Final 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)
51,065 (56%) of Pennsylvania farm owners are 55 and over. (National Agriculture Statistics Service, 2022) 66% of Americans will require nursing home care in their lifetime. (American Council of Aging, 2022) Therefore 33,702 Pennsylvania farm owners age 55 and over face long-term care needs and the 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 was held for 15 ag professionals. Expert elder law attorney MacGregor Brillhart, shared Medicaid rules, explained the five year look back and provided in-depth discussion regarding its impact on the family farm and farm assets. He also provided some planning options he uses.
The hybrid model proved less effective than anticipated and therefore an in-person service provider event was also held. Other events were pivoted to in-person events to eliminate the issue.
An in person ag professional training was held at the 2024 International Farm Transition Network (IFTN) Conference. A nurse RN MS and insurance specialist, and ag professional led the training. 30 ag professionals participated in the event. Participants were from several states. The breakouts proved successful and challenging. The asset breakout and determining the assets that would require reporting with a given scenario was successful. It also created additional conversation and clarification regarding assets and those that count and those that do not.
The breakout to calculate the potential cost of care and how long a person’s assets would pay for care did not work nearly as well. It was too complex. Therefore, the project team brainstormed best options for continued educational programming and resources to alleviate the issue. The decision was made to utilize the asset breakout with farmers but not the potential cost of care breakout since the ag professionals were not confident in their application of it. It was not wise to utilize it with farmers.
The project team was excited to learn the Medicaid breakout materials and scenarios were the most requested resources of the entire IFTN conference.
41 service providers learned options to mitigate the impact of Medicaid funded long term care on the family farm and farm assets. Ag professionals utilized the knowledge while working with 202 farm families who own 20,028 acres of farmland.
The planned farm succession training for farmers was extremely well received. Demand was greater than capacity and a wait list was created. The presenters agreed to participate in a second event and the event was repeated one month later.
Both farmer events received rave reviews with people stating it was the best program they’d been to. The presenters "got it" and were experienced farming community professionals and the farmer participants could relate to them and understand the topics they presented.
Long term care costs, Medicaid and five year look back was presented by the nurse with RN MS and insurance specialist as well as an ag professional and the Horizon Farm Credit Business Consultant assisted with the breakout.
The asset breakout proved to be very successful, providing great discussion and learning opportunities for all involved. The breakout created continued conversation and questions from the farmers regarding their owned assets. All participant questions were answered and follow up was planned with the presenters on various topics from long term care needs and planning to legal aspects of succession planning and listing assets on financial records.
The in-person events proved extremely successful and future programs will follow the same model.
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 12,000 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.
51,065 (56%) 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 33,702 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.
A second in-person training was held for ag professionals at the 2024 IFTN Conference. 30 professionals participated. A nurse RN MS and insurance specialist and ag professional led the training. 31 ag professionals participated in the event. Two breakouts were included one determining which assets counted the other calculating potential care cost. The potential care cost calculation breakout proved more work was required. Participants were from several states. Medicaid breakout materials and scenarios were the most requested resources of the entire conference.
41 service providers learned options to mitigate the impact of Medicaid funded long term care on the family farm and farm assets. The 41 ag professionals utilized the knowledge while working with 202 farm families who own 20,028 acres of farmland.
Educational Approach
Engagement:
A hybrid learning program was held in Pennsylvania, with 15 in-person and online participants. Participants were 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 17 organizations.
The event was promoted via social media, ag publications, newsletters, and printed materials distributed to professionals.
Continued education credits were offered to attorneys through the assistance of Penn State Ag and Shale Law Center. The free continued education featured a well-known expert incentivizing professional participation.
A second ag professional education event was held at the 2024 International Farm Transition Network (IFTN) Conference. 30 participants received continued education credits for participating in the conference seminars. The program was very well received. The program breakout materials were the most requested resources of the conference.
The third educational event was 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 completed the professional training provided by Attorney Brillhart.
