Creating an effective Medicaid trust requires not only a deep understanding of trust law, but also of estate and tax planning. You must know how to draft trust terms that will get approved—not always easy when it seems unclear what the state will—and will not—allow. Using the right language and key terms is vital—and more challenging than ever.
This program provides analysis of recent and current Medicaid trust cases both at the fair hearing stage and Superior Court cases through the SJC. The faculty include a complete review of the SJC’s decision in Fournier v. Sudders. Explore the current arguments the state is making, which includes attacks on the limited power of appointment to charities or children, the argument that nominee realty trusts are revocable, the power to loan money to the donor, the power to buy life insurance, and several others. Review the Hirvi Settlement, the new 130 CMR § 610.00 regulations, and the MassHealth Eligibility Operations Memo 20-04. Learn about the grantor powers that are safest to use and which ones are being challenged by the state. Hear a discussion of the income tax benefits of making the trust a grantor trust and the importance of keeping the § 121 capital gains exclusion.
Learn what paragraphs should and should not be in these irrevocable trusts, as well as how to draft around current challenges and make arguments to distinguish your trust from the Cohen, Doherty, and most recent Braiterman cases that MassHealth uses to attack Medicaid trusts. Explore the step-up basis rules and the estate and gift tax rules related to drafting these trusts along with the tax implications of using life estates. Learn how to draft a QTIP share and remainder share into these trusts to obtain estate tax reduction and nursing home protection at the same time. Finally, learn how naming the estate the beneficiary of your IRA coupled with a testamentary trust can offer significant estate tax savings and nursing home protection without a negative income tax hit on the required minimum distributions.