I-Emergency Nursing Home Medicaid Crisis Planning kanye Nokuvikelwa Kwempahla Yomshado¶

Lapho umuntu omdala osekhulile ehlushwa yinhlekelele yokushaywa unhlangothi, ukuphuka kwenyonga, noma ukuqhubeka kungazelelwe kwesifo i-Alzheimer's kanye noshintsho olusuka ekululameni esibhedlela luyiswe ekunakekelweni okuhlala isikhathi eside endaweni yokunakekela abahlengikazi (Skilled Nursing Facility) (SNF), imindeni iba nokushaqeka kwezimali ngokushesha. Umshwalense wezempilo ojwayelekile kanye ne-United States I-Medicare Ingxenye A ayikukhokheli ukunakekelwa kwekhaya labahlengikazi isikhathi eside uma ukuhlunyeleliswa kwamakhono esikhathi esifushane kuphela (imvamisa ngemva kwezinsuku ezingama-20 kuya kweziyi-100). Kungazelelwe, ihhovisi lebhizinisi lasekhaya lasebekhulile linikeza umndeni inkokhelo yangasese engu- 9,000 kuya ku-15,000 US dollars ngenyanga (noma 1,200 kuya ku-1,800 pounds ngesonto e-United Kingdom), okuholela abashadile bethukile kanye nezingane ezindala ukuthi benze amaphutha amabili ashaqisayo: ukusayina izikweletu zokwamukela umuntu omdala, ukunikeza ingane inkontileka yomuntu siqu noma isikweletu somuntu omdala. ukonga komzali ezihlotsheni ngokuphula izinyanga ezingama-60 (iminyaka emi-5) Inkathi Yokubheka Emuva Kwe-Medicaid.

Akudingeki uphelelwe imali, udayise ikhaya lomndeni, noma uhlupheke umngane womshado onempilo ekhaya ukuze ufanelekele othandekayo Isikhathi eside Sokunakekelwa Kwesikhungo Sezokwelapha , ngisho nalapho isiguli sesivele sihleli embhedeni wasekhaya lasebekhulile namuhla ngaphandle kokuhlela kusengaphambili. Umthetho we-Federal Medicaid (42 U.S.C. § 1396r-5) usungulaIzivikelo Zokuntula Umlingani ezinamandla ezivumela "Umlingani Womphakathi" oshadile ohlala ekhaya ukuthi agcine wonke umndeni wokuhlala, imoto eyodwa, izinto zomuntu siqu, kufika ku-154,140 amadola kukongiwa komshado okungabaleki komphakathi, kanye nokongiwa komshado konyaka. Amadola angu-3,853.50 ngenyanga emali engenayo ehlanganisiwe, kuyilapho ivumela abafake izicelo abangashadile noma abashadile ukuthi baguqule imali eningi ibe yimpahla ekhululwe ngokusemthethweni khona lapho. Lo mhlahlandlela uhlinzeka ngezinyathelo eziphuthumayo eziphuthumayo zokumisa ingcindezi yezezimali yekhaya labahlengikazi engekho emthethweni, ugweme izinhlawulo zokubheka emuva, kanye nokusebenzisa imali ephansi ye-Medicaid ephuthumayo.

Yenza lokhu manje¶

1. Ungalokothi usayine isivumelwano sokungena ekhaya lasebekhulile ngegama lakho siqu noma "njengomqinisekisi Wezezimali." Uma umzali ehlangabezana nesimo esiphuthumayo sezokwelapha phakathi nengxabano yendawo, shayela inombolo yakho yasendaweni yezimo eziphuthumayo (911 e-United States naseCanada, 112 kwi-European Union, 999 e-United Kingdom) noma uhlole eyethu izinombolo eziphuthumayo umkhombandlela. Ngaphansi koMthetho Wezinguquko Zekhaya Labahlengikazi (42 U.S.C. § 1396r©(5)(A)(ii))***, indawo inqatshelwe ngokuphelele ukudinga ingane endala noma inkampani yangaphandle ukuthi iqinisekise inkokhelo ngokwayo njengombandela wokwamukelwa; sayina ngokuqinile njengokuthi "Umenzeli ongaphansi kwamandla ommeli we-[Igama Lomzali], ngaphandle kwesibopho sezimali somuntu siqu."
2. YIMA ngokushesha ngaphambi kokupha, ukudlulisa, noma ukwengeza igama lengane kunoma iyiphi i-akhawunti yasebhange, itayitela lendlu, noma itayitela lemoto. Ukunikeza imali noma ukuthengisa indawo ngenani elingaphansi kwenani elifanelekile lemakethe phakathi izinyanga ezingu-60 (iminyaka emi-5) ngaphambi kokufaka isicelo se-Nursing Home Medicaid (izinyanga ezingu-30 e-California, ukunqamuka) kuvula I-Medicaid Transfer enzima ne-zero yemali ye-Medicaid, iZerosi eshiya i-Penal*, I-Penalty Ukufakwa kwe-Medicaid izinyanga noma iminyaka.
3. Ungalokothi udayise ikhaya lomndeni noma ukhiphe ama-akhawunti omhlalaphansi ukuze ukhokhele ikhaya lasebekhulile ngaphambi kokubonana Nommeli Womthetho Omdala noma umeluleki WE-SHIP. Umbhangqwana oshadile (noma umuntu omdala ongashadile ogcwalisa isitatimende esisayiniwe esithi "Inhloso Yokubuyela Ekhaya" ukuze abeke amanani okulingana angu-713,000 kuya ku-1,071,000+ wemali yokuhlalaPTmalini esele yemaliPTimali eyisipesheli ye-PTimali yentela yemaliPTimali eyisipesheli ye-Memes ukufaneleka, kuyilapho ukuthengisa indlu kuguqula ikhaya elikhululekile libe yimali eningi ezothathwa ikhaya labahlengikazi.
4. Funa izibalo ezisemthethweni "Zokuhlolwa Kwensiza / Usuku Lwesithombe Esifinyeziwe" uma umhlali wasekhaya asebekhulile ushadile. Ngaphansi kwemithetho yenhlangano Yokungabi Nemali Komlingani, umlingani ophile kahle ohlala ekhaya (Umlingani Womphakathi) unelungelo elingokomthetho lokugcina imali evikelekile **Isibonelelo Sisetshenziswa Somphakathi Nemali YesondloNemali Yesondlo (CSRA) (MMMNA) ngakho-ke abasoze bashiywa dengwane.
5. Guqula "Izimpahla Ezibalwayo" zibe "Izimpahla Ezikhululiwe" ngokusemthethweni uma udinga ukuchitha imali ngokushesha ngaphambi kokuphela kwenyanga yekhalenda. Esikhundleni sokunikeza ukonga okweqile ekhaya lasebekhulile noma ukukunikeza ngokungemthetho, abafake izicelo bangasebenzisa imali eningi ngokusemthethweni ekuthengeni okukhululiwe kwenani lenani: ukukhokha imali yendlu, ukukhulula noma ukulungisa ikhaya ** I-Pre-Paid Funeral and Burial Trust**, ukuthenga ukunakekelwa kwamazinyo okudingekile, izibuko zamehlo, noma isihlalo esinamasondo, noma ukwenza i-Medicaid-Compliant-Sousal annuity.
6. Thumela isicelo se-"Medicaid Pending" futhi ugomele ilungelo lakho lokukhishwa ngesikhathi umbuso ucubungula ifayela. Ngaphansi kwemithetho yokukhishwa kwekhaya labahlengikazi likahulumeni (bona umhlahlandlela wethu kokuthi ukuhlukunyezwa kwekhaya labahlengikazi, ukunganakwa, nokuvikela ukuxoshwa), isikhungo sabahlengikazi esigunyazwe yi-Medicaid asikwazi ukuxosha umhlali ngenxa yokungakhokhi kuyilapho isicelo se-Long Term Care Medicaid esithunyelwe sisalindile nesikhungo sikahulumeni.

