Medicaid is a joint federal and state program that provides payment for medical care for persons unable to afford to pay. Medicaid covers physicians’ services, hospital care, supplies and other necessary services once a person has been made eligible for the program. It also pays for the expenses of long-term care in a nursing home.
The Medicaid program is administered independently in each state. While the basic eligibility standards are the same throughout the United States, there are significant differences between the state Medicaid programs. Despite these differences, eligibility is generally based upon the amount of assets a person has along with the income that the person receives. Eligibility is determined at state Medicaid offices and, in the case of married individuals; the assets and income of both spouses are considered in the determination process.
It is important to distinguish between Medicare and Medicaid. Medicare is an insurance program providing payment for medical needs for persons 65 and over and for certain people with disabilities. All persons 65 and over, regardless of financial resources or income, are eligible for Medicare. Medicare and Medicare supplemental insurance, however, provide very limited coverage with regard to the cost of long-term care in nursing homes. These non-covered services must be paid privately by the individual, unless the individual has coverage under a long-term care insurance policy. Medicaid, on the other hand, pays for medical needs for those of any age that have been determined to be eligible. In fact, a person with limited income and resources who has Medicare coverage may also qualify for Medicaid benefits.
What You Need to Know
Medicaid is considered to be one of the most complex laws of the United States and, further complicating matters, each state has a different version of Medicaid. Many Elder Law attorneys have carefully studied the Medicaid statutes and regulations and are able to assist clients.
Medicaid is often of importance to middle-income Americans because Medicare does not cover the costs of long-term care for illnesses such as Alzheimer’s disease or paralysis caused by a stroke. Most people who need such care for extended periods will eventually deplete their assets and become unable to pay the costs of their care.
At such a time Medicaid is available to pay the difference between their income and the actual costs of care provided in a nursing home, including room and board, as well as physicians’ care, hospital care and all other reasonable necessary medical expenses. Medicaid covers the costs of such care in nursing homes, adult care homes, hospices, and, in appropriate cases, in the individual’s own home.
If faced with the possibility of such long-term care expenses, there are certain rules that you should be aware of:
• In determining eligibility for Medicaid payment for long-term care expenses, the eligibility team will review the individual’s actual need for care, the person’s available resources (including life insurance and retirement plans) and income received from any source. In some states, if monthly income exceeds a certain amount, then the individual is ineligible for Medicaid, even though the individual’s long–term care expenses exceed his or her income.
• In determining eligibility, a person will be disqualified from Medicaid for gifts made within the previous few years.
• In determining eligibility for one spouse, the assets and income for both spouses are considered, regardless of premarital agreements, community property laws or the nature of the ownership of the asset.
• Assets of married couples, however, receive special treatment so that the spouse who remains living at home will not be unduly impoverished. Such a community spouse is permitted to keep one-half of all of the available assets (up to a federally-established maximum) and is allowed to keep a minimal amount of income of the couple in order to provide for support expenses at home.
• In addition, there are certain resources that are considered non-countable for eligibility purposes; these include the family residence, household contents, a vehicle, a prepaid burial fund and other necessary items.
• It is important to be aware of the state specific eligibility provisions and exemptions so that assets will not be unnecessarily spent down before applying for Medicaid.
• Finally, it is important to know that there are appeals processes built into the Medicaid system. If you are unhappy with eligibility determinations, care decisions or placements made under Medicaid, there is a process for an administrative hearing and even court proceedings to enforce your rights. Where to Go For Help
WE ARE HERE TO HELP! We are attorneys who are versed in the rules of Medicaid eligibility. However, there are books published concerning the Medicaid program and its rules and you should check your library or bookstore for current titles. The Internet can be another source of Medicaid information. Keep in mind that the Medicaid laws and rules vary between states and are constantly changing so make certain that whatever you read is state specific and up to date. There have been major changes in the Medicaid program during the last few years.
Family support groups and organizations such as the Alzheimer’s Association and AARP provide assistance and often have literature available. Local Area Agencies on Aging (pursuant to the Older Americans Act) also have comprehensive advice and literature available concerning Medicaid. The state Medicaid Eligibility Office may be a good source of basic information about the program, its services and the requirements for eligibility.
