My Mom just qualified for Medicaid to pay for a Home Attendant. Using "Pooled Trust" method. Any advice?

Well the state in Question is New York State , however thank you all near and far. Mum's house is long-since paid for and not in her name anymore, by the ways...Thank you for the "lady bird" clarification, lol

.... hit post comment too soon.
If there is a spouse living in the home, they should get a diversion of the nh residents monthly income as their CSRA or MMNA. But if family is living in the home - even if they were caregivers before the move to the nh - they will have to pay for all costs on the home. But they can try to get the caregiver exemption to MERP's claim or lien.

Some states have it in their administrative code such that normal costs of maintaining the empty home are exclusions to MERP's claim or lein.

Not all states require that the NH Medicaid resident old home get sold. Some do and some don't. Some states do a "Right of rReturn" statement in the Medicaid application or renewal and as long as that's done, they continue to own the home.

Now paying for the costs on the home....well that falls to family to pay for everything for as long as they are in the facility and on Medicaid.

Amada - Medicaid is an "at need" entitlement and you have to be at need both financially & medically. Basically financially your impoverished - for TX it's 2k in assets and $ 2,163 in income allowed. A home & a car are exempt assets. Once they die these become non exempt assets for MERP (Medicaid estate recovery) and subject to a Class 7 claim for Texas probate. There are all sorts of exemptions and exclusions to MERP and class 1 - 6 claims for probate as well.

Lady bird deeds are a way to transfer a home after death outside of probate. BTW it has nothing to do with lady bird johnson either. LBD 's are done in only 5 or 6 states. They have to be written just right to be valid. Not a DIY project IMHO.

One issue with keeping an elders home whether your planning on using the ladybird deed to avoid probate or not, is that once they go onto Medicaid, they have to do a copay of all their income to the facility. They have no $ anymore. All costs on the home - taxes, insurance, maintenance,etc - will have to be paid for by family from now till their death and the through probate or after death legal process. Elder could live another 6 mos or 6 years and you better be able to pay for everything house for whatever time frame. It's kinda like having a 2nd or 3rd home but without any guarantee of ownership so runs a risk. Most cannot afford a 2nd home or like risk, so the house gets sold.

What is Lady Bird? I know she was Predident Johnson's wife...

What about Lady Bird Deed?

Also, with pooled income trusts that excess money will go back to Medicaid when the beneficiary dies.

Hi,

I can explain the acronyms at another time. But, to the other question. Yes, Medicaid is mandated to recover assets only if that person becomes permanently institutionalized, such as, permanent nursing home placement. After the beneficiary dies any property or accounts in her name can be subject to recovery but if these are joint accounts this does not apply. Always speak with an elder lawyer before placing a parent into long term institutional care.

Nugent: I have to decipher your acronyms in order to answer, so stand by. Thanks!

Question: These people that go on Medicaid, won't their family have to pay Medicaid back after they pass away? I had understood that if you receive Medicaid while you are living, when you pass away Medicaid will make a claim for repayment from the assets you leave behind. This is in Texas. Also I have heard there is an agreement named Lady Bird Deed that will help with this.

Hi,

I'm a RN who works in long term care. Yes, a pooled income trust is a way for a Medicaid benificiary to still use their income and receive long term care at the same time. As stated before, if anybody makes over 809 a month they will not qualify for Medicaid, because Medicaid is based on income unlike Medicare which is awarded to people who have worked at least 10 years and reach 65, develop chronic renal failure or are on disability for two years. Through what program is your mom receiving long term care? Is she in a MLTC, MAP, PACE, a waiver program or is coming directly from your local county? Thanks

My mother is in a "pooled" or community trust. Each month I write a check for $627.00 and mail that along with the deposit slip to the trust. I then fill out disbursement forms for the bills to be paid from the trust. I also make a copy of the bill. You can either fax the copies of the bills and disbursement forms to the trust, or mail them. It takes about 2 weeks for the trust to process the bills. There is a fee for the trust the same as a bank fee. Also, the trust will send you a statement each month. You should sign up as well, so that this a joint trust account. This will help in the event of your mother being unable to fill out the forms. My mother has a reverse mortgage so this was her only option for payment of home care. For single people Medicaid caps income at $809.00, anything over that goes into the pooled or community trust. From there your mother's bills are paid from the trust up to the amount available. While I was waiting for Medicaid to approve the application, the home care agency, wanted me to pay them the excess income. Don't go that route. The agency will get paid from Medicaid, and your mother will have her money for her bills. I haven't had a problem with it. I am a joint beneficiary on her account, so I usually take care of task for my mother. The only downside is that those bills paid by the trust are always going to be paid late. You can try contacting those companies to advise them that their bills will be late. Maybe they can change the due date for you. I've had no problem when calling the customer service number with questions about payments. They were very nice, and very helpful. You will receive a binder with all the information you need, along with deposit slips and disbursement forms. If you need more disbursement forms, just call the customer service number and they will send you more. If you have a joint checking or savings account with your mother, make sure that Medicaid knows that some of the money going into the account is yours. My sister and mother have a joint checking account, so even though my sister supplied a copy of her paycheck to prove that the additional money deposit was my sister's paycheck, Medicaid denied the application due to excess income. It took 7 longs months before Medicaid acknowledged my sister's income. I spent 7 months taking care of my mother at home with minimal help from family members. She was on a ventilator at that time. When the aide finally started, my mother went to the hospital and the doctors determined she no longer needed the ventilator. Be very careful with Medicaid, as any error on your forms will invalidate the application. Also, you need to refile the application each year. Good luck with everything.

