Concerns about paying for assisted living.

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I am paying for my parent to live in assistant living facility. If my parent goes into a nursing home will I be able to get my money back before ss takes the assetts inthe house


Hi, dberryjr ... I assume by "ss" you mean Medicaid? I am not a lawyer and have no (yet) personal experience dealing directly with Medicaid, but I've tried to research Medicaid requirements both in my state and the state where my father lives ... and my strong suspicion is that the answer to your question is "no." :-(

As I understand it, Medicaid does not "count" the house in determining whether a patient is asset-eligible for Medicaid ... as long as the patient "wants/intends" someday to move back into the house (even if you know this will never be possible) ... but as your question implies you already know, when the patient passes away, some state Medicaid programs can then take the house (or force its sale and take as much of the resulting proceeds as are needed to go toward the money the state has spent on the patient's behalf while alive).

Some Medicaid programs make a distinction if the house is being lived in (and has been lived in for some time) by a caregiver so that it is also arguably the caregiver's only residence ... or if an adult disabled child lives there ... or etc. I don't know if you live in the same state (or same house) as your parent, but you'd need to research the specific requirements in your state to find out if it would claim the house and reclaim monies spent after your parent passed away.

If the house is your parent's only "real" asset, he or she may already qualify for Medicaid assistance in your state. I would strongly suggest talking to a knowledgeable Mediaid attorney (by which, I mean an attorney expert in Medicaid, not a representative of Medicaid itself) about your situation and finding out what makes the most sense financially for you and your parent in the long run.

I'm guessing that one option would be to sell the house now and pay for your parent's care with the proceeds until they run out ... then apply for Medicaid for him or her, and use your personal funds to "supplement" the lifestyle of the Medicaid patient to be more comfortable than basic Medicaid can support. You'd still be paying out money from your own funds, but probably nowhere near what you're paying by picking up the entire bill for assisted living. This approach is not a "protect your parent's assets" approach so much as a "preserve your own assets" approach.

Again, I recommend talking to an attorney expert in Medicaid -- and again, I strongly suggest that you NOT rely on representatives from Medicaid to give you the information you need -- all state programs are, like everyone else in this economy, hurting financially, and they will not be inclined to show you the way to save your money.

Good luck, and stay tuned ... maybe someone on this board will have more direct experience/knowledge to answer your question definitively than I ... but if not, I really think it's worth spending a tiny bit of money (comparatively) to talk to someone knowledgeable in this area.
Do you have a contract promising reimbursement of your expenses upon sale of the house (or some other event)?

I think that you should see an attorney who specializes in Elder Law as soon as possible and find out what you can do to get the situation set up to be most advantageous to both your parent and you, before applying for Medicaid.
With Medicare Advantage, no monthly premiums/payments, why does one need Medicaid?
Medicare covers doctor visits, hospitalizations, drug. It covers some rehab, and some medical equipment such as wheelchairs. It does not cover in-home care on an ongoing basis. It does not cover residential care such as nursing homes.

Medicare is awesome and I am glad to have it. (I pay a monthly premium for it.) And I am sincerely thankful that it is all I need right now. But if I become incapacitated and need in-home care or a care center, then after I've used up all my own resources (which wouldn't take long) then I'd be grateful that Medicaid was available for me. I hope it never comes to that, but who knows what lies ahead?

Also, Medicare is only available to us old folks. But younger people who become disabled (as one of my brothers has) are often without any insurance or the ability to qualify for it and pay for it. Medicaid is available to them, too.
Medadvantage does not come with no monthly premiums for everyone (or probably even most people). I don't pretend to know all the details of how this works, but I'd guess that if you are (or a parent or friend is) a member of a Medadvantage plan and NOT paying monthly premiums, it is possible you may either be receiving a form of Medicaid or perhaps be having your premium paid for you by a former employer as part of your retirement or pension agreement with that company? My Dad is on a Medadvantage plan, for which he paid about $80/month last year (along with $35 per-visit copays) ... and the plan was very overpriced at that, as we rapidly discovered that there were very few doctors in the plan's "network" that were actually willing to take new Medicare patients. I have done what I can to get him switched back to "traditional" Medicare with a supplement policy this next year ... we'll still have to deal with the fact that few doctors in rural sourthern Oregon want to take on Medicare patients, but at least we'll have a bigger pool to choose from.

