In 1996, Sanford Okura, the founder of Okura & Associates, did some estate planning for his own mother, Kishiye Okura. She had suffered a stroke earlier, and was paralyzed on the right side of her body. She was not wealthy. She owned her home and some bank accounts. In analyzing his mother’s estate, Mr. Okura realized that the greatest threat to her estate was not estate taxes, because she did not have enough assets to be taxed by the estate tax. Probate would have been an inconvenience, but would cost only a few thousand dollars. He realized that the greatest threat to mother’s estate was potential nursing home costs. He was already specializing in estate planning, but then began his study of Elder Law. He devised an estate plan for his mother which would protect her home from Medicaid liens if she ever had to enter a nursing home.

Later, after suffering a second stroke, Kishiye Okura lived for a while with her son, then her daughter, then her son again. She then became so incapacitated that it became necessary to admit her into a nursing home. Sanford Okura applied for Medicaid for his own mother to pay the very expensive monthly nursing home bill. To his surprise, the Medicaid application was denied. The Medquest office claimed that an earlier transfer of assets by Kishiye Okura had created a penalty period which had not yet expired. Sanford rechecked his calculations and confirmed that the penalty period had expired, and that his mother’s application should have been approved. He asked the Medquest office to show him the table they used to calculate the value of the property interest which his mother had transferred. When he received a copy of their table, he discovered that they were using the wrong table! Mr. Okura had obtained his copy of the table directly from the Health Care Finance Administration, which was the agency of the federal government then in charge of the Medicaid program. He gave to the Medicaid eligibility worker a copy of the correct table. It was forwarded to the office in the Department of Human Services which writes and interprets the Hawaii Medicaid rules. They reviewed the table. The answer came back: they had made a mistake, and Kishiye Okura’s Medicaid application is approved. Mother died in 1998, but her legacy lives on. To Sanford’s knowledge, as a result of his own mother’s case, the Medquest offices throughout the State of Hawaii began using the correct table to perform the kind of calculations which were necessary for his mother’s Medicaid application.

Since then, Sanford and other attorneys at Okura & Associates have studied the complicated federal and state Medicaid laws much more carefully.  We have had other Medicaid applications which were initially denied by a Medicaid eligibility worker, but which were later approved after the denial was challenged by our law firm. We do not at all blame the Medicaid eligibility workers or the Medquest office that interprets the Medicaid rules. Their job is so difficult, the federal and state Medicaid laws are so complicated, and the workers are often so overworked, that it is understandable that they sometimes make mistakes.  We have found that most Medicaid workers take their jobs seriously and sincerely do their best under difficult circumstances.  When we use creative techniques to protect assets from nursing home costs and to qualify a client for Medicaid benefits, we try to work cooperatively with the Medicaid workers to show them why the technique is legal. We have a good relationship with a number of Medicaid workers, and try to work harmoniously with them. Occasionally, we have to disagree and appeal their decision.

Protection Of Assets From Nursing Home Costs

A study by the Kaiser Family Foundation in 2003 found that if you are 65 years of age or older, there is a 45% chance that you will spend some time in a nursing home. The study also found that the average nursing home stay is 2.4 years. The State of Hawaii in November 2008 determined that the average nursing home cost in Hawaii is $8,850 per month. That amounts to $106,200 a year. For the average nursing home stay of 2.4 years, the cost would be $254,880! This means that 45% of the population who are over 65 years of age, face potential nursing home costs of $254,880!

For the person who is not a multi-millionaire, the greatest threat to the estate is not probate. It is not estate taxes. The greatest threat is nursing home costs.

Okura & Associates specializes in protecting assets from nursing home costs. For a client who does not need to enter a nursing home right away, we use long range planning techniques to protect the home from Medicaid liens. For a client who is already in a nursing home or about to enter a nursing home, we use creative techniques to protect as much of the assets as possible, and to get the client qualified for Medicaid as soon as possible. We have had many clients marvel that we have been able to quickly get them qualified for Medicaid for nursing home costs, when they thought they would have to spend down their assets to almost nothing. We probably do more Elder Law planning to protect assets from nursing home costs than any other law firm in the State of Hawaii.

Call us to protect your assets from nursing home costs.

Medicaid and Nursing Home Costs Articles

Creative Medicaid Spend Down Techniques (May 2013)

As you are probably well aware, my father, Sanford K. Okura, and I have both written extensively on qualifying for Medicaid to pay for long term care costs while protecting your assets from nursing home costs.  Our law practice focuses on this problem as a key specialty within estate planning and elder law. Most people think that they have to spend all their money on their care–down to $2,000–before read more

2012 Estate Planning Update (January 2012)

Here is a 2012 update on important numbers used in Estate Planning and Medicaid Planning in Hawaii.

How much money and property can a person have at death without paying estate taxes?

Under a temporary federal law, $5,000,000 is tax free this year. From January 1, 2013, only $1,000,000 will be tax free.  There is a bill in Congress, introduced on November 17, 2011, called the “Sensible Estate Tax Act of 2011,” which proposes read more

Protect Your Home From Medicaid Liens – Part 3 (May 2010)


Last month and the month before, I explained how to protect your home from Medicaid liens.  In my April column, I described how a parent can transfer the family residence to the children, and keep a “life estate.”

The life estate allows the parent to continue to live in the home for life.  If the parent goes into a nursing home and receives Medicaid help, the government can still read more

Protect Your Home From Medicaid Liens – Part 2 (April 2010)


Last month we discussed the dangers of having the government put a Medicaid lien on your home and property if you end up in a nursing home.  Remember, a “revocable living trust” cannot protect your home from nursing home costs.

Some senior citizens who are worried about Medicaid liens just give the house to the children.  I do not think this is wise.  There are many cases read more

Protect Your Home From Medicaid Liens (March 2010)


More and more senior citizens are becoming concerned about nursing home costs.  No one really wants to go to a nursing home.  Nearly every elderly person would prefer to stay at home.  However, no matter how much children love their parents, caring for an elderly parent at home can be so stressful that a stay in a nursing home often becomes necessary.  A Kaiser Family Foundation Survey read more