I'll add something about the Miller Trust also known as a Qualified Income Trust in Florida. According to our elder law attorney this would be the way to go with my wife. In Florida, only the gross income of my wife will go into the QIT each month. Assets are not involved. Each month the trustee has to write a check for the income and Medicaid will pay the rest of the cost of the NH.
thecolemanlawfirm/Qualified_Income_Trust.php
Don

Gabriel, thanks for the contribution and distinction between high and lower levels of assets. It seems there are a lot of issues to consider and weigh before accepting a Medicaid pooled trust arrangement. I was hoping one of the experts would offer an opinion on this thread.

Igloo, you make some good points about unexpected expenses that may arise while subject to a pooled trust arrangement.

The aspect that troubles me just as much though is the potential for fraud on the part of management agencies. Medicare has been plagued by so much medical fraud just from the extended health care field.

It's such a large and extended operation that I would think it would be difficult to monitor already, but with the temptation of accessing trusts, the potential might I think exist for abuse.

Still, it reflects that Medicare is attempting to provide assistance to those with some assets, perhaps too many to qualify otherwise but insufficient to provide longer term care.

The link below to Russo Law is very helpful, as this is specific to those residing in New York state. Note that in many states a pooled trust also accepts contributions of assets--not just income--and in some states is limited to those contributions made before the Medicaid applicant turns age 65. If the individual does not have a lot of excess assets, it can be a perfect solution. If the individual has a lot of excess assets, then a private trust may offer more options and flexibility.

Guv - so the situation is that mom makes just too much monthly income to qualify for Medicaid but if she is able to divert the overage to a "trust" then Voila! Problem solved, that's the situation correct?

My undestsnding is that pooled trust method is similar to how a Miller Trust works in that the overage goes into a kitty that is distributed by the trust either to pay for their care or needs but instead of being drawn up by an attorney for an individual (& all strictly used for costs by that individual in a Miller) is is done by SW in a state form and the overage $ goes to an account of $$$ shared by ALL in the pool. (We looked into doing a Miller awhile back as we have RR retirement in our family and RR pays really high $$$$ but not quite enough for full NH costs).

How these work depends on your state laws - most have it so that all income goes to pay towards their needs so no accumulation of funds OR if the excess builds it all goes to the State upon their death. With miller all income & assets revert to state whether the month of accrual or upon death.

What I'd be concerned about is IF & HOW the pooled trust is set up is flexible to allow for easy diversion of moms monthly income to pay her housing and living costs. Most of the time a miller is done is when they are in a NH - which has fixed costs - so they dont need to determine where their income goes. But your mom is living in her home......what happens if say her homeowners insurance premium increases, or she needs to get a tree cut down ASAP, or something else that blows a hole in her budget? Will she have $ to do that or is it that once her overage $ goes into the pool it is no longer hers to be spent? It sounds like mom is really tight budget wise right now.....what happens if next October she has a 2k plumbing bill? If her $ is in the pool, can it be easily gotten back to mom? done via an series of paperwork with the state....or there is no getting back?

If so family will need to pay for whatever costs on her home or her needs from now till mom moves out of the house. Can family afford this for however long mom is in her home? I'd suggest you clearly have a agreement done as to reinbusrement for those costs from either her estate or sale of her home if need be. It may be that doing this now will be viewed as Medicaid avoidance. Has it been clearly explained to you & mom just how moms home will be viewed by the state after her death by MERP? You may find that if mom is at the point of possibly needing a NH, that it could be better to go & move her into one; sell house & use the proceeds to private pay for her care and do other allowed spend down and put off needing Medicaid.

There was a really good aging blog done by the NYT & an article on pooled trusts done by Tara Siegel a couple of years ago. Google it as it names attorneys with NY state experience on pools.

Guvna, I was curious as well so I did a quick search. This is a brief explanation of the concept:

vjrussolaw/resources/faqs/pooled-trust-frequently-asked-questions/

From an initial reading, it seems as though the long arm of Medicaid is reaching into trusts to access the assets, pool and leverage them. From what I read, Medicaid can benefit from the income (and gains??) on the assets.

Apparently it's a way of allowing people with assets in trust to still qualify for Medicaid, but with restrictions on the way the assets are used and managed.

I get the impression that Medicaid will either itself manage or appoint a firm to manage the trust's assets - i.e., pooling them with other trusts. I can just see investment firms climbing all over each other to get their hands on managing Medicaid recipient's trusts and billing Medicare for it.

See the section on the list of services which can be used with the funds. It does include supplemental home care services.

Do a google with your State in search
Don

I wish I could help but have no knowledge of this.
Grace + Peace,
Bob

Good. ThanQ

Just wanted to bump this up so others will see it and respond. I don't have any knowledge of a Pooled Trust but intend to do some research just to see what it is and how it works.