Nursing Home/Medicaid issues

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spartanap
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Nursing Home/Medicaid issues

Post by spartanap » Sun Sep 23, 2018 2:58 pm

My father-in-law recently moved my mother-in-law into a memory care home. My father-in-law is now wanting to give money to family members as well as sell their house. I've told him that these actions could have an impact on my MIL's Medicaid qualifications. We've tried to convince him to consult an elder law attorney but he doesn't want to. He feels he has the money/insurance to pay for his wife's care and my wife and I agree with this sentiment. Our concern is the impact that the money gift and house sale might have on the money he deserves (and may need) as the community spouse. Any advice on his matter would be appreciated.

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Watty
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Re: Nursing Home/Medicaid issues

Post by Watty » Sun Sep 23, 2018 3:02 pm

If he won't see an elder law attorney then get as much information as you can then see one without him. Tell him you are doing this and he might begrudgingly go with you.

Selling the house could be exactly the wrong thing to do unless he has other reasons to sell it, which is very possible.

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arcticpineapplecorp.
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Re: Nursing Home/Medicaid issues

Post by arcticpineapplecorp. » Sun Sep 23, 2018 5:18 pm

spartanap wrote:
Sun Sep 23, 2018 2:58 pm
My father-in-law recently moved my mother-in-law into a memory care home. My father-in-law is now wanting to give money to family members as well as sell their house. I've told him that these actions could have an impact on my MIL's Medicaid qualifications. We've tried to convince him to consult an elder law attorney but he doesn't want to. He feels he has the money/insurance to pay for his wife's care and my wife and I agree with this sentiment. Our concern is the impact that the money gift and house sale might have on the money he deserves (and may need) as the community spouse.
If you feel he has enough to cover his wife's care then there would be no need for medicaid, so it appears the gifting with respect to your MIL's eligibility is moot.

However, does he have enough to not only cover her care but also his own? Because if he gifts money and then needs care for himself (not MIL) within 5 years than he could be creating a problem (period of ineligibility for medicaid for himself). Have you/he considered this?

When you say "he has the money/insurance to pay for his wife's care..." are you saying they have long term care insurance? Because medicare and most supplemental insurance does not cover memory care/skilled care, unless it is for rehab/short term within 180 days or less. So why does he believe the "insurance" would cover monetarily the MIL's needs? Yes it would cover prescriptions/doctors, etc, but not the largest portion of the cost of skilled care, which is room and board (often several hundred dollars a day or over $100,000 a year to pay privately).

Why doesn't he want to consult with an elder law attorney? Is it the cost?
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spartanap
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Re: Nursing Home/Medicaid issues

Post by spartanap » Sun Sep 23, 2018 7:46 pm

arcticpineapplecorp. wrote:
Sun Sep 23, 2018 5:18 pm
spartanap wrote:
Sun Sep 23, 2018 2:58 pm
My father-in-law recently moved my mother-in-law into a memory care home. My father-in-law is now wanting to give money to family members as well as sell their house. I've told him that these actions could have an impact on my MIL's Medicaid qualifications. We've tried to convince him to consult an elder law attorney but he doesn't want to. He feels he has the money/insurance to pay for his wife's care and my wife and I agree with this sentiment. Our concern is the impact that the money gift and house sale might have on the money he deserves (and may need) as the community spouse.
If you feel he has enough to cover his wife's care then there would be no need for medicaid, so it appears the gifting with respect to your MIL's eligibility is moot.

However, does he have enough to not only cover her care but also his own? Because if he gifts money and then needs care for himself (not MIL) within 5 years than he could be creating a problem (period of ineligibility for medicaid for himself). Have you/he considered this?

When you say "he has the money/insurance to pay for his wife's care..." are you saying they have long term care insurance? Because medicare and most supplemental insurance does not cover memory care/skilled care, unless it is for rehab/short term within 180 days or less. So why does he believe the "insurance" would cover monetarily the MIL's needs? Yes it would cover prescriptions/doctors, etc, but not the largest portion of the cost of skilled care, which is room and board (often several hundred dollars a day or over $100,000 a year to pay privately).