Farmers were recruited by sharing information with ag organizations and partners across Pennsylvania, social media advertising, newspaper ads, newsletters, news releases and PA Farm Link trade show booths.
Farmers participation was incentivized by the value of topics covered including Medicaid and the five year look back, farm financials, legal considerations, and farm family communication. Covering several succession planning topics created greater interest. Farmers desire events that provide a high value for the time they invest. Speakers were available to talk one on one with farmers following the presentations and at breaks. Due to event success and a waiting list to participate the event was repeated one month later to accommodate everyone. Farmers were happy with the program.
Learning:
Effects of Medicaid on farm assets continued education for ag professionals was 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 served as the expert speaker.
A second event, in-person education opportunity was held at the 2024 IFTN Conference with even greater participation. Two breakouts with assets and scenarios was extremely well received, even though instructors realized the need for further training as the breakouts proved extremely challenging for the ag professionals.
The asset breakout provided items to determine if they counted or not. The other involving scenarios and calculating potential costs of care and how long the farmer’s assets would pay for the required care.
Expectation and Goals:
Ag professionals developed 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 understood 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
- Which Assets Count
- Protecting Assets
- Early Transfer
- Converting Assets to Income
- Other Options
- Five Year Look Back
- Early Planning Provides Best Results
- A Team Approach
- Ensuring Understanding – Two breakouts were held for ag professionals
For farmers:
Two in-person succession trainings were held focusing on in-depth Medicaid information for farm families. Instructors were a nurse RN MS and insurance specialist who assisted families with Medicaid applications when a loved one entered a long term care facility and another ag professional. Both participated in Attorney Brillhart’s program.
Expectations and Goals:
The Medicaid presentation and asset breakout educated farmers and created great discussion about event participants assets and the potential impact of Medicaid on the family farm. The Horizon Business Consultant also assisted with the breakout and answered many financial and Medicaid related questions.
Breakout session activity provided small group learning opportunities for farmers to work together to evaluate a farm scenario with a senior gen requiring long term care and how Medicaid would impact farm family assets owned by various family members for the given situation and set of assets. The small groups reported back to all participants discussing their conclusions and increasing their knowledge of options. Farmers left with a better understanding and personal application through the questions the breakout exercise brought about with the entire group engaging in Q&A about their own assets and their personal situations.
Evaluation:
Ag professionals supplied data at registration providing the number of farmers they were assisting with succession/transition planning and number of acres represented. Number of farms that potentially would be impacted by Medicaid/five year look back. As well as particular questions they had on the topic.
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 were 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 workshops were 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 were 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 navigated post Covid programming we learned it was best to have separate programs for virtual and in-person audiences. Speakers taught differently with in person vs virtual audiences and when it was hybrid it gave many people the option to change their plans at the last minute and participate virtually instead of in-person. The last-minute participant mode switch created an event planning issue for in person venues. - A second ag professional training was held at the International Farm Transition Network Conference on June 6, 2024. 30 ag professionals participated in the event. Participants were from several states. Conference participation provided IFTN continued education credits for IFTN Certified Succession Coordinators.
- Final Accomplishment: 75 service providers participated in Medicaid continued education events.
- 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: 41 service providers completed the evaluation.
Event #1 - The 2023 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 an 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 successes 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.
Event #2 - 14 ag professionals completed surveys following the June 2024 Medicaid program. The 14 service providers were assisting 62 farmers representing 8180 acres of farmland. - Cumulative accomplishment including events #1 and #2: 41 service providers completed the evaluation at the end of the events. They were working with 202 farmers with 20,028 acres of farmland. Service providers felt Medicaid and long-term care risks would impact 53% of the farmers they worked with. Service providers reported a 64% increase in Medicaid knowledge and understanding. 63% reported increased knowledge and understanding of the five year look back on assets. 46% of ag professionals reported increased knowledge and understanding of planning options to mitigate risk of Medicaid and the five year look back on farm assets.
- 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: Complete
- Accomplishments: 21 service providers shared Medicaid information with 114 farmers.
