Nzubu wa bakulakaje wa tshimpitshimpi Medicaid Dilongolola dia ntatu ne dikuba dia bintu bia muena dibaka¶

Padi muntu mukulakaje upeta disama dia tshimpitshimpi, ditshibuka dia tshiadi, anyi dikola dia tshimpitshimpi dia disama dia Alzheimer ne udi umbuka ku dilama dia mu lupitadi uya mu dilama dia kashidi mu nzubu wa baminganga bapiluke (SNF), mêku adi apeta lutatu lua makuta lua lukasa. Tshishimbi tshia bukola bua mubidi ne tshia mu États-Unis Medicare Part A katshiena tshifuta bua kulama bakulakaje mu nzubu wa bakulakaje mutantshi mule to padi dilongolola dia matuku makese dia bantu bapiluke dijika (pa tshibidilu kunyima kua matuku 20 too ne ku 100). Mu tshimpitshimpi, biro bia mudimu bia nzubu wa bakulakaje bidi bileja dîku dibeji dia makuta a pa nkaya dia 9 000 too ne ku 15 000 ya dolare ya mu États-Unis ku ngondo (anyi 1 200 too ne ku 1 800 ya mapaundi ku lumingu mu Royaume-Uni), bienza bua bena dibaka ne bana bakulumpe bikale ne buôwa bua kuenza bilema bibidi binene: kutua tshiala pa mukanda wa dianyisha udi wenza bua baledi anyi bana bakulumpe bikale ne dibanza dia kufuta kufila makuta a muledi kudi balela mu dishipa dia 60-month (5-year) Medicaid Look-Back Period.

Kuena ne tshia kujimija makuta, kusumbisha nzubu wa dîku, anyi kunyanga muena dibaka nebe udi ne makanda a mubidi mimpe kumbelu bua kupeta muntu uudi munange bua kupeta Long-Term Care Institutional Medicaid, nansha padi mubedi ukadi musombe mu bulalu bua nzubu wa bakulakaje lelu kayi mulongolole malu kumpala kua dîba to. Mikenji ya Federal Medicaid (42 U.S.C. § 1396r-5) idi iteka Dikuba dia bupele dia bena dibaka idi yanyishila "Muena dibaka wa mu tshisumbu" udi mu dibaka udi musombele kumbelu bua kulama nzubu wa dîku dijima, mashinyi amue, bintu bia muntu nkayende, too ne ku 154 140dolare idi mua kulama mu dibaka (Spousal Spouse Difutu dia bintu, dishintulula ku tshidimu tshionso), ne too ne ku 3,853.50 dolare ku ngondu ya makuta onso adibu bapeta, eku banyishila bantu badi kabayi baselangane anyi badi baselangane bua kukudimuna makuta adi mapite bungi bua kulua bintu bidi kabiyi biumvuangana ne mikenji pa muaba au. Mukanda ewu udi ufila malu a lukasa a kuenza bua kuimanyika ntatu ya mfranga ya nzubu ya bakulakaje idi kayiyi mianyishibue kudi mikenji, kuepuka dinyoka dia dipingana dia bintu bia kale, ne kuenza mudimu wa tshimpitshimpi wa dijimija dia makuta a Medicaid.

Enza nunku mpindieu¶

1. Kuena ne tshia kutua tshiala pa mukanda wa dianyisha dia kubuela mu nzubu wa bakulakaje mu dina diebe anyi bu "Mufidi wa makuta." Shi muledi udi upeta lutatu lua lukasa mu tshikondo tshia dikokangana dia nzubu, ubikile nimero wa njiwu wa muaba unudi (911 mu États-Unis ne mu Canada, 112 mu matunga masanga a ku Mputu, 999 mu Royaume-Uni) anyi tangila nomba ya tshimpitshimpi tshilaminu. Muinshi mua Nursing Home Reform Act (42 U.S.C. § 1396r©(5)(A)(ii)), nzubu udi mukandika bikole bua kulomba muana mukulumpe anyi muntu mukuabu bua kufila tshijadiki tshia difutu bu tshintu tshidi tshilomba bua kubuela; funda anu bu "Muena mudimu muinshi mua bukokeshi bua [Dîna dia muledi], kayi ne dibanza dia makuta."
2. Lekela diakamue kumpala kua kufila dipa, kufila, anyi kusakidila dina dia muana ku konte yonso wa ku banke, mukanda wa nzubu, anyi mukanda wa mashinyi. Kufila makuta anyi kusumbisha nzubu ku mushinga mukese wa mu tshisalu mu ngondo 60 (bidimu 5) kumpala kua kulomba Nursing Home Medicaid (ngondo 30 mu Californie, ku kakese ku kakese) udi ufila dinyoka dikole dia Medicaid Tshikondo, tshishiya mukulumpe kayi ne makuta ne kayi ne dikuba dia Medicaid munkatshi mua ngondo anyi bidimu.
3. Kuena ne bua kusumbisha nzubu wa dîku anyi kupatula makuta a pansio bua kufuta nzubu wa bakulakaje kumpala kua wewe kuya kuyukila ne muena mikenji wa bakulakaje anyi mufidi wa mibelu wa SHIP to. Bua bena dibaka (anyi muntu mukulumpe umue udi ufunda mukanda wa "Dijinga dia kupingana kumbelu" too ne ku tshipiminu tshia makuta a mbulamatadi tshia 713 000 too ne ku 1 071, 000+), dolare wa kumpala udi muaba wa kumpala wa kusombela EXEMPT asset** bua Medicaid eligibility, eku dipana dia nzubu didi dikudimuna nzubu udi kayi ne exempt mu makuta adibu mua kubala adi nzubu wa bakulakaje mua kuangata.
4. Lomba dibala dia "Resource Assessment / Snapshot Date" pikala muntu udi musombele mu nzubu wa bakulakaje musele. Muinshi mua mikenji ya mbulamatadi ya Spousal Impoverishment, muena dibaka udi ne makanda a mubidi mimpe udi musombele kumbelu (Community Spouse) udi ne bukenji bua kulama Community Spouse Resource Allowance (CS) Difutu dia ku ngondo yonso dia majinga a dilama dia bintu (MMMNA) nunku kabatu bashala bapele nansha kakese.
5. Kudimuna "Bintu bidi mua kubala" mu "Bintu bidi kabiyi ne mushinga" bilondeshile mikenji shi udi dijinga ne dijimija dia lukasa kumpala kua ndekelu wa ngondo wa kalandriye. Pamutu pa kufila makuta adi mapite bungi ku nzubu wa bakulakaje anyi kuafila mu mushindu udi kauyi mu diumvuangana ne mikenji, badi balomba badi mua kutula makuta adibu mua kubala bilondeshile mikenji mu bintu bia mushinga mukole: kufuta anyi kupingaja makuta a nzubu nzubu wa dîku udi kayi ne tshia kufuta, kusumba Irrevocable Pre-Paid Funeral and Burial Trust, kusumba luondapu lua meno ludi lukengedibua, makalashi a mêsu, anyi kakalu ka balema, anyi kuenza mudimu wa difutu dia mulume anyi mukaji didi dilonda mikenji ya Medicaid.
6. Tuma dilomba dia "Medicaid Pending" ne uleje bukenji buebe bua kubenga kuipata mu nzubu padi mbulamatadi wenza mudimu ne mukanda. Muinshi mua mikenji ya mbulamatadi ya dipatuka mu nzubu wa bakulakaje (tangila bulombodi buetu pa dikengeshibua mu nzubu wa bakulakaje, dilengulula, ne dikuba dia dipatuka mu nzubu), nzubu wa baminganga udi muanyishibue kudi Medicaid kena mua kuipata muena musoko bua dibenga kufuta padi dilomba dia Medicaid dia matuku a bungi didibu batume dienda dienzeka kudi tshibambalu tshia mbulamatadi to.

