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I am in an echo chamber over an issue I hope someone can help. My husband has limited funds and a 3-yr long term care insurance policy. He is currently in an assisted living that is costing him $9000/mon. At this rate, he will burn thru his long term care insurance (which only pays 60% of the AL monthly fee) and his savings in less than five years - the magical number to be qualified for Medicaid. An 8-hr night home care and adult day care program with medication management (while I am at work) turns out to be a better option because it will cost around $1500 less each month. This saving would allow him to stretch out his funds longer and he gets to live at home longer while he is still aware what is going on. He'd have a dignified quality of life until he is no longer aware what is going on. When the funds run out, he will have passed the 5-yr look back and qualify for Medicaid. So, two scenarios: 1. If he stays at the facility, he will use up his funds in less than 5 yrs and then must return home. He'd be too early to qualify for Medicaid. By that time, he would have to reacclimate to a new setting with a worsen condition. As I mentioned above, he is still aware what is going on and hates where he lives. 2. If he returns home now, he can enjoy living in his own home until he is qualified for Medicaid. By that time, his condition will probably deteriorate beyond his ability to recognize his surrounding and enjoy life at home. In either case, he will have to be at home at some point before Medicaid kicks in. No matter how I play with the figure, he just does not have the funds to last him at the facility beyond 5 yrs. Wouldn't it be better to bring him home now (with adult day care and night help) so that he can live in a dignified manner when he is still aware if what real life is??

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Bummer. Will chk with my attorney.
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But that only applies in the 3 states mentioned. Fl, N.Y. and CT
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Wow. Good to know.
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Spouse can refuse to use their funds to pay for NH care
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What is spousal refusal?
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In most states, the "community spouse" can keep half of the "countable assets" up to $120,000. Three states do allow for "spousal refusal" (NY, CT, and FL).
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Worried Spouse, there are also provisions in Medicaid law to prevent the impoverishment of the "community spouse", the one Not in a facility.

Again, an eldercare attorney can help with this.
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Thank you, LTCShop, for the heads up.
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Medicaid does NOT look at a married couple's assets as being "separate". Even if you have a prenuptial agreement, Medicaid does not look at your assets as being "separate". You may have to spend most of "your" assets/savings on his care before he can receive Medicaid.

A long-term care "Partnership policy" is a special type of long-term care insurance that allows assets to be protected from Medicaid even after the long-term care insurance runs out of benefits.
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Thank you, LTCShop.

1. Will check to see if his policy is "Partnership Policy." What does it mean anyway?

2. Yes. Our finances are separate. He has no possessions. Just his savings and LTC policy.
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Two thoughts for you to consider:

1) If your husband's long-term care insurance policy is a "Partnership Policy" then he can apply for Medicaid without spending all the savings.

2) Do you and your husband keep your assets "separate"? Even if they are separate in your view, Medicaid may not look at it that way. Medicaid counts the savings/assets of both spouses, not just the spouse who needs care?
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Grammyteacher: My husband developed sundowning that seemed unexpectedly and he wandered. I was ill-prepared and quickly moved him to an assisted living to keep him safe and stabilized with Seroquel so that I could explore other care options. He does not acclimate well in the facility. As I looked at other care options, I became more convinced that home care with adult day care and night aides is the best care option at this time. I still need to put together an action plan in case we have another crisis again.
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I guess my question would be, what caused you to decide to place him to begin with? If he was too much for you to handle at home then, what has changed? Being at home is always a better choice in my mind, but only if it is safe and doable for both of you.
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Oh wow! This is really helpful. I misunderstood the 5-yr look back rule. Thank you all for trying to explain to me. I feel a bit better now.
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Worried,
I think you are missing the point the others are trying to make/ask. Medicaid does have a 5 yr look back on funds that are given away to others NOT what the person spends on themselves. If you are spending funds on your husband, that is not counted towards Medicaids look back. So if you are using the funds to pay for AL, that doesn't count towards the 5 yr look back. When the funds are depleted, and he needs to go to NH, you can apply for Medicaid. I hope this helps but if you are spending the funds taking care of him either at AL or in your own home, it won't stop you from applying for Medicaid. So in my opinion, keep him where you feel would be the most comfortable for you and him and enjoy the time you have.
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I thought Medicaid in all states had a 5-yr look back. At the rate he is using his funds, it will be depleted before the 5 yrs. Am I missing something?
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Why does he have to come home when he runs out of money? Will Medicaid not cover his AL feed through waiver? Certainly they will cover NH fees.
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Can you cover the weekends when adult day care is not available and it's 24/7 care? Have you figured that into your figure? Your spouse's life with dignity if it destroys your life is not going to help him in the long run. 40% of caregivers have significant health events or die before their loved ones do, which would necessitate a move at the last minute.
The reason others are asking about Medicaid is that YOU made it a big part of your financial decision question. If your husband and you gifted money that will cause a transfer penalty within 5 years look back, then it's a problem. If the assisted living facility that he is at won't accept Medicaid by waiver, that's a problem. A lawyer in your area will be able to review his finances, perhaps come up with some creative ideas that will stretch the money farther, and leave you with some options as community spouse. My father-in-law was determined to keep mother-in-law at home. She refused to have home care and insisted that he be the one caring for her. If spouse needs exceed what the adult day care can provide, what then? If you get in-home night caregivers privately, what if no one shows up? That's what the other caregivers that responded to you were concerned about. Moving people in and out of assisted living is very disruptive and later stages will be more difficult to adjust. You can visit and take out spouse in assisted living to go to programs too - does the long term care reimburse directly to you or cover certain programs? Lots of questions. Your quality of life is important too.
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Well, my question is not about how to spend his money to qualify for Medicaid. The question is whether to spend the money for home care or in assisted living. Either way, it will be depleted soon because the savings is not big. When depleted, he has to come home. So, why not have him home now and let him enjoy life with dignity. That's all I am asking...
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Worrried; What do you understand about the Medicaid 5 year lookback?

Has your husband gifted funds to someone or made large financial contributions to someone or some institution, i.e., spent money on something other than his own living expenses or care?

THOSE are the things that Medicaid is looking back at--giving away a house, stocks, money. Not spending money on himself.

Getting clarity on this from the certified Eldercare attorney who understands Medicaid might be a very good use of HIS money right now.
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What has occurred in the 5 year look back that you are concerned about?

I hope that you'll get some responses from some around here who know a lot about this. When, I had questions, I consulted with an Elder Law attorney who focuses on Medicaid issues. He was able to help me quite a bit. Have you gotten an expert's opinion and/or legal advice? I would likely do that, since so much is at stake.
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