The Role of the Elder Law Attorney
Many Elder Law attorneys have extensive training and experience concerning Medicaid and have been advising clients and their families for many years. Much of the planning done by older persons concerning Medicaid has been done with the help of such experienced attorneys. It is important to see such an advisor as soon as possible to enable the greatest benefit from such planning.
Long-term care insurance is one way of preparing for the expenses of long-term care and should be considered. Such insurance is not available for everyone and will not be available once a disabling long-term illness has struck.
Because the law is so complex, Elder Law attorneys are a particularly appropriate source of advice. We can assist you in planning for the expenses of long-term care as well as planning for the protection of assets for the rest of the family.
Congressman Gabe Amo (D-RI) introduced two bipartisan pieces of legislation to combat scams, the National Strategy for Combating Scams Act and the Strengthening Task Forces to Oppose Predatory (STOP) Scams Against Seniors Act.
“Too many Rhode Islanders have been taken for a ride by scammers skimming their pockets and stealing their hard-earned money, leaving many devastated and destitute,” said Congressman Gabe Amo (D-RI). “I’m proud to introduce these bipartisan measures, one of which is also bicameral, to ensure we are addressing the rising scam threat in a coordinated and strategic manner. I look forward to working with my colleagues in the House and the Senate as the national strategy is developed to keep fighting scammers and keep Rhode Islanders money where it belongs, in their pockets.”
Last year alone, Americans lost over $16 billion to scams. That’s a staggering amount of money that’s been stolen from our families, our neighbors, and, disproportionately, our seniors,” said Senator Kirsten Gillibrand (D-NY), Senate co-lead of the National Strategy for Combating Scams Act. It’s clear that we need a coordinated national strategy to tackle the increasingly sophisticated scams targeting our seniors, and this legislation would bring that to fruition. I look forward to working with my colleagues on both sides of the aisle to get this vital bill across the finish line.”
The bipartisan, bicameral National Strategy for Combating Scams Act would establish a federal working group led by the Federal Bureau of Investigation to coordinate the efforts of more than a dozen federal agencies in combating scams. The bill is co-led by Congressman Derek Schmidt (R-KS) in the U.S. House of Representatives. Companion legislation was introduced in the U.S. Senate by Senators Kirsten Gillibrand (D-NY), Rick Scott (R-FL), Mark Kelly (D-AZ), and Ashley Moody (R-FL).
The bipartisan STOP Scams Against Seniors Act, introduced in the House, would authorize the creation of Elder Justice Task Forces to help local, state, and Federal agencies work together to investigate and prosecute illegal scammers. The bill is co-led by Congressman Jeffersen Shreve (R-IN)
Source: The ElderLaw Report, Vol. XXXVII, No. 6, January 2026
America faces a looming long-term care crisis that threatens both family finances and state budgets. As the Baby Boomer generation enters its 80s and 90s, demand for assistance with basic daily activities is surging. Yet most Americans lack adequate savings or insurance to cover care costs that routinely exceed $168,000 annually.
The problem is amplified by widespread misconceptions.
How Is Long Term Care Paid For?
Fifty-six percent of Americans mistakenly believe Medicare covers long-term care, and many also assume their health insurance or disability-income insurance will pay for these services. They do not.
In reality, Medicare covers only up to 100 days of short-term skilled nursing following a hospitalization, not ongoing long-term care. As a result, families are left exposed to catastrophic costs that can quickly drain retirement savings and ultimately force reliance on Medicaid after assets are exhausted.
State Resources and Medicaid
This reality places enormous fiscal pressure on states. Driven by basic supply-and-demand dynamics, the share of annual state Medicaid budgets allocated to Long-Term Services and Supports continues to rise year over year.
Medicaid now pays for roughly half of all long-term care in the United States, placing growing strain on state budgets as middle-class families are forced to “spend down” into poverty just to qualify. To prevent abuse, Medicaid imposes an intrusive five-year look-back audit, scrutinizing financial transactions to ensure assets were not transferred below market value to appear “poor on paper.”
In Facility Placement versus Home Based Waiver Care
Rhode Island does offer resources to provide assistance in home for families that are doing their best to care for their loved ones at home. The Home Based Waiver is a program where once you establish a medical need, countable assets in accordance with the regulations, you can apply for help to come into the house. Representatives from DHS will meet with the family, determine need, and help coordinate resources to come into the home. This can often act as a lifeline for families and allow them to have some respite or time to get out of the house, for employment or errands.
