Does she have to spend that amount on nursing home care before Medicaid begins to pay? If so, what are the options for coming up with that amount? Selling or mortgaging the land which has been in the family for 130 years?

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Well this is interesting, couple of thoughts:
Is DHS telling you that you have a 100K transfer penalty because of the LE? If that is the case, there should be an appeal process in the letter they send to you. You need to file an appeal. But it has to be in writing. Just to cya, send the appeal request certified mail and then also by fax (and make sure you send the fax from someplace - like a Kinkos'/Fed Ex - where you get a transmission report that the fax was sent and when. The appeal will give you extra time to get whatever together. If mom is in the NH Medicaid pending, usually they have to keep her while the appeal process is in the works. You may have to be firm on all this but you have to do what you have to do.......

I have no experience with farms but I have been executrix for an aunt who had ranchland (cattle grazing no fields) in TX & NM and had to deal with valuation and in getting it to what it was actually worth versus assessor value for her probate. That being said, there are a couple of items I would look into....1. DHS is basing the value of 100K on what? Do you have a current tax assessor statement and what does that read for value? If you don't have the last assessor statement you probably can go-online and download it for a small fee. Is it the same as DHS figure? If not, then send a letter (again certified and return registered receipt) to DHS asking for the documentation on how they derived 100K. 2. Now what is the reality of the value of the property? Is it really 100K, if it is a fallow farm (not producing) and has been fallow for a while it might be worth alot less than 100K. To find that out, that I'd contact a Realtor who does farms in Iowa as to what the comps (comparables) are for other farms and also what the DOM is. You will have to tell the Realtor that you are considering selling the farm and are just trying to get a bead on what's what - you do NOT have to sign a contract to sell the farm. This is really just an exploratory into getting information. A good Realtor will be with a firm that has a program that can run this for the property for you in a couple of days and will do a little binder on it for you. DOM is days on market and this is important because if the DOM is in months rather than days, then you can try to establish a hardship on selling the property and selling it at 100K if you decide to go that route. If the comps come in at 50K then DHS can change their valuation of the LE but you kinda have to do the work so they can justify the change. You just don't have to accept what DHS says is the value as the final word. Understand?

Then I'd get an attorney, you know I bet for you an estate attorney is going to be better than elder care because of the having to understand farm/ranch rules and how their taxes & structure are very different. Now who did the life estate? Was this done recently or a long time ago? Is it irrevocable or revocable? Do you think the person who did it knew what they were doing? You kinda need to understand how a LE works and why it gets rejected by Medicaid. How it's done can make a big difference and the caseworker is not a legal person so may just be going by their list that says "Life Estates unacceptable" . My point is that DHS may not understand if the LE was done a long long time ago or has alot of farm valuation info in the paperwork. LE get a transfer penalty because it can be viewed as a gift and gifting is not allowed by Medicaid. You know some state's allow for an enhanced benefit life estate (a Lady Bird Deed) but not a traditional life estate but the caseworker may have to have it explained to them. Devil is in the details and the caseworker does not have legal expertise.

have you spoken with a caseworker and do they seem to have a clue or are more reading from a document? For the average caseworker ...well I bet farm stuff is well this is above their pay grade, so to speak.

Do you know what MERP is? At 99, realistically you will have to deal with MERP in your near future. MERP is after death estate recovery & all states have to do this. How it is done varies by state law, so again a good attorney will come into being needed. You want to keep the farm, right?

Family farm or ranchland is an exclusion or exemption from MERP for Texas Medicaid. MERP is post death Medicaid estate recovery. I bet other states also have this exclusion or exemption too. If your state does this too, then what the attorney might suggest if the LE is revocable, is that mom revokes the LE and the farm returns to her ownership and if it is her family farm it is an exempt asset for Medicaid. Mom gets into the NH on Medicaid (assuming she qualifies medically and also her other assets are under 2K and her income is below the max allowed in Iowa). Then when mom dies, you or whomever is executor of her will, files for the family farm exemption from MERP and the property will have no MERP claim. The attorney & you can then do probate to get the land transferred as per mom's will. At 99, time is not on your side, so good luck and find a good attorney.
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