flowchart TD
    A["Abadala Badinga Ukunakekelwa Kwasekhaya Kwabahlengikazi Kwaphakade (I-Medicare Rehab Iyaphela)"] --> B{"Ingabe Isakhamuzi SaseKhaya Labahlengikazi Sishadile Noma Asishadile/Ungumfelokazi?"}
    B -->|"Ushadile (Omunye Umlingani Ohlala Ekhaya)"| C["Cela Imithetho Yokungabi Namali Yomlingani Wombuso (42 USC 1396r-5)"]
    B -->|"Ongashadile, Ohlukanisile, Noma Umfelokazi"| D["Ukucwaningwa Kwamabhuku Okungabalwayo vs. Izimpahla Ezikhululiwe Ngokumelene Nomkhawulo Womuntu ngamunye ongu-$2,000 (Ophezulu e-CA/NY)"]
    C --> E["Ikhaya, Imoto E-1, Nokufika Ku-$154,140 I-CSRA Evikelwe Umlingani Womphakathi + Ukushintsha Kwemali engenayo (MMMNA)"]
    D --> F["Vikela Indawo Yokuhlala Eyisisekelo 'Ngenhloso Yokubuyela Ekhaya' noma Ngokukhululeka Kwengane Umnakekeli"]
    E --> G{"Ingabe Izimpahla Ezisele Ezibalwayo Zisengaphezu Komkhawulo Wezwe?"}
    F --> G
    G -->|"Yebo: Imali Engabalwa Ngokweqile"| H["Yenza Inkinga Yomthetho Uchithe Phansi NGAPHAMBI Kokuphela Kwenyanga (UNGALINGE Izimpahla Zesipho Ekubukeni Kweminyaka Emi-5)"]
    G -->|"Cha: Ngaphakathi Komkhawulo Wefa"| I["Bheka Iholo Lanyanga Zonke Ngokumelene 'Ne-Income Cap' (Sebenzisa Iholo Elifanelekayo / I-Miller Trust uma Idingeka)"]
    H --> I
    I --> J["Faka isicelo seMedicaid Yokunakekelwa Kwesikhathi Eside (I-Trigger 'Medicaid Pending' Eviction Protection)"]

Kungani i-Medicare iyeka ukukhokha ngemva kwezinsuku ezingu-20 kuya kweziyi-100 (Amakhono aqhathaniswa Nokunakekelwa Kokugcina)¶

Inkinga yezezimali ejwayeleke kakhulu ekugugeni yenzeka cisheUsuku lwama-20 kuya kuSuku lwama-35 lokuhlala kwangemva kwesibhedlela Esikhungweni Sobuhlengikazi Esinekhono (SNF). Imindeni izwa esibhedlela ukuthi "I-Medicare ihlanganisa izinsuku eziyi-100 zokuvuselela ikhaya labahlengikazi," ukuze ithole Isaziso Se-Medicare Non-Coverage (Ifomu CMS-10123) emasontweni amathathu kamuva esisho ukuthi ukuhlinzekwa kwe-Medicare kuphela emahoreni angu-48 nokuthi umndeni kufanele ukhokhe amadola angu-400 kuya kwangu-500 kusukela ngoLwesine.

