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Episode 27: Long-Term Care and the Farm with Robert Moore

Farmers are always preparing ahead for the future – for next year’s seed and inputs. But when it comes to planning for how they’re going to care for themselves in the future, especially for older farmers, long-term care planning just isn’t at the forefront of their minds until it needs to be paid for, leaving the legacy of the farm at risk for future generations.

“For farmers today, the number one risk to transferring that farm onto the next generation is long-term care costs,” says Robert Moore, Ohio State University Agricultural & Resource Law Program attorney and research specialist. “Not only are farmers getting older, but people are living longer and that has a big impact on the number of years long-term care might be needed.”

What is Long-Term Care?

So what exactly is long-term care? And why do we need to plan for it in advance?

Robert explains that long-term care for farmers doesn’t automatically mean nursing home care, which is often the first thought that comes to mind when thinking about care.

Long-term care can encompass home-based care or facility-based care.

“On average, a 65-year-old will need three years of long-term care,” says Robert. “The average in-home care cost is about $60,000 a year, and in Ohio, the average nursing home care cost is about $90,000 a year.”

Statistics show that long-term care costs are a potential financial threat to farms. The next question is, how do farms mitigate risk and protect assets?

Strategies to Mitigate Risk and Protect Assets

First, it’s important to understand how Medicaid factors into long-term care options.

“To qualify for Medicaid, you can own almost no assets. For an unmarried person, you can only own $2,000 of assets to be eligible for Medicaid. That means no farmer qualifies for Medicaid,” explains Robert. “So we have to decide, if we want to qualify for Medicaid, what do we do?”

Medicaid is a state and federal program that assists people with their health needs when they do not have the resources to take care of themselves.

Robert shares that long-term care planning often looks like “guessing five years down the road” because, if the strategy is to qualify for Medicaid, any gifting of assets such as farmland, equipment, or livestock has to be made five years before long-term care starts.

While gifting is one option, it’s often a challenging one.

“Farmers work hard to accumulate their assets, and especially with land, it can be really difficult for some farmers just to give away all their land and wait five years and see if they need long-term care,” says Robert.

When Medicaid is not an option, there are some additional strategies.

Long-term care insurance is one alternative. Robert explains that this is an insurance policy you can buy when long-term care is needed. However, not everyone may be insurable due to pre-existing conditions.

“I tell people to start looking at long-term care insurance when they are in their 40s, 50s,” says Robert.

Another strategy is to take a wait-and-see approach.

Typical for medium to large farms, Robert says, “If someone has the ability to pay for five years worth of long-term care, let’s say $500,000, whether that’s in savings, equipment, or grain, the strategy is to wait until we know somebody needs long-term care.”

A third strategy is to use an irrevocable trust to protect assets from long-term care costs.

“When you gift land, but it goes into an irrevocable trust, it protects the land from creditors or poor management,” Robert says.

Considerations and First Steps for Long-Term Care Planning

Overall, each option has its advantages and disadvantages. The important first step is to start planning.

Robert suggests beginning with an analysis of risk.

“Number one is determining what kind of income we can expect once you would stop farming and need long-term care. We need to do an analysis of what are the long-term care costs versus what income you have and other assets you are willing to spend.”

For young farmers wanting to start a long-term care planning conversation, Robert recommends first becoming educated on what long-term care is, the average costs, how it works, and determining how at risk the family farm is to long-term care costs. Then, seeking an attorney is the next best step.

For more information on long-term care planning, Robert has written a publication that examines the needs, risks and strategies farmers can take to protect their farm assets in Long-Term Care and the Farm, available online.

Here’s a glance at this episode:

  • [00:53] Robert introduces himself and his background.
  • [02:21] Robert explains what long-term care is and the statistics of long-term care.
  • [05:46] For farming operations, Robert explains why it’s important for farmers to start planning for long-term care.
  • [07:59] Robert shares why long-term care costs are the number one risk to transferring the farm to the next generation.  
  • [09:39] Robert explains how Medicaid plays into the recommended five-year look-ahead approach to long-term care.
  • [12:55] When farmers don’t qualify for Medicaid, Robert shares some other options for long-term care.
  • [18:05] Robert explains the steps farmers can take to start long-term care planning.
  • [21:48] For young farmers, Robert shares the steps they can take to approach the conversation and planning process.
  • [26:27] Robert shares resources for more information about long-term care planning.