In facility placement is having your family member reside at the skilled nursing facility. Current Medicaid Long Term Supports and Services rules require individuals to satisfy 4 prongs before they are eligible for LTSS Medicaid benefits:
Medical Need – applicants must demonstrate that they have a medical need for skilled nursing care.
Countable Resources – applicants must demonstrate that they have countable resources as defined by the Medicaid regulations below $4,000
Monthly Income – must be below $10,190 per month in Rhode Island to be eligible for LTSS Medicaid benefits
No Disqualifying Transactions – applicants must be prepared to demonstrate that they have not engaged in any transfers of assets in the 5 years prior to applying for benefits where they would be deemed to have made a transfer of assets for less than full consideration in return (i.e.: did you make a gift of assets?)
The Importance of Planning
Planning for long term skilled nursing is more critical than ever. The fiscal pressures placed on spouses and families to provide for the level of care needed for our aging family is not a matter of if the services will be need by rather when.
With the ever present 5 year look-back rule the sooner you discuss and execute a plan that establishes a path to Medicaid eligibility the better.
On November 14, 2025, the Centers for Medicare & Medicaid Services (CMS) released notices detailing the Medicare Part A and Part B premiums and deductibles for calendar year 2026:
The Medicare Part A inpatient hospital deductible that beneficiaries pay if admitted to the hospital will be $1,736 in 2026, an increase of $60 from $1,676 in 2025.
The Part A inpatient hospital deductible covers beneficiaries’ share of costs for the first 60 days of Medicare-covered inpatient hospital care in a benefit period. In 2026, beneficiaries must pay a coinsurance amount of $434 per day for the 61st through 90th day of a hospitalization in a benefit period and $868 per day for lifetime reserve days.
For beneficiaries in skilled nursing facilities, the daily coinsurance for days 21 through 100 of extended care services in a benefit period will be $217 in 2026.
Individuals who had at least 30 quarters of coverage, or were married to someone with at least 30 quarters of coverage, may buy into Part A at a reduced monthly premium rate, which will be $311 in 2026, a $26 increase from 2025. Certain uninsured older individuals who have fewer than 30 quarters of coverage, and certain individuals with disabilities who have exhausted other entitlements, will pay the full premium, which will be $565 a month in 2026, a $47 increase from 2025.
The standard monthly premium for Medicare Part B enrollees will be $202.90 for 2026, an increase of $17.90 from $185 in 2025. The annual deductible for all Medicare Part B beneficiaries will be $283 in 2026, an increase of $26 from the annual deductible of $257 in 2025.
Electronic Monitoring in Nursing and Assisted Living Facilities
Effective January 30, 2025 the State of Rhode Island enacted a law related to the electronic monitoring of a resident’s room or private living unit in nursing homes and assisted living facilities. The law can be found at RIGL§ 23-17.29, et. al.
The law allows for the use of electronic monitoring devices in residents’ rooms (provided that the resident or resident representative acting on behalf of the resident, as well as the resident’s roommate or roommate’s representative acting on behalf of the roommate, consent to such electronic monitoring in writing). While nothing previously prohibited the use of electronic monitoring devices in rooms, this law puts more structure around the use of such devices. For example, the law calls for the use of standard forms to indicate consent for the use of electronic monitoring devices.
RIDOH is in the process of developing these forms, and additional guidance for facilities on the implementation of this law. These forms will be provided to facilities in the coming weeks. Guidance from RIDOH will follow.
If an IRA owner or other retirement plan participant died before 2020, his designated beneficiary is generally “grandfathered” from the new more stringent required minimum distribution (RMD) regime imposed by the SECURE law (2019). The designated beneficiary of the pre-2020 decedent can take RMDs over his own life expectancy no matter how long it is and regardless of whether he would qualify as an “eligible designated beneficiary” (EDB) under post-SECURE rules.
Death of Grandfathered Beneficiary
But what happens when that “grandfathered” designated beneficiary dies before his “life expectancy” runs out? What RMD rules apply to his successor beneficiary(ies)?
