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How does this effect spend-down? A patient is in a temporary nursing home prior to Medicaid Approval but does not have enough funds to continue payments prior to selling of home and Medicaid Approval. Steps are being taken to move applicant from Skilled Nursing Facility (SNF) to Medicaid Eligible Facility, but "months" of expenses are anticipated prior to Medicaid Approval. If the family pays the nursing home costs of the temporary SNF and Initial Costs of the Medicaid Pending Facility until the House is sold, can they be reimbursed from proceeds of the house sale (buy down assets)?

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Not easily.
To me, you’d need to have something in place that make whatever costs you’ve paid from your own $ as not to be included as part of the proceeds from the act of sale. So the lien you’ve placed must be paid in order for act of sale to go through. Like a workman’s lien or some other legal document that is witnesses and notarized so a lien can be placed on property & needs to be settled in order for clear title issued. Hard to do this after the fact.  

But I’m wondering IF it’s just that you are only paying mom’s NH costs directly, IF the NH can repay you directly as it’s an overage once she’s gotten her house $ and pays the NH retroactively for her stay from day 1. Its something to discuss clearly with business office. A head of time too. They may need to have the overage paid to mom as she’s the resident and the contract is with her. The first NH really has no pressing interest to help you out in this as she’s no longer a resident, unless they want to. The second NH maybe can as there’s a relationship happening. 

You do realize that by selling her home, all the $ from act of sale must go towards spend down for her care and her needs. So if say house sells for 100k, she is private pay, till she has correctly spent down to 98k.

Are you or other family also paying some property costs?
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