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Guest Robert Moore

Robert is an Attorney and Research Specialist for the OSU Agricultural & Resource Law Program.  He was raised on a dairy farm in Coshocton County, Ohio, where his family continues to raise beef cattle, sheep, and crops. Robert is an owner emeritus of Wright & Moore Law Co. LPA where he practiced law for 18 years. During that time, he primarily focused on farm succession, estate planning, and business planning and represented clients across Ohio. Robert also worked with clients on real estate transactions, landlord/tenant issues, contracts and many other issues related to agricultural law.

Host Matt Adams

Matt serves Paulding County as an account officer at AgCredit. He has worked in ag lending for over four years and previously worked in farm equipment sales for 11 years. He and his wife farm in northwest Ohio with their two daughters and son. His favorite part about AgCredit is the people. From the member-borrowers to the internal team at AgCredit, every day keeps getting better. Matt hopes to bring insights to ag lending and some laughs to the AgCredit Said It podcast.

Host Libby Wixtead

Libby has been an account officer for eight years serving AgCredit members in Marion County. She grew up on a 200-acre grain farm and was very active in 4-H and FFA. Today, Libby and her husband operate a 2,400-head swine finishing barn. Her favorite part about working at AgCredit is working with local farmers from the same area where she grew up and seeing their operations thrive. She loves working in agriculture and helping her customers be successful year after year.


Voiceover (00:08):Welcome to AgCredit Said It. In each episode, our hosts sit down with experts from all parts of the agriculture industry to bring you insights and must-have information on all things from farming to finances and everything in between.

Matt Adams (00:26):Hey everyone, and welcome back to another episode of AgCredit Said It. I'm your host Matt, along with my co-host.

Libby Wixtead (00:33):I'm Libby Wixtead.

Matt Adams (00:35):Back together again. So Libby, what are we talking about today?

Libby Wixtead (00:39):So we have Robert Moore with us today who is an attorney with OSU Agricultural and Resource Law Program and he specializes in pharma state transition tax and business planning. So we are in for a treat today.

Matt Adams (00:53):I think this is something that is going to be a lot of good information, especially when you look at the average age of a farmer that we always hear. Farmers are getting older, so long-term healthcare is, that's probably a topic that needs to be brought up more but probably isn't a lot at the dinner table for a lot of these operations. So we'll get right into it. So Robert, thanks for joining us, sir. And why don't you go ahead and tell us a little bit about yourself and your background?

Robert Moore (01:21):Okay, well I grew up on a dairy farm in Coshocton County and started my career at Ohio State working in Fairfield County as the ag educator there. Then moved into the ag econ department and while I was at Ohio State, I decided to go to law school at night. So I did that and then decided to go into private practice. So for about the last 18 years I've been with Wright & Moore, which is a law firm in Delaware, Ohio, which specializes in working with farmers and landowners. And then earlier this year I had an opportunity to go back to Ohio State in the ag and resource law program and decided to do that. So that's what got me here.

Matt Adams (02:11):Back at Ohio State again.

Robert Moore (02:12):Yep.

Libby Wixtead (02:13):Just not as a student and in a greater position this time.

Robert Moore (02:17):Right. Not as a poor college student.

Libby Wixtead (02:21):So as Matt had mentioned, there's this long-term care that not a lot of families seem to talk about in advance, it seems like it's one of those things that we just kind of go through the motions of when it happens. But can you tell us a little bit about long-term care and what that truly means when you sit down and look at it?

Robert Moore (02:43):So as I've been practicing law over the last 18 years, an area of the law that I saw that was really lacking was long-term care for farmers because they have certain needs and we're dealing with a lot of capital on these farms and I couldn't find anybody who was an expert on both long-term care and working with farmers. So when I joined Ohio State, the first project I took on was doing some research and creating a publication for farmers on long-term care. But as we look at long-term care, we need to keep in mind that it's not just nursing home care. I know before I kind of started looking into it, I just thought long-term care means automatically nursing home care.

Matt Adams (03:37):That's the first thing that comes to my mind when you start talking about that.

Robert Moore (03:41):But what the statistics show is that actually about a third of long-term care is done in the home by family members or friends at no cost. And then about another third of long-term care is typically done in home, but for paid services, somebody that may come in for eight or 10 hours a day, and only about a third of long-term care is actually in a nursing home.

