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Spouse in nursing home and the spouse in community. The spouse in NH does not have any property in his/her name.

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Gleneagles, I don't know about your state, Hawaii, but that is not the case in all states. Perhaps you could investigate taking your wife to another state, instead of out of the country. But if you have found a good foreign solution that works for you, I am happy for you.
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This is not an answer, just an observation. The people who pay taxes pay for programs like Medicaid, then have to pay it back if THEY need it, even though they have contributed all their working lives.

However, those who live off and abuse the system, still get it free. They pay nothing toward the program and pay nothing for using it. Seems like the ones who earned it, should have some benefit.

Pretty unfair if you ask me.
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After the death of the patient, the surviving spose will never be allowed to earn more than $1200 per month for the rest of his/her life, or until the entire reimbursement is paid off. I will not accept this, and I'm taking my wife out of the country for long-term care.
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If they shared a home then Medicaid will put a lean on the home. The spouse will be allowed to live in the home until his death. He would be free to do with his money as he pleases. To get on Medicaid you can own a home but have under $2000. In the bank. The total money would be split with the spouse. Any thing left over would go to the NH first. Then you would go on Medicaid. I found out one exemption. If you are a child and you live in the home and cared for a parent for at least two years. The house would become exempt. You would have to prove to the NH who reports to Medicaid. The first thing they look at is you voting record. Did you vote in the area where your parents would of voted. I am sure there are other ways to prove your residence. The home would become Medicaid exempt. There is a catch. You have to live in the house and not sell it.
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Wow, great answer. I think I will print this out for future reference.
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The community spouse gets to keep the house but you probably will have to do simple paperwork to get the exemption or exclusion to the state's claim.

What will likely happen is this: all states have to have in place MERP - Medicaid Estate Recovery Program. When the Medicaid recipient is alive they are allowed exempt assets - like their home. But once they die, those exempt assets become non-exempt and are assets for their estate. If NH is a community property state, then the home even if not in her name is considered her asset under MERP. But MERP has all kinds of exemptions and the main one is for allowing their assets (the house) go to the surviving spouse. Now the community spouse may get a letter from NH MERP program that states the amount of $ the state spend and wants to be repaid and asking about any exemptions. You have to respond to this letter within whatever deadline is in the letter with whatever exemptions you will (or could) be filing against the estate. MERP like Medicaid is run by each state, so just how NH does it could be different than VT or Maine.

For example, in my mom's state (TX), the MERP letter comes at about 4 -6 weeks after death to whatever address Medicaid has been sending their correspondence to (so it will come to me at my address in a different state as I am my mom's contact). But some states send it to the property address. In the letter it will state something like…"we're sorry for the death, but the state paid $ 134,589.13
for her care which the state would like to be reimburse for from her estate if there are no exemptions or exclusions to MERP's claim". It is not a warm & fuzzy letter. TX MERP is a claim against the estate for MERP so it ultimately is something that is settled in probate; now other states have this as a lein on the property. Big difference legally in those approaches, too. Now I will be filing exemption expenses on my mom's empty house (like taxes, insurance, yard) and I can & will provide documentation on all those costs if MERP requests too. If I was the surviving spouse, I would file an exemption as the surviving spouse. For TX, there is a check off list of the most common exemptions. For the spouse one, Medicaid has all this info on file so it's not an issue to prove you are the surviving spouse. You check off the form and send it back within the timeframe required.

One thing you want to make sure to get is whatever NH does for a release of MERP's claim or lien on the property. It likely will be a one page form on state letterhead that says the state has no claim or lein on the property with the specific details on the property address and perhaps even tax assessor info and property parcel number. This is important to safe-keep. You will need this when in the future, you want to sell the house and need a clear title and title insurance done.
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