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My FIL has dementia, and already has been declared incompetent to manage his own affairs... he has been in a NC hospital for the last two weeks, as they try and deal with his physical and mental issues.


They are proposing to move him to a memory care facility, and one of his daughters has been in touch with a state agency that said he should immediately apply for Medicaid... for which purpose they want us to divest him of his assets (i.e. transfer them all to his wife's name). This advice is coming from someone who works for Stanley County NC (stanleycountync.gov).


Although this is being proposed as a correct course of action from a state official, it sounds a little bit like trying to hide his assets from Medicaid, which we would never do. (FWIW, the total assets for the pair is probably about $60,000, and the siblings are *not* trying to take a dime... everyone wants this money to be used for their care, whereever that is).


The siblings have contacted an elder-care lawyer, but they cannot get in to see her until Mar. 11. Meanwhile, this facility has an open bed and the hospital wants to move him there.


My wife is going to NC tomorrow to try and help with this... My main question is whether anyone (esp. in NC) has heard of this type of Medicaid maneuver and whether it is legal.... REMEMBER, the assets are being transferred to his spouse, not his children.


Thanks,


Bood

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I can’t specifically answer your question, many matters of Medicaid tend to be state specific, but will share that when my mother needed Medicaid we were walked through the process by the business manager at the nursing home (which also had a memory care facility) She was very knowledgeable about all of it and it didn’t cost anything for us to use her services. My parents assets were jointly held, not huge, and the only change for my dad (the community spouse in Medicaid speak) was that he had to sell one car. He couldn’t have two. My mother’s SS check went directly to the NH. He kept his retirement, SS, and their savings and checking, along with their home. The advice to go ahead and move your FIL is solid, the business office where he’ll go should be accustomed to working with people on Medicaid pending cases. I wish you the best
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CarrieLockhart Mar 12, 2020
So your mom and dad didn't have to split assets and do the "spend down"? My mom is having a hard time with that part, especially after years of saving.
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The asset amount is so low, NC Medicaid may very well allow 100% transfer to wife. Send the social worker at the hospital an email to document your understanding, wait for a response. Then move forward after speaking with the attorney. Wife may even be allowed a portion of his social security.

You could also Google spousal impoverishment laws in NC. Try to find an attorney that will give you a free half hour consult immediately.

The problem with not transferring assets to wife now is that the monthly fee for memory care will lower assets that wife may be able to keep.
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Reply to gladimhere
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I would move her into the memory care facility right away and then wait until after you talk to the lawyer before taking any action on the asset transfer. It will likely mean spending some of their assets, but that's better than making yourself ineligible for Medicaid.
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Reply to NewandTrying
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Bood - Daughterof1930 point abt cars is SUPER important. Medicaid rules only allow for 1 car. So either it’s sell 1 OR look to trade in both to get 1 better / newer car that CS can have for the long view.

state is probably going to want the CS & NH spouse to each have their own separate bank accounts into which each get their own monthly SS income & any other individual income. CS savings acct would get 60k. All this is about NOT having anything thats commingling of $ for Medicaid to ever see as it will throw his LTC NH Medicaid whack for “income” & “assets” if CS $ is there.

Remember only NH spouses “income” matters for Medicaid; CS income is not a factor nor is it included in the required copay for the NH spouse. Thier “assets” however are viewed jointly BUT the CS is able to have their own asset account in their name of up to 120/128k depending on what your state puts as the $ ceiling.

Also find out IF they have life insurance policy that names each other as beneficiaries. Bad, bad, super bad idea if Medicaid involved. Why? Well if CS gets hit by a bus & NH spouse gets insurance $, that $ takes him over income & asset max for LTC Medicaid & he’s ineligible. & as CS is dead, so who’s gonna do all the new spend down & paperwork for NH spouse now? Just ASAP change it to one of the kids, probably whichever would be the eventual Executor. If it’s a term policy, you can change beneficiaries easily & no issues for Medicaid as term has nothing beyond “face” value till after death (face value will likely be low that’s how Terms kinda run). If it’s whole life policy, those actually have a cash value & may need to get cashed in.... but don’t fret on that unless you know absolutely for sure it’s a whole life policy.

if NC is like TX or LA, for NH/CS situations, state does an affixed “snap-shot” day to which all income & assets are tied to & so can factor in for any spend down needed. In theory it’s the date the application is signed off on as that’s day 1 of being “Medicaid Pending”.