Libby Wixtead (04:09):And that, I guess that is what surprises me when you think about it because you don't think of, oh, grandma and grandpa or mom and dad need some help, that that's truly the start of when long-term care is. And Matt, I don't know about you, but if you have some elderly customers that are starting to have that in-home care that's paid for, the families aren't really necessarily thinking about that long-term care piece of it starting that soon.

Matt Adams (04:36):Yeah, it definitely seems to be always more like a reactive thing than a proactive one. So, Robert, I'm kind of curious, when you started, you said this was kind of a spot that wasn't really researched a lot, just not a lot of people. In your guys' research, why was agriculture long-term healthcare, and why was that something that was really never a big thing for us?

Robert Moore (05:02):Yeah, well there's just not a lot of attorneys that focus their practice on agricultural law, and then within that kind of small group-

Matt Adams (05:12):You take a little.

Robert Moore (05:12):... even a smaller part, yeah. So that's why I'm saying I don't know that there's that one person or a few people out there that really know farming and know agriculture and also focus on long-term care cost.

Matt Adams (05:29):Gotcha. So we kind of talk about what long-term care is, when can long-term care truly start when we look at that as far as on a farm operation and transition planning?

Robert Moore (05:46):So the obvious answer is it depends. It depends on the farm, it depends on the family. But unfortunately, the planning often does not start until the long-term care needs to be paid for and we need to start planning well in advance of that day. And I know we're going to get into Medicaid a little bit, because of the Medicaid rules we're always looking down the road five years. So any kind of long-term care planning is a five-year plan. And so we're always guessing five years ahead of time, well, will somebody be in the nursing home in five years or not? Nobody wants to go in the nursing home. So it's kind of one of those things where you may just say, that's not happening to me, I'm not going in the nursing home, and so the planning doesn't get done. And especially with farmers being independent, the thought of being in a nursing home just is not something that they want to think about.

Matt Adams (06:51):That's like worst case scenario for them and yeah, that's not going to happen to me type thing. And I was, Libby, I kind of think, we work with our members and we're always, farming especially, we're always planning ahead for that next crop year and even two crop years ahead where when it comes to taking care of ourselves, I guess it's one of those things we must put on the back burner a little bit that we just don't want to think about, I guess a little bit for long term stuff.

Libby Wixtead (07:16):Absolutely. And Robert, you've been a speaker at many AgCredit events for estate planning and I feel like we finally got people to talk about estate planning and now it's this next piece of the long-term care and wanting to get that process started because I think we need to start planning that sooner as you said. And I think that having the impact on the estate planning piece of it, this long-term care can have almost greater impact if we're not planning for that. Is that something you guys are starting to do with the estate planning talking about that long-term care piece and bringing that up? Because I feel like that is a connection where that we need to make.

Robert Moore (07:59):So I think we are discussing long-term care more, maybe 10 or 15 years ago, estate taxes were the biggest risk to transferring the farm to the next generation. Today estate taxes aren't nearly the risk they used to be because the estate tax exemptions are much higher. So I think today for many farms, the number one risk to transferring that farm to the next generation or long-term care cost, not only are farmers getting older, but people are living longer and that has a big impact on the number of years of long-term care that we might need. The average 65-year-old will need three years of long-term care, again, on average. And like I was saying before, usually, about one year of that's in home with friends, and family taking care of you. About one year of that is in-home care and the average in-home care cost is about $60,000 a year and then another year in the nursing home. And in Ohio, the average nursing home costs about $90,000 a year.

Libby Wixtead (09:11):And so those costs can be different from each state, is that correct?

Robert Moore (09:15):Yes. Yeah, definitely. The state you're in has a big impact on long-term care costs. But even within Ohio, the more rural long-term care facilities will be less expensive, whereas the facilities in Cleveland, Columbus, and Cincinnati are more expensive. So there's quite a range in Ohio as well.

Matt Adams (09:39):So Robert, you touched on the five-year lookback period. Can you go into that for me and just explain what we're looking at there and does that kind of take a play in with Medicaid and all that fun stuff?