- Service providers reported having great confidence sharing with farmers the potential risk of Medicaid and five year look back on farm assets and which assets must be reported for Medicaid purposes.
- 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: Complete
- Accomplishments: 18 service providers are currently working with 103 farmers.
- Service providers have placed more focus on sharing the risk of Medicaid and five year look back with farmers in relation to potential asset risks especially its impact to the next generation. They have observed that succession planning continues to be a slow process as farmers work through the decisions they need to make.
- Engagement, April 15, 2025. 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: Complete
- Accomplishments: 3648 farmers learned about events.
- Promoted of March 18, 2025 & April 16, 2025 farm succession workshops at in-person trade shows, enewsletter, advertising in print farm newspaper and FB, news releases, flyer distribution by partner organizations and posted in local businesses.
- Learning, April 30, 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: Complete
- Accomplishments: 46 farmer participants
- In person farm succession workshops on March 18 and April 16, 2025 had a total of 46 farmer participants. Breakouts with assets to determine if they would be counted for Medicaid and the five year look back were well received and created much discussion and additional farmer questions were answered by qualified ag professionals.
- Hybrid workshops were not utilized because of lessons learned early in the project. The model was not successful in the region post Covid.
- Evaluation, April 30, 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: Complete
- Accomplishments: 40 farmer participants completed evaluations at end of events.
- Evaluation, April 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: Complete
- Accomplishments: 17 farmers shared with family members, utilized it for planning discussions, met with Medicaid expert, ag professional and legal professionals.
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
41
202
20028
- 113 Consultations
- 1 Webinars/talks/presentations
Performance target verification methods included evaluations and surveys during events. Participants completed printed documents, supplied during webinars and follow up verification via online options. Results were also verified through conversations and interviews with ag professionals and farmers.
Obtaining follow up results was challenging with both service providers and farmers potentially due to the spring season when follows up was sought.
Service providers saw the need and were eager to learn about Medicaid and the five year look back, however, it proved to be a more complex topic than anticipated. Through the educational program they comprehended and could sort the personal and farm assets potentially impacted, understood the five year look back and learned about possible planning options.
Service providers reported a 67% increase in overall understanding and knowledge of Medicaid. A 71% increase in knowledge and understanding of the five year look back was reported. Service providers reported a 62% increase in overall planning knowledge and understanding.
However, they weren’t comfortable or confident in calculating the most complex item, the potential financial impact in given scenario situations, and showed the need for continued work and learning.
A potential solution will be created through a 2025 SARE Ag Professional Development grant project: Growing the Understanding of the Effects of Medicaid and Five Year Look Back on Family Farm Assets. An online calculator will be created and the information entered in it will allow families to utilize document pages for actual Medicaid applications required when someone enters a long term care facility.
Spring is a busy and stressful time of year and farm succession planning is a slower process than one thinks for farmers to complete all the necessary planning, which includes agreement of all parties involved and evaluating potential issues.
One interesting result was while the number of farmers that drafted documents as a result of ag professional assistance was lower than anticipated, most likely due to the length of time farmers require for succession planning. The acreage impacted was higher than projected. The acreage obviously varied from small to large farms, however, the overall number was larger than anticipated.
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
77
12,131 acres
Additional Project Outcomes
This project brought 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. Permission was obtained to edit the booklet for Wisconsin and Pennsylvania!
PA Farm Link edited the booklet for Pennsylvania. It was made available online and as a hard copy resource for Pennsylvania farmers and ag professionals. 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 was distributed to the farmers who participate in the farmer portion of this grant.
The first printing of the Long Term Care and the Farm for Pennsylvania was distributed. A second printing was completed utilizing funds from this grant to print 300 more copies to utilize for the additional farmer workshop and to distribute to farmers and service providers. An updated digital copy is also available online.
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
The packet of asset pictures and scenarios utilized for ag professional and farmer breakouts and created through this grant was the most requested material/item from the 2024 International Farm Transition Network (IFTN) Conference sessions. Ag professionals requested the items to utilize in their own programs.
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 Covid.