How much of mom's funds can I spend for her when we're working toward the five year look back and Medicare?


She is in assisted living now. She is paying for all of her own care. She owns a car but doesn't drive it, has a condo fee to pay every month in case she goes home to live. In Florida an elder's home never becomes payment for services but in my mom's case, keeping that home entails monthly fees. I keep every receipt to show what has been purchased.

This question has been closed for answers. Ask a New Question.


A big yes on Heiser here , too!

Sunshine - what requires a spend-down is MedicAID. MediCARE is a general entitlement for hospital and medical costs and limited to short term care. It is Medicaid which can pay for long term care in a NH. Medicaid is a needs-based program and requires them to be at a specific low income & assets.THis site has really good articles on the difference, it is kinda important that you understand the difference and what they do & more importantly don't do (or pay for). MediCARE almost everybody over 65 has and gets; MedicAID is for "at-need" only.

About the condo....what is the game plan on it? Keep it; sell it, rent it?
I ask this because, it sounds like the HOA on the condo is pinching financially right now and this will only get more intense in the future.

I'm assuming that eventually she will be applying for MedicAID & that mom is a widow and lived alone at the condo, my thoughts are based on that. Once they go onto Medicaid, the state fully expects them to do a co-pay for their care each & every month. The amount of the copay is whatever is their monthly income LESS whatever your state has as their personal needs allowance. So say mom gets 800 SS; 1K retirement and state has a $ 60.00 allowance. So every month the NH must be paid by mom $ 1,740.00. There will really be NO real money to pay for everything for the condo. Insurance, taxes, utilites, HOA fees,....the list goes on. So who is able to pay for all this for the possibly months or years that mom wants to maintain her "right to return" to the condo? and what would be the long term cost & gain in doing this for the possible years mom may still be here?

Now some states allow for a diversion of some of their income for the property, other states may not. You need to find out what the situation is in your state. My mom (in her late mid90's) still has her home and is in a NH & on Medicaid, she could get a diversion of her monthly income for 6 months and only if there was an active legal contract listing with a Realtor. No FSBO stuff either. I met with Realtors to get a good bead on what the likely hood was on the property and really for us doing a spend down of her assets for items for her needs (lots of dental work) was better that doing a renovation on a property that would be a difficult sale. Also she just has been adamant in returning home, so that would be an issue in going to Act of Sale. So the house remains there & in her name with full homestead exemption and she maintains an annual "right of return" letter done by her attorney. I & another family member pay for all on the house - neither of us live there or even in the state. Modest house, no mortgage, minimal costs to maintain. For us it works, & I still have a sense of humor on dealing with it, but realistically this isn't feasible for everybody to basically have a 2nd home.

If you decide to sell it, it is really good that you are keeping detailed records. You will need all that to file a reimbursement for all your costs from the proceeds of the sale of the condo. Otherwise the state will assume that all the $ from the sale in now to be used for her spend-down. If you decide to keep it, also good to keep the records as you will have to file a detailed exemption to MERP (Medicaid estate recovery program) to the penny on all you or other family members have spend on the condo, to have all that $$ excluded from MERP's claim or lien.

It's alot to think about and if HOA costs are a big issue now, then really give some serious thought as to whether you all can do this for the many years that mom could possibly be living. Yeah it's tough to do this.......Good luck.
Helpful Answer (0)

Attorney Heiser who writes on this site from time to time has a book that is full of all of this information. He is a Medicaid guru of sorts. You might want to look on Amazon to see if you can find his book.
Helpful Answer (1)

Federal guideline is 'a person applying for Medicaid can not have more then $2000 in cash & assets.'
I have been told that, 'each state has the right to set their own asset limit; in NY that limit is $14.5k.'
For the 'five year look back' the Federal Govt. will count all 'gifts' as asset. So if, per say, your mother currently has 10k in assets & has gifted 30k during that five year look back.....the FedGovt says she has 40k assets, NOT 10k & the spend down is based at that 40k.
Some expenses that will count as 'spend down' are medical, home (1), vehicle (1), final arrangements (prepaid)....those are the better known ones. You would be well advised to seek counsel from an Elder Attorney. Attorney fees will vary, of course, the one we retained is $240 p/h.
This is an area we were never educated in nor prepared for. It's an experience that will put anyone faced with it to the test -many tests. Research all you can, keep very good records, which include receipts for everything. If you go for Guardianship you WILL have to report to the court annually. Bookkeeping is really, really needed, that means accurate, thorough documentation.
I don't which this on anyone, but when faced with it we have got to be 'Step-up' and grab the bull by the horns.
Love my country, fear my government.
Helpful Answer (1)

The law understands money spent for the behalf of the elder. It is part of the spending down. She is paying her way at the assisted living, all her non paid medical which will grow as she ages to probably over her income. It is proper to pay the condo fee so she has the option to come home if possible. You should
be fine. The 5 yr look back is looking for transfers to other family members which diminish the amount of assets she has and makes her eligible for Medicaid to pay for her nursing home needs. It is part of spending down your assets so you qualify for Medicaid to pay for the persons long term care in a nursing home.
Helpful Answer (0)

This question has been closed for answers. Ask a New Question.