Robert Moore (09:50):Yeah, so that's a Medicaid role. So let's kind of summarize how Medicaid plays into this. And also just to make clear, there's Medicaid and there's Medicare. Medicare really doesn't help with long-term care cost. So we're talking about Medicaid, and Medicaid is the state and federal program that assists people with their health needs when they do not have the resources to take care of themselves.


(10:20):So to qualify for Medicaid you can own almost no assets. For an unmarried person, you can own only $2,000 of assets and be eligible for Medicaid. So no farmer qualifies for Medicaid right now. So then we have to decide, well if we want to qualify for Medicaid, what do we do? Well, that means gifting your assets away, and the five-year rule says that if you make large gifts of farmland, equipment, livestock, whatever it is, you're ineligible for Medicaid for five years. So that's why long-term care planning is always guessing five years down the road because if the plan is to qualify for Medicaid, we have to make that gift five years before you go into a nursing home or need long-term care facility and who knows what five years down the road's going to look like. So that's the challenge with Medicaid in the five-year planning.

Matt Adams (11:26):Are there changes, anything coming in the future from that five years that they're looking at trying to change anything on that?

Robert Moore (11:33):So back in, I think it was 2006 or 2007, it went from a three-year lookback period to a five year lookback period. There's talk of it going to seven years, it probably will, but I've not heard that that is anytime soon. But it's likely going to go to seven years, maybe even 10 years.

Matt Adams (11:54):Which just makes the transition planning look and preparing for this that much, I mean when you're looking seven years, I mean that's a pretty good chunk of time on the operation to really start looking for the transition plan.

Robert Moore (12:07):Right. And farmers work hard to accumulate their assets and especially the land, it can be really difficult for some farmers to say, well, I'm just going to give all my land away and wait five years and see if I go into a nursing home. That's really challenging for people. And when I've had clients come in in the past and say, "Hey, I want to do some long-term care planning." And I say, "Well, you're probably going to have to give away all your land." The discussion can turn very quickly to: well what else can I do?

Libby Wixtead (12:45):Yeah, absolutely.

Robert Moore (12:47):So it's another challenge with long-term care. If you own very much land at all, you are not going to be eligible for Medicaid.

Libby Wixtead (12:55):So what other options are out there that farmers can do to plan for long-term care if Medicaid is not an option for them?

Robert Moore (13:05):So there is long-term care insurance, so it's just an insurance policy you buy and when you need long-term care it will pay some or all of those costs. The challenge with long-term care insurance is not everybody's insurable. If you've got some health issues or some preexisting conditions, you may not be insurable. Long-term care does not have to insure over pre-existing conditions as medical insurance does. And then the other thing is the cost. If you wait till you're 70 years old to get long-term care insurance, that's going to be a big chunk of money. So I tell people to start looking at long-term care insurance when they are in their 40s, 50s.

Matt Adams (13:52):Really, that soon?

Robert Moore (13:54):Yeah, to make it affordable.

Matt Adams (13:56):To make it affordable, okay.

Robert Moore (13:56):It gets very costly very quickly.

Libby Wixtead (13:58):So it's kind of similar to life insurance, kind of the sooner you start the better off you are?

Robert Moore (14:03):That's right. Yeah. The lower premiums will be, and there are many different kinds of policies. There are long-term care policies that if you don't use the policy for long-term care, your heirs can get the death benefit in that month, but that amount. So that's become pretty popular because some people were saying, well if I buy long-term care I may never use it. Well if you add on the life insurance component, you can make sure somebody gets to use that money that way. So that seems to be a pretty popular plan. But there are some other strategies as well. Probably for the people I've worked with the most, which are medium to large farms, we kind of take a wait and see approach. If someone has the ability to pay for five years of long-term care, let's say $500,000, whether that's savings, equipment, grain, or whatever it is, the strategy is well let's wait until we know somebody needs long-term care.


(15:09):And if we're sure that somebody's going to need long-term care, we'll gift all the assets except for enough held back to pay for five years of long-term care, then after five years all their assets have been gifted, we've gone past the five year lookback period and all the assets are protected and then they can qualify for Medicaid. So my experience is that's what a lot of farmers like to do, but they've got to make sure they've got five years of something to pay for long-term care.

Matt Adams (15:44):And that five-year, I'm just kind of thinking here, so say if these guys move their farm into an LLC or a corp, does the five-year role kind of still apply from their owner if they still have moved it to kind of a different entity or something like that?