And yes, the issue is that Medicare (whether Medadvantage or traditional Medicare + a supplemental insurance policy and part D plan) does not cover long-term care. A person with a dementia condition (such as Alzheimer's or FTD) can live 8 to 20 years after diagnosis, and will need continuing and increasing monitoring during that time ... eventually requiring facility care, which is extremely expensive for dementia/memory care patients ($6,000 - $9,000/month, depending on where you live in the country). Most people cannot sustain ongoing charges like that indefinitely without depleting their savings and having to go on government assistance (Medicaid). The situation gets even uglier when one member of a married couple needs the care, but the other will also need to "hang onto" some amount of their mutual nest egg to plan for his or her own eventual medical care (not to mention living costs). There are legal ways to plan for and manage this financial quagmire, but it's best to talk to an elder-law attorney experienced with Medicaid to make sure you don't inadvertently hurt yourself financially (for example, by applying for Medicaid too soon).
Previously I had Medicare ( premiums taken out of the S.S. check every month).
Along with that, I had Supplemental Plan F ( the most expensive supplemental plan with premiums of $187.13 - $200.00 per month. I rarely went to the doctor, and finally decided upon Medicare Advantage. No monthly premiums, only the ordinary subtraction for belonging to Medicare taken out of my S.S. check each month. Yes, the co-pay is about $35.00 when you do go to the doctor, and who knows what the expense would be for hospitalization. Medicare Advantage also includes Part D. It's all that I need right now. How 'bout others out there? Why Medicaid ( a state/federal program that demands a payback) ?
dberry - in order to be paid by your parents, you need to have a legally drawn up "personal services contract" in place in order for any $ paid from them to you NOT to be considered to be a possible "transfer penalty" if they apply for Medicaid. But by doing a contract, it needs to be done totally business like, with a 1099 to you and you include it as taxable income. Otherwise whatever you spend on them is considered normal love & concern care and expenses.If you spend enough on them, you might be able to have them as a dependent on your taxes though.

about the house, SS does NOT take the assets out of the house. If your parents apply for Medicaid to pay for their NH care and meet the criteria both financially and medically for Medicaid and they have a house.....then the state through MERP (Medicaid Estate Recovery Program) can place a claim or a lein on their home to recover the expenses the state paid for their care via Medicaid. MERP is required in order for a state to participate in Medicaid. Whether or not, MERP is done on your parents property depends on alot of things. If your state is a "level of claim" probate state, MERP rates are low. For example, for TX MERP is a class 7 claim in probate so there are 6 other classes ahead to get paid, so it's low in TX. OTher states have an equal claim probate system, so MERP rates are higher. Other states have it as an automatic lein on the property, so you have to deal with MERP in order to transfer ownership. State law is mucho importante when it comes to MERP. All states have MERP exclusions, like if you lived at the home for at least 2 years prior to the elders going into the NH and your care kept them from going into a NH and on Medicaid for those full 2 years. BUt you have to show you could have provided the care. If the house is empty, you or whomever pays the expenses on the empty home (taxes, insurance, yard work,etc) can let MERP know they will file a claim against the estate for those costs and those costs are deducted from the MERP tally. If you have a low value home and exemptions, then MERP may not view going through the probate court process as worthwhile so MERP does a release of claim on the property. MERP is really just kicking into gear maybe the past couple of years in most states, so it should be interesting to see how aggressive states do MERP.
N1 - Noreen, I think the thought behind MedicAID is that it is a needs based program and so in order to get any benefit you need to be at need. So when they are alive that is kinda limited to 2K each for both assets and income. Basically impoverished, but they can have a car and a house as an exempt asset. Those have been exempt assets since Medicaid was started. Once they die, that exemption dies with them and the house is non-exempt. So any proceeds from the sale of the house or value of the transfer of the house, has to be paid to the state to recover some of the states cost to provide for NH care via the Medicaid program in order for the Medicaid/MERP claim or lein on the house to be released.