Ukuqonda umugqa osemthethweni phakathi kwe-Medicare Part A kanye ne-I-Long Term Care Medicaid kuyisisekelo sokuhlela inkinga:

• I-Medicare Ingxenye A (Ukuvuselelwa Kwekhono Lesikhathi Esifushane KUPHELA): Ngemva kokuhlala esibhedlela kwesiguli esiphakathi kwamabili okufanelekile oku-3-phakathi kwamabili, Ingxenye A ye-Traditional Medicare ihlanganisa amaphesenti angu-100 wezinsuku 1 kuya ku-20, futhi ikhokhisa umshwalense wokubambisana wansuku zonke klzzwxh:0072 ngezinsuku ezingu-21) Inqubomgomo yokwengeza ye-Medigap), **KUPHELA inqobo nje uma isigu sidinga futhi sibamba iqhaza "Ekunakekelweni Kwamakhono" kwansuku zonke (njengokwelapha Ngomzim kwansuku zonke, Ukwelapha Ngomsebenzi, Ukwelapha Ngenkulumo, noma ukuhlengikaza okuyinkimbinkimbi kwe-IV/amanxeba). Usuku oluqondile lwethafa lokuhamba kwesiguli noma zidinga kuphela "Ukunakekelwa Kokugcina"** (uso lokugeza, ukugqoka, indlu yangasese, ukudla, nokugadwa kokuwohloka komqondo), I-Medicare Part A ikhokha u-$0, ngisho noma isiguli sisebenzise izinsuku ezingu-18 kuphela kweziyi-100. (Uma ukholelwa ukuthi i-rehab inqanyulwa ngaphambi kwesikhathi kuyilapho abadala besakwazi ukuba ngcono, faka isikhalazo se-QIO ngokushesha usebenzisa uhlelo lwethu lokusebenza. isibhedlela esingaphephile noma umhlahlandlela wokukhishwa kwe-rehab discharge.)
• I-Institutional Medicaid Yesikhungo Sokunakekelwa Kwesikhathi Eside (Ukugcina Unomphela + Ukunakekelwa Kwekhono): Uma umuntu omdala esedinga ukunakekelwa kwaphakade kwamahora angu-24 ekhaya lasebekhulile futhi engenawo Umshwalense Wokunakekela Wesikhathi Eside oyimfihlo, I-Medicaid iwuhlelo oluyinhloko lomphakathi e-United States olukhokha i-10,00-month-dollar eyi-10,000 ngenyanga ngayinye impilo yomhlali, uma imithetho yokufaneleka yezezimali nezomtholampilo ("Indawo Yokunakekela Abahlengikazi") isifinyelelwe.

Ukubalwa uma kuqhathaniswa. Izimpahla Ezikhululiwe: yiziphi i-Medicaid ekuvumela ukuthi uzigcine¶

Ukuze ufanelekele ukuthola i-Long-Term-Term Care Institutional Medicaid ezifundazweni eziningi zase-U.S., umfakisicelo "Izimpahla Ezibalwa" (izinsiza ezingakhululiwe) kufanele zibe ngaphansi kuka-2,000 dollars ngosuku lokugcina lwenyanga (inothi: I-California isuse umkhawulo wempahla ngokuphelele kusukela ngo-2024 futhi inyuswe ngaphezu kuka-2024, i-New York ibe ngaphezu kuka-5 umkhawulo, i-New York amadola**).

Kodwa-ke, i-Medicaid ** ayibali** yonke into onayo kulowo mkhawulo wamadola angu-2,000. Imithetho yeMedicaid kahulumeni neyesifunda ihlukanisa yonke impahla ibe Izimpahla Ezikhululiwe (Ezingabaleki) ongazigcina ngokukhululekile, kanye nokuthi Izimpahla Ezibalwa okufanele zivikelwe noma zichithwe phansi.

I-Federal Sousal Impoverishment Protections (lapho umlingani oyedwa ehlala ekhaya)¶

Ngaphambi kokuthi iCongress yenze umthetho we- Medicare Catastrophic Coverage Act ka-1988 (42 U.S.C. § 1396r-5), lapho umyeni engena ekhaya lasebekhulile, lo mbhangqwana kwadingeka uchithe cishe yonke imali yawo yokuphila kuze kufike kumadola angu-2,000 ngaphambi kokuba i-Medicaid isize, ishiya inkosikazi enempilo ekhaya impofu. Namuhla, umthetho wezwe othi Umthetho Wokuntula Umlingani Womshado uhlukanisa umbhangqwana oshadile ube Umlingani Osungulwe (ekhaya lasebekhulile) kanye Nomlingani Womphakathi (ohlala ekhaya noma oziphilisa ngokuzimele) futhi uvikela kokubili impahla kanye nemali engenayo yanyanga zonke yomngane womshado ekhaya.

1. Ukuvikela Imali Eyongiwa Emshadweni: I-Community Spouse Resource Allowance (CSRA)¶

Ngaphansi komthetho wombuso, i-Medicaid ihlanganisa zonke izimpahla ezingabalwayo zomlingani womshado (kungakhathaliseki ukuthi igama likabani eliku-akhawunti yasebhange noma ukuthi basayine isivumelwano sangaphambi komshado) futhi ivumela Umlingani Womphakathi ukuthi agcine isabelo esivikelwe esibizwa ngokuthi Isibonelelo Sezinsiza Zomphakathi (CSRA):

• Isilinganiso esiphezulu se-CSRA (2024/2025 Federal Standard): Kungafika ku-$154,140 wamadola* (ishintshwa ikhuphuke njalo ngoMasingana ukuze kukhuphuke amanani emali) ekongeni uketshezi oluningi, PLUS indlu yomndeni ekhululiwe, imoto eyodwa, nemingcwabo ekhokhelwa kusengaphambili, kuyilapho isikhungo sigcina amadola angu-02* elengeziwe.
• "100% Ubukhulu be-CSRA States" vs. "50% Isifinyezo States":
  • Ku- 100% States (njengeFlorida, Texas, New York, Pennsylvania, Georgia, neColorado), Umlingani Womphakathi ugcina ngokuzenzakalelayo amaphesenti angu-100 wezimpahla ezibalwayo zombhangqwana kuze kufike kusilingi wamadola angu-154,140.
  • E-50% Yezifinyezo Zezifunda (njenge-Ohio, New Jersey, North Carolina, Virginia, ne-Indiana), Umlingani Womphakathi ugcina ingxenye eyodwa (50%) yesamba sempahla engabalwayo yombhangqwana njengoba kulinganiswa "Idethi Yesithombe" (usuku lokuqala oluqhubekayo lokuqala oluqhubekayo lwesikhulu esiphezulu sokulaliswa ekhaya kombuso kwezinsuku ezingu-30), i-RA eqinisekisiwe yokuhlala esibhedlela/abahlengikazi 30,828 dollar** kanye Ubukhulu bosilingi obungamadola angu-154,140.