SECURE has an answer: The grandfathered original designated beneficiary is treated as an “eligible designated beneficiary,” so his life expectancy payout continues after his death for his successor beneficiary—but not for more than 10 years.
How does the State of Rhode Island address owning an Annuity with Medicaid qualification?
Rhode Island DHS regulations as to owning or holding an Annuity states as follows:
210-RICR-50-00-6
UPDATED: April 29, 2025
An annuity is an investment of funds from which an individual is paid or promised regular payments over a lifetime or a fixed period of time. Generally, an annuity is established with a lump sum of money which is paid to a bank, insurance company, or other entity.
A deferred annuity is one under which payments begin at some date to be specified in the future. Once an individual selects a periodic payment option (frequency, amount, and duration of payments), and begins to receive income, the annuity has been annuitized.
An annuity may guarantee periodic payments for a stated period (termed period certain) or guarantee periodic payments for the remainder of the life of the individual, without regard to how long the individual lives (termed life annuity).
All applicants must disclose any interest in an annuity that the applicant or his/her spouse has at the time of application and/or recertification of eligibility. Under 42 U.S.C.1396p(e), as amended by the Deficit Reduction Act, the State becomes a remainder beneficiary of all of the couples’ annuities (or other similar financial document) which were purchased or transacted by either spouse on or after February 8, 2006 by virtue of the provision of such Medicaid up to the amount of Medicaid paid on behalf of the institutionalized spouse.
Upon the determination that an applicant is eligible for benefits under LTSS-Medicaid, the Medicaid agency will notify the issuer of any annuity disclosed for purposes of section 1917(c)(1)(F) of the State’s rights as a preferred remainder beneficiary.
The Medicaid agency will additionally require the issuer of the annuity to notify the Medicaid agency regarding any changes in a disbursement of income or principal from the annuity.
When determining eligibility for Medicaid,
Count as an Available Resource:
The cash value of an annuity which can be surrendered or “cashed in.” The cash value is equal to the amount of money used to establish the annuity, plus any earnings, minus any earlier withdrawals and surrender fees. No consideration in determining cash value is given for income tax withheld or tax penalties for early withdrawal.
Annuity contracts that do not allow for cash surrender but instead allow the owner to sell the annuity on the open market are assignable. Annuity contracts that are silent regarding assignability are presumed to be assignable. Assignable annuities are countable resources. The countable value of the resource is equal to the outstanding principal balance unless the individual can furnish evidence from a reliable source which shows that the annuity is worth a lesser amount. Reliable sources include banks, other financial institutions, insurance companies, brokers, viatical settlement companies, etc.
Reading your annuity contract is important.
Count as Available Income:
Payments made to the individual from an annuity are counted as unearned income. Any change in the income from the annuity must be reported within ten (10) days to the agency and may affect eligibility and/or post-eligibility treatment of income.
Transfer of Asset Provisions for Institutionalized Individuals May Apply When:
A non-cashable, non-assignable annuity was purchased by the individual (or by the individual’s spouse):
Within thirty-six (36) months (if purchased prior to February 8, 2006), or OR
Within sixty (60) months (if purchased or after February 8, 2006)
Immediately prior to, or any time after, the date the individual was both institutionalized and applied for Medicaid. See Sec. 210 RICR-50 et al. for a description of how the 5-year look-back on resource transfers is phased in).
In this case, a determination must be made as to whether its purchase constitutes a transfer of assets for less than fair market value.
Determine Whether Any Annuities Create a Penalty Period of Ineligibility For LTSS Medicaid
A non-cashable, non-assignable annuity purchased by the individual (or by the individual’s spouse) may be determined to be a transfer of assets for less than fair market value, and therefore create a penalty period of ineligibility.
There are two situations in which this may occur:
When the asset was literally converted, within certain time frames, into an annuity which does not meet the criteria for being a “VALID TRANSFER FOR FAIR MARKET VALUE” in return (See the remainder of this Section, along with Section 0356.15.35 AND 0384.35 for detailed discussions of these topics). and/or
When the annuity (if purchased on or after February 8, 2006) does not name the “State as Beneficiary” of the annuity. When such an annuity does not comply with this requirement, it is defined as being a transfer for less than fair market value.