flowchart TD
    A["Muntu mukulakaje udi dijinga ne dilama dia kashidi mu nzubu wa bakulakaje (Medicare Rehab Ending)"] --> B{"Muntu udi musombele mu nzubu wa bakulakaje udi mu dibaka anyi mujike?"}
    B -->|"Mu dibaka (muena dibaka umue udi musombele kumbelu)"| C["Bikila mikenji ya ditunga idi itangila bupele bua bena dibaka (42 USC 1396r-5)"]
    B -->|"Mujike, mushipe dibaka anyi mukaji mukamba"| D["Bintu bidi mua kubala vs. Bintu bidibu kabayi mua kubala kumpala kua tshipiminu tshia dolare 2 000 tshia muntu pa nkayende (tshia bungi mu CA/NY)"]
    C --> E["Nzubu, mashinyi umua, ne too ne ku $154,140 CSRA mikuba bua muena dibaka wa mu tshisumbu + dishintuluka dia makuta (MMMNA)"]
    D --> F["Lama nzubu wa kumpala ku diambuluisha dia 'Dijinga dia kupingana kumbelu' anyi dilekedibua dia muana wa mulami"]
    E --> G{"Bintu bidi bishale bia kubala bidi anu pa mutu pa mikalu ya ditunga anyi?"}
    F --> G
    G -->|"Eyowa: Makuta a bungi adi mua kubala"| H["Enza mudimu wa dijimija dia makuta mu tshilumbu tshia mikenji KUMPALA kua ndekelu kua ngondo (KUPEDI bintu bia dipa mu bidimu 5)"]
    G -->|"Tòo: Mu tshitupa tshia bintu"| I["Tangila makuta a ngondo yonso bilondeshile 'Income Cap' wa ditunga (enza mudimu ne Qualified Income / Miller Trust pikalabi bikengela)"]
    H --> I
    I --> J["Funda dilomba dia Medicaid dia matuku a bungi (Trigger 'Medicaid Pending' Protection)"]

Bua tshinyi Medicare udi ulekela kufuta kunyima kua matuku 20 to ne 100 (Skilled vs. Custodial Care)¶

Tshilumbu tshia mfranga tshidi tshitamba kuenzeka mu bukulakaje tshidi tshienzeka pabuipi ne Dituku dia 20 too ne ku dia 35 dia disomba dia panyima pa lupitadi mu nzubu wa baminganga bapiluke (SNF). Bena mu mêku badi bumvua mu lupitadi ne: "Medicare udi ufuta matuku 100 a diondopangana mu nzubu wa bakulakaje," anu bua kupeta Dimanyisha dia dipanga dia Medicare (Form CMS-10123) mbingu isatu pashishe diamba ne: dikuba dia Medicare didi dijika mu mêba 48 ne dîku didi ne bua kufuta dolare 400 too ne ku 500 ku dituku kutuadijila mu Dia lumingu.

