MIL will be disqualified for Medicaid, what can we do? - AgingCare.com

MIL will be disqualified for Medicaid, what can we do?

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My MIL is getting to the point where she can't live on her own. Right now she is in the hospital due to a fall and a urinary tract infection. She recently signed her property over to my dh so that if she were to go into LTC, Medicaid couldn't come after the land and force us to move. We have a mobile home on what was her property, but is now my husband's. She also has her own mobile home here. Do they ever make exceptions on disqualification or is it an arbitrary disqualification? She wasn't signing over the land to qualify for Medicaid. She actually already has it as her secondary insurance and had she not signed over the property she would have qualified already as she meets all the financial criteria of equity well below the limit and income well below the limit, one vehicle, no other resources and she's been on disability for years. Is there any way to appeal the disqualification that we know will be coming? If not, would the NH just kick her out and we would have to figure out how to make sure she's taken care of?

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Good advice, here. I recommend an elder law attorney if there isn't time to try for pro bono advice through the state law office. Your mother wouldn't be "kicked out," unless no one paid her bill, but that would mount up as you wait, so yes, time is of the essence.
Good luck,
Carol
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My suggestion is to call your State Bar Association.... and ask if they have a "lawyer referral program".... where they give you the names/numbers of lawyers who have identified themselves as expert in the area of law..... "Medicaid Law"... where you need help. If you are referred by the State Bar Association.. your consultation with the lawyer will be under $50,

Tell the state bar that you need legal help ASAP... and tell that to the lawyer's office... when you call for your appointment.

If there isn't time to go through the Bar Association... get out the yellow pages (or internet).... and look for lawyers near you... that advertise help with Medicaid. Get to the lawyer fast.
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Also, Alzheimer's Association has a list of elder law attorneys (which I think they share with anyone who asks). And there should be a Council on Aging in your state that could help you.
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Just out of curiosity, who did the paperwork on the property? Was it properly done and recorded? In other words, was it an agreement between your MIL & your DH OR has this all been done by a real estate professional or attorney with a routine change of ownership documents and filed as such?

You say she was on Medicaid, right? Do you know if in your state, there is MERP estate recovery for ALL Medicaid programs and not just NH Medicaid? If there is, there may already be a claim or a lein on the property because of this. It may not show up just yet if all this just happened. A claim or lein on a property will be problem eventually in doing anything with the property - like selling it later on or getting a loan or other equity out of the property.

She will not be disqualified from Medicaid NH program per se. But she will get a transfer penalty for whatever amount the state places on the property at the time of the transfer. For property, it usually is based on the most recent tax assessor's value - the exact amount would be in the annual tax form that most places mail out in Oct/Nov. The transfer penalty is based on whatever your state has for their NH Medicaid reinbursement rate. It's different for each state. In TX it's about $ 145.00 a day - so a property with a value of and penalty of 50K would mean 344 days of private pay to the NH. The transfer penalty has to be worked out in order for her to stay at the NH. The NH fully expects someone to pay for her stay and her care.

Did you realize before she gave the property to your DH that Medicaid has all sorts of exemptions from MERP - estate recovery??; that her property is an exempt asset in most states for her lifetime even while she is in a NH and on Medicaid; that some states routinely do not even do an MERP estate recovery for low value property (like in MS it's 75K - so anything below 75K in value doesn't get MERP at all)?

One good thing is by & large mobile homes have a low value so if you do have a transfer penalty, it will likely be low for that value plus the land value.

What may need to happen is that your DH has to "sell" the property back to her and then it will be an Medicaid exempt property. But you all will have to pay for all - and I do mean all...taxes, insurance, maintenance, etc. - on the property as MIL will have no SS or retirement to do this once she goes into the NH. And you will have to do so till MIL dies and then you file for a MERP exemption and hopefully get one.
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It was done by a lawyer. I have no idea if my state does MERP on anything other than a NH or other long-term care facility. My BIL and SIL were both on Medicaid when they passed and as far as I know Medicaid never came looking for any property, which they also didn't own anything. My state does do TEFRA liens though, so they could've put a TEFRA lien on the property if she hadn't signed it over to DH and would only remove it if she were able to come home. I'm hoping to find a lawyer who does pro bono since we can't afford an attorney. The land is only 1.5 acres and compared to some, is not worth a whole lot. She'd only be ineligible for a few months I think. Sure, we could file for an exemption after death, but there are no guarantees that they would grant it. My state also has not given any criteria for undue hardship. I think we would/should get it, but like I said, no guarantees. She's not in a NH yet. She's in the hospital now and will be going to a NH for rehab. DH and my nephew are taking steps to have her put in a NH permanently but as of right now she's just going for rehab which from what I understand is not considered LTC and will be covered under Medicare with Medicaid as secondary. I don't know what can be done during the few months she's disqualified except for bring her home. We don't have the money to pay the NH cost and if we were able to afford to borrow money on the land to pay for it, as was suggested by the hospital caseworker, we would've just bought the land from her outright instead of dealing with all of the drama we may be dealing with now. We would be seriously overextended if we did that. We've lived here for 17 years,(actually DH has lived on this property his whole life) we're raising our children here, and we have nowhere else to go, so putting it back in her name I don't believe would be an option.
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Mama - all states are required to do MERP for Medicaid paid NH costs. Most states also do count other Medicaid programs for MERP - like mental health and the Star programs but do not seem to ever count any WIC type of programs. The states have to have this information somewhere accessible on-line (federally required). Really try to find it and print it up so you have it as a reference.