(This requirement to name the state as beneficiary is found in Section 1917(c)(1)(F)(i) of the Social Security Act (42 U.S.C.) 1396p(c)(1)(F)(i)), as added by section 6012(b) of the Deficit Reduction Act of 2005, and as amended by the Tax Relief and Health Care Act of 2006. (See the remainder of this Section, along with Section210 RICR-50-00-6 for detailed discussions of these topics).
Time-frames for evaluating the transfer of resources DHS may “look back” at resource transfers for the 36 months, or for the 60 months, immediately prior to the date that the individual was both institutionalized, and applied for LTSS-Medicaid.
(Transfers which occurred prior to February 8, 2006 are subject to the 36 month “look back”).
(Transfers which occurred on or after February 8, 2006 are subject to the 60 month “look back”).
Additionally, transfers which occur any time after the application are also evaluated to determine whether they generated a penalty period of ineligibility for LTSS-Medicaid.
(See Section 0210 RICR-50-00 for detailed discussions of these topics).
To be considered a valid transfer for fair market value, an annuity must:
Be irrevocable and non-assignable;
Provide regular payments in both frequency and amount, with no deferral and no balloon payments, to or for the sole benefit of the individual; and
Be actuarially sound. Scheduled payments must return at least the principal within the number of years of expected life remaining for the individual.
Life expectancy tables compiled from information by the Office of the Chief Actuary of the Social Security Administration for this purpose are used to determine the number of years of expected life remaining for the individual. (See MCAR Section 0382.15.35.05).
If based on life expectancy tables compiled by the Social Security Administration’s Office of the Actuary and published by HCFA CMS, the individual is not expected to live longer than the guaranteed period of the annuity, the guaranteed period of the annuity, the annuity is not actuarially sound, and a transfer of assets for less than fair market value has taken place. The transfer is considered to have taken place at the time the annuity was purchased. The uncompensated value of the transfer is based on the amount projected to be paid beyond the individual’s reasonable life expectancy. (See Section 0384- Resource Transfers).
If an annuity is purchased or transacted on or after February 8, 2006 whether by the applicant or by their spouse, the beneficiary clause of the annuity must provide that the beneficiary of the annuity is as follows:
Must, except as provided in this section, name the State of Rhode Island as the remainder beneficiary in the first position for at least the amount of Medicaid paid on behalf of the institutionalized individual.
If however, the institutionalized individual has a minor or disabled child, such child may be named as the beneficiary in the first position, provided the State of Rhode Island is named as a beneficiary of the annuity in the second position for at least the amount of Medicaid paid on behalf of the institutionalized individual.
In the event such child or his or her representative disposes of any such remainder for less than fair market value, the State of Rhode Island must be named in the first position.
Any change in the beneficiary clause must be reported to the Medicaid agency within ten (10) days of any change and may result in a transfer of assets penalty.
An institutionalized spouse, that is, an institutionalized individual who has a community spouse:
Must, except as provided in this section, name the State of Rhode Island as the remainder beneficiary in the first position for at least the amount of Medicaid paid on behalf of such institutionalized spouse.
However, the institutionalized spouse may name as the beneficiary in the first position his or her community spouse or his or her minor or disabled child, provided the State of Rhode Island is named as a beneficiary of the annuity in the second position for at least the amount of Medicaid paid on behalf of the institutionalized spouse.
In the event the community spouse or such child or his or her representative disposes of any such remainder for less than fair market values, the State of Rhode Island must be named in the first position.
Any change in the beneficiary clause must be reported to the Medicaid agency within ten (10) days of any change and may result in a transfer of assets penalty.
A community spouse:
Must name the State of Rhode Island as the remainder beneficiary in the first position for at least the amount of Medicaid paid on behalf of his or her institutionalized spouse.
The community spouse may not change the beneficiary of the annuity after the death of the institutionalized spouse.
Any change in the beneficiary clause, before or after the death of the institutionalized spouse, must be reported to the Medicaid agency within ten (10) days of any change and may result in a transfer of assets penalty.
In the event the community spouse becomes institutionalized and applies for Medicaid, the beneficiary clause must be amended to additionally name the State of Rhode Island as the remainder beneficiary in the first position for at least the amount of Medicaid paid on behalf of such community spouse who becomes institutionalized, at the time such spouse applies for Medicaid for himself or herself, if the annuity was purchased during the look-back period.