Kujingulula mulongo wa mikenji udi pankatshi pa Medicare Part A ne Long-Term Care Medicaid ke tshishimikidi tshia dilongolola dia malu a ntatu:

• Medicare Part A (Short-Term Skilled Rehabilitation ONLY): Panyima pa 3-midnight inpatient hospital stay, Traditional Medicare Part A udi utangila 100 pa lukama ya matuku 1 too ne ku 20, ne udi ulomba assurance wa dituku dionso wa 204 dollars ku dituku (adjusted ku tshidimu) too ne ku 2010 (pa tshibidilu bidi bikuba kudi tshipangu tshia Medigap), ANYI bua tshikondo tshidi mubedi dijinga ne udi wenza mudimu wa "Skilled Care" (bu mudi: diondapangana dia mubidi dia dituku dionso, diondapangana dia ku mudimu, diondapangana dia ngakuilu, anyi diondapangana dia IV/mputa). Dituku dilelela didi dienda dia mubedi dijika anyi badi dijinga anu ne "Custodial Care" (diambuluisha bua kuowa mâyi, kuvuala, kuya mu tshina tshia mâyi, kudia, ne kutangila disama dia lungenyi), Medicare Part A udi ufuta $0, nansha mudi mubedi muenze anu matuku 18 pa 100. (Wewe wela meji ne: diondopangana didi dijika kumpala kua dîba padi mukulumpe utshidi anu mua kukola, funda diakamue dilomba dia QIO ku diambuluisha dia bulombodi bua dilomba dia dipatuka mu lupitadi anyi mu nzubu wa diondopangana.)
• Long-Term Care Institutional Medicaid (Permanent Custodial + Skilled Care): Padi muntu mukulakaje dijinga ne dilama dia kashidi dia mêba 24 mu nzubu wa bakulakaje ne kayi ne tshishimbi tshia pa nkayende tshia Long-Term Care, Medicaid ke programe wa kumpala wa mbulamatadi wa mu États-Unis udi ufuta dolare 10 000 ku ngondo ku nzubu bua kashidi matuku onso a muoyo wa muena musoko, padi mikenji ya malu a mfranga ne ya luondapu ("Nursing Facility Level of Care") mikumbane.

Bintu bidi mua kubala ne bidibu kabayi mua kulekela: tshidi Medicaid ukuanyishila bua kulama¶

Bua kupeta diambuluisha dia Long-Term Care Institutional Medicaid mu matunga a bungi a mu États-Unis, "Bintu bidi mua kubala" (bintu bidi kabiyi bilekedibua) bia muntu udi ulomba nzubu wa bakulakaje bidi ne bua kuikala muinshi mua 2 000 dolare dituku dia ndekelu dia ngondo (manya ne: Californie mmumbushe tshipiminu tshia bintu bia 2000 ** ** ne New York mmumbushe tshipiminu tshia bintu bia muntu pa nkayende tshidi tshipita dolare 31,175).

Ino, Medicaid kena ubala bintu byonso biudi nabyo ku tshipiminu tshia 2,000-dollar. Bijila bia Medicaid bia mbulamatadi ne bia ditunga bidi bitapulula bintu bionso mu Bintu bidi kabiyi mua kubala biudi mua kulama tshianana, ne Bintu bidibu mua kubala bidi ne bua kukuba anyi kujimija.

Malu adi atangila bupele bua bena dibaka (padi umue wa ku bena dibaka ushala kumbelu)¶

Kumpala kua tshipangu tshia ditunga kuela mikenji ya Medicare Catastrophic Coverage Act of 1988 (42 U.S.C. § 1396r-5), pavua mulume mubuele mu nzubu wa bakulakaje, bena dibaka aba bavua ne bua kupitshisha pabuipi ne makuta abu onso a muoyo too ne ku dolare 2 000 kumpala kua Medicaid kuambuluishaye, kushiya mukaji uvua ne makanda a mubidi mu bupele mu nzubu. Lelu, Mukenji wa dipanga dia bena dibaka wa mbulamatadi udi utapulula bena dibaka mu Muena dibaka udi mu nzubu wa tshilala benyi (mu nzubu wa bakulakaje) ne Muena dibaka wa mu tshisumbu (udi musombele kumbelu anyi mu nsombelu wa pa nkayende) ne udi ulama bintu ne makuta adibu bapeta ku ngondo bua muena dibaka nende kumbelu.

1. Kulama makuta a mu dibaka: Dikuatshisha dia bena dibaka dia mu tshisumbu (CSRA)¶

Muinshi mua mikenji ya mbulamatadi, Medicaid udi usangisha bintu bionso bidi mua kubala bia mulume anyi mukaji (nansha dina dia nganyi didi mu konte wa banke anyi ni badi batua tshiala pa tshipungidi tshia kumpala kua dibaka) ne udi ulekela Muena dibaka wa mu tshisumbu bua kulama tshitupa tshidibu balame tshidibu babikila ne: Community Spouse Resource Allowance (CSRA):

• Maximum CSRA (2024/2025 Federal Standard): Kufika ku 154,140 dollars (bashintulula kuulu mu ngondo wa kumpala yonso bua dibandila dia mushinga wa bintu) mu makuta adibu mua kulama, PLUS nzubu wa dîku udi kayi ne tshia kufuta, mashinyi amue, ne madilu adibu bafuta kumpala kua dîba, eku **Muena dibaka udi mu nzubu wa tshilala benyi ulama 20,000 dollars mikuabu.
• "100% Maximum CSRA States" vs. "50% Snapshot States":
  • Mu 100% States (bu mudi Floride, Texas, New York, Pennsylvania, Georgia, ne Colorado), muena dibaka wa mu tshisumbu udi ulama 100% ya bintu bia bena dibaka too ne ku 154,140-dollar ceiling.
  • Mu 50% ya matunga a tshimpitshimpi (bu mudi Ohio, New Jersey, Caroline wa ku Nord, Virginie, ne Indiana), muena dibaka wa mu tshisumbu udi ulama tshitupa tshimue (50%) tshia bintu bionso bia bena dibaka bidi mua kubala bilondeshile "Dituku dia tshimpitshimpi" (dituku dia kumpala dia dilala dia mu lupitadi dia matuku 30/dituku dijima), ne tshijadiki tshia mbulamatadi wa ditunga Mushindu mukese wa CSRA wa 30,828 dolare ne Mushiku wa 154,140 dolare.

