I was recently told by a person on the Medicaid hotline that as of August 1, there is no more spend down for Medicaid.

Anything that was told to you on a Medicaid Hotline needs to be confirmed by a reliable source and in writing. Same if you call Medicare. imo.

my understanding was that they can take stuff that is not in trust.

Talked to elder law attorney regarding qualified income trusts, special needs trusts, personal service contract and income producing real estate all in an effort to get some help with LTC cost. Then last night read about the Medicaid Recovery that igloo mentioned above. Dad's condo is exempt from Medicaid qualification, but then after he dies, Medicaid can take it! What??!! Can they also take what was paid by a personal service contract? Or any money salvaged from the real estate investment?

No, Stacey, you didn't make it all about you. Your questions about the
process, how it is done will help others. It is how things work on this great forum.

I have read, when dH was put on disability, and, as rep-payee, his funds could be used to fix up his space and repair anything he damages. No one said there would never be enough money for that.

Sorry guy's, I guess I made this all about me, didn't I.

Thanks Igloo! So then, HOW LONG BEFORE he's depleated his savings on his NH monthly payments, does he apply for Medicaid, and do you then establish this Miller's Trust at the same time? As I assume that his monies Will run out within 2 years or so. Also, In this 2 years, while he's living there in the NH and paying cash, is it still OK to use his money towards any denture needs, pre-paid funeral plans, heck, the occasional weekend getaway, clothes, shoes, and expensive meals out, what have you, without penalty, as it is still his money, right?
And, if he is established in a Nursing home for 2 years, and then WILL run out of sufficient money to cover his monthly rent payment, and must go onto Medicaid to supplement the overages, could the NH kick him out?

I'm not sure what is the best thing to do, as hubby and I are pretty much done as caregivers after 13 years, FIL's decline, and our own personal mental burnout and physical decline, and we are still relatively young, have our Kids and Grandchildren to enjoy, and want to live (some) our own lives/retirementbefore it's too late. I mean, do we feel bad because we made the Old Man's life comfortable and cozy in our home for the past 13 years, and get on with our life, or do we use his money to get him a little senior apartment with lots of additional help, ie: care aides and such, a then risk moving him again, whe something bad happens to him? If he's gonna end up on Medicaid at some point anyways? Its all so confusing as he gets weaker, and more frail, but we are prisoners to his frailties.

We want to sell our home as it is too much for my husband to manage anymore, he's in his 60's with a bad back too, and we want to simplify, buy a little Condo, and travel as much as we can, while we still can. I just don't know what to do without one of us feeling bad about the situation! Guilt is a terrible thing! But then again, why am I even feeling guilty, for thinking about our own happiness?

Ruthie - its a 5 year look back. 60 months.
Actually states can go back even more but it would be unwieldy to do.

In 2005, Bush signed in DRA (deficit reduction act) that basically required the states to make "at need" programs that get federal matching $$ more uniform. 5 year look back became the standard. One big item from DRA was the requirement for assets that extend into death to have a Medicaid compliant requirement. So annuities to be ok for Medicaid have to be compliant & have state as beneficiary. If they die owning a home, the home although an exempt asset during thier lifetime becomes a nonexempt asset of thier estate and state is required to attempt a recovery of the asset which is the value of the home from heirs - this is called MERP /Medicaid estate recovery program. Also under DRA the penalty for transferring assets is now done by a uniform formula by the states.

States as they administer Medicaid have some latitude in all this but have to do whatever within the overall federal guidelines. Like some states can move the 5 yr look back to 3 years IF the elder has been in a facility as private pay for 2 or more years prior. This was the case for my mom, she had a 3yr & 6 mo look back on her bank statements as she was private pay in lL before the NH. But nevertheless, I had to provide an on bank letterhead with bank officers signature the disposition of any & all accounts closed within 5 years. All moms CDs, etc were not rolled over but as they expired went into her checking account; if it hadn't been done this way, and sme were just cashed out, I'm pretty sure I would have had to have dealt with a transfer penalty inquiry by Medicaid on my moms application. Applying for Medicaid really allows for an all-access pass to their financial history.

Elderly Medicaid costs to state's are real budget busters. Many states are now going into after death recovery from things - like Life Estates - which were sancroscant and done to pass outside of probate and so in theory outside of MERP. But not so anymore.

Really your folks would have to move all assets this month and not apply for Medicaid till September, 2021 to be beyond the look-back.

Although I've lost my crystal ball, my take is that the eligibility process for NH medicaid will get even more rigorous. Especially for qualifying to be "at need" medically as states can come up with a pretty exacting list of health issues to qualify.

Trusts are not necessarily the solution......whatever is done (trusts, SPIA, etc.) has to be fully Medicaid compliant &/or done 5+ years ago .....and that is rare.

IF widow moved that 300k in her savings to a trust, or an annuity, cashed in her life insurance, got house appraised and then sold FMV to favorite nephew, gifted her car & extra $$$ & everything totally done back in July, 2011 and have spent down the rest of her $ only on her care, & her needs so now August, 2016 she is down to 2k assets and under $ 2,199 in monthly income maximum each month in the bank then all is ok.

