Progress report for ENE23-181
Project Information
Problem or Opportunity and Justification: Long-term care costs and therefore Medicaid liens are the largest threat to the transfer of farm assets. (Jody A. Leighty, 2020) Ag professionals require better understanding of Medicaid risks when consulting farm families about a succession plan and the transfer of farmland to the next generation.
41,530 (59%) of Pennsylvania farm owners are 55 and over. (National Agriculture Statistics Service, 2017) 66% of Americans will require nursing home care. (American Council of Aging, 2022) Therefore 27409 Pennsylvania farm owners age 55 and over face long-term care needs and related risks to owned assets within 20 years. Farmland is normally the largest owned asset and often transferred at death due to favorable Pennsylvania laws.
Solution and Approach A hybrid continued education event, the preferred model of learning, for ag professionals will be held. (Livingston, 2022) Expert elder law attorney MacGregor Brillhart, will share Medicaid rules and explain the five year look back and provide in-depth discussion regarding its impact on the family farm and farm assets.
35 service providers will learn options to mitigate the impact of Medicaid funded long term care on the family farm and farm assets. Ag professionals will utilize the knowledge while working with 105 farm families who own 12000 acres of farmland.
35 Pennsylvania ag professionals will utilize asset planning strategies and increased Medicaid and the five year look back knowledge to educate farmers about the effects of Medicaid on farm assets. 105 Pennsylvania farmers with 12000 acres of land will minimize Medicaid risk to farm assets through documents drafted as a result of assistance provided by ag professionals and knowledge gained in the farmer training program.
Problem: Long-term care costs and therefore Medicaid liens are the largest threat to the transfer of farm assets. (Jody A. Leighty, 2020) Ag professionals require better understanding of Medicaid risks when consulting farm families about a succession plan and the transfer of farmland to the next generation.
41,530 (59%) of Pennsylvania farm owners are 55 and over. (National Agriculture Statistics Service, 2017) 66% of Americans will require nursing home care. (American Council of Aging, 2022) Therefore 27409 Pennsylvania farm owners age 55 and over face long-term care needs and related risks to owned assets within 20 years. Farmland is normally the largest owned asset and often transferred at death due to favorable Pennsylvania laws.
Solution and Approach A hybrid continued education event, for ag professionals was held with in-person location in Harrisburg, PA. Expert elder law attorney MacGregor Brillhart, shared Medicaid rules and explained the five year look back and provided in-depth discussion regarding its impact on the family farm and farm assets. Mac also shared several methods of keeping farm assets safe from Medicaid and the five year look back.
27 service providers learned options to mitigate the impact of Medicaid funded long term care on the family farm and farm assets. To date the 27 ag professionals plan to utilize the knowledge while working with 140 farm families who own 11848 acres of farmland.
Educational Approach
Engagement:
A hybrid learning program will be held in Pennsylvania, with 35 in-person and online participants. Participants will be recruited through the PA Ag Professionals group, PA Bar Association (CLE’s), PA International Farm Transition Network (IFTN) Certified Succession Facilitators, and PA Farm Link Board members with representatives from 16 organizations.
The event will be promoted via social media, ag publications, newsletters, and printed materials distributed to professionals.
Continued education credits will be offered to attorneys and IFTN Coordinators encouraging succession coordinators to participate. The free continued education with a well-known expert will incentivize professional participation.
The second educational event will be a farm succession training, focusing on the effects of Medicaid and the five year look back in relation to the transition of the family farm. Presenters will have completed the professional training provided by Attorney Brillhart.
Farmers will be recruited by sharing information with ag organizations across Pennsylvania, social media advertising, newspapers, newsletters and PA Farm Link trade show booths.
Farmers participation will be incentivized by the value of topics covered at the event. Covering several succession planning topics will create further incentive to participate because farmers desire events that provide a high value for the time they invest. Speakers will also be available to talk one on one with farmers following the event. Those joining via a hybrid model will be offered a time for questions as well.
Learning:
Effects of Medicaid on farm assets continued education for ag professionals will be presented as a hybrid continued education event, offering CLE credits. Instructor, Attorney Mac Brillhart, Stock & Leader Attorneys at Law, York PA specializing in Medicaid planning will serve as the expert speaker.