2. Ukuvikela Imali Engenayo Yanyanga Zonke: Isibonelelo Sezidingo Zesondlo Esincane Sanyanga Zonke (MMMNA)¶

Umthetho wombuso usebenzisa imithetho emibili ehluke ngokuphelele kokuthi Imali Engenayo Yanyanga zonke (amasheke Ezokuphepha Komphakathi, izimpesheni, izimali ezitholwa minyaka yonke) kwabashadile:

1. Umthetho othi "Igama Eshekeni" Wenzuzo Yomuntu Oshade Naye Womphakathi: Kungakhathaliseki ukuthi iyiphi isheke Lokuvikeleka Komphakathi noma isheke lempesheni lanyanga zonke elikhokhwa egameni Lomlingani Womphakathi lingelika- amaphesenti angu-100 Lomlingani Womphakathi. Kungakhathaliseki ukuthi impesheni yomlingani ophile kahle noma isheke Lokuvikeleka Komphakathi likhulu kangakanani, i-Medicaid ayikwazi ukuthinta ngisho nesenti elilodwa lemali engenayo yanyanga zonke yomlingani Womphakathi ukuze akhokhele ukunakekelwa kwasekhaya lasebekhulile Lomlingani Omiselwe Isikhungo.
2. Ukushintsha Iholo ELISUKA Kumlingani Wasekhaya Labahlengikazi liye Kumlingani Womphakathi (I-MMMNA): Ngokujwayelekile, umhlali wasekhaya asebekhulile e-Medicaid kufanele azikhokhele ingxenye enkulu yesheke lakhe lanyanga zonke le-Social Security kanye nesheke lempesheni ngesikweletu sakhe sasekhaya labahlengikazi ("Isikweletu Sesiguli / Isabelo Sezindleko"), egcina kuphela encane Izidingo Zomuntu siqu zedola elingu-30 ngenyanga* NOMA kunjalo, uma Umlingani Womphakathi onempilo ekhaya enemali engenayo ephansi yenyanga eyakhe, ngaphansi kwe-*Minimum Monthly Monthly Needs Allowance (MMMNA), esukela ku-2,555 dollars kuya ku-3,853.50 dollars ngenyanga, Medicaid ivumela i-Spostitualized and transfer of their parts (noma i-Medicaid ivumela i-Instituation) ukuthi idlulisele yonke imali ye-Instituation isheke lanyanga zonke le-Social Security kanye nempesheni ku-Community Spouse njalo ngenyanga ukuze oshade naye ekhaya afinyelele i-MMMNA engenayo imali etholakalayo.

Izinyanga ezingama-60 (Iminyaka emi-5) Isikhathi Sokubheka Emuva kanye nokuthi ungazigwema kanjani Izijeziso Zokudlulisa¶

Lapho umkhaya uqaphela ukuthi umzali ongayedwa une-dollar engu-80 000 e-akhawuntini yokonga futhi kudingeka abe ngaphansi kwama-dollar angu-2 000 e-Medicaid, umuzwa wawo wokuqala uwukuthi: “Masibhalele izingane isheke lama-dollar angu-78 000 namuhla, noma sidayisele indodana yakhe indlu kamama nge-dollar elilodwa, bese kusasa sifaka isicelo se-Medicaid.”

Isebenza kanjani iMedicaid Transfer Penalty Divisor (nokuthi kungani iwugibe)¶

Uma i-Medicaid ithola ukuthi umama wakho wapha izingane zakhe ama-dollar angu-70,000 eminyakeni emithathu edlule, i-Medicaid ayiceli izingane imali ngesizotha; esikhundleni salokho, i-Medicaid ibala Inkathi Yenhlawulo Yokungafaneleki ngokuhlukanisa inani lesiphiwo ngenyanga yezwe ethi Isihlukanisi Sesijeziso (izindleko ezimaphakathi zanyanga zonke zekhaya lasebekhulile esifundeni sakho, isb., amadola angu-10,000):

Okubi nakakhulu, ngaphansi koMthetho Wokunciphisa Izikweletu, leso washi lesigwebo sezinyanga ezingu-7 ALIQALI ukuphawula kuze kube usuku umama wakho (1) ehlala ekhaya lasebekhulile, (2) ephukile (ngaphansi kwamadola angu-2,000), FUTHI (3) athumele isicelo se-Medicaid. Uma izingane sezivele zisebenzise imali engu-70,000 yamadola ezinyangeni ezintathu ezedlule futhi zivaleleke ekhaya manje yezikweletu ezingakhokhiwe ze-10,000-dollar-ngenyanga.

*(Ukwelapha inkinga uma isipho sase senziwe: Uma ingane endala isenayo imali enesiphiwo, ukubuyisela amaphesenti angu-100 ezimali ezinesiphiwo ku-akhawunti yasebhange yomzali "kuphulukisa" inhlawulo yokudluliswa kwemali ngokuphelele ukuze-ke sisetshenziswe phansi ngokusemthethweni ezintweni ezikhululiwe, noma ummeli we-Elder Law angakwazi ukusebenzisa ingxenye "Isipho Nesipho Sokugunyazwa) /Isaziso Sokugunyazwa"

Okuhlukile Okune Okuphathelene Nomthetho lapho ukudlulisa ikhaya noma imali kubangela inhlawulo engu-ZERO¶

Umthetho kahulumeni (42 U.S.C. § 1396p©(2)) uvumela umfakisicelo wekhaya lasebekhulile ukuthi adlulisele indawo yokuhlala eyinhloko noma impahla yakhe ezigabeni ezine zamalungu omndeni ngisho nangosuku olungaphambi kokufaka isicelo se-Medicaid nge zero yenhlawulo yokubheka emuva yeminyaka emi-5:

1. Ukudluliselwa Kowakwakho: Ukudluliswa okungenamkhawulo kwanoma iyiphi impahla noma itayitela lendlu phakathi kwabashade nabo kukhululwe esijezisweni ngamaphesenti angu-100.
2. Dlulisela Enganeni Engaboni Noma Enokukhubazeka Unomphela (kwanoma iyiphi iminyaka): Umzali angadlulisela impahla noma ikhaya ngqo enganeni ehlangabezana nencazelo ye-Social Security yobumpumputhe noma ukukhubazeka unomphela (noma ku- Sole Benefit Disability Trust / Special Needs Trust yomuntu okhubazekile ongaphansi kweminyaka engu-65) ongenayo inhlawulo yokubheka emuva.
3. "Ukukhululwa Kwengane Yomnakekeli" (Ukudluliswa Kwekhaya Lomndeni): Umzali angakwazi ukuthenga indlu yakhe yomndeni eyinhloko amaphesenti angu-100 mahhala futhi ecacile (ikhululwe kukho kokubili ukubheka emuva kweminyaka engu-5 KANYE Nokutholwa Kwefa kwe-Medicaid esizayo) endodaneni noma endodakazini endala ethi:
   • Ubehlala ngaphakathi kwekhaya lomzali ngokuqhubekayo okungenani iminyaka engu **ezimbili (2) egcwele ngaphambi nje kokuba umzali angene ekhaya lasebekhulile, FUTHI
   • Kuhlinzekwe ngokunakekelwa kwansuku zonke okubhaliwe (okuqinisekiswe incwadi kadokotela namalogi okunakekela) okubambezele umzali ekudingeni ukwamukelwa kwekhaya labahlengikazi phakathi naleyo minyaka emibili.
4. Ukukhululwa "Kwezingane Ezikanye Nenzalo Elinganayo": Ukudlulisela ikhaya kumfowethu noma udade osevele enenzalo yobunikazi bokulingana endlini futhi wahlala lapho okungenani unyaka owodwa (1) ngokushesha ngaphambi kokuba umuntu omdala angene ekhaya lasebekhulile.

Uhlu Lokuhlola Lokuchithwa Kwezingqinamba Zezomthetho: ungayinciphisa kanjani imali ebalwayo ezinsukwini ezingama-30¶

Uma umzali wakho noma umngane womshado wakho esekhaya lasebekhulile namuhla nge-20,000 kuya ku-150,000 amadola* emalini eyonga ebhange engaphezu komkhawulo wempahla ye-Medicaid, akudingeki ukuba unikeze yonke leyo mali ekhaya lasebekhulile. Ukufaneleka kwe-Medicaid kunqunywa kusifinyezo samabhalansi asebhange ngosuku lokugcina lwekhalenda lwenyanga (noma idethi yokufakwa kwesicelo). Ungasebenzisa imali eyeqile wehlele kumkhawulo wamadola angu-2,000 ngaphambi kwaphakathi kwamabili ngosuku lokugcina lwenyanga ngokuthenga izimpahla namasevisi ngenani lemakethe elifanelekile ukuze kuzuze umfakisicelo noma umlingani wakhe:

• Khokha izikweletu nezindlu ezibolekiwe ekhaya elikhululiwe: Khokha phansi noma ukhokhe imali yendlu, umugqa wesikweletu wemali yendlu (HELOC), intela yezakhiwo, noma isikweletu sekhadi lesikweletu somfakisicelo noma Umlingani Womphakathi.
• Yenza ukulungisa imali kanye nokuthuthukiswa kokufinyeleleka endaweni yokuhlala eyinhloko ekhululiwe: Shintsha uphahla olugugile, faka isithando somlilo esisha se-HVAC, lungisa kabusha igumbi lokugezela elineshawa yokungena, faka irempu yesihlalo sabakhubazekile, ushintshe amafasitela, noma uthenge izinto zikagesi ezintsha zasekhishini zekhaya Lomlingani Womphakathi.
• Thenga Uhlelo Lomngcwabo Nomngcwabo Olukhokhelwe Ngaphambilini Olungaguquleki: Vakashela ikhaya labangcwabi elinelayisensi futhi uguqule amadola ayi-10,000 kuye kwangu-15,000 umlingani ngamunye abe Isikhwama Somngcwabo Esingenakuguquleka esigunyazwe nguhulumeni, indawo yokungcwaba, ibhokisi kanye netshe lekhanda.
• Thuthukisa noma shintsha imoto yomndeni ekhululiwe: Thengisa ngemoto endala (noma izimoto ezimbili ezindala) futhi uthenge imoto eyodwa ethembekile entsha noma ephelelwe yisikhathi (noma iveni elifinyeleleka ngesihlalo sabakhubazekile) enesihloko egameni lomfakisicelo noma Umlingani Womphakathi.
• Thenga izinto ezingakhaviwe zezokwelapha, ezamazinyo, zokuzwa, nezokunethezeka kwabakhulile: Thenga amazinyo okufakelwa ngokwezifiso noma izigxivizo zamazinyo, izibuko zamehlo ezibhalwe ngamagama aphezulu, izinsiza zokuzwa zedijithali, isihlalo esinamasondo esenziwe ngokwezifiso esinenjini noma esinyakazayo, isitulo sokuphakamisa isihlalo sendlu yabo yabahlengikazi, ikhompuyutha yethebhulethi, kanye newodilophu egcwele yezingubo zabo ezibhalwe ngamagama.
• Sebenzisa i-Medicaid-Compliant Single Premium Immediate Annuity (SPIA) (nge-Elder Law Attorney): Ngaphansi kuka-42 U.S.C. § 1396p©(1)(F)-(G), ezifundazweni eziningi Umlingani Womphakathi oshadile (noma umfakisicelo oyedwa osebenzisa isu lesigamu sesinkwa) angaguqula amakhulu ezinkulungwane zamadola emali eningi ebalwayo ibe imali evikelwe I-Medicaid-Compliant Immediate Annuity eguqula isigaxa sesamba somshado esivikelekile sibe isamba semali engenayo evikelekile, inqobo nje uma isamba semali engenayo yenyanga esivikelekile siyisamba semali engenayo evikelekile. engenakuhoxiswa, engabelwe, ezwakala kahle, ikhokha ngezitolimende ezilinganayo zanyanga zonke, futhi ibiza i-ejensi ye-Medicaid yesifundazwe njengomzuzi osele kuze kufike ezinzuzweni ezikhokhiwe.