Robert Moore (16:00):So using business entities doesn't really help because it still gets counted as an asset. So it's still going to disqualify you from Medicaid. So there are some advantages, maybe tax wise, liability-wise, but just transferring assets into an entity really does not have an impact on qualifying for Medicaid.

Libby Wixtead (16:22):Are there disadvantages in gifting their equipment or whatever, what disadvantages do they have that might impact them doing that option I guess?

Robert Moore (16:36):So the thing with long-term care, there are no really good perfect options. There's always a negative. If you get long-term care, you're going to have premium payments. On the gifting side of things, if you gift all your land to someone and then that someone gets into financial difficulties or does something with the land you didn't anticipate, that can be very troubling. So on the gifting side, you give up ownership and control and the income from it. So that's why when people come in and say, "Well I want to qualify for Medicaid." And I'm like, "Well then we got to give away all your land." That's why the discussion sometimes turns very quickly. We can use irrevocable trusts, that's where you gift the land away, but it goes into an irrevocable trust which protects it from creditors and poor management and poor money management. So if you want to give the land away but you want to make sure it doesn't get sold or creditors don't force the sale, we can use an irrevocable trust which would hold that land for the beneficiaries, maybe for a lifetime or two lifetimes.


(17:53):So we can still protect it but no matter what, whether we just gift it, use an irrevocable trust, you have to give up ownership and control and that's very important.

Matt Adams (18:05):Yeah, I guess I can see that it is very difficult for some farmers to do, when you hear that giving away basically everything you've worked to build, it's got to be a very tough conversation. Robert, when you are in those tough conversations, that guy kind of like, hey, I want to do something different, or no, I don't want to do something like this. What steps do you take? How do you work with them to help them get to that transition time?

Robert Moore (18:35):So the first step really is seeing what kind of risk is there to long-term care. I mean, if somebody has enough income that they're going to be able to pay the long-term care costs, maybe social security, retirement, land rent, sometimes there's enough income there to pay for long-term care insurance, so we shouldn't be giving all the assets away. So that's really number one, is what kind of income can we expect once you would quit farming and go into a nursing home. And then if there isn't enough income, what are we lacking in income? How big a gap do we have and can we cover that with savings? Can we cover that with crops? If not, then machinery and land come into being at risk.


(19:27):And then that's when the hard discussions begin because most farmers will spend income on long-term care if they need to and they'll spend savings if they have to, maybe machinery. But when it gets to the land, that's kind of off-limits. So we really need to do this analysis of what's long-term care costs versus what income do you have and what other assets are you willing to spend. And once we get there, if the land is still exposed to risk, then we may get pretty aggressive in doing some gifting or an irrevocable trust.

Matt Adams (20:00):And I think that might change, especially with our land prices having increased so much, so we're looking at so much higher net worth on an operation where a couple of years ago, does that kind of get in the back of guys' minds on a tax implication at that point when we start looking at moving around those assets and everything?

Robert Moore (20:17):Yeah, so generally gifting is not the best tax strategy. One, if you make large gifts, then the value of that gift is deducted from the federal estate tax exemption. So gifting assets really doesn't get you ahead on the estate tax issue. The other big issue with gifting is when you inherit an asset, you get a stepped-up tax basis, and the person inheriting that asset can sell it and not pay any tax because there's no gain or they can re-depreciate it if it's a depreciable asset. So generally gifting is not a good tax strategy. Gifting is best done if we're looking at a 40% estate tax or if those assets are definitely at risk of being consumed by long-term care.

Libby Wixtead (21:11):So I guess with that, what can a young farmer do to help this conversation? And especially when they start talking about when you have multi-generational farms and talking about estate planning, what are some things that they can do to protect the farm and help make sure that mom and dad or grandma and grandpa are still going to be taken care of, to help some of these tax implications? I mean, I guess what's the best-case scenario that they could go into? I know there's no perfect scenario.

Robert Moore (21:48):So I would say the first thing is to become educated on what long-term care is, what the costs are, how it works, and then also kind of do an analysis of how exposed is the family, how exposed is the family farm to long-term care cost. And then once you're educated, then maybe go to an attorney that can help do some long-term care. Again, you may have to educate that attorney a bit on how a farm works and kind of the unique aspects of it. But go to an attorney and see if an irrevocable trust is the best thing, if gifting is the best thing, if long-term care insurance is the best thing. But few people know much about Medicaid and long-term care insurance until they have to know because they're about to go into a nursing home. So educate yourself well in advance of when you have to have long-term care so that you can plan accordingly.


