What do I need to know about Medicaid spend down?

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An elder attorney wants $275.00 for a consultation fee. My mom went into a nursing home with assets. I was told she can have a house, car and $999.00 in the bank. What do I do wiht her money?

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There are many variables, such as how much money your mother still has, whether there is any real estate, and what state you live in! A good place to start, to both review the rules of Medicaid eligibility as well as all of the current planning techniques, would be the book "How to Protect Your Family's Assets from Devastating Nursing Home Costs: Medicaid Secrets." (www.MedicaidSecrets.com)
Since I wrote this book 8 years ago, it has helped thousands of people understand the complex Medicaid rules.
If you decide to read it (available in some libraries, too), be sure to post any questions on this site and I will try to answer them. Thanks and good luck!
Your question was what you needed to know about Medicaid spend down. I will give you a prospective as an Elder Law attorney.
Medicaid is a federal program administered by the states. The laws of each state differ to some extent. The federal law allows some "wiggle room" in applying the regulations. In addition to differences in the law, there are differences in practical applications of the law. One state may allow $8,000. to be set aside for funeral expenses into an irrevocable funeral trust, another state may allow a greater amount, but insist that it be pre-paid to a funeral director.
Elder law is not the most lucrative area of law, and you must be able to chat with seniors and visit nursing homes. However, it is satisfying work. Also, as a group, elder lawyers communicate with each other, and help each other on a daily basis. Find someone who is a member of NAELA, the National Academy of Elder Lawyers, because that is where the networking takes place.
Money you pay to an elder lawyer is a qualified spend down. That is, you either pay the lawyer or you pay the nursing home. All of the above ideas posted by others are good. You might make home improvements, purchase a wheelchair accessible van to make trips to family events, and a host of other ideas. But, I only know the laws of my state, Pennsylvania. You should consult with an attorney in your state.
One post above mentions the home waiver program where someone can receive Medicaid services at home. Although the program is part of the federal law, some states use it more than others. In some states it is almost impossible to get into the waiver program, even though it makes much for sense to allow the senior to be home. As for the family members getting paid for care, the states also differ on that issue.
In addition to application of the law, an elder lawyer is usually able to help fill out the Medicaid Application. You may have to go back five years in financial records. I was a former accountant and I can deal with shoe boxes full of financial information and turn it into accounting statements using QuickBooks. If there is a questionable payment, I can speak to the case worker about it, and ask for a hearing if it is contested. When you hire an attorney, as with any service person, you pay for knowledge of the laws and for experience.

You can also learn about it on your own. It is your choice. I am the same way. For some items I call the plumber (putting in a new garbage disposal) and some items I do myself (replacing small piece of drain pipe). You decide what you want to do, and what you want someone else to do.
First, as hard as it is to do....pay for her funeral now. That will spend some of it down. Is your Mom going to be staying in the nursing home or will she be coming home to live with you or someone in the family? My MIL lives with us, she is in the last stages of Alzheimers. She has Medicaid but she had a lot of money she had to spend down before she would become eligible. Her funeral is all paid for and some improvements were made to the home so that we could get her around (she is not mobile and needs a wheelchair). She now has Medicaid but she still makes more than the $880.00 a month that the wonderful government thinks she should be able to live on, so we have to send the County $509.00 a month or spend it on "medical" bills/supplies. She takes no medication so we only have her Depends, Poise Pads, rubber gloves, things like that, that we spend it on. So, we keep the receipts and each month, we send the county a check for the amount that they require MINUS the amount we have spent on supplies. We have aides that come in to help us out daily that is covered by a program that she is in (Consumer Directed) that is paid for by her Medicaid so we figure spending the $500 each month is worth is as we get 76 hours a week help with her care. We couldn't ask for more and as painful as it is to send in that money each month, we know that we couldn't have this program if we had to pay the whole thing out of our pockets. The best part though is that because my boyfriend and I are not married, I am one of the aides so that money comes back to the house each month anyways.

If anyone would like some help/infor ... please let me know. We have been through hell and back and jumped through a lot of hoops to get this but it is so worth it in the end. We love Mom and will never let her go back into the nursing home (she spent 4 months there with a broken (replaced) hip). She will be with us, in HER home, till her last breath.
Sorry, but the cost of a "good" eldercare lawyer is really worth it! They know the legal "ins and outs" and can save you MUCH heartache later. Run--don't walk!
If Mom lives here with me, but will probably have to go into a nursing home, soon. She is 92 in March. Does anyone know if I can spend her money to adapt the house for her use, like a ramp, a new door with a dead bolt, things like that? Just asking. I'm not paying an attorney if I can get away with it. I went to a Medicaid seminar lead by an attorney and when I asked too many questions I could tell he was irritated because he wants you to pay big bucks to talk to him. I've learned pretty much everything I need to know except for improvements to MY house where she has lived for the last year. Thanks if anyone knows.
Dear sprtsjnke,

I am in need of your experience and advice. My aunt ( like a mother to me), fell and broke her hip, was in rehab for sox weeks, is a huge fall risk and poor memory. Is now in a nh but wants out and it's killing me having her in there. I am going through the Medicaid app. Process now and it's hard to know how to spend down beyond the funeral etc, meds, clothes... I have questions about spending down and about how or if it's possible to get her home, with the amount of sevices you describe...I didn't think she could get home because I thought she would only get a couple of hours maybe a day or less even... 70 plus hours a week could possibly get her home...help! I am desperate for information as I feel like I am pulling her life out from underneath her. I just don't know what to do..everyone seems to think the nh is the only answer but it just doesn't feel right. I have a very small house and two young boys so it's not a realistic option to bring her to my house..plus we are rarely home...but with 79 hours of help per week...we may be able to swing it... Any help, info. Would be sooooo appreciated. Thank you!

The question about where to place funeral funds differs in each state. Elder Law Answers is a great resource, and I am one of the attorneys who are a member of Elder Law Answers and who help build the site. In my state, Pennsylvania, there are a few banks that will set up irrevocable trusts for free. In other states, especially with regard to recent changes in the federal regulations too complicated to discuss here, the funds must be left with a funeral director. The issue about leaving with a funeral director is that funeral homes are bought and sold, and the new owner of the funeral home might be very different from the original owners.
I might suggest another resource, the Funeral Consumer's Alliance. Find the group for your state and ask about pre-paid contracts in your state.
Simple answer is use the money to pay the nursing home until it is gone, then she will qualify for Medicaid. But if you are trying to not spend the money, then you will need to talk to the elder care attorney.
You can use it for most anything but not gifting it to others. I went to an elder lawyer for this and used the money for home improvements such as fencing in the yard (so husband couldn't roam), new roof, air conditioning, home help, respite, could have even bought a new car; of course all of this has been done before NH placement.
There is a lot of info on this site and in the web in general.
Decide if you are going to keep the house, particularly if nobody is living in it. You would not be able to profit from rent and would have to pay taxes and upkeep from her $, sounds like a waste, but is an emotional decision.
If you keep the house, some of the $ will be spent there.
Definitely prepay funeral.
The intent of the look back is clear, you can inform yourself, if her money is substantial, I would pay the $275 for professional advice.

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