What if your parents live in Oklahoma, you live in Virginia and your brothers and sisters live in New York and California? Having the important conversation with your aging parents about what the future might hold if one of them should need long-term care is going to be a challenge, to say the least.
It’s not just about whether they want to leave their home, reports the article “What is the best state for long term care” from Pennsylvania’s The Mercury newspaper. There are many more complications. Every state has different availability, levels of care and taxes, and deciding where to get long-term care is a challenge. If the family is considering a continuing care retirement community, or if the parents already live in one, what are the terms of the contract?
It is important to remember that Medicaid is a joint Federal-State program. Some things are the same across the country. But there are differences between states, and even within a state, so there can be dramatic differences, depending upon whether the facility being considered is in a metropolitan, suburban or rural area. (And perhaps not surprisingly, Virginia is one of the “stingiest” states when it comes to Medicaid.) There’s also the question of whether the facility will accept Medicaid patients, if the parents have long-term care insurance or any other resources.
Here’s what often happens: you open up a glossy brochure of a senior community in a warm climate, like Florida or Arizona. There are golf courses, swimming pools and a great looking main house where clubs and other activities take place. However, what happens when the active phase of your life ends, slowly or suddenly? The questions to ask concern levels of care and quality of care. Where is the nearest hospital, and is it a good one? What kind of care can you receive in your own apartment? Are you locked into to your purchase, regardless of your wishes to sell and move to be closer to or live with your adult children?
And what happens if you or a “well” spouse runs out of money? That’s the question no one wants to think about, but it does have to be considered.
For people who move to Florida, which has a very generous homestead exemption for property taxes and no state tax, the incentives are strong. However, what if you become sick and need to return north?
For seniors who live in Pennsylvania and receive long-term care and other services, the well spouse’s retirement funds are exempt for Medicaid regardless of the amount. However, if you move over the state’s border to New Jersey, and those accounts will need to be spent down to qualify for Medicaid. Virginia — just down I-81 from Pennsylvania — counts the resources of both spouses, but disregards the income of the healthy spouse. The difference to the well spouse could be life changing.
Delaware and New Jersey have Medicaid available for assisted living/personal care. Virginia and Pennsylvania do not. The Keystone State has strict income limitations regarding “at home” services through Medicaid, whereas California is very open in how it interprets rules about Medicaid gifting.
The answer of where to live when long-term care is in play depends on many different factors. Your best bet is to meet with an estate planning and elder care attorney who understands the pros and cons of your state, your family’s situation and what will work best for you and your spouse, or you as an individual.
Reference: The Mercury (March 4, 2020) “What is the best state for long term care”