Cases involving annuities are referred by field staff to the LTSS Administrator (or his/her designee) for evaluation. The agency representative forwards a copy of the annuity document, including date of purchase to the LTSS Administrator.
The LTSS Administrator (or his/her designee) consults, as needed, with the Office of Legal Services, and determines:
Whether the annuity is an available or unavailable resource;
The countable amount of the resource (i.e., the cash surrender value and/or negotiable value of the annuity); and
Whether the State has been made a remainder beneficiary for at least the amount Medicaid paid on behalf of the institutionalized individual; and
Whether a transfer of assets for less than fair market value has occurred as well as the amount of the uncompensated value and date of the transfer.
2025 UPDATE
THE REGULATION:
6.7 Asset Transfers Involving Annuities
A. An annuity is a contract reflecting payment to an insurance company, bank, charitable organization, or other registered or licensed entity; it may also be a private contract between two (2) parties. This section provides the criteria for determining whether annuity is treated as disqualifying transfer resulting in a period of ineligibility for Medicaid LTSS. Irrespective of whether the establishment of the annuity is considered a disqualifying transfer, the provisions pertaining to whether any income derived is counted or excluded for eligibility purposes is located in § 40-00-3.5.5(A)(2)(a) of this Title are applied.
B. Annuities established pre-DRA- Before February 8, 2006:
1.Disqualifying transfer – The annuity was purchased beforeFebruary 8, 2006, and the expected return on the annuity is not commensurate with a reasonable estimate of life expectancy, also referred to as “actuarially sound.”
2.Allowed transfer – When an annuity purchased before February 8, 2006, is “actuarially sound,” then it is not considered a transfer of assets for less than fair market value. The annuitant has just converted the resources to income.
C. To determine whether the annuity is “actuarially sound,” the State uses the life expectancy tables compiled from information published by the Office of the Chief Actuary of the Social Security Administration. These tables may be accessed at .
D. The average number of years of expected life remaining for the annuitant must coincide with the life of the annuity. If the annuitant is not reasonably expected to live as long as or longer than the guarantee period of the annuity, the annuitant will not receive fair market value for the annuity based on the projected return. In that case, the annuity is not actuarially sound and a disqualifying transfer has occurred. The penalty is assessed based on the disqualifying transfer at the time the annuity was purchased or the date the annuity became available as a countable resource, whichever is later.
E. Post-DRA – Annuities established on or after February 8, 2006.
1.Disqualifying transfer – Purchase of a Medicaid non-compliant annuity on or after February 8, 2006, by an LTSS applicant or beneficiary as the annuitant. An annuity is considered non compliant if purchased at less than FMV or has no readily ascertainable FMV;
2.Allowed transfer – Purchase of a Medicaid compliant annuity. A Medicaid compliant annuity must meet one (1) of the first two (2) conditions and the third (3rd) condition described below when purchased for the applicant or beneficiary:
a. The annuity is an annuity described in subsection (b) or (q) of § 408 of the United States Internal Revenue Code of 1986 (26 U.S.C. § 408); or
b. The annuity is purchased with proceeds from:
(1) An account or trust described in § 408(a), (c), or (p) of of the United States Internal Revenue Code of 1986 (26 U.S.C. § 408); or
(2)A simplified employee pension (within the meaning of § 408(k) of the United States Internal Revenue Code of 1986) (26 U.S.C. § 408); or
(3) A Roth IRA described in § 408A of the United States Internal Revenue Code of 1986 (26 U.S.C. § 408); and
c. The annuity must be:
(1) Irrevocable and non-assignable;
(2) Actuarially sound, as determined in accordance with actuarial publications of the Office of the Chief Actuary of the United States Social Security Administration; and provides for payments in equal amounts during the term of the annuity, with no deferral and no balloon payments made; and
(3) Have the State of Rhode Island named as the remainder beneficiary for at least the total amount of Medicaid paid on behalf of the annuitant or the annuitant’s spouse, if either is currently receiving Medicaid LTSS. Rhode Island may be named as either:
(AA) The remainder beneficiary in the first (1st) position, or
(BB) The remainder beneficiary in the second (2nd) position, after the community spouse, minor child or disabled child, and in the first (1st) position if the spouse or a representative of the child does not dispose of the remainder for less than fair market value.
