. From reading your book, I already know we have incurred a penalty of approx 3-5 months. My question is, how does this affect the timing of the application process? If he enters a nursing home and we have spent down our assets so that he is Medicaid eligible, do I have to private pay out of what I have left as the community spouse those 3-5 months before Medicaid kicks in?

[K. Gabriel Heiser]

A penalty for gifts made within the five-year period prior to applying for Medicaid does not start to run until a person applies for Medicaid and would be otherwise eligible BUT FOR the gift(s). If you are correct that the penalty period in your situation would be 3-5 months, then you are also correct that once you apply you must be prepared to pay privately for that 3-5-month period. That's exactly what the penalty period is designed to do.

[Penanger]

(03-22-2014, 03:18 AM)K. Gabriel Heiser Wrote:  A penalty for gifts made within the five-year period prior to applying for Medicaid does not start to run until a person applies for Medicaid and would be otherwise eligible BUT FOR the gift(s). If you are correct that the penalty period in your situation would be 3-5 months, then you are also correct that once you apply you must be prepared to pay privately for that 3-5-month period. That's exactly what the penalty period is designed to do.

So, in the case of a penalty period, what do people do? Do they borrow the money so they can private pay? With a small 3-5 month penalty I should be able to private pay out of my remaining Community Spouse assets ($117,920), but what do people with longer penalty periods of say, 15 or more months do?

[K. Gabriel Heiser]

It is common to reduce the amount of the gift and instead put a portion of what would have been gifted into a Medicaid-compliant annuity. This is known as the "half-a-loaf" technique. I discuss this in great detail in my book (http://www.MedicaidSecrets.com), including the actual formula needed to calculate the amount of the gift vs amount of the annuity. I also include many examples there of how this works.