2. Kulama makuta a ngondo yonso: Mushinga mukese wa makuta a ku ngondo (MMMNA)¶

Mikenji ya mbulamatadi idi itangila mikenji ibidi mishilangane bikole bua Makuta a ku ngondo (makuta a bukubi bua bantu, makuta a pansio, makuta a tshidimu tshijima) bua bena dibaka:

1. Mukenji wa "Dîna pa tsheke" bua makuta a muena dibaka wa mu tshisumbu: Tshibutshilu kayi tshionso tshia Social Security anyi tshia pansio tshidibu ne bua kufuta mu dîna dia muena dibaka wa mu tshisumbu tshidi 100 pa lukama tshia muena dibaka wa mu tshisumbu. Nansha makuta a pansio a muena dibaka udi ne makanda a mubidi mimpe anyi a Social Security mikale manene mushindu kayi, Medicaid kena mua kulenga nansha dikuta dimue dia makuta a muena dibaka wa mu tshisumbu bua kufuta makuta a dilama dia muena dibaka udi mu nzubu wa bakulakaje to.
2. Kushintulula makuta a muena dibaka wa mu nzubu wa bakulakaje kuya kudi muena dibaka wa mu tshisumbu (MMMNA): Pa tshibidilu, muntu udi musombele mu nzubu wa bakulakaje udi ne Medicaid udi ne bua kufuta makuta ende a bungi a Social Security ne a pansio ku ngondo yonso bua kufuta makuta a nzubu wende wa bakulakaje ("Patient Liability / Share of Cost"), ulama anu muntu mukese udi ne bua kufuta A50 130 dolare ku ngondu. Nansha, pikala Muena dibaka udi ne makanda a mubidi mimpe udi kumbelu ne makuta makese a ku ngondo, muinshi mua Minimum Monthly Maintenance Needs Allowance (MMMNA) wa ditunga, udi utuadijila ku 2,555 dolare too ne ku 3,853,50 dolare ku ngondu, Medicaid udi wanyishila tshibambalu etshi bua kuenza mudimu ne makuta makuabu tshitupa (anyi bionso) tshia tshikebelu tshiabu tshia ngondo yonso tshia Social Security ne tshia pansio buludiludi kudi muena dibaka wa mu tshisumbu ngondo yonso bua muena dibaka udi kumbelu afike ku tshipiminu tshia makuta a kusomba nawu a MMMNA.

Tshikondo tshia kutangila panyima tshia ngondo 60 (bidimu 5) ne mushindu wa kuepuka manyoka a dishintulula dia bintu¶

Padi dîku dijingulula ne: muledi udi udikoleshila bana nkayende udi ne dolare 80 000 mu konte wende wa makuta ne udi ne bua kuikala muinshi mua dolare 2 000 bua Medicaid, lungenyi luabu lua kumpala ludi ne: "Tufundile bana tsheke wa dolare 78 000 lelu, anyi tusumbishe muanende wa balume nzubu wa mamu ku dolare umue, ne pashishe kulomba Medicaid malaba."

Mushindu udi Medicaid Transfer Penalty Divisor wenza mudimu (ne bua tshinyi udi buteyi)¶

Bikala Medicaid mupeta ne: mamuebe uvua mupeshe bana bende 70 000 dollars kukadi bidimu bisatu, Medicaid kena ulomba bana makuta au ne kanemu to; Pamutu pa nanku, Medicaid udi ubala Tshikondo tshia dinyoka tshia dipanga diakane pa kuabanya bungi bua dipa ne Muaba wa dinyoka wa ngondo yonso wa ditunga (mushinga wa ngondo yonso wa nzubu wa bakulakaje mu ditunga dienu, tshilejilu, dolare 10 000):

Tshidi tshibi menemene, muinshi mua mukenji wa dipuekesha dia dipanga dia makuta, tshikondo tshia dinyoka tshia ngondo 7 katshiena tshituadija kuenza too ne dituku didi mamuebe (1) musombele mu nzubu wa bakulakaje, (2) mupangile makuta (muinshi mua dolare 2 000), NE (3) utuma dilomba dia Medicaid. Bikala bana bakadi bapitshishe bidimu 70,000, mamu udi mpindieu mu buloko mu dolare nzubu wa bakulakaje udi kayi ne makuta ne ngondo 7 ya makuta a dolare 10 000 ku ngondo kayiyi mifuta.

(Diondapangana dia lutatu pikala dipa dimane kufidibua: Shi muana mukulumpe utshidi ne makuta adibu bamupeshe, kupingaja 100 pa lukama ya makuta adibu bamupeshe mu konte wa banke wa muledi "udi ujikija" tshibawu tshia difila dia bintu bionso nunku bidi mua kufidibua mu mikenji ku bintu bidi kabiyi bifuta, anyi avocat wa mikenji ya bakulumpe udi mua kuenza tshitupa tshia dipa ne difutu dia dipa " Mukanda wa dilaya" buanga.)

