If your parents live in Kentucky and you live here in Pennsylvania and your brothers and sisters live in California and New York, chances are you may have had “the conversation” discussing with your parents where they might live if one of them needs long term care. It is not just a question whether they might leave home but also what supports and funding are available and, if a continuing care retirement community is involved, what are the terms of the contract. Also, the questioner needs to know differences between States. States can differ dramatically when it comes to long term care as to availability, quality, government benefits, and cost.

If you are nearing retirement and you open a splashy brochure advertising a senior community with golf courses and swimming pools in North Carolina, you might hesitate before signing on because you do not know what your options are if you need some serious care. What happens if you want to move back to be near the kids and what happens if you run out of money?

If you live most of the year in Florida and return to Pennsylvania during the summer are you better off, when you are tired of commuting, to live full time in Florida or in Pennsylvania?

These are all questions faced every day by ordinary people that are largely ignored by planners and they do make a huge difference. The questions should not be new. I discovered a few years ago there are firms on the border between the U.S. and Canada that specialize in planning whether Americans who commute to their vacation homes in Canada should take the plunge and move or stay here based on financial considerations.

Some years back I co-authored a book titled “The Medicaid Program: Interstate Planning Opportunities in Pennsylvania and Delaware” addressing just one issue – the difference in Medicaid programs between two adjoining states. Some of the information has changed – Delaware improved in one area. However, the overall analysis still stands.

Here are some examples.

If you live in Pennsylvania and receive long term care services and supports here whether in a nursing home or at home under the Medicaid Waiver Program, your spouse’s retirement funds – IRA, 401(k), 403(b) or similar – are exempt regardless of the amount and you can still receive services if you otherwise qualify. However, if you cross the bridge into New Jersey for services, New Jersey has historically not recognized an exemption for your spouse’s retirement accounts and they would be spent down as part of the Medicaid spenddown. The difference to the couple could mean hundreds of thousands of dollars’ lost or saved.

Delaware, and, for that matter, New Jersey, have Medicaid availability for assisted living/personal care. Not so in Pennsylvania.

Pennsylvania is not known for its “at home” services and supports. Many other states are much more generous in supplying help at home.

California is very open in its interpretation of the Medicaid gifting rules. Pennsylvania allows $500 total (not per recipient) per month without penalty. New Jersey has no minimum amount allowed before counting it against the applicant.

This would be another strike against New Jersey.

I remember participating in a conversation with other elder law attorneys several years ago in Georgia as we waited to leave a conference on our respective flights home. Although I do not remember the exact details I do recall as a result of our conversation I would not recommend clients move to Iowa for long term care.

The way our office answers these questions and makes sure that we are current in our answers is to connect with elder law attorneys in other states. This is one time among many when it pays to belong to a national organization, the National Academy of Elder Law Attorneys (NAELA) to further connect with other lawyers who concentrate in this field across the U.S. Many of these attorneys I met before at national conferences and this makes it easy to reconnect with specific questions from specific clients.  Whether you move to North Carolina or Florida or keep your residency and care in Pennsylvania can depend on, among other considerations, the differences from State to State.