F. Annuities purchased by a non-LTSS spouse:
Disqualifying transfer – Purchase of an annuity on or after February 8, 2006, by the non-LTSS spouse of a Medicaid LTSS applicant or beneficiary in which the spouse is the annuitant.
2. Allowed transfer – The annuity has the State of Rhode Island named as the remainder beneficiary for at least the total amount of Medicaid paid on behalf of the annuitant or the annuitant’s spouse, if either is currently receiving Medicaid LTSS. The State may be named as either:
a. The remainder beneficiaryinthe first (1st) position; or
b. The remainder beneficiary inthe second (2nd)position,afterthecommunityspouse,minor child ordisabled child,and in thefirst(1st) positionifthe spouseorarepresentative ofthe child does notdisposeof the remainder forless thanfair marketvalue.
Every year the State of Rhode Island Department of Health and Human Services updates the asset and income limits to be eligible for Long Term Support Services Medicaid benefits – which help subsidize the cost of long-term care for medically needy individuals. Below are the figures that have been published for 2025:
Community Spouse Resource Allowance:
Minimum
$31,584.00
Maximum
Spousal Share (1/2 joint resources as of beginning of period of continuous institutionalization), up to $157,920.00
Resource Allowance for Individual:
$4,000.00 (Medically Needy)
Monthly Maintenance Needs Allowance:
Minimum
$2,555.00
Maximum
$3,948.00
Allowance for Personal Needs:
$75.00 (unless specific circumstances)
Therapeutic Employment:
+$85+(1/2 bal., max. $265) = max. $400
Guardianship, Legal, & Tax:
varies
Community Spouse Monthly Housing Allowance:
$766.50 (unless excess)
Standard Utility Allowances:
$676.00 (no heat/non distinction)
Home Equity Limit:
$730,000.00 Minimum
$1,097,000 Maximum
Divestment Penalty Divisor and Allowable Income Limit:
NEW FOR 2025 – Simplified Eligibility Criteria: Single Nursing Home Applicant
In 2025, a single Nursing Home Medicaid applicant in Rhode Island must meet the following criteria: 1) Income under $2,901 / month 2) Assets under $4,000 3) Require a Nursing Home Level of Care.
A Spousal Lifetime Access Trust (SLAT) can be a valuable tool to transfer wealth to future generations while helping to ensure your spouse’s financial security.
What is a SLAT?
A SLAT is an irrevocable trust that can provide significant flexibility for married couples. One spouse creates and funds a trust primarily for the benefit of the other spouse. The spouse that is the beneficiary of the SLAT can receive distributions from the trust. Thus, if necessary, your spouse is able to use funds from the trust to maintain their standard of living even though the trust assets have been removed from your estate. SLATs most often terminate at the death of the beneficiary spouse, at which point the trust assets pass to the other SLAT beneficiaries (typically a younger generation), either outright or in trust.
What are the requirements for establishing a SLAT?
The donor spouse must gift assets that are their sole property (not property owned by the spouses jointly).
If you reside in a community property state (AZ, CA, ID, LA, NV, NM, TX, WA, and WI), you may first need to convert your community property into separate property before making gifts to a SLAT.
If two SLATs are created (one for each spouse), they cannot be identical to each other. If they are identical, the IRS can apply the” reciprocal trust doctrine,” which can undo the benefits of your planning.
The donor spouse cannot directly retain any rights to the assets gifted.
The trust must be irrevocable.
What are the benefits of setting up a SLAT?
Your spouse can maintain access to the assets owned by the SLAT if they need additional cash flow.
Any asset appreciation after the initial gift occurs outside of your estate.
You are responsible for paying income tax on any income generated by the SLAT. Paying income taxes on behalf of the SLAT is not considered an additional gift to the SLAT. The SLAT is able to grow without being reduced by the payment of income taxes, leaving more to pass to your beneficiaries.
Assets placed in a properly-established SLAT are generally protected from creditors of the beneficiary spouse.
Generally, SLATs can hold S corporation shares.
What are the potential downsides to setting up a SLAT?