But don’t panic. If he’s in the hospital right now, imo, you all have time on your side. What you want to try to have happen is for him to stay in the hospital as long as possible (MediCARE & whatever secondary health insurance coverage pays); then he is discharged from the hospital to rehab facility (this will likely be a NH that is both rehab & skilled nursing care); post hospitalization rehab is a MediCARE benefit which usually has first 20/21 days as standard 100% paid by MediCARE & up to 100 days @ 80%. You use this MediCARE coverage period to get whatever done, $ move, beneficiary changes, new car, etc. So that when he stops “progressing” in rehab, he’s got paperwork in order for his LTC Medicaid application at the ready. Believe me, NH will want to keep him on MediCARE benefit as long as possible as they make triple $+ for a rehab stay as compared to Medicaid paymt. But again you have to use the paid by mediCARE time to get things organized.

Be sure to go over in detail CS living costs. Remember in theory LTC Medicaid spouse is to basically have almost all his monthly income go to NH as required copay. Should CS need his income to maintain her standards of living, she needs to get CSRA / MMNA from his income waived over to her each month. If that means the NH gets just $100 a mo as his left over copay, it is what it is. There was a poster onAC who’s dad paid NH $45 copay as mom had mortgage, expensive RXs, high energy bills. They did have CELA level of elder atty do application & CSRA paperwork. Personally for CS/NH situations there’s lots of lil items to deal with. I think having an elder law atty is worthwhile, especially if CS is likely to outlive NH spouse by years & years. 60k isn’t much $ to s...t...r...e...t...c...h out for decades. For widow or widower LTC Medicaid, those I think the dpoa kid can wade thru as a DIY.
Good luck next week!
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KaleyBug Feb 29, 2020
Medicare original does not cover 100 days at 80% anymore after the 21 days at 100%. We learned that when mom broke her femur. Dad paid $15,000 of the additional days needed out of pocket. Its possible an advantage Medicare plan pays what you stated.
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I’m with Glad that at 60K it’s low enough $$ that any transfer in full to the community spouse will be ok.
community spouse asset limit usually is set so that they are allowed to have their own exempt assets at abt $120k - 128k.

Id be more concerned IF the CS needs some of the NH spouse monthly income to be able to have enough $ from their own income alone to manage their true living in the community costs. In theory once on LTC Medicaid the NH spouse has to basically have all thier mo income go to the NH less a small personal needs allowance.

Should the CS need some of the NH spouses mo income, they need to file for a waiver to get some of the NH spouses income $ to get “waived” to go to them. It’s called CSRA or MMNA, just what & how to do depends on how your state runs LTC Medicaid. Basically it’s a needs assessment filing. Think of it kind like old school alimony. I’d suggest you clearly look at the CS’s living costs & then file for a CSRA or MMNA waiver. There’s been folks who’s stay in the home parent basically got almost all of the NH parents income as they had a mortgage, high prescription costs, etc. & the NH got under $100 as the required copay.
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Reply to igloo572
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Don't spend down to qualify. The assets are low enough that spend down most likely will not be required. Community spouse gets all.
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Reply to gladimhere
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Our family consulted with an elder lawyer with special knowledge of Medicaid rules in our state. In NY, a transfer of assets from one spouse to another was allowed.

We were not charged for the consultation. We did pay for him to draw up some other legal papers for the spouse. I would suggest that your wife and her family see if they could do something similar. There are many rules in place, especially to protect a community spouse. Following the rules is not "hiding" assets.
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If you intend to use Medicaid, just know that they will do a 5 year look back into their finances. Meaning, from the time the application is accepted by NC there’s a 45 day calendar day process and during this time is when the state will do this. We have a lawyer doing this for my mother-in-law who has been diagnosed with Dementia and is incompetent (Husband and myself are POA). We are at the end of the 45 day application process trying to place her into a nursing facility. We are also the two main caregivers. With all this said, you can’t hide anything from the state in regards to transferring funds. It’s been a learning process for us.
God Bless
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Reply to AngelsAllAround
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Hi there, Bood,
I feel your frustration. In fact, I am dealing with similar circumstances to what your in-laws are going through.

