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So I would like to purchase my grandmother's home that has a Medicaid lien on it. The home's value has drastically decreased due to the condition. Would I be able to purchase the home for the current value which is less than the lien value? How do I go about doing this?

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Thank you so much for that info igloo!! I get it now. We don’t have all the facts so impossible to know which of the 4 factors apply but it’s still possible for the OP to buy the house without satisfying the lien which is good for her!!
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PB & Cali, Ok on the lien, here’s my not an attorney understanding on them..... gonna be long, get an adult beverage..... there’s 4 factors that come into play as to what happens with house sale $: 1. what can happen while they are still alive aka “predeath”, 2 what happens once they die aka “post death or estate”. But both factors cross with 3. TEFRA. tEFRA allows for predeath liens IF, again IF, your states laws allow it. If not, it’s a post death lein or claim if probate is opened. (If probate opened, then probate laws enter). It’s Tax Equity Fiscal Responsibility Act from 198o’s. It wasn’t done for Medicaid per se, but now used since DRA 2005 by states for Medicaid. If I had to guess any more pro-property right states - like that allow Lady Bird Deeds, like TX & FL - are antiTEFRA. 4th factor is what your states Medicaid requires to be done for changes in assets, & this is not just house sale $ but also like if they get an inheritance.

If your in a TIFRA state, those that want to can allow a lien to be placed onto property when any Medicaid over age 55 starts. It’s seems to be a somewhat subterranean lein. Like it might not get recorded into the easy to find records filed at the courthouse, like a Warranty Deed is. It seems to be put into land evidence records.... for a lot of places land evidence is it’s own division; it’s where right of way or public egress stuff goes. Like part of your property actually is RoW for railroad side area or where phone co has switching boxes. Title companies do the deep searches and their the ones who find the Medicaid lien. I imagine that if it’s an elderly homeowner, title co know to look for the lien.

Anyways subterranean lein is there. But one of the issues with Medicaid doing this is the lein does not have a exact $ amount when lein is placed. It’s a lien of Medicaids interest. For most states, neither the recipient nor their DPOA get an actual Medicaid tally of costs each month. Medicaid doesn’t seem to do what CMS Medicare does in that they mail out statements of services done & vendors paid. My mom got a forest of CMS MediCARE statements. But from Medicaid, nothing. Really unless business office of the NH gives you a summary of what Medicaid paid them (the NH), your not going to know the amount, The Nh isn’t required to share that info with you as it’s not a summary of anything your elder paid either. Sigh.

So actual amount a NH resident may owe Medicaid is a mystery & family is gobsmacked when they find theres a lien on house when they go to sell it or when they get - from Medicaid or their outside contractor for MERP - a post death NOI (notice of Intent) with a $ amount supposedly owed.

Then add into this #4 - what your states administrative code for Medicaid requires for assets changes for Medicaid recipients. The asset increase makes them ineligible for Medicaid but... some states allow the elder to keep the $ but all must go to private pay the facility for their care. Others seem to allow them keep the $ but ok to buy a preneed funeral policy and then everything else pays the NH. Some states require reinbursement to date of Medicaid costs and what they do with the rest of the $ Medicaid doesn’t care. But if they get impoverished again and apply for Medicaid again if there’s been any gifting, thats a problem for eligibility. Thats what I meant by “no gifting”.

On what happen if sale is less than lien, most of posts on AC for predeath, is that caseworker / Medicaid has to approve sale so a release can be done to transfer title. For post death, it’s in my experience, going to depend on probate laws & your judge as to how claims dealt with.

If OP needs mortgage, id try to get tentative ok by Medicaid for FMV or appraisal to take to lender. May need to go conventional (yeah, horrors). The investor who bought old ladies place, if I’m remembering right, did all cash time limited bid / proposal to Medicaid, which they approved.
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igloo572 Sep 28, 2020
continued: The investor was dealing with a predeath / Tefra lein. But if OPs gran has died, ime, she’s going to need to contact the executor - assuming there’s a valid will - as to what value the asset was entered in probate and what the creditors filed are looking like & if her offer works for probate. The probate atty should know what type of negotiations could happen with the creditors if need be.
If gran died intestate, that’s sticky, as it seems intestate deaths fall to the state to have control over. Grans heirs would need to have an atty file a Lineal Heirship action in probate court to show why it moves to them instead f the state. I don’t know if the state could sell a property before Lineal finalized.
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K - yes, can be done...but won’t be simple. Just How to deal with it imho depends on if she is still alive OR if she has already died.