Expectation and Goals:
Ag professionals will develop a better understanding of Medicaid, the five year look back and its impact on the family farm. Best planning methods for optimal outcomes will be shared. Professionals will understand the importance of including the proper specialists on a transition planning team to ensure best outcomes.
Topics include:
- Understanding the Need to Plan for Long Term Care
- Average Cost of Long-Term Care
- Average Length of Long-Term Care Stay
- Paying for Long Term Care
- Out of Pocket
- Long Term Care Insurance
- Medicare vs. Medicaid
- General Eligibility for Medicaid in Pennsylvania
- Financial Eligibility
- Income Limits
- Resource Limits
- Community Spouse Rules
- The Potential Impact of Asset Declaration on the Family Farm
- Livestock and Equipment
- Land
- Protecting Assets
- Early Transfer
- Converting Assets to Income
- Other Options
- Five Year Look Back
- Early Planning Provides Best Results
- A Team Approach
- Ensuring Understanding
For farmers:
A hybrid farm succession training will be held focusing on in-depth Medicaid information for farm families. Instructors will be a Horizon Farm Credit Business Consultant and ag attorney who completed the ag professional continued education provided through this project.
Expectations and Goals:
The ag attorney as well as the ag business consultant presentations will educate farmers on the potential impact of Medicaid on the family farm.
Breakout session activity will provide small group learning opportunities for farmers to work together to evaluate farm scenarios with senior gens requiring long term care and how Medicaid will impact farm family assets for the given situation and set of assets. Small groups will report back to all participants discussing their conclusions and increase their knowledge of options. Allowing farmers to put the information into real life scenarios provided to the small groups.
Evaluation:
Ag professionals will begin supplying data at registration providing the number of farmers they are currently assisting with succession/transition planning and number of acres represented. Number of farms that may be affected by Medicaid/five year look back. Particular questions they'd like answered.
Questions asked ag professionals in event and follow up evaluations:
- How many farmers have you worked with to develop plans to minimize Medicaid risks to farm assets?
- How many acres do these farmers manage?
- How many of your farmer clients have drafted succession/transition plan documents as a result?
- How many acres do these plans represent?
They will be asked their level of understanding/knowledge of Medicaid, five year look back and Medicaid planning options, both before and after the continued education event.
Farmers participating in the farm succession/transition workshop will be surveyed regarding their understanding/knowledge of Medicaid and five year look back before and after the workshop and potential impact to their farm.
Follow up surveys will be completed with both groups.
Milestones
- Engagement, October 31, 2023. 100 service providers learned about the Medicaid continued education program through in-person sharing at trade shows (count), newsletter and electronic notices (determined by opening rate), Board organizations sharing (report count). Tracked by PA Farm Link staff.
- Status: Complete
- Accomplishments: 218 service providers learned about this program.
- Learning, November 30, 2023. 35 service providers participate in one Medicaid hybrid continued education event. Participants learn about Medicaid and the five year look back and the potential negative impact this has on family farm assets. Attorneys obtain CLE credits and IFTN Certified Succession Coordinators may obtain continued education credit. Registration will be free but required to track participation.
- Status: Complete.
- Accomplishments: 45 service providers participated in the event.
As we navigate post Covid programming I believe we are seeing more and more it's best to have separate programs for virtual and in-person audiences. Speakers teach differently to various audiences and when it's hybrid it gives to many people the option to change their plans at the last minute and participate virtually instead of in-person.
- Evaluation, November 30, 2023. 35 service providers will complete the evaluation at the end of the continued education event to determine understanding/knowledge gained from the program and to determine future needs. PA Farm Link will tally the results.
- Status: Complete.
- Accomplishments: 27 service providers completed the evaluation.
The Ag Professional continued education hybrid program utilized a written evaluation for in-person and virtual audiences. Unfortunately, because the evaluation was provided very close the end of the program we did not get as many submitted online as we thought we would. Lesson learned potentially divide up the evaluation and do what parts we can at the beginning as a ice breaker type item, such as gathering the number of farmers they are working with on farm succession and who would benefit from Medicaid information being taught as well as the acreage, etc. This may also create buy in to answer the remaining questions at the end of the program. Another method would be to provide the CLE credit link after evaluations were completed, although not all participants were attorneys so that would not cover all participants.