Personally I think the house & car exempt rules will change for Medicaid within the next few years. Like the exemption will be good for 2 or 3 years as opposed to the NH residents lifetime. Medicaid came about when the most died in their 80's and now the % of nonagenarians has doubled? tripled? Also MERP came about in the early 2000's and about the same time real estate just boomed and you know the mindset was that real estate value would only go up & up. So MERP made perfect sense as grannies bought in 1960 for 25K house could be worth 300K and $$ for everybody from family members to the state Medicaid program when grannie died.
So much for that bubble bursting. I think qualifying for Medicaid is going to be lots more difficult in the next couple of years as more transfer penalty found out.
N1K2R3, I think you might be mixing up apples with oranges. :-) No one chooses Medicaid instead of Medicare/Medadvantage for ordinary health care like you're describing -- i.e., going to the doctor or paying for prescription drugs -- and I don't think anyone is suggesting that Medicaid is "better" than a regular Medicare or Medadvantage plan.

On this board, when people talk about applying for Medicaid, it is typically because they (or the person they are caretaking) has either already run out of the personal funds necessary to pay for the long-term care they require, or will likely do so within a forseeable period of time. Medicare/Medadvantage has nothing to do with this. Medicare/Medadvantage DOES NOT PAY for nursing home, assisted living, or dementia/memory care facilities. This type of long-term care is very expensive, and most people with dementia will need it -- many of them for many years. For most people in this position, their life savings will be depleted after a few months of years of such care, and then they will no longer be able to pay for it themselves, and will have to apply for government assistance (i.e., Medicaid).

It's not a matter of "choosing" Medicaid over Medicare or Medadvantage. It's a matter of running out of money to pay for the care you need and THEN having to apply for Medicaid for assistance.

For a person to qualify for Medicaid coverage of long-term care, the government basically requires that you have no assets, as (somewhat reasonably), the government doesn't want to pay for your care until you have used up all your money paying for it yourself. This is upsetting to a parent who wants to leave a money or house to his or her children ... or to a couple wherein one spouse requires expensive long-term care now, but the other spouse will need some of those same assets to continue to live on. For this reason, there is a continuing "arms race" between the government and people wanting to have their long-term care subsidized by Medicaid without having to blow through all of their assets first. The government now has a 5-year "lookback" policy where if you apply for Medicaid and appear on the surface to meet the needs qualifications, they can dig through your financial records for the last five years to satisfy themselves that you haven't simply given your money away (for example, to your children) over that period of time ... and penalize you if you have, by delaying the time they will start paying for your care according to a formula based on the average cost of facility care in your state. (For example, if you gave away $10K to your kid and long-term care in your state costs $5K a month, they will delay commencement of your Medicaid benefits for two months, and so on.)

The "house" issue raised by the original poster arises because when the government "needs-tests" a Medicaid applicant, most states will exempt the home and car from the list of assets that must be sold and "spent down" before a person can apply for Medicaid ... because arguably, the person may still need that home and car while alive. But the government want to ensure that this doesn't mean that people simply shield a large chunk of their assets by going and buying a house of the maximum allowable home-exemption value (which varies by state). So many states have solved this "problem" by dictating that the person for whom they are paying Medicaid benefits can keep the house as long as he or she is alive, but that when he or she dies, the asset must be sold and the state reimbursed for as much of the care it paid for as the proceeds will cover. Only the remainder (if anything is left) will go to the person's beneficiaries as inheritance.
It sounds like Paula said it in a nut shell-it is complicated and you really need an elder lawyer to help with the application-medicaide has to make sure you did not hide or give away monies to avoid paying to medicaide-many whealthy people did do that in the past so the system guards against it now.

Keep the conversation going (or start a new one)

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