(22:50):And I would say we have published a publication, you can find it at and it's a publication that looks at the impacts of long-term care on family farms. So that's where I would start on the education side of things.

Matt Adams (23:09):Robert, you'd also talked about people living longer, costs of everything, of what I'm sure the costs on long-term healthcare went up and will probably continue to go up when you guys start running your numbers and the information out there to help educate people. How often do you guys reevaluate the cost of everything? Is that on a yearly basis you guys kind of look at stuff? Because I'm sure anymore with inflation and everything else, it's probably been pretty hard to keep up with.

Robert Moore (23:36):Right. There's a good survey that comes out, Genworth Financial, which is an insurance company that sells long-term care insurance, puts out a really good survey, I think it's every year on the cost of long-term care in every state. So that's usually where we start on the cost. But I said long-term care or nursing home in Ohio was probably 90,000. That was last year's number. I'll bet it's closer to 100,000 because of inflation now. So as we do our planning, we need to understand it just like anything long-term care costs are going to go up, maybe faster than inflation because it's in the medical field and that can see higher than normal increases in costs. But we need to keep an eye on the cost because that affects our analysis.

Matt Adams (24:28):And I think you talked about long-term healthcare insurance, that that might be a very good product, especially with the increase of the price of stuff all the time that, if you kind of fill the gaps in a little bit for that long term plan for that operation, and like you said, you recommend in your 40s to start really looking at that stuff.

Robert Moore (24:51):Yeah, I mean if you wait till you get in your 60s and 70s, it may not be affordable. And I wonder when lenders will start maybe requiring long-term care insurance along with that term life insurance policy to protect the loans. And I could see it going that way. I don't know if you all have looked into that or not, but I think it's a real risk and that may be a way to help farmers look toward long-term care, which is to maybe have that as a requirement to get a loan.

Matt Adams (25:30):And I think that's something we don't see on our side at the moment, but with the ever-changing environment that we're in, who knows really what's on the horizon. I go back to it's the cost of everything. It's the cost of doing business, the cost of owning that asset, that the better you're protected, and as a lender, the more that we can reassure that that operation are going to be able to sustain us for the long run. It helps on our end a lot, Libby. I know that.

Libby Wixtead (26:01):Yeah, we want your farms to be successful. We want you guys to be successful and we want your farms to go on for generations. That benefits you, and that benefits everyone here sitting at the table.

Matt Adams (26:13):Well Robert, I want to thank you for being on our podcast today. This has been some great information. And you said you guys have, what was your information again if people want to look up stuff that you guys have for long-term healthcare?

Robert Moore (26:27):Yeah, so we just came out with a publication about a month ago. It's called Long-Term Care in the Farm. It talks about everything we've talked about today but in a lot more discussion. And you can find that at It's under the Ag Law library. But I'd encourage you to take a look at that and make that your first step in your long-term care planning.

Matt Adams (26:53):And we'll be sure to put that in our show notes for everyone to be able to look up.

Libby Wixtead (26:59):And they have in their ag law section, they have a lot of good information in there that I would encourage everybody to go in and look at. They even have a blog, I get their blog emails all the time, and as I said, there's a lot of good information in there. And I do want to give a plug for Robert, their office, or the law office that he is a part of. They have done fantastic work for a lot of our farmers in the estate planning and succession planning piece of it. And even for my husband and I, they've done a great job. So they are a great resource and they're located in Delaware. And you guys have another location too, right?

Robert Moore (27:41):There is an office in Celina now too.

Libby Wixtead (27:43):Yes. So they have expanded a little bit across the state. So if you guys are looking for a succession planning attorney, look at the Wright & Moore office. They're a great resource as well.

Matt Adams (27:56):Referred by Libby herself.

Libby Wixtead (27:57):Hey, I tell everybody because we've had such a great experience working with their office.

Matt Adams (28:04):Well, thank you everyone for being part of the podcast today. If you want more information on anything, be sure to contact your local AgCredit office or look us up on I'm Matt here with Libby and we will catch you on the next episode of AgCredit Said It.

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