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My wife is in a memory care unit at an assisted living care facility. She is at the point where she needs more care than the facility can provide. I have, as her husband been paying out of pocket for her care. Now I am faced with paying an elder care attorney $12,000.00 for help with the application for Medicaid. Are there any alternatives?

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The business manager at the nursing home my mother was in helped our family through the process after her long term care insurance ran out. We paid nothing. It was a somewhat involved process, but we received good guidance. Paying the amount you’ve been told is ridiculous
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Reply to Daughterof1930
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Al, 12k is high. I’m with Garden that atty isn’t interested & a way to get you off his porch so to speak. Was atty one who promotes themselves as being “Estate” atty? If so, 12k, isn’t crazy high as they usually are dealing with a couple with serious assets, investments, trusts & dealing with NY state laws.

But personally, I do think that for couples where 1 (your Arlene) needs LTC Medicaid & the other (you) are still healthy & likely to continue to be living in your community as a CS (community spouse) for several years more, well that situation needs a NAELA or CELA level of elder law attorney. There’s lots of little factors for couples that do not come into play for a widower or widow individual LTC Medicaid application. For individual Medicaid, kids can DIY it totally if they know the parents financials & have POA imo.

But couple stuff more complicated, like there’s the spousal exemption that Cali mentioned. But bank accounts have to be set up to isolate your income & assets from Arlene’s and do them so no future issue for Medicaid. Can you do this DIY, maybe but.... maybe not. Your income doesn’t count for her Medicaid eligibility. But month after you get income, it becomes an asset & might affect her eligibility if it takes you above spouse asset limit.

If you should be over the spouse asset max, you might be able to do a SPIA (single premium immediate annuity) for overage. I hate annuities in general as imho they have commission structure not in your favor & folks don’t clearly understand them. But a SPIA is a very special creature for a CS like you.
Like say you all have 225k in savings. Your CS exemption is $126k, so you’re 99k over. Which Medicaid expects to be spent down on Arlene. But you might could put 125k into a SPIA & drag it so it pays you minimum possible under actuarial tables. This way your under the 126k max. Say $500 mo from SPIA to you as income. Now you personally get $800 a mo from your SS. Your income $1300 mo. But you have rent, recurring medical, prescription, other living costs that run $1900 mo. Your short $600 a mo to cover CS costs. Say Arlene gets $1250 SS a mo paid to her. You can file for you to get CSRA or MMNA paid to you from Arlene’s SS$. So $600 of her monthly income gets waived to go to you rather than to NH as her required copay or SOC (share of cost). Community spouse resource allowance or Monthly maintenance needs allowance- think of these like oldschool alimony. She would pay NH just $600 as her Medicaid copay & keep $50 as her own NYS needs allowance.
Can you file for CSRA or MMNA on your own?, maybe but NAELA atty will know how to structure all income & assets as to balance out your needs both for now & your own future but keeps your wife ok for her Medicaid eligibility. You should not impoverish yourself, only your NH spouse needs to. Not all states allow SPIA.

SPIAs are speciality underwriting. Maybe dz or so firms that do them & usually thru NAELA /CELA attorneys. SPIA not, imo, done by some guy holding an insurance license. Not a DIY to wade thru ever imo.

I truly think for couples it’s not a DIY as your overwhelmed by the day to day of still being a husband & living independently. Atty will be able to give you options as to what to do & that is ok for how New York medicaid runs. NYS seems to have different financials than other states.

Also if you are like most couples, you have each other as beneficiary of each other’s life insurance. Bad idea if Medicaid involved. There’s usual cash value spend down aspect for Medicaid. But for couples theres another problem if you predecease her. That insurance $ from your death takes her over Medicaid limits. Your gone, so who is gonna deal with her Medicaid eligibility? Insurance policies will need to be looked at & probably changed. That too an atty can guide you on. There’s going to be one with fee at least half of what the one you saw. $5k seems to be a standard for doing couples planning & legal. Good luck!
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Reply to igloo572
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AlvaDeer Sep 12, 2019
Just paid more than 1,000 for simple revision, changing executor on Trust. I am telling you. California! At least the SF portion of it.
Igloo, may I ask what you do? Are you an attorney. I don't understand some of what you say but know you know YOUR stuff. Are there alternatives to attorneys for information. I know they have to do the final setting in stone, but can the details be worked out with, say, a good CPA. An estate manager? I know DollyMe and Cali have such great advice, and once knew what they did. There must be some alternatives out there for folks. Found all this fascinating. Thank you for it.
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I applied for Mom myself at the Medicaid office for free, but hers was pretty simple. My married friend who had a house, assets, retirement income etc had the Finance people at his wife’s NH help him apply. Not to say he wouldn’t have made out better by having a lawyer do it but who knows. (I digress but I still remember the day I was with them during the application process and he came running back to his wife’s room in the NH and blurted out “where do you want to be buried?” Not cool! Boy did she let him have it. We could laugh about that...later. Anyway the point is you can spend down assets by prepaying for your funeral.)

So if you have complicated finances and lots of assets I would try a different lawyer because that’s ridiculous.
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Reply to rocketjcat
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AlvaDeer Sep 12, 2019
I thought they might help. And I thought maybe run it by a lawyer, too. Because paying for the one hour advice works better than the 12,000 I think for the whole deal.
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I think if you have significant assets, have insurance policies and your wife has her own monthly income (pension, ss, combined, etc) which is higher than the Medicaid limit in your state it probably would be beneficial to just pay the attorney to do it for you. The reason is trusts will need to be set up properly and the insurance policies and home and assets and spend down to Medicaid level need to be handled in a certain way. It can get fairly complicated. Otherwise you might be able to do it yourself with the help of state social worker or Nursing Home social worker or accountant.
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Reply to mstrbill
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Any attorney who overcharges like that is (a) gouging (b) exploiting, or (c) just plain not interested.    The high price is intended to discourage someone w/o having to be frank and admit that the case for whatever reason is not appealing or worth his/her time.
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Reply to GardenArtist
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Go to the Medicaid office in your county and have them help you. That’s what they’re there for. How do have money for a $12,000 attorney fee if your wife is needy and applying for Medicaid.
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Reply to anonymous901498
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kirahfaye Sep 10, 2019
He didn't say he had that amount, but that is what he'd apparently been told is the cost.
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Many homes have advocates that can help you. or, you can do it yourself, detailed but doable. 12K is definitely price gouging.
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Reply to DollyMe
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The social workers at my relative's rehab facility on one hand, and at the chosen nursing home on the other, together walked us through the Medicaid process. It was fairly easy and it didn't cost anything. $12,000 is highway robbery.
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Reply to realtime
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That is crazy! Go to the local website or office, and get help. Ask the social worker at the MC for help. This is a service you are supposed to be able to do on your own, I believe.
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Reply to pamzimmrrt
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You mean Medicaid I think. 12k is a little much. Have you tried to start the process yourself? There are things that will be needed. As a surviving spouse your assets will be split. Her half will need to be spent down. Call your local Office of Aging and see if they can help or put you in contact with someone who will not charge u an arm and leg.
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Reply to JoAnn29
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worriedinCali Sep 10, 2019
Their assets will not have to be split in half. As the spouse he is allowed to keep up to $126,000 of exempt resources.
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