This is regarding a medicaid recipient who is in a long term care nursing home. She entered in possible after March 1, 2005 but I'm not sure if she was on an interest list to enter or what. My question is the family thinks they have to sell the home because once they take her out of the nursing home they might want to recover for services medicaid provided, and the spouse is still alive and remains in the home how would we work this out and keep medicaid from recovering the estate when the spouse or medicaid recipient dies. Does it have to be a certain amount of time after the spouse dies or the medicaid recipient dies. Please let me know, and can they sell the house while the medicaid recipient is in the nursing home. Her name is on the deed and the spouse both .

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Laura - go to the State of TX DADS site - this is the clearinghouse for all things Medicaid, then go to the MERP section. MERP is Medicaid Estate Recovery Program - all states have are required to have a MERP policy in place in order for the state to get federal $ for the state to administer Medicaid. MERP is for more than just NH too, it also extends to recovery for payment for mental health and other community based program paid for by Medicaid. Base amount Medicaid pays for NH room & board is $ 145.00 a day in TX, so $ 53K a year. Her overall tally could be over 300K for 7 years.

But you really need to find out the exact date, she went in. MERP went into enforcement in TX sometime in 2005. So she may have entered the program right before MERP started, so no MERP recovery allowed if that's her lucky situation.

How MERP runs is very much dependent on state law. TX is a level of claim state for probate, and MERP is a class 7 claim. So Class 1 - 6 get paid first and foremost. MERP still happens but the % is lower in TX than in other states.

You kinda have 2 different issues going on imho.....1. what happens regarding her NH Medicaid tally if the family takes her out of the NH & 2. how the state of TX deals with community spouse issues within Medicaid. The first one I really am kinda clueless on what happens then, but I am curious as to why take her out of the NH now (?!?), if she has been in a NH since 2005.

As far as recovery, all states have to do something MERP as they have to show an effort to recover some of the costs the state paid the NH through Medicaid. Now there are all kinds of exemptions to MERP - like if there is a surviving community spouse who is still living in the home, then no MERP; or if there was documented caregiving by a family member who lives in the home for 2 full years prior to the NH which kept them out of the NH for that period of time, then no MERP; or if family who would inherit & live in the home would be in another at-need program for housing if they couldn't live in the home (like they could get section 8); and if the home is empty then all the costs to maintain the home can be a MERP exemption. Pretty varied list. BUT the key in all this is that you have a small window to file for the MERP exemption and provide the documentation to MERP. MERP letter goes out automatically (it seems) but they have to do an evaluation as to whether recovery is feasible & cost-effective. It is a legal process and take time.
If there is a community spouse living in the home, then no MERP. But you have to let MERP know that he qualifies for the community spouse exemption and respond to their letter.

TX does an annual recertification for Medicaid and in the form, it asks about their home and the status on it along with other things (like info on their burial pre-need, health costs not covered by Medicaid, their latest annual statement from SS and any retirement, etc). I get the one for my mom about 6 weeks after her anniversary date of being accepted by Medicaid for NH. Who has been getting this form and filling it out? If it's been going to the NH and social services is doing it, then you really need to get it changed so that all comes to you or whomever is going to be the detailed person to do the follow through needed with MERP. That person is going to be the one to get everything Medicaid and the MERP letter as they are in the system for the contact for the NH resident now and their estate's representative.

About selling the house, if they do that, then as a co-owner of the property, the NH one is entitled to 50% of the proceeds from the sale and the $$ from the sale will take her over the asset limit of 2K. Understand? She will have to spend-it down and private pay for the NH till she gets back to the 2K asset limit to go back onto Medicaid. If this is what happens, they really need to get an elder care attorney to work it out so that they can do a decent spend-down without Medicaid issues. But at least, she will have the $ to pay for the attorney! Good luck and keep a sense of humor - you'll need it.
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