But let’s take a few steps back, if she was on LTC NH Medicaid someone in the family has been paying property costs as her monthly income has been a copay to NH. Who all pays /paid house stuff?
Whats that figure?

If she’s alive, does her DPOA allow full financials, like 2 sell property?

If she’s dead, has the old DPOA gotten a MERP questionnaire from the state or it’s outside contractor? Did it get responded to? Has whomever named in her will to be executor started dealing with her estate? Whomever is named executor as per Grans will, has to do some type of action (sm estate affidavit, a Muniment or full-on probate) in probate court to get authority (like Letters Testamentary) to deal with settling her estate, selling house, having executor fees / expenses paid, dealing with claims. If no will, lots stickier. Stuff like this isn’t a DIY for most of us. So has anyone spoken with probate atty yet? Or filed will at courthouse?

Medicaid, thru MERP system, is required (by the feds) to attempt a recovery of costs paid by Medicaid. If your in a TiFRA state, lien can be placed once on LTC Medicaid. If your in a nonTifra state, it’s an after death lien or claim. Now All states have exemptions and Exclusions to MERP. Whomever are the heirs as per her will, need to look into this to see which ones they can file. Also whoever paid property taxes & insurance on her empty house while she was in the NH, need to get all that together & file it as an exclusion to MERP &/or file as their own claim (debt) against the estate.

Medicaid is an unsecured debt (unlike a mortgage which is secured). If your state has it that Debts against an estate are placed into categories for priority, where MERP fits can make a big difference imho as to how involved all this might just be. Like Tx is a Level of Claim by Class for probate & MERP is class 7, so all in 1-6 are priority before 7. But none of this is really DIY, you need an atty who understands MERP.

Regarding FMV, if house value is whack as compared to current tax assessor bill, you can get it appraised to get a more realistic value. If it has decades of delayed maintenance or has issues with the majors - roof, foundation, electric, plumbing - I’d suggest you get it inspected first & the inspection report given to the appraiser. Both the inspector & appraiser need to be state licensed. They put a # & seal on their reports and it is legal. It can be submitted to Medicaid. It can be entered into probate as to value of estates asset. If it’s significantly less than tax assessor, it is what it is. It has a new FMV.

Realtor comps are helpful but are based on recent sales. If house is in area of big renovations or tear downs, comps are going to be way off. You need to get it appraised imo.

To buy it, You will need to have either the cash outright or be able to get a mortgage for the appraised value. Probate won’t allow title transfer on an asset being sold unless its in full, in my experience. No rent to own or buy in installments. The $ becomes an asset placed in “Estate Of” bank account that’s used to settle all claims against the estate. If MERP files a claim, then they are in line to be paid however your state has claimants prioritized.

if gran is still alive, then you’ll have to put together a proposal to buy the house along with documentation as to its FMV that the dpoa submits to gran caseworker. There was an investor on this site few months back who bought house from a lady on Medicaid. He got subs he works with to do estimates on all repairs needed & used this to essentially put in all cash bid to buy. Medicaid approved it; took abt 2 months. Realize if gran’s alive & sells house, $ is all hers, so she’s ineligible for Medicaid as no longer poor. She cannot gift any $. $ used to private pay NH.
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AlvaDeer Sep 27, 2020
I was so hoping you would be around to answer this question when it was first posted. You always have the best information for us on these issues, Igloo. You are one of the people who makes Forum such a great place.
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As I understand it, your grandmother's home is now a part of her total estate, that is to say whatever she left. It will enter probate either through a will, or pass on to her heirs. When the home is sold, Medicaid will recover what they can of their investment. So let us say for instance that your father is the beneficiary of your grandmother's home. Let us assume that the home is just about all that is in the estate (since she was on medicaid). Your father will now place the home for sale at fair market value, determined by a realtor in your area. If you purchase the home, what you pay for the home will likely go to Medicaid, so there will be no profit for the heirs. This is my understanding, but I think that a visit to a realtor might answer some questions. Medicaid is a joint program through the federal government and the State. You might want to check with a Lawyer in your area, or even call 1-800-medicare which administers both medicaid and medicare. There are some really bright folks on this site who know a whole lot about medicaid and how it works, and I hope they will chime in because they could have a good deal more information for you. I think the most important thing is that you should purchase the home at fair market. That is to say it could be looked upon as fraud if you purchased the home, say, from your Dad who is beneficiary for 2,000.00, if you see what I mean? I sure am no expert on this and I would want you to consult with someone who IS before doing anything.
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