But the reality is that Maw refused to deal with assets, or move from her old years of delayed maintenance house and went & broke her hip walking that cur of a dog, did NO planning prior to July, 2011 so she isn't eligible for Medicaid as she isn't "at need". There is no shortcut.

Miller is pretty fabulous, but needs to be done before the Medicaid application as it needs to be in place so she never is over the monthly income limit from day 1. Miller either requires the overage paid each mo to the NH or build into a state controlled miller trust that has state as the beneficiary. Other trusts, like special needs trusts, will need to be medicaid compliant & that means that if maw does a SnT and there are funds in the SNT after she dies that the beneficiary of the trust is the state. No $ to heirs.

To me, for widow or widower Medicaid application, there isn't any gray areas to be creative with their $ unless they have planned ages ago. Really if they live long enough that they just flat run out of $ to become "at need" & qualify for Medicaid.

StaceyB - I'm pretty sure the miller paperwork should be done & waiting to be put into play right in tandem with the NH Medicaid application. It's not a DIY project as it needs to be drawn up to be flexible so if SS goes up due to a COLA it adjusts seamlessly with no legal issues.

Ruthie, maybe in CA. In a less progressive state like Texas, putting assets into a trust less than 5 years before Medicaid looks like "gifting" since as you put it the heirs can get part of the trust assets. Putting income into a trust that does not give back to the state (i.e. Miller trust) means that EVERYONE would be putting their income into trusts and no one would ever pay nursing homes. The assets and income works for IRS planning (because the trust pays taxes), but it does not always work for Medicaid planning and benefits from the state.

I went to an estate planning workshop where this lawyer said to essentially put basically everything except the car into a trust, because then everything "supports" the senior, and their heirs", there is no spend down at that point, because the trust has it's own "SSN" the seniors income is 0 their assets are 0, but they are still the trustee until they stipulate that they are not...death, incapacity, just because....it's their deal...the purpose is for estate planning....the side effect is that since there is no income or assets they qualify for medicaid. some states have a 30 month look back period. Check with an estate lawyer. But that's what I heard from an estate lawyer, in CA in an estate planning workshop.

Medicaid is a PIA -- before, during, and after. I hope that I'll be able to avoid it forever, but you never know.

So right now, my FIL makes like 10 dollars over the monthly limit, so does this mean to start this Miller's Trust now, while he still has his other assets like savings, life insurance and CD's, or wait until he has paid out all of his excess assets, on Assisted living or Nursing home costs, and Then establish a Miller's Trust, for the ten dollars a month once all of his assets are depleated? That seems so silly, and what if there are SS cost of living in reases in the new year. Then everybody who is right on the cusp will have to make adjustments to their Miller's Trust each year? What if you want to establish your LO in the Nursing Home, and walk away because you are flat out Burnt Out, Lol! Just kidding! What a PITA!

Just checked and saw that monthly spend-down in states that allow it has to be on medical bills not covered by Medicaid. Only certain people qualify to do this. It includes people over 65.

guestshopadmin mentioned what has to be done when income is too much to qualify for Medicaid, but too little to pay for NH care -- a Miller trust to deposit extra cash in each payday. From what I understand, the money in the trust is paid to the state and lets people keep their assets from being too high for assistance.

This is interesting. Is this saying if your income is 2200 and you only have assets of $1,999.00 you can not get Medicaid and you end up old and homeless? This is not good at all.

So what happens if the resident's income exceeds 2199/ month? How is long term care paid for?

It has to do with both. You have asset limits and income limits.

What's confusing to me is that SPEND DOWN doesn't have to do with INCOME, it has to do with ASSETS, doesn't it? Where's IGGY?

Found article from February 2016 in an elder law journal that has had accurate useful info for me in past. The August date relates to actually implementing the income cap in certain states (Ohio will be added to the list below on 8-1-16) for the 2016-2017 budget.
"...But some states set a hard limit on the income permissible to qualify for Medicaid -- no spend-down is allowed. In these states, known as "income cap" states, eligibility for Medicaid benefits is barred if the nursing home resident's income exceeds $2,199 a month (for 2016), unless the excess income above this amount is paid into a "(d)(4)(B)" or "Miller" trust. If you live in an income cap state and require more information on such trusts, consult an elder law specialist in your state. The income cap states as of this writing are: Alabama, Alaska, Arizona, Arkansas, Colorado, Delaware, Florida, Georgia, Idaho, Iowa, Kentucky, Louisiana, Mississippi, Nevada, New Mexico, New Jersey, Oklahoma, Oregon, South Carolina, South Dakota, Tennessee, Texas, and Wyoming."

Hmmm - on the one hand, forcing seniors to spend what little money that have in an almost frantic manner in order to qualify has never made much sense. On the other hand, this is the government... But if there is any truth to this, I imagine there's more to it. It makes no sense that a person could hang on to a large sum of money and recieve full assistance. But back to that other hand...

I have read on-line that this is true for certain states.

I hadn't heard this. Medicaid is a state run progam so this would vary by state. The only information I can see online is that Ohio is preparing to end the spend down (I don't live in Ohio). This could mean that people who are using this method to qualify/stay qualified for medicaid no longer will be able to. Scary for those already using this method.

Angel