The first advice I can give you is to use the resources of AgingCare.com. Here is the link to one of their articles (contributed by an elder care attorney) about Medicaid issues when one only one spouse is going into a skilled nursing facility. The remaining spouse is identified as the "Community Spouse". I see that other posters have referred to this as the "CS" , but were not sure that you knew what that meant.

https://www.agingcare.com/articles/medicaid-spend-down-for-spouses-158628.htm

Secondly, "don't panic". As you will see by reading this article the CS will NOT be left "stranded". It is true that there is a 5-year look back period for assets (presumably to prevent fraud and "gaming" of the Medicaid benefit for those not in need). Unfortunately, many folks out of ignorance and/or fear, especially those of modest means, fail to plan ahead. Then,as in your case, when the care is needed immediately it's too late to transfer assets! This is generally only a problem for couples with complicated estates or relatively high net worth that one would not like have gobbled up by long-term care costs.

Assuming the $60K in your in-law's assets doesn't include their home, you will see when you read the article that this is below the threshold to qualify for benefits already! So, to the best of my understanding, the worst case scenario is that only half would be countable to your FIL. This means that $30K would have to be paid out of pocket before Medicaid would take over. While not ideal, it is also not that massive of a loss. (e.g., my own mother had to spend down her last 120K in savings before she went on Medicaid. The worst part is that only covered 3 months of her care in her SNF!)

The other thing that is not very well-known or clear (if anything is regarding senior care!) is that after the spouse who was on Medicaid passes AND the community spouse also passes, the state may come back to the estate to recover previous benefits. However, generally if the estate is very small, this retroactive payment may be waived or reduced. However, I would say cross that bridge when one get's to it.

Lastly, one has to consider your in-law's income as well as assets. Again, I believe that half of any SS, pensions, annuities or IRA distributions can be reserved for the CS, while the balance would go to the SNF (less a small monthly allowance for your FIL).

Again, the disclaimer is that I myself am not a lawyer. However, I have had do much of this research for my mother and now my spouse. It's surely no fun and not easy, but eventually one can find the path to assistance manageable. I would not hold up your FIL's care waiting for one eldercare attorney to get back to you! Also, if your FIL is a veteran, you should be able to get assistance and advice from the local veteran's service officer. Your wife should probably contact the NC county where they are residing to try to connect with that person. In the same vain, every state has some version of an Elder Care clearing house to help seniors navigate all the resources that may be available to help with care, etc. (e.g., in Florida, where I reside, it's called ElderSource.). If you search through the "CARE TOPICS". tab on this site, you should probably find more information and links to these types of agencies and services.

I hope this helps a little. Good Luck
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Frances73 Feb 29, 2020
All good info. Catholic Family Services hooked me up with a pro bono attorney service which was a big help and saved us thousands of dollars. You don’t have to be Catholic to get their help.

And I had forgotten the Social Security income, as I recall Dad was allowed to have monthly assets of up to $2000 which included his SS.
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Five year look back for Medicaid. (Use to be three) Best advice is to transfer money little by little to someone you trust. Put the house in a living trust to take the intended Medicaid person’s name off. Spend down until total assets on paper are $2000 or less. For the Medicaid intended you can buy hearing aids, a year’s supply of batteries, clothes, PJ’s, transport chair, pad for chair, a lift chair, a TV, shoes, on and on to help get to that $2000. Keep receipts. Boom, ready for Medicaid if you worked it for five years. Start now. Have some consumer know how so the NH can’t kick you to the curb like a piece of trash.

Now you have a plan. If not for a loved one then for you.

Wise planning is the key along with a savvy lawyer.
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BoodaGazelle Feb 27, 2020
My wife and I are 62/63.... we have no children, and believe we will be all set.

But I will pass along all advice to my sisters-in-law....
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