Why doesn't he want to consult with an elder law attorney? Is it the cost?
Some clarification. My MiL (83) has LTC insurance that will cover about 50% of the cost for three years. My FiL (82) does not have insurance. I think he feels that by selling the house, along with their savings, he can provide for her care for quite some time. It's my understanding that he is entitled to keep a portion of their savings at which time she could be covered by Medicaid. I'm worried that he may gift a good portion of their savings which could impact his right to this community spouse money. As for why he doesn't want to meet with the attorney. He doesn't really say. The attorney is asking for a lot of information and he may not want the hassle. I think he also feels that he isn't going to live much longer so he doesn't see the point.

DC3509
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Re: Nursing Home/Medicaid issues

Post by DC3509 » Sun Sep 23, 2018 10:00 pm

spartanap wrote:
Sun Sep 23, 2018 7:46 pm
arcticpineapplecorp. wrote:
Sun Sep 23, 2018 5:18 pm
spartanap wrote:
Sun Sep 23, 2018 2:58 pm
My father-in-law recently moved my mother-in-law into a memory care home. My father-in-law is now wanting to give money to family members as well as sell their house. I've told him that these actions could have an impact on my MIL's Medicaid qualifications. We've tried to convince him to consult an elder law attorney but he doesn't want to. He feels he has the money/insurance to pay for his wife's care and my wife and I agree with this sentiment. Our concern is the impact that the money gift and house sale might have on the money he deserves (and may need) as the community spouse.
If you feel he has enough to cover his wife's care then there would be no need for medicaid, so it appears the gifting with respect to your MIL's eligibility is moot.

However, does he have enough to not only cover her care but also his own? Because if he gifts money and then needs care for himself (not MIL) within 5 years than he could be creating a problem (period of ineligibility for medicaid for himself). Have you/he considered this?

When you say "he has the money/insurance to pay for his wife's care..." are you saying they have long term care insurance? Because medicare and most supplemental insurance does not cover memory care/skilled care, unless it is for rehab/short term within 180 days or less. So why does he believe the "insurance" would cover monetarily the MIL's needs? Yes it would cover prescriptions/doctors, etc, but not the largest portion of the cost of skilled care, which is room and board (often several hundred dollars a day or over $100,000 a year to pay privately).

Why doesn't he want to consult with an elder law attorney? Is it the cost?
Some clarification. My MiL (83) has LTC insurance that will cover about 50% of the cost for three years. My FiL (82) does not have insurance. I think he feels that by selling the house, along with their savings, he can provide for her care for quite some time. It's my understanding that he is entitled to keep a portion of their savings at which time she could be covered by Medicaid. I'm worried that he may gift a good portion of their savings which could impact his right to this community spouse money. As for why he doesn't want to meet with the attorney. He doesn't really say. The attorney is asking for a lot of information and he may not want the hassle. I think he also feels that he isn't going to live much longer so he doesn't see the point.
He should absolutely consult with an elder law attorney. From what you have said, he really has no idea what he is doing. The rules in this area are extremely complicated. The worst case scenario though is that Medicaid could come after whatever assets he had including the items that were gifted. So you as the heirs would just get nothing. I would not spend any money he gifts right now either.

WhyNotUs
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Re: Nursing Home/Medicaid issues

Post by WhyNotUs » Sun Sep 23, 2018 10:42 pm

Presumably, your FIL has a person who will serve as their Power of Attorney. That suggests that person is someone who they trust and respect. I would talk to that person and see if they can speak with FIL to try to help him navigate good decisions. Obviously a scary time and a lot of change for someone that age to process. A trusted voice might be effective.
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kaudrey
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Re: Nursing Home/Medicaid issues

Post by kaudrey » Mon Sep 24, 2018 8:12 am

Google "Medicaid lookback", and you will get this:

A Medicaid applicant is penalized if assets (money, homes, cars, artwork, etc.) were gifted, transferred, given away, or sold for less than the fair market value. Even payments to a caregiver can be found in violation of the look-back period if done informally, meaning no written agreement has been made. Please note, asset transfers by the applicant’s spouse can also affect the applicant and can result in a Medicaid penalty period for the applicant. The reason for this penalty period is that these assets could have been used to help cover the cost of long-term care, had they not been gifted or transferred.

