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We have a mother who is needing long term care in Florida. Her husband, has decided to deny her spousal support, as he does not want to spend any of his funds on her care. She has given her daughter almost $50,000 in the past 2 years, which could be a reason to deny her Medicaid coverage, but we also know that may not be a reason to deny her Medicaid. The question we have is, if Florida decides to place her on Medicaid, what assets can they go after in recovery, including money, after she dies? Also, since we live in another state, can Florida cross state lines to try to recoup any money? She has no real assets, other than the money she has given to her daughter. Sadly, the husband has the money to offset her Medicaid costs, but refuses to do anything.

The biggest shock to us, in Florida, is how a spouse can just state they won't be responsible for their spouses future care and the state just accepts it. We were told by the husbands lawyer (not the one who needs protecting) that they can actually place the mate in something like an indigent status. Being out of state and since both Florida and our state aren't filial states, there isn't that much that can come back on us, even taking the large amount from the mom, except they would deny her Medicaid for X number of months equal to that amount. What's sad, is the husband states he has taken care of the wife in his will, but refuses to do anything until then, even though he could easily stand the look back amount and has told my wife several times, both of them don't want the money back. My wife has ovarian cancer and another health issue we're still trying to diagnose, so the money is very much needed by my wife..
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Reply to grammadee
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Need - my understanding is that “Medicaid expansion” is related to ACA/Obamacare & for those who are in the grayish area of having too much monthly income to be eligible for low income Medicaid or don’t fall into one of the time limited Medicaid categories (like CHIP or a WIC program) AND could not afford existing marketplace health insurance. Or were uninsurable due to preexisting illness like cancer. So they were uninsured for any type of health insurance prior to ACA.  

If your state did Medicaid expansion, then there would be insurance available that was affordable & racked to your income as to your premium. Perhaps with a % or other adjustments paid to the insurer by the state and the adjustment was partially paid by the feds to the state. Not all states took Medicaid expansion done through existing state run Medicaid program. Most often R governor states did NOT take Medicaid expansion. For those states, nonprofits set up marketplace expansion programs. 

The answer to why Medicaid expansion does NOT apply to “older” people is that by & large most over age 65 qualify for MediCARE as they or their spouse contributed to Medicare via thier FICA during thier working years. So they can get Medicare and so no need for a Medicaid expansion program. They have health insurance = Medicare. But since Medicare does NOT pay for facility’s LTC / room&board costs, BUT old school Medicaid will pay for LTC, so “older” folks find that they need to apply to Medicaid as they do not have enough income or assets to private pay the R&B for a facility. To afford a facility, they become “duals”, that is on Medicare & Medicaid. And they meet the strict income/asset levels for LTC Medicaid. Between the M&Ms in theory all costs should be covered if they are in a NH. Many community based programs - like PACE - actually need you to be a “dual” as the program is set up to have everything paid between the M&Ms. So like say flu shot or high blood pressure screening is paid 65% by Medicare and 35% by community based Medicaid, you can’t easily private pay for any of it as the system is set up for Co sharing between the M&Ms. 

Medicaid expansion basically is all about those too young for Medicare and too old for being on CHIP and without health insurance or uninsurable. 

About the “having billions”, Medicaid expansion programs usually are affiliated with health systems as it contains costs. So if you take expansion coverage within system “A” you are limited to that system or network. Similar to how Medicare Advantage plans work. Someone with billions in my experience isn’t going to want or ever accept being told you can’t go to MD Anderson or Cleveland Clinic or Mayo, they have the $$$ and will go and private pay for whatever care needed beyond what baseline Medicare pays. They are not going to go and sit and wait with the great unwashed at the neighborhood clinic. They have $$$, they want service. But for the rest who were uninsured or uninsurable, Medicaid expansion has been very much needed.  Ok & that’s it for my health planning & policy rant of the day.....
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Reply to igloo572
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Expanded Medicaid is a state program used to expand health care access for care by supplementing premium for insurance bought on marketplace. Long term care is NOT paid by regular health insurance. The long term care that Medicaid covers as nursing home is not subject to same rules due to nature of care and statutes. Price long term care insurance and you’ll find NO Medicaid help on marketplace.
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Reply to Guestshopadmin
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Depending on the state, the daughter may have to PAY BACK the $50,000, either NOW or when her Mom dies, since the money was given to her by her Mom within the past 2 years. You really need to talk to a Medicaid lawyer for the state of Florida.
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Reply to DeeAnna
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I've brought this up before, when are the different rules for what I call traditional medicaid and expanded medicaid applied. In expanded medicaid, you can have a billion dollars but as long as your income is lower than $16,000 or so, you qualify. It's income based, not asset based. Why can't older people apply for expanded medicaid?
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Reply to needtowashhair
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Your mom is still living, what could or couldn’t happen after death and through a probate court action at this point in time is just conjecture.

To be an individual on LTC Medicaid you have to be basically impoverished with no more than 2k in non exempt assets. They certainly have no $ or savings beyond the 2k. Unless they die still owning thier home or have a life insurance policy that has the beneficiary as their estate, there isn’t going to be any need for probate as there’s no assets to probate.

To me the issue to be concern about like today is that your mom gifted 50k within the past 2 years. It will surface in the financials required & submitted routinely for Medicaid LTC applications. She won’t be eligible for Medicaid.
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Reply to igloo572
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First the gift of $50K will effect her receiving Medicaid. That will have to be private paid until spent down. Its called a penalty. No, the husband will not have to pay fully for her care. The assets will be split. He will be able to stay in the home. Check with Medicaid to see how this works in FLA state. If they r still married I would think he could be held accountable for her care. If Mom eventually gets Medicaid, there will be no assets to recoup upon her death. Now if the house is theirs together, a lean may be put on it at time of death but they may not recoup the money until her husband sells the house. Then the lean will have to be satisfied. You as her child will not be held responsible for her debts. You really need to run this by Medicaid or ask a Medicaid lawyer. Which in Moms instance may be a good idea.
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Reply to JoAnn29
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