Bintu binayi bidi kabiyi biumvuangana ne mikenji mudi difila dia nzubu anyi makuta kadiyi difila dinyoka dia ZERO¶

Mikenji ya mbulamatadi (42 U.S.C. § 1396p©(2)) idi yanyishila muntu udi ulomba nzubu wa bakulakaje bua kufila nzubu wende wa kumpala anyi bintu biende kudi bena mu dîku diabu nansha dituku dia kumpala kua kulombaye Medicaid ne tshibawu tshia bidimu 5 tshia kutangila panyima:

1. Difila kudi muena dibaka: Difila dia bintu anyi mukanda wa nzubu pankatshi pa bena dibaka didi kadiyi ne mikalu dia dinyoka.
2. Kufila kudi muana mufofo anyi mulema wa kashidi (wa bidimu bionso): Muledi udi mua kufila bintu anyi nzubu buludiludi kudi muana udi ukumbaja diumvuija dia Social Security dia bufofo anyi bulema bua kashidi (anyi mu Sole Benefit Disability Trust / Special Needs Trust bua muntu mulema udi ne bidimu muinshi mua 65) ne dinyoka dia tshianana.
3. Dilekedibua dia muana wa mulami" (Difila dia nzubu wa dîku): Muledi udi mua kufila nzubu wende wa kumpala wa dîku 100 pa lukama tshianana ne mutoke (kayi ne bidimu 5 bia kutangila panyima ne dipingaja dia bintu bia Medicaid bia matuku atshilualua) kudi muanende wa balume anyi wa bakaji mukole udi:
   • Uvua musombele mu nzubu wa muledi matuku onso munkatshi mua bidimu **bidi (2) bijima kumpala kua muledi kubuela mu nzubu wa bakulakaje, NE
   • Uvua mufila diambuluisha dia dituku dionso (dijadikibua kudi mukanda wa munganga ne mikanda ya diambuluisha) bivua bipangishe muledi bua kuikala dijinga ne dibuela mu nzubu wa bakulakaje mu bidimu bibidi abi.
4. Dilekedibua dia "Muanetu udi ne tshitupa tshia makuta": Kufila nzubu kudi muanetu wa balume anyi wa bakaji udi ne tshitupa tshia makuta mu nzubu ne uvua musombelemu nansha tshidimu tshimue (1) diakamue kumpala kua muntu mukulumpe kubuela mu nzubu wa bakulakaje.

Mulongo wa malu a mikenji: mushindu wa kukepesha makuta adibu mua kubala mu matuku 30¶

Shi muledi webe nansha muena dibaka nebe udi mu nzubu wa bakulakaje lelu ne 20,000 too ne ku 150,000 ya dolare mu makuta a ku banke adibu mua kubala adi mapita tshipiminu tshia bintu bia Medicaid, kuena ne bua kufila makuta onso au ku nzubu wa bakulakaje to. Dikumbana dia Medicaid didi dimanyibua ku tshimfuanyi tshia makuta adi mashale ku banke mu dituku dia ndekelu dia ngondo (anyi dituku dia dilomba). Ubwanya kutula makuta a bungi too ne ku tshipiminu tshia 2,000-dollar kumpala kua minuit mu dituku dia ndekelu dia ngondo pa kusumba bintu ne midimu bua mushinga mujalame wa mu tshisalu bua diakalenga dia muena dilomba anyi dia muena dibaka nende:

• Futa mabanza ne mabanza a nzubu udi kayi ne tshia kufuta: Futa anyi futa mabanza a nzubu, tshitupa tshia nzubu (HELOC), bitadi bia nzubu, anyi mabanza a karte ka mfranga a muena dilomba anyi muena dibaka nende wa mu tshisumbu.
• Wenza mudimu wa dilongolola dia bintu ne dilengeja dia mushindu wa kufika mu nzubu wa kumpala udi kayi ne tshia kufuta: Pingaja nzubu wa tshisasa udi mukulakaje, teka tshioshelu tshipiatshipia tshia HVAC, ulongolole nzubu wa kuowa mâyi udi ne tshiamu tshia kuowela mâyi, teka tshibandilu tshia bantu badi ne makalu a balema, uteka madidishi, anyi sumba bintu bipiabipia bia mu tshikuku bua nzubu ya muena dibaka wa mu tshisumbu.
• Sumba tshilaminu tshia madilu ne tshia dijika tshidi katshiyi mua kushintuluka: Tangila nzubu wa madilu udi ne mukanda wa dianyisha ne ukudimuna dolare 10 000 too ne ku 15 000 kudi muena dibaka yonso mu Tshibutshilu tshia madilu tshidi katshiyi mua kushintuluka tshidi tshianyishibue kudi mbulamatadi, lupangu lua madilu, tshibombi tshia madilu ne dibue dia ku lukita.
• Kulengeja anyi kupingana pa muaba wa mashinyi a dîku adi kaayi ne mushinga: Sumba mashinyi a kale (anyi mashinyi abidi a kale) ne usumbe mashinyi mapiamapia anyi a tshikondo tshia ndekelu (anyi mashinyi adi bantu badi ne makalu a balema) adibu bafunde mu dîna dia muntu udi ulomba anyi dia muena dibaka nende wa mu tshisumbu.
• Sumba bintu bia luondapu, bia meno, bia matshi ne bia busambi bua bakulakaje bidi kabiyi bikuba: Sumba meno a tshiamu tshia mishiku anyi bintu bia kuela nabi meno, makalashi a mêsu a mushinga mukole, biamu bia kuteleja nabi bia ku Enternete, nkuasa wa balema udi ne motere anyi udi mua kutenteka mu tshibuashibuashi, nkuasa wa kubandila bua nzubu wabu wa bana batekete, nzubu wa tshilala benyi wa ordinatere ne nzubu wa tshilala benyi mujima bilamba bidi ne dina diabu.
• Kuenza mudimu wa Medicaid-Compliant Single Premium Immediate Annuity (SPIA) (ku diambuluisha dia Elder Law Attorney): Muinshi mua 42 U.S.C. § 1396p©(1)(F)-(G), mu matunga a bungi muena dibaka udi mu dibaka (anyi muena dibaka umuepele udi wenza mudimu ne tshilele tshia tshitupa tshia mampa) udi mua kukudimuna nkama ya binunu bia dolare ya makuta a bungi adibu mua kubala mu tshibutshilu tshia **Medicaid-Compliant Immediate Annuity ** tshidi mua kukuba tshitupa tshia makuta a ngondo yonso bua muena dibaka udi ne makanda a mubidi mimpe, anu pikala makuta a tshidimu tshijima kaayi mua kupingajibua, kaayi mua kufidibua kudi muntu mukuabu, adi makane, adi afuta mu bitupa bia muomumue bia ngondo yonso, ne adi aleja tshibambalu tshia Medicaid tshia ditunga bu muntu udi mushale too ne ku makuta adibu bafuta.