In 49 of the 50 states, the length of the look back period is 5 years (60 months). As of 2018, the one exception to this rule is California, which has a 2.5 year (30 month) look back period. The look back period begins the date that one applies for Medicaid. For instance, if an elderly individual completes an application for Medicaid on July 15, 2017, then the look back period begins on that date and goes back 5 years to July 15, 2012

clydewolf
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Re: Nursing Home/Medicaid issues

Post by clydewolf » Mon Sep 24, 2018 9:20 am

Maybe he would talk with a counselor at the local Office for The Aging. This just requires an appointment. Other than time it is at no cost to him.

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arcticpineapplecorp.
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Re: Nursing Home/Medicaid issues

Post by arcticpineapplecorp. » Mon Sep 24, 2018 9:23 am

clydewolf wrote:
Mon Sep 24, 2018 9:20 am
Maybe he would talk with a counselor at the local Office for The Aging. This just requires an appointment. Other than time it is at no cost to him.
They won't know the ins and outs of medicaid policy so that won't help with the gifting. An elder law attorney would assist in the correct gifting according to medicaid policy.
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arcticpineapplecorp.
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Re: Nursing Home/Medicaid issues

Post by arcticpineapplecorp. » Mon Sep 24, 2018 9:28 am

spartanap wrote:
Sun Sep 23, 2018 7:46 pm
Some clarification. My MiL (83) has LTC insurance that will cover about 50% of the cost for three years. My FiL (82) does not have insurance. I think he feels that by selling the house, along with their savings, he can provide for her care for quite some time. It's my understanding that he is entitled to keep a portion of their savings at which time she could be covered by Medicaid. I'm worried that he may gift a good portion of their savings which could impact his right to this community spouse money. As for why he doesn't want to meet with the attorney. He doesn't really say. The attorney is asking for a lot of information and he may not want the hassle. I think he also feels that he isn't going to live much longer so he doesn't see the point.
you're confusing a couple of issues. The spousal protected share has nothing to do with issues of gifting. Just because he's entitled to a spousal protected share (generally half the value of the total countable resources as of the date of admission of MIL to skilled nursing, up to a maximum amount allowed by medicaid) doesn't mean he can gift her portion or his (either half) to others. If an amount of gifting exceeds an amount allowable per state or was done for the purposes of qualifying for medicaid, this could become an issue of qualifying for medicaid to pay the room and board portion.

The gifting doesn't "impact his right to the community spouse money" but he could wind up having to spend his protected share (or part of it) to cover a penalty period imposed by medicaid (on the MIL) to cover any gifting that occurred during the lookback period.

It's complicated which is why it's advisable to consult with an elder law attorney when considering gifting assets if there's a potential for needing medicaid. It may cost a few thousand dollars, but it could save a lot of money (and headaches/heartaches) later on. Your FIL shouldn't be penny wise and pound foolish.
"Invest we must." -- Jack Bogle | “The purpose of investing is not to simply optimise returns and make yourself rich. The purpose is not to die poor.” -- William Bernstein

Thegame14
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Re: Nursing Home/Medicaid issues

Post by Thegame14 » Mon Sep 24, 2018 1:22 pm

there is a 5 year lockback for all assets for medicaid

When you apply for Medicaid, any gifts or transfers of assets made within five years (60 months) of the date of application are subject to penalties. Any gifts or transfers of assets made greater than 5 years of the date of application are not subject to penalties.

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