Elder Law Report
Elder Law Report
The One Big Beautiful Bill: What NC Residents Need to Know About Long-Term Care Changes
The landscape of long-term care benefits in North Carolina is shifting dramatically with the implementation of the "One Big Beautiful Bill." This legislation introduces several key changes that could significantly impact how you or your loved ones access crucial healthcare services when they're needed most.
Most notably, the bill establishes a flat home equity cap of $1 million for Medicaid eligibility. For homeowners who have built substantial equity over decades – particularly in urban areas with higher property values – this could create unexpected barriers to receiving necessary care. Fortunately, several protective measures remain available, including convertible trusts, irrevocable Medicaid asset protection trusts, and traditional life estate deeds, but timing is critical. These strategies must be implemented outside the five-year look-back period to be effective.
The legislation also introduces more frequent eligibility redeterminations (now semi-annual rather than annual) and reduces the retroactive coverage period from 90 days to just 30 days. This shortened window makes immediate action essential when facing a healthcare crisis. Waiting even a few weeks to begin the application process could result in thousands of dollars in uncovered expenses that previously would have been retroactively covered.
Despite these challenges, proactive planning remains your strongest defense. By putting protective measures in place before they're needed, you can avoid sacrificing your home or other assets due to a long-term care situation that's no fault of your own. The tools available haven't changed – but the urgency of implementing them has increased substantially.
Ready to protect what you've worked so hard to build? Call us at 1-888-999-6600 to schedule a free consultation. Let's develop a strategy that shields your assets while ensuring you maintain access to the care you may need in the future.
The one big beautiful bill and how it affects long-term care benefits in North Carolina. Let's get into it. My law partner, brenton Begley, wrote a summary yesterday on the one big beautiful bill and how it affects long-term care benefits. You can find that on our blog. On our site. We've got a ton of resources there mcelderallcom slash blog. Our site. We've got a ton of resources there mcelderallcom slash blog Great article.
Greg McIntyre:I'm going to hit the high points on this bill and long-term care benefits. So the benefit that pays for skilled nursing care in North Carolina a couple of in-home care programs PACE and CAP, pacing cap will be affected, but really only in specific ways. There's a flat home equity cap of one million dollars. That means if you have over one million dollars equity not the value of your home, but equity in your home then you're not going to be eligible. So the way you avoid that is by using tools like convertible trust that we offer or irrevocable Medicaid asset protection trust to move your home into that trust but still have your trustee, which could be a trusted child, for example. Maintain control of that home in the trust and keep that maintained for your use of benefit for the rest of your life. And then you have beneficiary designations from the trust where you're passing it, say, to the children. So planning ahead is important there with your home, always has been. Another thing is putting, say, a life estate deed on that home ahead of time. A traditional life estate deed could be done as well. So that's a tool that could be used as long as it's done outside of the look back period for that benefit, which is five years. So there's some absolute planning tools there that are just readily available for us that we use now and we won't. Nothing will change there. But four you should really be aware of that. If you might have or be approaching a million dollars in equity in your house and if that's the case, especially in urban areas, then you should. You know where home values might be higher and equity might be higher. If you've been paying a mortgage down for 30 years, you should really pay attention to that and we should sit down and talk about that and plan ahead.
Greg McIntyre:There's semi-annual eligibility redeterminations. I've seen that before. Anyway, most departments do it annually but semi-annual. We handle recertifications which are not super burdensome, but anything dealing with a governmental agency can be complex. Along those lines. There's the suspension of enrollment, simplification rules. This was really, I think, set to be implemented more than anything. But you know we handle those applications from the beginning and recertifications, and they can be complex to put together. However, we have a whole department that's dedicated to doing that and it's a great department led by Mary Kells, who's phenomenal in that area. And just you know we handle that for clients anyway. So no change there for us, aside from perhaps more frequent certifications. So no change there for us, aside from perhaps more frequent certifications.
Greg McIntyre:And then there is a short and retroactive coverage period. This is one of the main points. Previously, the long-term care, medicaid benefit, paying for skilled nursing care, which let's call it nursing home care, or two in-home care programs, pace and CAP they would pay back to retroactively, say for a facility, up to 90 days. So we'd get someone financially in shape to qualify, put in the application and then they'd pay back up to 90 days. Now they've shortened that, they'll pay back up to 90 days. Now they've shortened that They'll pay back up to 30 days.
Greg McIntyre:It's just more important that when you have a crisis, when you or your spouse does, or someone in your family, that we sit down quickly and determine so, because time matters there. The quicker we can get that everything moving along and putting the application and get to a point of financial qualification, the longer they'll pay back, okay. Or the more chances or more likelihood that we'll get the 30-day payback and max out that period okay. The 30-day payback and max out that period Okay. So that's very important as well. Long story short, there's some slight effects to long-term care benefits, not affecting everyone. However, as I've always said, planning ahead helps put you in the driver's seat, helps you avoid these types of conflict.
Greg McIntyre:It's just more important than ever to sit down and plan ahead to make sure you don't sacrifice your home or other assets because of a long term care situation.
Greg McIntyre:You know, a nursing home or assisted living situation that's no fault of your own. In addition, we still have the same tools applied to the new bill that applied to the old that we use legally so, but the timing is a bit different. So just want to make sure, especially if you're you know, if you have a home that could build over that million dollars in equity, let's get that in a Medicaid asset protection trust, in an irrevocable trust, put that in a safe and lock the door to make sure it's safe. Or let's look at deep planning, like traditional life estate needs on that home. I'd offer a free consult to sit down and talk about it. If you want to look at planning ahead, look at getting your affairs in order, because you never know what changes in the law might do to your eligibility. So you want to take advantage of the planning just period and plan ahead. You can give us a call at 1-888-999-6600 to take advantage of that free consultation and let's sit down and talk about protecting what you've worked so long and hard for.