It is not ideal for the beneficiary spouse to withdraw funds from the SLAT unless they are truly needed. SLAT distributions to the beneficiary spouse bring assets back into their estate and reduce the trust assets that can grow estate tax free for the ultimate beneficiaries.
If the beneficiary spouse dies first, the donor spouse loses their indirect access to the trust assets through the distributions to the beneficiary spouse.
In the event of a divorce, you may still be responsible for paying the income tax on a trust for the benefit of a now ex-spouse.
When your beneficiaries inherit the assets, they inherit the original tax basis you had. This might not be ideal for assets with low basis, meaning the beneficiaries could owe more capital gains tax when they eventually sell. However, many SLAT documents allow the donor spouse to remove a low basis asset and replace it with a high basis asset if those assets have the same value.
Is a SLAT right for you?
SLATs can be a flexible way to transfer wealth to future generations at current values while allowing your spouse to have access to that same wealth. If you want to take advantage of the current estate tax exemption amounts but aren’t quite ready to give up complete access to your assets, a SLAT could be the right strategy for you. By understanding the requirements, advantages, and potential downsides, you can make an informed decision about whether a SLAT is right for your estate planning needs. As always, consult with your tax advisor to tailor a strategy that best suits your situation and goals.
Scams targeting the elderly have become an increasingly concerning issue, exploiting vulnerabilities and often resulting in significant financial and emotional distress for victims. These scams can take various forms, including telephone fraud, internet phishing, and even door-to-door schemes, where scammers use deceitful tactics to gain trust before swindling their targets out of money or personal information. The elderly, often perceived as more trusting and less tech-savvy, are particularly at risk.
These scams not only lead to the loss of life savings but can also cause a profound sense of betrayal and a decrease in quality of life. Awareness and education are key in combating these malicious acts, as is the implementation of stronger protective measures by families, communities, and authorities to safeguard the well-being of the elderly population.
The Role of the Lawyer
Lawyers play a crucial role in advising and protecting individuals, including the elderly, from the pervasive threat of scams. Their expertise in legal frameworks and rights enables them to offer invaluable guidance on how to recognize and avoid fraudulent schemes. By educating clients about the common characteristics of scams, such as unsolicited communications or too-good-to-be true offers, lawyers empower them to act with caution and skepticism. Furthermore, in the unfortunate event of falling victim to a scam, lawyers can provide critical assistance in navigating the complex legal avenues for recourse, such as reporting the crime to the appropriate authorities, and pursuing litigation or other legal actions to recover lost assets. Their advocacy and intervention are essential in not only providing a safety net for victims but also in fostering a broader awareness and deterrence of scams in the community.
Some practical advice for clients includes:
• Refrain from sharing your personal details over phone calls, through the mail, or online.
• If an offer seems unclear or suspicious, it’s best to ignore it.
• Ensure you get a written estimate for any job and make payments only after the work is completed to your satisfaction.
• Properly dispose of any documents containing your credit card information by shredding them.
• Protect your Medicare, Social Security, and credit card information diligently.
• Avoid signing documents that are blank or consenting to open-ended permissions.
• Exercise caution when approached by telemarketers or door-to-door sales agents, unless they are known and trusted by you.
• Approach offers that claim to be free with skepticism, as they may have hidden costs.
• Stand your ground against high-pressure sales tactics that aim to coerce you into making purchases.
• Steer clear of conducting business with unfamiliar companies.
• Be vigilant against telephone fraud, particularly scenarios where someone pretends to be a relative in distress requiring financial help.
Need to discuss a plan for your loved one? Call us for a no obligation consultation.
,” said Congressman Gabe Amo (D-RI). “I’m proud to introduce these bipartisan measures, one of which is also bicameral, to ensure we are addressing the rising scam threat in a coordinated and strategic manner. I look forward to working with my colleagues in the House and the Senate as the national strategy is developed to keep fighting scammers and keep Rhode Islanders money where it belongs, in their pockets.”
esident, as well as the resident’s roommate or roommate’s representative acting on behalf of the roommate, consent to such electronic monitoring in writing). While nothing previously prohibited the use of electronic monitoring devices in rooms, this law puts more structure around the use of such devices. For example, the law calls for the use of standard forms to indicate consent for the use of electronic monitoring devices.
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