Kujikija lutatu lua "Income Cap" (Qualified Income Trusts / Miller Trusts)¶

Pabuipi ne tshitupa tshia matunga a mu États-Unis (mudi Floride, Texas, Ohio, New Jersey, Arizona, Colorado, Indiana, ne Georgia) badi bafunda bu "Matunga adi ne makuta a bungi." Mu ditunga didi ne makuta a bungi, bikala makuta a muntu udi ulomba nzubu wa bakulakaje adiye upeta ku ngondo yonso (Social Security + pension before deductions) mapite pa **2, ** 290 pa lukama (300 pa lukama lua dolare ku ngondo yonso SSI rate, adjusted annual) nansha 1 dollar, nansha mudi nzubu wa bakulakaje mushinga wa 10,000 dollars ku ngondo, ordinatere wa ditunga ne kubenga bua kupeta Medicaid pa kumbusha wewe mubulule konte mupepele wa ku banke udibu babikila ne: Qualified Income Trust (QIT) / Miller Trust.

flowchart TD
    A["Tangila makuta onso a muntu udi ulomba nzubu wa bakulakaje upeta ku ngondo yonso (tshiamu tshia bukubi + tshia pansio)"] --> B{"Udiku musombele mu 'Ditunga didi ne makuta a bungi' ne makuta onso audi nawu adi mapite pa $2,829/Ngondo anyi?"}
    B -->|"Tòo: Muinshi mua tshipiminu anyi 'Ditunga didi dijinga ne luondapu'"| C["Kakuena dijinga dia Miller Trust to: Makuta adibu bafila buludiludi ku tshitupa tshia mushinga wa mubedi / muena dibaka nende MMMNA"]
    B -->|"Eyowa: Pa mutu pa $2,829/Ngondo mu ditunga didi ne makuta a bungi"| D["Enza mukanda wa tshilaminu tshia makuta (QIT / Miller Trust)"]
    D --> E["Kangula konte wa tshikebelu udi kayi ne makuta udi ne tshiena bualu mu dina dia QIT"]
    E --> F["Ela makuta a muntu udi ulomba makuta a ngondo yonso adi mapite bungi mu konte wa QIT ngondo yonso"]
    F --> G["Futa tshitupa tshia nzubu wa bakulakaje ne MMMNA wa muena dibaka nebe mu konte wa QIT ku ngondo yonso"]

• Mushindu udi Miller Trust wenza mudimu: Muanyishibue kudi mikenji ya mbulamatadi (42 U.S.C. § 1396p(d)(4)(B)), Qualified Income Trust (QIT) i mukanda mupepele wa mabeji 4 mufunda kudi mukulumpe anyi kudi muena mudimu wende muinshi mua bukokeshi bua muena mudimu. Udi mua kuya ne mukanda wa QIT mufunda ku banke kayi yonso, kunzulula konte wa tshibutshilu udi ne tshiena bualu tshia "The [Parent's Name] Qualified Income Trust," ne kutuma makuta a pansio anyi makuta a Social Security a muntu mukulumpe mu konte wa QIT au ngondo yonso kumpala kua kufuta tshitupa tshia mushinga wa nzubu wa bakulakaje. Dola yonso udibu bateka mu tshibutshilu tshia Miller Trust udi mupatula mu tshipiminu tshia makuta 2 829, udi unzulula diakamue dianyisha dionso dia Nursing Home Medicaid.

Kukuba nzubu wa dîku ku lufu lua "Medicaid Estate Recovery" (MERP)¶

Nansha mudi nzubu wa kumpala wa dîku kayi ne tshia kusombela padi muntu mukulumpe ne muoyo**, mikenji ya ditunga (42 U.S.C. § 1396p(b)) idi ilomba ditunga dionso bua kuenza mudimu ne Programme wa dipingaja dia bintu bia mu Medicaid (MERP) udi ufila dilomba dia **bintu bia mufue bia Medicaid ** panyima pa lufu lua nzubu bua kufuta bitadi pa muaba wabu.