Unexpected successions included the fact the number of farmers (140) the 27 who responded were working with was higher than we anticipated as was the acreage (11,848 acres) the 27 ag professionals were potentially impacting through their work.
- Evaluation, February 28, 2024. 28 service providers will respond to the continued education follow up survey sharing the number of farmers they have shared the information with, how many farmers they are currently assisting and how the training has impacted their work. PA Farm Link staff will manage the survey and results.
- Status: In Progress
- Accomplishments:
- Evaluation, May 25, 2024. 20 service providers will respond to six-month continued education follow-up survey sharing the number of farmers they have utilized the information with, number of farmers they are currently assisting and how the training has impacted their work. PA Farm Link staff will manage the survey and results.
- Status: Not Begun
- Accomplishments:
- Engagement, September 30, 2024. 200 farmers learn about the Medicaid focused farm succession workshop through in-person trade shows (count), newsletter and electronic notices (determined by open rate), advertising in ag publications (% of viewership), Board organizations sharing and reporting count. Tracked by PA Farm Link staff.
- Status: Not Begun
- Accomplishments:
- Learning, December 15, 2025. 30 farmers participate in the hybrid farm succession workshop gaining an understanding/knowledge about Medicaid and its threat to family farm assets. Farmers participate in breakout sessions to put their knowledge into practice and providing experience determining what assets are at risk. PA Farm Link staff track numbers through event participation.
- Status: Not Begun
- Accomplishments:
- Evaluation, December 15, 2025. 30 farmers will complete evaluation at the end of the event. Farmers will learn the impact of Medicaid and the five year look back on the family farm through presentations and breakout exercise. PA Farm link staff will tally results.
- Status: Not Begun
- Accomplishments:
- Evaluation, March 30, 2025. 22 farmers will respond to follow up survey providing how they’d utilized their knowledge of Medicaid and five year look back to date. PA Farm Link staff will distribute survey and tally results.
- Status: Not Begun
- Accomplishments:
Milestone Activities and Participation Summary
Educational activities and events conducted by the project team:
Participants in the project’s educational activities:
Learning Outcomes
Performance Target Outcomes
Performance Target Outcomes - Service Providers
Target #1
35
35 Ag Professionals will share increased knowledge of Medicaid and the five year look back and options to minimize the risk to farm assets with farmers they counsel.
105
12,000 acres
Performance Target Outcomes - Farmers
Target #1
105
105 Pennsylvania farmers with 12000 acres of land will minimize Medicaid risk to farm assets through documents drafted as a result of assistance provided by ag professionals and knowledge gained in the farmer training program.
12,000 acres
Additional Project Outcomes
This project is bringing attention to the importance of the topic! While working with the University of Wisconsin on a separate farm succession project, Joy Kirkpatrick introduced me to Attorney Robert Moore's booklet he created for Ohio titled Long Term Care and the Farm. As I read through it I realized it was the best resource written in laymen's terms that farmers could comprehend. I began sharing it with farmers. Joy suggested we ask if we could edit it for Wisconsin and Pennsylvania. We did and Robert Moore was kind enough to check with the National Ag Law Center which funded the original project and Ohio State Ag Law Center and the National Ag Law Center gave us permission to edit the booklet for Wisconsin and Pennsylvania!
PA Farm Link has since edited the booklet for Pennsylvania and it's currently at the printer for updating and printing. It will be available online and as a hard copy resource. PA Farm Link is grateful for the expert who edited the booklet as well as Pennsylvania State Department of Agriculture for funding the Long Term Care and the Farm, Pennsylvania Edition! It will be distributed to the farmers who participate in the farmer portion of this grant.
A quote from an evaluation of the ag professional program: Excellent program! I hope that you are able to obtain funding to produce more like this. Legal topics especially are not readily available without paying large fees. Pennsylvania Ag Attorney
Attorney Mac Brillhart was an expert in Medicaid and the five year look back and well known for his work. He drew an audience because of his excellent reputation.
Next time I would provide in person and virtual events separately as it's a better working model post C0vid.