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Spouses resources almost all spent down for nursing home. Other assets belong to community spouse. It appears that community spouse will keep all income of the NH spouse directed back through a QIT setup. We don't know how Medicaid will arrive at a figure of who gets to keep how much and who must spend down most or all assets.

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How an IRA is treated as an asset varies by state. Some do not count the principal if the IRA is in monthly distribution. Others will not count the IRA principal if the IRA distribution also includes principal. Yet others will count the IRA as an asset and the only way to protect it without causing a potentially large tax event is by annuitizing the IRA.
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Massachusetts Medicaid Waiver Programs
MassHealth under the Home and Community Based Services Waiver,

Another way to get home health services is through one of Massachusetts’s Medicaid Waiver programs.

To qualify for one of MassHealth's Waiver programs, you must have income at or below 300% of the SSI Federal Benefit Rate, or $2,163 per month in 2014. You also must have less than $2,000 in assets. If you are married, MassHealth only looks at your individual income and assets, not those of your spouse. If you have too much income, you can still qualify for MassHealth Waiver programs by meeting a deductible.

To receive waiver services in Massachusetts, you must also show that you would be institutionalized in a nursing home if you were not receiving waiver services. To do that, you must show either that you need at least one skilled nursing or therapy service daily (such as help with injections, catheters, feeding tubes, or physical or occupational therapy) OR that you need a nursing service at least three times per week, plus two "other" services. Other services can be additional nursing services or assistance with activities of daily living like bathing, dressing, toileting, getting in or out of a bed or chair, walking, or eating.
Massachusetts Frail Elder Waiver

If you meet the above financial and level of care requirements, you may qualify for Massachusetts’s Frail Elder Waiver Program. To qualify, you must be 60 or over, but if you are under age 65 you must be disabled.

When you apply for the Frail Elder Waiver, an assessor from your local Aging Services Access Point (ASAP) will visit your home and decide how much help you need every month and with which tasks. Then MassHealth will pay for the cost of services to meet those needs every month. Services provided under the Frail Elder Waiver include personal care services; housekeeping, chore, and laundry services; home health and skilled nursing; adult day programs; grocery shopping and delivered meals; transportation; respite care; and accessibility adaptations to your home.
Community Choices Waiver Program

If you meet the criteria for the Frail Elder Waiver Program, but you are at imminent risk of being institutionalized in a nursing home unless you receive help, you might qualify for the Community Choices Waiver Program. You must have a serious condition evidenced by one of the following:

a need for 24-hour supervision
a significant cognitive impairment
an inability to manage your medications
frequent incontinence, or
a need for daily assistance with activities of daily living.
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if the person has a relatively small amount of excess income, a special type of trust can be drawn up in order that the applicant can become eligible.
Mass Health also considers one's countable assets. The limits for an individual and couple respectively are $2,000 and $3,000. However, as with the income limits, there is flexibility. When only one spouse of a married couple is applying, the asset limit for the other spouse is $119,220. Their home, if owner-occupied, is considered exempt up to a value of approximately $802,000. There are also other exempt assets such as a vehicle, funeral trusts, and personal valuables. As with other state Medicaid programs, the applicant's financially history has a five-year look back period.
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MassHealth is a public health insurance program for low-to medium-income residents of Massachusetts. The national name of this health insurance program is Medicaid.
option 3 speak with a certified counselor
1-800-243-4636

60 North Bow Street, Milford, MA 01757, USA 1-800-243-4636, option 3 info@shinema.org
Contact Us 508 422 9931

SHINE (Serving the Health Insurance Needs of Everyone) is funded by the Agency for Community Living and coordinated by the Massachusetts Executive Office of Elder Affairs in partnership with the Friends of The Milford Senior Center.
60 North Bow Street, Milford, MA 01757, USA 1-800-243-4636, option 3 info@shinema.org
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Medicaid has a 5 year 'Look Back', Proper advance planning may assure that the otherwise known as community spouse may have sufficient assets to draw from, and that property is exempted from estate recovery.

Utilizing the funeral trust, which does not require a specific funeral home, and does not require a funeral home to be purchased , and is good ANYWHERE, can assure that the parents and their children have those services covered, assets devoted to the trust are medicaid exempt.

In the case of assets; it is very important to seek a nursing home that you like, ans accepts both Medicaid and private pay, so that you can choose the home of your choice. Additionally preserved assets can be used to supplement the care at a nursing home, when the recipient is on Medicaid, for a better quality of life. further info my profile
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You should consult with an elder law attorney that specializes in Medicaid. There is a spousal impoverishment process that will apply.
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Get elder law attorney immediately! The spend down is horrible. All assets are included. Community spouse limited to house, car, allowance etc. Brace yourself and good luck.
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Medicaid is 100% bureaucracy, and you have to be careful how you "spend down". It's sad a person is forced to do that. You really need to see an eldercare attorney.
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Medicaid is controlled by the States. Every State has different requirements and rules. Definitely see a elder care attorney.
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Applicant eligibility and asset treatment vary from state-to-state. You really need to seek an attorney specializing in Medicaid for your state. As indicated above; there is a 5-year Look Back period where property and money transfers are reviewed. Applying for Medicaid is one thing - getting it something else. The Medicaid system is so backlogged right now that they are prioritizing their case load. Even then - it can take months of screening and questions. It's to a point in California where you need an expert just to get through the application process. Unfortunately, many people die before their application is approved & then the payments, etc., are done retroactively. It's horrendous.
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You are allowed to have under $2K in assests. Plus there is a 5 yr look back so be prepared with your records.
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