Mother in nursing home as Medicaid-pending. If family signs over SS checks and pensions, would there be any any negative consequences to her only source of equity, her house? My brother and I hired an elder-care att for the 'life of mother's case' at $6,000. After the att did a couple of administrative changes to documents, he went AWOL, so for now we do not have any legal authority to get information from. To put this in more context, we are now getting pressure from the NH to sign over these documents, and we JUST found out that the eldercare lawyer won't be in the picture. We plan on getting additional legal advice but were wondering if anyone has dealt with a similar situation for which the signing of the SS and pensions to the NH caused irreparable damages to mom's status? Thank you for any help.

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Couple of thoughts -
The NH can request that her income gets send directly to them, NH probably cannot legally require that this happens. I know that the NH cannot require this for TX. My mom's first NH pressed heavily that I do this - no way it was going to happen. My mom's SS & federal retirement from my late dad gets direct deposited to her bank account. I write a check to the NH for her required under Medicaid co-pay (or her "SOC" share of cost in Medicaid speak) at the exact amount required as per her TXHHSC Form TF0001. It is NOT for the full amount monthly income before taxes either.

Each state has a set amount - usually called a personal needs allowance or personal trust allowance - that the Medicaid recipient gets to keep each month. It varies by state from $ 35 - 90 a month. For my mom in TX, the PNA is $ 60 a month. So mom's $ 1,800 a mo income of which $ 1,740 gets paid to NH and $ 60 stays in her bank account. So her checking builds by $ 60 a month.

The advantage to control of income, is that you get to have the PNA to spend when you need to. So your @ Target and find dusters & socks in clearance and you can buy them right then and pay from a check drawn on mom's account. If 5 months from now you need to buy mom glasses, you let the PNA build to have the funds to do so. Another advantage is IF you decide that you want to move mom to another NH. If the NH is getting the money, it will be totally sticky to do this. My mom's first NH went off the rails and I moved her out within the first year. The month I did, her old NH was only paid for just the exact copay for their days and new NH got their copay for their days. The old NH was a total cluster of incompetence in biz office and they would have held onto the check for months.

About the PNA, if it's @ the NH, you have to go to the biz office to withdraw from it. This could or could not be easy for you. My mom's NH biz office for PNA withdrawals is only open noon - 3PM Mon - Fri. Rarely would work for me.
The NH should send you an accounting on PNA too. Mom's old NH never sent one; NH # 2 sends an PNA statement every 90 days to me. Even though I pay for mom's NH copay, she does have a PNA type of trust account @ the NH to pay for hairdresser, stuff from the canteen type of things that have a direct draw for the item. Mom's NH trust account has about $ 100 - 200 max in it. When it gets low, I can mail a check just for the trust account to NH. For me, all this works as I'm big on control & oversight of mom's financials & the NH seem to have revolving staff in business office and ripe for accounting problems.

About the house, what do you see as the long view on it?
Realize that mom's small PNA will really only be enough $ to pay for things she needs @ NH. If she is the type to do hair salon every week, that alone will use up all the PNA. There will no longer be any $ from mom to pay anything on the house. Family will have to pay for all the whatevers on the house for the rest of mom's lifetime. This could or could not be manageable. In many ways it is like having a second or third home without the benefit of true ownership. So carefully look at the costs on home. If there is a mortgage, probably not at all feasible.

And atop of all this once they are on Medicaid, the state is required to do any asset recovery from the Medicaid recipient. The MERP - Medicaid Estate Recovery Program. If mom sells the house when she is alive and already in a NH, all the proceeds from the sale have to be spent on her care or her needs. If mom keeps the house for her lifetime (most states allows for the Medicaid recipient to keep their homestead), then upon her death the state can do a MERP action. MERP will be a claim or a lien on her estates assets. Now all states have all sorts of exemptions, exclusions, hardships to MERP. Your state's Medicaid program should have the details on how MERP runs in your state. (Your state will make a difference for it's laws on probate, death & property laws as to just how MERP runs. Like MERP in TX is a probate class 7 claim on being paid, but MERP in TN is a class 3 claim.) If heirs qualify for any of these, they can provide documentation for MERP review to offset or cancel any MERP recovery within whatever timeframe and conditions your state has. It totally is up to family to do this & in documentable detail. Otherwise MERP's claim or lien gets applied to the home. Family has to sell property @ FMV with proceeds at act of sale paid to MERP to get the claim or lien released from the property.

Now some states have unique legal that can be done on the property. Like a Lady Bird deed or other ownership that passes the property outside of probate. This avoids MERP but family still has to have funds pay everything on the house.

imho keeping the house can make sense if there are unique reasons to keep it; family can file for an exemptions, exclusions, hardship or some combo of those; and family has deep enough pockets to pay for everything (taxes,insurance, utilities, maintenance, yard, etc) on the house for years & years; and can be OCD enough to keep records and document all the house costs for years both for MERP and for probate claims. Also probably a good sense of humor to deal with a phone call from the neighbor that mom's pecan tree snapped across their driveway……

If you want to keep the house, realistically you have to go into this committed to the long view on it. We just don't know how long our elder will be with us, could be 6 mos or 6 years. If you likely can't do years on the house, it probably is best to sell it asap and do a spend-down before getting Medicaid. Good luck.
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Read the admittance agreement. You agreed to sign over SS and pension checks. Medicaid only makes up the difference. Medicaid required full disclosure of all assets, not just the house. So, if mom gets $3K a month and the NH is $10K a month, Medicaid pays the missing $7K a month.
There is no money left to upkeep the house. If you rent it, the rental income goes to Mom's NH too. When she dies and the house is sold, the proceeds pay back Medicaid for the accumulated cost of care. Report the AWOL to the attorney general and the bar association and ask for help.
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