Lama njibo ya kisaka kyobe ku lufu lua Estate Recovery ku diambuluisha dia bintu ebi:

1. Mikenji idi ikandika dipingaja dia bintu: Mikenji ya mbulamatadi idi ikandika bikole dipingaja dia bintu bia Medicaid padi mulela yonso udi ulonda eu ne muoyo:
   • Muena dibaka udi ne muoyo (muaba wonso udibu basombele);
   • Muana udi ne bidimu muinshi mua 21; anyi
   • Muana mufofo anyi mulema wa kashidi wa bidimu bionso.
2. Wenza mudimu ne "Lady Bird Deed" (Enhanced Life Estate Deed) anyi "Transfer on Death (TOD) Deed" mu matunga adi afila mikalu ya dipingaja dia bintu ku Probate: Mu matunga a bungi (bu mudi Floride, Texas, Michigan, ne makuabu), Medicaid Estate Recovery udi mua kulomba anu bintu bidi bipita ku court probate. Kufunda mukanda wa Enhanced Life Estate Deed (Lady Bird Deed) padi muntu mukulumpe ne bukokeshi bua mikenji (anyi ku diambuluisha dia mukanda wa bukole udi ufila bukokeshi bua kufila mapa/kueyemena) kudi kulama 100 pa lukama ya bumfumu ne bukokeshi bua muntu mukulumpe (kufikisha ku zero 5-year back-penalty), ne mu tshikondo tshia muoyo wende pambelu pa nzubu lufu, ludi lukuba ku dipingaja dia bintu bia bumpianyi.
3. Bintu bia pa buloba bujima (UK Local Authority Care Cap, Deferred Payment Agreements, ne NHS Continuing Healthcare):
   • Mu Royaume-Uni, dilama dia bantu dia mu tshimenga didi diumvuija diteta (didi dienda dipita pa mutu pa 23,250 pounds mu Angleterre) didi dipepeja mushinga wa nzubu wa dîku pikala mulume anyi mukaji, muena dibaka anyi mulela wa bidimu 60 anyi kupita apu (anyi kayi ne bukole) utungunuka ne kusombela mu nzubu.
   • Kumpala kua kufuta dikuta dimue bua nzubu wa bakulakaje wa mu UK, lomba misangu yonso dikonkonona dia malu a bungi bua NHS Continuing Healthcare (NHS CHC): bikala muntu mukulakaje ne "dijinga dia kumpala dia bukola bua mubidi" (majinga a mu lupitadi makole, makole, adi kaayi mua kumanyibua), NHS udi ne bua kufuta 100 pa lukama ya makuta onso a nzubu wa bakulakaje ne a nzubu wa tshilala benyikakuyi kutangila mateta a mfranga bungi bua makuta anyi bintu bidi muntu mukulumpe nabi.

Nkonko itubu bela misangu ya bungi¶

Nzubu wa bakulakaje udiku mua kunfunda (muana mukulumpe) meme nkayanyi bua dibanza dia baledi banyi didi kadiyi difuta anyi?¶

Shi kuena muanji kutua tshiala pa mukanda wa dianyisha bu mufidi wa makuta ne kuyi muanji kuiba, kusokoka, anyi kulama makuta a baledi bebe anyi makuta a Social Security, nzubu wa bakulakaje kena mua kuikala ne bujitu bua dibanza dia baledi bebe bilondeshile mikenji ya mbulamatadi (42 U.S.C. § 1396r(c)(5)(A)(ii)). Ino, ikala mudimuke bininge ku mateyi abidi adi nzubu ya bakulakaje mua kufunda bana bakulumpe: (1) shi udi ne bukokeshi bua mfranga (POA) bua muledi webe ne wewe mupangile bua kufila makuta a Social Security/pension a muledi webe ku ngondo yonso kudi nzubu wa tshilala benyi anyi kuyi mufile mikanda ya ku banke idi nzubu wa Medicaid mulomba, udi mua kushipa dibanza dia makuta atanu dishipa dia tshipungidi bu muntu udi ne bujitu"; ne (2) mu matunga makese adi ne "mikenji ya dilama dia bana" (nangananga Pennsylvanie), tubadi tudi misangu mikuabu tuela bana bakulumpe tshibawu padibu bapangisha dilomba dia Medicaid anyi bashintulula makuta a baledi. Misangu yonso lomba Medicaid ne lukasa ne ufuta pa mutu pa tshitupa tshia dibanza tshia mubedi tshidi muledi ulomba ku ngondo yonso pa dîba.

Netuambe tshinyi bikala muledi wanyi udi mu nzubu wa bakulakaje ukadi ne disama dia lungenyi dikole ne kayi muanji kutua tshiala pa mukanda wa bukokeshi?¶

Bikala muledi webe kayi ne lungenyi lua kumvua ne kutua tshiala pa mukanda wa bukokeshi bua makuta (POA) ne konte yende ya ku banke, IRA, anyi mukanda wa nzubu mifunda anu mu dîna diabu, banke neyibenge bua kukuanyishila bua kubuela mu konte yende bua kupeta mikanda ya bidimu 5 ya kutangila panyima anyi kuenza mudimu wa dijimija dia makuta. Tshia kumpala, manya ne: muntu yonso udi wambuluisha muntu mukulumpe udi mua kutua tshiala ne kutuma mukanda wa kumpala wa dilomba dia Medicaid nkayende bu muleji-mpala udibu banyishile bua kukanga ngondo wa dilomba, ne bibambalu bia Medicaid bia mu ditunga bidi ne bukokeshi bua kulomba makuta adi mashale ku banke buludiludi ku diambuluisha dia Asset Verification System (AVS) wewe mumanyishe muena mudimu wa tshilumbu mu mukanda ne: muntu udi ulomba kena ne bukole to. Tshibidi, bua kupeta ne kufila makuta mu konte ya banke mikanga, udi ne tshia kufila dilomba dia lukasa ku kabadi ka Probate / Surrogate ka mu tshimenga tshienu bua **Dilama / Dilama dia bintu** (anyi kulomba mukenji wa bukubi wa kabadi ka tshilumbu tshimue udi ufila bintu bia muena dibaka udi kayi ne bukole kudi muena dibaka udi ne makanda a mubidi mimpe).

