Long-Term Care Considerations for LGBT Adults (Part 2)

Housing Considerations

Whether they are looking for supportive services in their current home or looking for new housing with supportive services, LGBT individuals and couples need to ensure that services or housing providers are inclusive and culturally competent to work with LGBT families.

A new and growing option is LGBT elder housing. It's limited in availability now, but more of these residences designed specifically for the needs of the LGBT aging community are springing up across the U.S. For more information on housing and supportive services, including LGBT-specific housing, go to the National Resource Center on LGBT Aging at Link opens in a new windowhttps://www.lgbtagingcenter.org.

Continuing Care Retirement Communities (CCRCs)

Not all CCRCs are the same, and not all are LGBT competent:

• Since LGBT individuals or same-sex couples may be treated differently depending on the CCRC, it's important to research the facility thoroughly before making a decision.
• As noted above, you may want to consider retirement housing with services designed for LGBT older adults.

Financial Planning

Due to the lack of uniformity in state and federal laws, the financial implications for LGBT couples—even those who are legally married—are very different than for heterosexual married couples. Consider the following:

• In states that allow it, having a legally recognized partnership (domestic partnership, civil union, marriage, etc.) increases your chances of maximizing insurance and financial benefits.
• However, as long as the Defense of Marriage Act (DOMA) remains the law, you have very limited access to federal partner benefits.
• There are over 1,000 Federal laws in which marriage status is a consideration. These laws confer rights, protections, and benefits to opposite-sex married couples.
• Under DOMA, partners in same-sex unions cannot receive a wide range of federal benefits, including Social Security survivor benefits, federal tax benefits, and federal employee health and retirement benefits.
• Although some states allow gay and lesbian couples to marry, the majority of states don't recognize marriages between same-sex partners.
• In other states, same-sex couples can register as domestic partners, but under most Federal laws, this makes no difference in terms of benefit eligibility.
• Same-sex couples, whether unmarried, married, or registered as domestic partners, are not permitted to enjoy most of the federal marriage benefits provided to opposite-sex married couples. Plan accordingly.

Legal Issues

Planning for long-term care can be complicated and filled with pitfalls. That's why having legal documents that clearly define your relationship and individual interests, and clearly express your wishes, is of particular importance to members of the LGBT community. Regardless of whether you are in a domestic partnership, marriage, or other legal relationship, you should still be prepared with a power of attorney for health or property, a will, and any other legal documents that clearly state your wishes.

Paying for Long-Term Care—Public and Private

Applying for Medicaid

Medicaid regulations related to long-term care include a series of spousal impoverishment protections that prevent a healthy spouse from losing a primary residence or savings in order to qualify a spouse for Medicaid. In most states these protections don't apply to same-sex couples; however, note the following:

• States have received guidance from the Centers for Medicare and Medicaid Services on how they can extend the spousal impoverishment protections to same-sex couples: Link opens in a new windowwww.cms.gov/smdl/downloads/SMD11-006.pdf. The intent of this guidance is to encourage additional states to recognize that same-sex couples have the same need for spousal protections.
• SAGE (Services and Advocacy for LGBT Elders) has produced a guide to help the LGBT community understand Medicaid and spousal impoverishment, including estate recovery, and the implications for same-sex couples: Link opens in a new windowhttps://www.sageusa.org/your-rights-resources.
• The National Resource Center on LGBT Aging has an excellent section, "Medicaid and the LGBT Community: Paying for Long-Term Care, that is a recommended read. It provides in depth coverage on what LGBT individuals and couples should look for in applying for Medicaid: Link opens in a new windowhttps://www.lgbtagingcenter.org/resources/resource.cfm?r=63.

Older Americans Act Programs

Older Americans Act (OAA) programs are available to adults aged 60 and older. There are no specific financial eligibility criteria for OAA services, though Congress has directed that they generally be targeted for low-income, frail seniors, minority older adults, seniors living in rural areas, and other older adults of greatest social need. Here are some additional considerations:

• Not all providers of aging services funded through the OAA are inclusive and culturally competent.
• Check with LGBT friends and acquaintances to see if they have any suggestions.
• Your local LGBT community center may be helpful in steering you toward inclusive providers.
• The National Resource on LGBT Aging has a special section for LGBT older adults with many resources, including a tool that helps you find resources in your state: Link opens in a new windowhttps://www.lgbtagingcenter.org/resources/area.cfm.

Veterans Affairs Long-Term Care Benefits

While "don't ask, don't tell" is gone now, the impact of its demise on LGBT veterans is yet to be determined. In general, VA benefits are some of the best. Should you want to do some research before contacting the VA directly, here are a few resources you may find helpful:

• The United States Department of Veterans Affairs has a list of organizations that may be of assistance: Link opens in a new windowwww.diversity.va.gov/org/lgbt.aspx.
• The Modern Military Association of America (formerly the Servicemembers Legal Defense Network, or SLDN) has a lot of information for LGBT service members on its website and offers free legal advice: Link opens in a new windowhttps://modernmilitary.org.

Long-Term Care Insurance

Many issues need to be considered before buying long-term care insurance. In addition to the standard information on this type of product, you should note the following:

• Different states have different policies, and these may include different definitions of "family" that could affect eligibility requirements for same-sex partners.
• These definitions may also affect a public employee's ability to buy into benefits, depending on the state. Thorough research should be done before purchasing any policy.
• It may be a good time to reference Lambda Legal's map of relevant state laws: Link opens in a new windowhttps://www.lambdalegal.org/states-regions/in-your-state.

Reverse Mortgages

For LGBT people living with others, where the home is not jointly owned, you may want to consult an LGBT-friendly lawyer, Lambda Legal (Link opens in a new windowhttps://www.lambdalegal.org) or the National Center for Lesbian Rights (Link opens in a new windowhttps://www.nclrights.org) for assistance.

Annuities

The use of annuities to pay for long-term care may not involve special considerations for LGBT people, but seeking advice from a trusted professional is always advised:

• There may be issues under immediate annuities for transgender individuals, because payment is gender based under the assumption that women live longer than men and therefore receive smaller monthly payments.
• Work with a trusted legal professional or consult the National Center for Transgender Equality to determine how being transgender affects the calculation for this insurance in your state (Link opens in a new windowhttps://transequality.org).

Trusts

• Charitable remainder trusts may be a good option for LGBT individuals with assets, though same-sex couples should be sure that state laws don't have a negative impact on them should one partner die. For more information, refer to Lambda Legal's Take the Power: Tools for Life and Financial Planning at Link opens in a new windowhttps://www.lgbtagingcenter.org/resources/resource.cfm?r=42.
• Spousal impoverishment laws in your state may impact how same-sex couples are treated under Medicaid Disability Trusts, so be sure to do your homework before entering into this arrangement. To learn more, see the National Resource Center on LGBT Aging's Medicaid and the LGBT Community: Paying for Long-Term Care at Link opens in a new windowhttps://www.lgbtagingcenter.org/resources/resource.cfm?r=63.