Ukuxazulula inkinga ye-"Income Cap" (Ama-Qualified Income Trusts / Miller Trusts)¶

Cishe uhhafu wezifunda zase-U.S. (okuhlanganisa iFlorida, iTexas, i-Ohio, i-New Jersey, i-Arizona, i-Colorado, i-Indiana, ne-Georgia) zihlukaniswa ngokuthi "I-Income Cap States." E-Income Cap State, uma umfakisicelo wekhaya lasebekhulile iholo lanyanga zonke lomfakisicelo (Social Security + ngaphambi kokudonswa kwempesheni) lidlula 2,829 izinga le-federal (isilinganiso samadola angu-300 ngonyaka ngisho namaphesenti angu-30)* Idola elingu-1, noma ikhaya labahlengikazi libiza amadola angu-10,000 ngenyanga, ikhompuyutha yesifunda izokwenqaba ngokuzenzakalelayo ukufanelekela i-Medicaid ngaphandle kokuthi uvule i-akhawunti yasebhange elula ebizwa ngokuthi I-Qualified Income Trust (QIT) / Miller Trust.

flowchart TD
    A["Bheka Iholo Lanyanga Zonke Lomfakisicelo Wasekhaya Labahlengikazi (Ukuphepha Komphakathi + Nempesheni)"] --> B{"Ingabe Uhlala 'Esifundeni Semali Engenayo' futhi Ingabe Iholo Eliphelele Lingaphezu kuka-$2,829/Ngenyanga?"}
    B -->|"Cha: Ngezansi kwe-Cap noma 'Isifunda Sokuchitha Imali Esidinga Ngezempilo'"| C["Ayikho I-Miller Trust Edingekayo: Imali Engenayo Isebenza Ngokuqondile Engxenyeni Yesiguli Yezindleko / Umlingani U-MMMNA"]
    B -->|"Yebo: Ngaphezulu kokungu-$2,829/Ngenyanga Esifundazweni Semali Engenayo"| D["Sebenzisa i-Qualified Income Trust (QIT/Miller Trust) Document"]
    D --> E["Vula I-akhawunti Ezinikezele Yokuhlola Okungeyona Inzalo Enesihloko Egameni Le-QIT"]
    E --> F["Idiphozithi Imali Engenayo Yanyanga Yonke Yomfakisicelo Idlula Ikhephu Ku-akhawunti Ye-QIT Njalo Inyanga"]
    F --> G["Khokha Isabelo Sekhaya Labahlengikazi Sezindleko kanye Nomlingani U-MMMNA Ku-akhawunti Ye-QIT Nyanga Zonke"]

• Isebenza kanjani i-Miller Trust: Igunyazwe yisimiso sombuso (42 U.S.C. § 1396p(d)(4)(B)), I-Qualified Income Trust (QIT) iyidokhumenti yokwethenjwa yamakhasi angu-4 elula esayinwe yisikhulu noma i-Agent yabo ngaphansi kwamandla ommeli. Uyisa idokhumenti ye-QIT esayiniwe kunoma iliphi ibhange, uvule i-akhawunti yokuhlola ezinikele enesihloko esithi "I-[Igama Lomzali] I-Qualified Income Trust," futhi udlulisele impesheni yanyanga zonke yomdala noma idiphozi Yezokuphepha Komphakathi kuleyo akhawunti ye-QIT njalo ngenyanga ngaphambi kokukhokha Isabelo Sezindleko Zekhaya lasebekhulile. Idola ngalinye elifakwe ku-Miller Trust likhishwa ngokusemthethweni elikhishiwe kukhephu yemali engenayo engama-dollar angu-2,829, okuvula ngokushesha ukufaneleka okugcwele Kwekhaya Labahlengikazi Medicaid.

Ukuvikela Ikhaya Lomndeni Ku-Post-Death "I-Medicaid Estate Recovery" (MERP)¶

Ngisho noma indawo yokuhlala yomndeni eyinhloko ikhululiwe ngenkathi omdala esaphila, umthetho wenhlangano (42 U.S.C. § 1396p(b)) udinga ukuthi zonke izifundazwe zisebenzise i-Medicaid Estate Recovery Programme (MERP) efaka isimangalo ngokumelene nomamukeli oshonile we-Medicaid ngemuva kokuthola izikweletu ezikhokhelwayo **

Vikela ikhaya lomndeni wakho ekubuyiselweni kwezindlu kwangemva kokufa usebenzisa lezi zihlangu ezisemthethweni:

1. Imigoqo esemthethweni ephelele ngokumelene ne-Estate Recovery: Umthetho we-Federal ukunqabela ngokuqinile ukubuyiswa kwe-Medicaid Estate kuyilapho noma iyiphi izihlobo ezilandelayo zisaphila:
   • A umlingani ophilayo (noma yikuphi lapho behlala khona);
   • ingane engaphansi kweminyaka engu-21; noma
   • Ingane engaboni noma ekhubazekile unomphela yanoma yimuphi ubudala.
2. Sebenzisa i-"Lady Bird Deed" (Itayitela Lendawo Yokuphila Esithuthukisiwe) noma "Itayitela Lokudluliselwa Ekufeni (TOD)" ezifundazweni ezikhawulela ukutakula kube yi-Probate: Ezifundeni eziningi (njengeFlorida, i-Texas, i-Michigan, nezinye), i-Medicaid Estate Recovery ingafuna kuphela impahla edlula icala lenkantolo. Ukurekhoda Itayitela Lendawo Yokuphila Esithuthukisiwe (Itayitela LeNyoni Yokuphila) kuyilapho umdala enegunya elingokomthetho (noma Amandla Ommeli anikeza ngokucacile amandla esipho/okwethemba) kugcina ubunikazi nokulawula ukuphila konke okungamaphesenti angu-100 kumuntu omdala (okubangela iminyaka engu-5 yokubheka emuva eyiziro ngesikhathi sokuphila), futhi kudlulisa ngokuzenzakalelayo ukukhishwa kwe-probate ngemuva kokufa.
3. Okulingana namazwe ngamazwe (I-UK Local Authority Care Cap, Izivumelwano Zokukhokha Ezihlehlisiwe, kanye Nokunakekelwa Kwezempilo Okuqhubekayo kwe-NHS):
   • E-United Kingdom, ukunakekelwa komphakathi komkhandlu wendawo kusho ukuhlola (okwamanje ukukhahlela ngenhla amaphawundi angu-23,250 e-England) kulishaya indiva inani lekhaya lomndeni inqobo nje uma umngane womshado, umlingani womphakathi, noma isihlobo esineminyaka engu 60 noma ngaphezulu (noma esingakwazi ukusebenza) siqhubeka nokuhlala endaweni.
   • Ngaphambi kokukhokha isenti lekhaya labahlengikazi lase-UK, funa njalo ukuhlolwa okusemthethweni kwemisebenzi eminingi ye-*NHS Continuing Healthcare (NHS CHC)**: uma umuntu omdala ene "isidingo sezempilo esiyinhloko" (izidingo zomtholampilo ezinzima, eziyinkimbinkimbi, ezingalindelekile), **i-NHS kufanele ikhokhe amaphesenti angu-100 awo wonke amakhaya asebekhulile kanye nemali yokuhlola ukuthi ingakanani imali etholakalayo, imali yokuhlola noma indawo yokuhlala. umnikazi.

Imibuzo evame ukubuzwa¶

Ingabe ikhaya lasebekhulile lingakwazi ukungimangalela mina (ingane endala) mathupha ngesikweletu esingakhokhelwa somzali wami?¶

Uma ungakaze usayine inkontileka yokungena njengomuntu oqinisekisayo ngokwezimali futhi ungakaze untshontshe, ufihle, noma ugcine imali yomzali wakho noma amasheke e-Social Security, ikhaya lasebekhulile ngokuvamile alikwazi ukukuthwala ngokomuntu siqu ngesikweletu somzali wakho ngaphansi komthetho wenhlangano (42 U.S.C. § 1396r(c)(5)(A)(ii)). Kodwa-ke, qaphela kakhulu izicupho ezimbili lapho amakhaya asebekhulile INGABE amangalele ngempumelelo izingane ezindala: (1) uma ubambele umzali wakho Amandla Ezezimali (POA) futhi wehluleka ngobudedengu ukunikeza isheke lomzali wakho lanyanga zonke le-Social Security/pension esikhungweni noma wehluleka ukunikeza izitatimende zasebhange ezicelwe yi-Medicaid, isikhungo singakumangalela "ngokuphulwa kwesivumelwano sokwephulwa kwesivumelwano; futhi (2) ezifundazweni ezimbalwa ezine-"Filial Responsibility Statutes" (ikakhulukazi ePennsylvania), izinkantolo ngezikhathi ezithile ziye zathwesa izingane ezindala zinesibopho lapho ziphazamisa isicelo se-Medicaid noma ziphambukisa izimali zomzali. Ngaso sonke isikhathi faka isicelo se-Medicaid ngokushesha futhi ukhokhe isabelo sesikweletu sesiguli sanyanga zonke esidingekayo ngesikhathi.

Kuthiwani uma umzali wami ekhaya lasebekhulile esenokuwohloka komqondo okuthuthukile futhi engakaze asayine Amandla Ommeli?¶

Uma umzali wakho engenawo amandla okuqonda okuqonda nokusayina i-Financial Power of Attorney (POA) futhi ama-akhawunti abo asebhange, i-IRA, noma itayitela lendlu libhalwe ngamagama abo kuphela, amabhange azokwenqaba ukukuvumela ukuthi ufinyelele kuma-akhawunti awo ukuze uqoqe izitatimende zokubheka emuva kweminyaka emi-5 noma usebenzise imali ephansi. Okokuqala, qaphela ukuthi noma ubani osiza umuntu osekhulile angasayina futhi athumele ifomu lokuqala lesicelo se-Medicaid ngokwalo njengoMmeleli Ogunyaziwe ukuze likhiyelwe enyangeni yokufaka isicelo, futhi izinhlangano ze-Medicaid zikahulumeni zinamandla okuphatha okucela amabhalansi asebhange ngokuqondile ngoHlelo Lokuqinisekisa Impahla (AVS) uma wazisa isisebenzi ngokubhala ukuthi umfakisicelo akakwazi ukwenza lutho. Okwesibili, ukuze ufinyelele futhi usebenzise imali ephansi yama-akhawunti asebhange afriziwe, uzodinga ukufaka isicelo esiphuthumayo eNkantolo Yezabasebenzi / Yenkantolo Yendawo yangakini ukuze uthole **Ukugcinwa Kokugcinwa Kwempahla / Ukunakekela Ifa** (noma ucele umyalelo wokuvikela wenkantolo womsebenzi owodwa odlulisela izimpahla zomlingani ongakwazi ukuzenzela kumlingani onempilo womphakathi).

