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Grandmasunshine Asked April 2018

Can I sell my home and buy another while my husband is in nursing home on Medicaid?

igloo572 Apr 2018
Countrymouse, the “protection of income for spouse at home” reads to be about Medicaid’s CSRA or MMNA waivers. Community Spouse Resource Allowance, Monthly maintenance Needs Allowance/Assessment. If this is it, then it’s a different income category for Medicaid than income / assets arising from a house sale.

CSRA / MMNA to me are kinda like alimony for the still living at their home & in the community spouse. The source of the CSRA $ is the monthly income the NH spouse is paid. Its that income that CSRA gets pulled (or waived) from.

TX has a really high MMNA at abt $2,900+. Say Tex1 husband in the NH has a mo. income of $2100 & under Medicaid rules is expected to have all of that income less $60 paid to the NH. So in theory dad to pay NH $2040 every mo to NH as his Medicaid SOC (share of cost). But his wife - the CS - is a much younger 2nd wife with a kid under 18 and a mortgage; & she works part-time (& has the Medicaid maximum of 119k in assets, which is untouchable). Her CSRA /MMNA determination could take it to the maximum $2900+ for TX. His required copay or SOC of $2040 to the NH is waived by Medicaid, and instead goes to Kaitlin & the kid. NH gets zero in copay. 

Also in this scenario, kid gets his own portion of dads SS (if dad did SS retirement at 66) as dependent income every  month till he turns 18 or stops being in high school. Not included in parents income. It has to be spent too as anything left when he goes out of the program is supposed to be returned to SSA. 

This is kinda an outlier example. The usual is both are elderly, Tex2 is 95 in a NH & she’s 90 still spry & living in their paid off home. He gets $1200 SS a mo, she gets $700 SS a mo & has 50k in assets (so way under the untouchable max of 119k). Her living costs run $1300 a mo. Her CSRA would be $600 a mo (her SS $700 + CSRA $600 =$1300) & waived from dads SOC to the NH. So dad would only pay the NH $540 a mo as he required copay.

CS’s attorney can file for more than the state determines too.
It’s stuff like this that makes couples planning for Medicaid very complicated. Couples stuff needs experienced, savvy atty to review their situation and come up with options. Not ever a DIY imo.

Countrymouse Apr 2018
Looking for something else, I came across this which may also be relevant to your situation:

"Protection of income for spouse at home: When an individual is in a nursing facility and has a spouse living at home, a portion of the income of the spouse in the facility may be protected to bring the income of the spouse at home up to a level specified by federal law. Currently, that amount is $2,030/mo and can be as much as $3,090 depending upon at-home spouse’s cost for housing. The amount protected for the at-home spouse is not counted in determining the eligibility of the spouse in the nursing facility."

If any of that applies to you, you will want to make sure your moving won't affect your entitlement to the protected share of your husband's income.

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Countrymouse Apr 2018
I should ask Medicaid, or whoever runs it in your county/state. They should be able to explain what lien they have on your ?jointly-owned home and what happens when the property is sold. Would you still be able to afford the place you would like to move to if you could only use, say, half the sale price of your current home?

After all, they can't stop you selling your house and moving - you're not under house arrest! But it may be that your husband's share of the money you get for it will immediately be claimed by Medicaid, or will cause him no longer to be eligible for Medicaid at least.

I hope other posters may have been through this process and will be along with better information shortly.

igloo572 Apr 2018
Yes, but to me you need to have a very tight plan before doing this.

Reason being is that the house is still owned by the both of you so any proceeds from the sale of the home is looked as assets for the both of you. 50/50 split. So whatever’s done needs to be timed so that the month of the sale your hubs starts the month ok for Medicaid financial and ends the month ok for Medicaid financials. To me it’s not a diy project but needs a plan worked through in consultation with an elder law atty. Especially if your going from big $$$ house to much smaller $ home, as you as a CS (community spouse) have to keep your assets under a fixed amount. It’s usually 119k for a CS. So unless you do something creative with the overage, it triggers an ineligiblity for hubs till spent down.

Like say, current home sells for 450k on 6/02/18 and you buy condo for 200k 6/10/18. There’s 250k left. Over the 119k for CS and over the 2k for NH spouse. If you already have savings, the $ from house sale gets added to it, so it could add up to lots of $ beyond Medicaid strict financial requirements. BUT you might be able to do something creative with the extra $. For Medicaid, your income does NOT count. Your assets do as those are joint; but your income doesn’t. What the atty can guide you through is how to create the income stream for you from the extra $. Often it’s done via a SPIA - single premium immediate annuity. Personally I hate annuities as they seem to be sold to fearful, gullible elders with lousy terms & hefty commissions by the insurance agent who sold it. But a SPIA is a very special type of annuity, it takes the excess $ and creates an immediate income stream for the CS. It has to be Medicaid compliant so it’s very speciality underwriting. If you are a somewhat younger healthier CS, you could well outlive the SPIA. It does not affect hubs Medicaid at all, if done right. And this is why you need an experienced atty to help in all this. 

Also if you live in a state that places Estate Recovery on CS, ask atty as to how to notify Medicaid as to exempt asset change.

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