About the transferring it back to her name, what I meant by that is IF she does that - that is your DH "sells/transfers" whatever you want to call it, then it goes back to her name and ownership and the property is an exempt asset for Medicaid. Whether or not it wouldl be the best option for you all....well you need experienced elder care legal to work this out for you. What the transfer back does is give you time to figure out what to do but you all will have to pay for everything on the property as MIL can't. Perchance is there a family business on the property? That is an exemption in TX so maybe in your state too. Another one is the caregiver exemption for full time caregiving for 2 years prior - TX is now seeming to require secondary documentation on this (like a MD letter) so you may have to jump through this hurdle.

So what is the property assessed at? You need to know that to use for the base line for the transfer penalty.

What is your states Medicaid reimbursement day rate? Again you need to know that to try to roughly figure out what the penalty might be. There is a formula or equation to do this. It is total loco to figure out and I'm pretty OCD on this crap & I just could not figure it out. I dealt with one on my mom's car.

Do you understand how the whole "rehab" stuff works? Basicially it's if mom was in the hospital for 3 full days and nights and the doc order's "rehab"or "continued care" for her, she can go into a rehab facility. You need to make sure that whatever place she goes into is a NH that also does rehabilitation and that they take Medicaid and do admissions "MEDICAID PENDING". Some facilities are really just rehab and you don't want that - for the elderly that usually doesn't happen but you want to make sure of it. Like some big hospitals have rehab centers like for brain trauma recovery - that wouldn't work for your MIL.

Now - and this is IMPORTANT - because MIL was in hospital before rehab, Medicare will pay for the first few days. The rules are that if an individual covered by MediCARE is discharge from a hospital to a nursing home for continued care (rehabilitation) after an inpatient stay of at least 3 days, Medicare will cover 100% of the first 20 days and MAY pay up to 100 days, subject to a co-payment by the patient of $141.50 per day for days 21 to 100 (for 2011). Medicare does not pay for the many months/years that some people reside in a NH for long-term custodial care. In general, Medicare is limited to short-term acute care.But this MediCARE paid period of time in the NH is when you need to get the documents together to apply for MedicAID. It buys you time to speak to an attorney to really figure out how to resolve the cluster you all are in and what's the best option both financially and logistically to provide the care that MIL needs.

Now rehab rules require that MIL is PROGRESSING in her "rehab". If she just won't do OR just can't do whatever occupational therapy that the doc's wrote up orders for, then she will be discharged from rehab and from Medicaid paying for it.
So you need to motivate her to do whatever and you need to touch base with the social worker to see where she is for rehab and Medicare coverage every other couple of days. Really is she just complains and won't do, she will be discharged from Medicare payed for "rehab" & then you have that much sooner to deal with Medicaid and the house/property issue. Keep her motivated. Understand?

If it seems the whole transfer penalty just can't be worked out, I'd ask for her to be evaluated for hospice. It's not the 24/7 care and services that a NH provides, but it does provide for many, many services and MediCARE pays. I'm not familiar with at home hospice as we didn't do this for either my mom or my MIL. But there are folks on this site who have so post a ? about that, if you want insight. Good luck
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Thanks igloo! She did go into rehab before, for about 3 weeks due to clots in her lungs. She progressed pretty well. When she realized she was going home soon, it motivated her to get up and walk around, talking to people. That's another thing I'm struggling with. If she gets put in a home, I'm afraid she'll just give up. At the same time though, she can't stay by herself. My dh is talking about during the penalty just having her stay with us. I think she'll fight that too, plus we really don't have room so she'll be sleeping on our couch for a few months. The fair market value of the property seems higher than I thought it would be. For some reason the lawyer added her mobile home value on it, don't know why, since she didn't sign it over to him. It didn't run up it too much higher though. The FMV is still less than $28,000, so the penalty won't be very long. I'm thinking 5.5 months. I live in Alabama. If the mobile home, or rather two mobile homes that she owns hadn't been added, the value would only be around $18,000. She's showing signs of dementia but has not been diagnosed with it. One of her brothers has it. She was talking to dh today, saying that our nephew was on his way with the papers to put her away. She does not want to go.
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We wouldn't get the caregiver exemption anyway since we don't live in the house with her. The land doesn't bring us any income but had it stayed in her name and she were to die in the NH, we'd have nowhere to go. I don't know if the state would grant us undue hardship or not. We're not rich by any means. DH makes too much to qualify for any kind of government program but not enough to do a whole lot after the bills are paid if you know what I mean. (I stay home with the kids)I just don't trust the government to be honest.
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You should be able to go to your state's Medicaid site and if there is no information there, there should be a phone number of someone to call...if you can't get the info you need that way, then perhaps try for some legit but free legal advice. There are a lot of things that might come into play, such as you might be able to stay there until you both pass and then the property would be sold with the proceeds being recouped by Medicaid. Also, in some states, there are exemptions for an adult son or daughter to be given uncompensated ownership if they can prove they've resided as caregiver for at least 2 years. There is so much variance from state to state that you must not guess or take layman's advice other than to consult with your own state's legislation. Which is something you can probably even research yourself if you get nowhere with the other two suggestions. Most states have their complete legislation on line and publicly available...Google can hook you up with that.

But don't guess. Find out for sure.
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