Ingabe i-Medicaid ibuyela emuva futhi ithathe amasheke Wokuvikeleka Komphakathi komzali kusukela eminyakeni emi-5 edlule?¶

Cha. I-Medicaid Look-Back Period yeminyaka emi-5 (izinyanga ezingu-60) ayigodli imali umzali wakho ayisebenzise ngokusemthethweni ezindlekweni zakhe zokuphila ezivamile, ukuqasha, igrosa, izinsiza, abasizi bokunakekela ekhaya, izintela, noma amaholide kule minyaka emihlanu edlule. Ukucwaninga kweminyaka emi-5 kuphela kubheka **izipho ezinganxeshezelwa noma ukudluliselwa kwenani elingaphansi kwenani elifanelekile lemakethe** (njengokubhalela umzukulu isheke lama-dollar angu-10,000 noma ukunikeza umshana indlwana ngedola elinguziro). Uma nje imali yomzali wakho isetshenziswe ezimpahleni nasezinkonzweni zomzali wakho (noma umngane womshado), lezo zindleko zingokomthetho ngamaphesenti ayi-100. Nokho, gwema ukuhoxisa izitaki ezinkulu zemali ye-ATM ukuze ukhokhele abanakekeli abangahlelekile “ngaphansi kwetafula” ngaphandle kweSivumelwano Sokunakekelwa Komuntu Siqu** esibhaliwe kanye namarisidi, njengoba i-Medicaid iphatha ukuhoxiswa kwemali okungabhaliwe njengezipho ezingaqinisekisiwe.

Ingabe kufanele sithole isehlukaniso esisemthethweni ukuze umlingani ophile kahle akwazi ukugcina yonke imali esiyilondolozile?¶

Ezimweni eziningi, ukuthola "isehlukaniso se-Medicaid" akudingekile neze futhi ngokuvamile kushiya umngane womshado onempilo embi kunokuhlala eshadile nokusebenzisa amathuluzi e-federal Sousal Impoverishment. Uma udivosa, ulahlekelwa i-automatic Spousal Impoverishment income shift (MMMNA), ulahlekelwa ilungelo lakho lokuthola inzuzo ephakeme yokusinda Kokuvikeleka Komphakathi kamufi uma eshade ngaphansi kweminyaka eyi-10, futhi izikhungo zeMedicaid zivamise ukuphonsela inselelo izivumelwano zedivosi eziphundukile ezisayinwa ngesikhathi senhlekelele yezokwelapha njengokudluliselwa kokubheka emuva komgunyathi. Kunalokho, ukuhlala ushadile nokusebenzisa i-Certified Elder Law Attorney (CELA) ukuhlanganisa ikhaya elikhululiwe, i-CSRA engu-$154,140, ​​kanye ne-Medicaid-Compliant Immediate Annuity noma i-Court Support Order ngokuvamile kuvikela amaphesenti angu-90 kuya kwangu-100 okonga ukuphila kombhangqwana oshadile ngaphandle kokuwuhlakaza umshado wakho.

Imithombo ihloliwe¶

• Ikhodi Yase-United States Nezikhungo Zezinsizakalo Ze-Medicare & Medicaid (CMS, United States): 42 U.S.C. § 1396r-5 (Ukuphathwa Kwemali Engenayo Nezinsiza Zabashadile Abathile Abafakwe Isikhungo / Amazinga Okungabi Namali Omshado: CSRA kanye ne-MMMNA) kanye 42 U.S.C. § 1396p (Amalayini, Ukulungiswa, Ukubuyiswa Kwempahla, Ukudluliswa Kokubheka Emuva Kwezinyanga ezingu-60, Ukukhululwa Kwengane Umnakekeli, kanye Nemali Engenayo Efanelekayo / Ama-Miller Trust).
• I-Federal Nursing Home Reform Act (OBRA '87, United States): 42 U.S.C. § 1396r©(5)(A)(ii) kanye no-42 C.F.R. § 483.15 (Ukwenqatshelwa Okumelene Nokudinga Iziqinisekiso Zezezimali Zenkampani Yangaphandle Ekwamukelweni Nokuvikelwa Kwezakhamuzi "Zokulinda I-Medicaid" Ezimelene Nokukhishwa).
• I-Social Security Administration (SSA, United States): Isistimu Yokusebenza Yohlelo (POMS) SI 01130.100 nge-SI 01130.420 (Izinsiza Ezingabandakanyi: Imikhawulo Yokulingana Kwendawo Yokuhlala, Ukukhululwa Kwemoto Okukodwa, kanye Nezimali Zokungcwatshwa Ezingaguquleki).
• I-National Academy of Elder Law Attorneys (NAELA) kanye Nezwi Likazwelonke Lomthengi Lokunakekelwa Kwesikhathi Eside Sekhwalithi (e-United States): Iziqondiso Zokuchitha Phansi Kwe-Crisis Medicaid, Izivumelwano Zokunakekelwa Komuntu Siqu, Nokuzivikela Ngokumelene Nemikhuba Yokuqoqwa Kwekhaya Labahlengikazi Elingekho emthethweni.
• Umnyango Wezempilo Nokunakekelwa Komphakathi kanye ne-NHS England (United Kingdom): Umthetho Wokunakekela 2014 Isiqondiso Somthetho (Isijobelelo B: Ukuphathwa Kwemali Enkulu Nokunganakwa Kwendawo Eyinhloko Yokuhlala Yabashadile Nezihlobo Ezineminyaka engu-60+) kanye Uhlaka Lukazwelonke Lwe-NHS Ukunakekelwa Kwezempilo Okuqhubekayo (NHS CHC).

Iziqondiso ezihlobene¶

• Ukuhlukunyezwa kwekhaya labahlengikazi, ukunganakwa, nokuvikela ukuxoshwa
• Ukuphonsela inselelo isibhedlela esingaphephile noma ukukhishwa kabusha
• Ukuxhashazwa okuphezulu kwezezimali kanye nokuvikela umkhonyovu
• I-delirium yasesibhedlela kanye nokumela ukwelashwa kwabantu abadala
• Ukukhubazeka okungazelelwe komnakekeli kanye nokuhlenga abantu abadala abathembele
• Izinombolo eziphuthumayo