Medicaid udiku upingana ne wangata makuta a Social Security a muledi a bidimu 5 bishale anyi?¶

Tòo. Tshikondo tshia bidimu 5 (60 tshia ngondo 60) tshia Medicaid Look-Back Period katshiena tshipingaja makuta avua muledi webe mupitshishe mu mushindu udi muanyishibue bua bintu biabu bia pa tshibidilu, nzubu, bintu bia kudia, bintu bia mudimu, diambuluisha dia ku nzubu, bitadi anyi dikisha mu bidimu bitanu bishale ebi to. Dikonkonona dia bidimu bitanu didi anu dikeba **mapa adi kaayi mafuta anyi difila dia bintu bidi muinshi mua mushinga wa mu tshisalu** (bu mudi kufunda tsheke wa dolare 10 000 kudi muana wa muanabu anyi kufila nzubu wa tshilala benyi kudi muana wa muanabu ku dolare zero). Bu mudi makuta a muledi webe mifila ku bintu ne ku midimu ya muledi webe (anyi muena dibaka nende), makuta aa adi mu mikenji 100 pa lukama. Ino, epuka kupatula makuta a bungi a ATM bua kufuta bantu badi balama bana "muinshi mua mesa" kuyi ne mukanda mufunda wa **Mukanda wa dilama dia muntu nkayende** ne bipetu, bualu Medicaid udi wangata dipatula dia makuta didi kadiyi ne mikanda bu mapa adi kaayi malelela.

Tudiku ne bua kushipa dibaka bilondeshile mikenji bua muena dibaka udi ne makanda a mubidi ikale mua kulama makuta etu onso adibu balame anyi?¶

Mu misangu ya bungi, kupeta "Dishipa dia dibaka dia Medicaid" kakuena ne mushinga nansha kakese ne misangu ya bungi kudi kushiya muena dibaka udi ne makanda a mubidi mu njiwu mikole kupita kushala mu dibaka ne kuenza mudimu ne biamu bia mbulamatadi bia Spousal Impoverishment. Wewe mushipe dibaka, udi ujimija tshitupa tshia makuta a muena dibaka (MMMNA), udi ujimija bukenji buebe bua kupiana makuta a bungi a Social Security a muena dibaka nebe udi mufue pikalaye mu dibaka udi ne bidimu muinshi mua 10, ne bibambalu bia Medicaid bitu bitamba kuela mpata bua bipungidi bia dishipa dia dibaka bidibu bafunde mu tshikondo tshia lutatu lua luondapu bu dishintulula dia malu dia tshianana. Pamutu pa nanku, kushala mu dibaka ne kuenza mudimu ne mumanyi wa malu a mikenji wa bakulumpe (CELA) bua kusangisha nzubu udibu kabayi bafuta, CSRA wa dolare 154 140, ne mukanda wa Medicaid-Compliant Immediate Annuity anyi Court Support Order bidi bitamba kukuba 90 too ne ku 100 pa lukama bia bena dibaka badi baselangane kuyi ushipa dibaka diebe.

Miaba mifumina¶

• United States Code and Centers for Medicare & Medicaid Services (CMS, United States): 42 U.S.C. § 1396r-5 (Dilama dia makuta ne bintu bia bamue bena dibaka badi mu nzubu wa tshilala benyi / Mikenji ya dipanga dia bena dibaka: CSRA ne MMMNA) ne 42 U.S.C. § 1396p (Liens, Adjustments, Estate Recovery, 60-Month Look-Back Transfers, Caregiver Child Exemption, and Qualified Income / Miller Trusts).
• Federal Nursing Home Reform Act (OBRA '87, United States): 42 U.S.C. § 1396r©(5)(A)(ii) ne 42 C.F.R. § 483.15 (Dikandika dia kulomba dianyisha dia makuta dia muntu muisatu pa bidi bitangila dianyisha ne dikuba dia "Medicaid Pending" bena musoko bua kubenga kuipata).
• Social Security Administration (SSA, United States): Program Operations Manual System (POMS) SI 01130.100 to SI 01130.420 (Excluded Resources: Primary Residence Equity Limits, One Automobile Exemption, and Irrevocable Burial Funds).
• Tshilongelu tshia ditunga tshia ba avocats bakulumpe (NAELA) ne dîyi dia ditunga dia badi basumba bintu bua dilama dia matuku a bungi (ditunga dia États-Unis): Mikenji ya dipuekesha dia makuta a Medicaid, bipungidi bia dilama dia muntu nkayende, ne dikuba dia malu adi kaayi malelela a disangisha dia makuta mu nzubu ya bakulakaje.
• Tshibambalu tshia malu a bukola bua mubidi ne a nsombelu wa bantu ne NHS Angleterre (Royaume-Uni): Mukenji wa malu a bukubi wa 2014 (Annex B: Diangatangana dia makuta ne dibenga kunemeka nzubu munene wa bena dibaka ne balela badi ne bidimu 60+) ne Mulongolodi wa ditunga wa NHS Continuing Healthcare (NHS CHC).

Malu adi apetangana¶

• Dikengesha dia mu nzubu wa bakulakaje, dilengulula, ne dikuba dia dipatuka mu nzubu
• Kuela mpata ku lupitadi ludi kaluyi ne bukubi anyi kupatuka mu nzubu wa diondopangana
• Dikengesha dia makuta dia bakulumpe ne dikuba dia malu a tshinyangu
• Dibungama dia mu lupitadi ne dikuba dia malu a luondapu bua bakulakaje
• Dipanga dia mudimu dia tshimpitshimpi dia muena mudimu ne dipandisha dia muntu mukulumpe
• Nomba ya tshimpitshimpi