Mom has been in a nursing home for almost 4 years....we paid for her care until there was no money left and then applied for Institutional Medicaid for her. Her home, which is valued at 40,000. (perhaps less) was excluded from assets. My brother has taken the sole responsibility of paying for taxes, insurance and repairs etc...since she has been in the NH, and also lives there. Will Medicaid use the value of the home as an asset after she has passed and try to recoup monies? Forcing us to sell the home and repay the proceeds? Now leaving my brother without a home?

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Sgarcia, usually if a patient is living in a nursing home and Medicaid is paying for all the room, board, and care, Medicaid would like to be reimbursed from whatever is available. If a house is available, then Medicaid can place a lien on the house. Once Mom passes, then the house needs to be sold and the equity is collected by Medicaid.

Your Mom has been in a nursing home for 4 years, so the equity from the house would only cover maybe 4 months of care. Medicaid [which is taxpayer funded] would have to eat the rest of the cost which would be around $475,000 if the nursing home cost $10k per month.

There are some exceptions, such as if your brother was a full-time caregiver, doing all the work that a nursing home would be doing for 2 years prior to your Mom going into a nursing home, the house could possibly stay with the family. Brother would need documents to prove he was a 24/7 caregiver, such as notes from Mom's doctors, a daily diary, etc.

I would recommend you talk to your State Medicaid office.
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Medicaid is required to attempt a recovery or recoup of all $ paid by Medicaid for her & it’s done via MERP. 4 years is going to be at least 300k and way way beyond value of that 40k home. It is not your debt but a debt of her estate. The house - in her name - is an exempt asset for Medicaid but upon her death goes from exempt to a nonexempt asset of her estate. So her estate will have debts and an asset (the house). MERP can be done by the state or done for the state by an outside contractor- there are 2 main contractors and are very much akin to how debt collectors work & are very precise in their approach to recovery.

How to deal with MERP is going to imo be very very interdependent on your states laws & administrative codes for property, probate & Medicaid rules. There have been folks on this site who have dealt with it and most have it done with a probate atty involved (even if probate isn’t opened) or an estate atty.

To me the first step would be right now to make sure mom has a valid will. Cause if not then get one done ASAP as otherwise she’s viewed as dying intestate which usually means all assets escheat to the state. State totally in charge. 

Then second look at exemptions. All states have exemptions and exclusions to MERP but it’s totally up to the heirs or family to figure out which ones could work & get all the various documentation needed to be eligible for them. Can it be done & done successfully?, yeah definitely. But your parent imo needs to have a existing valid will at the ready and whomever to be named as executor as per the will has been or can be gathering documentation for MERP and/or opening probate if need be. Each heir would need their own exemptions too.

Look over the exemption to recovery list. It should be somewhere within states Medicaid website. So any of those? Like low income heir, caregiver exclusion, elderly sibling...... if so they need to get their paperwork together to have at the ready to submit to MERP once the recovery determination starts going after mom dies. Some states have a hardship exemption; other have a minimum property value for Recovery. Really whomever will names as executor needs to review the situation & get cooperation with all heirs to come up with a plan.

Look at states administrative code to see what the exemptions are for costs paid by family before Medicaid applied for or paid on property. Like for Some states, any $ paid by family for the elders care that kept them out of a NH or off Medicaid can be deducted; costs paid for taxes, insurance, required maintenance can be deducted. For the house - from what I’ve seen- seems to be only if the property is VACANT. If bro has been living there for years rent free, I think this can’t be deducted as it’s viewed as he’s getting a benefit from the house, so costs cannot be deducted.

Ideally brother should have had some sort of memo of understanding or promissory note between mom & him regarding property costs done years ago. It’s to me kinda too late now but something to ask an atty. But he can enter all costs paid after she died as his very own claim against her estate if you end up opening probate. He can enter the predeath costs too but it’s up to executor and the judge to determine if allowed. If you go probate route, then MERP becomes a claim against the estate however probate rules run. Like for TX it’s a Level of Claim by Class with MERP as class 7 so all claims in 1-6 are paid first.  

And you might want to determine if property is accurately 40k. It could be worth even less. The feds have a required cost benefit/ cost effectiveness equation for recovery, so estate 10k or under in value means no recovery required by the feds. Some states - like MS - have the estate value at 65/75k so under that no Recovery. 

There was a only heir on this site who found when attempting to sell (via muniment) deceased mom’s house that MERP claim clouded title. House 35k with years of property taxes past due & blight fees. She paid those off like 20k and Realtor had buyer at 35k but the MERP claim killed the deal. MERP was total surprise. Took months of negotiations to get MERP release done by paying MERP 10k at closing. 
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