I just listed her house for sale and she only has 1 month of cash left to pay for the SNF. She has late stage dementia and I'm her only family left. Do I just apply for Medicaid after this month in case it takes a while for her house to sell?
I wouldn't count on her not being kicked out for non-payment because the manager use to be married to a family member, it is not within her ability to let anyone stay without payment, only the owner(s) can make that kind of call.
Couple of other items to keep in mind: - if Moms house is probably not what the tax assessor/ collector has as it’s value and it is significantly below their value, please try to get the property appraised. Not a Realtor “value” but an appraisal done by a licensed and registered appraiser. Their report will have some sort of state seal and it is a legal document. Medicaid - as others have mentioned- will want the property sold at FMV and FMV usually is whatever the tax assessor has as property value. But if her home is in an area with lots of new builds or renovations, the comparables the assessor uses will reflect all the sales of these new builds / new renovations. It will not be accurate for an old unrenovated years of delayed maintenance home. The appraisal will be specific to her home and it is a more accurate legit value. If it comes in thousands and thousands of $ under the tax assessors value, doesn’t matter. You can show Medicaid why it sold for $250K vs tax assessor value of $325K.
- house needs “arms length” type of sale if it’s not sold at FMV or it’s Appraisal value. Which means it’s a MLS type of Realtor listing. No FSBO nonsense as Medicaid can have issues with these.
- should mom become “Medicaid Pending” or fully go onto LTC Medicaid, the month the Act of Sale on the house happens she then becomes ineligible for Medicaid. She will have to private pay for the NH and legitimately spend down all the $ to her from the Act of Sale and only when she becomes impoverished again can she apply to Medicaid. Please keep a binder in detail with receipts as to exactly where all sale $ goes. All the $ from house sale is her $ as home in her name & used on her care & her needs. Should she gift any of this money & should she run out of $ and need to once again apply to LTC Medicaid, the $ will be viewed as gifting and penalty applied.
- If your state allows for Medicaid to place a proactive lien on the property, Medicaid will require to be repaid from the Act of Sale $ for the lein to be lifted. So if she’s on Medicaid 5 months and then house sold, Medicaid can place a lien for all the $ they paid on her for 5 months. Please please ask your Realtor what happens in your state and how title companies do their discovery on liens. A proactive Medicaid lein is somewhat subterranean but will surface in the title search. It could add a bit of time to actually closing. Realtors who have experience with liens understand how to position this to smooth out the sale so the buyers & their lenders don’t get worried.
Again, if you just know there are gifting issues that most definitely will surface in the 5 yr lookback on moms financials, & if mom has had stocks or other more involved investments that she zeroed out or sold off in the past 5 years, personally I would not try to DIY her LTC Medicaid application. Find a CELA level of elder law attorney to deal with her application as well as freshen up her old legal and be moms attorney for the house sale paperwork. Good luck.
Cfour, on when to apply, it’s dependent on how your State runs it’s LTC facility Medicaid program. Some States you can do 90 days in advance, while others require that they are at impoverished level of asset requirements and have already done any spend down. Ask billing staff at NH as to what the system is AND also what documentation will need to accompany her application.
When you get the document list, please please carefully look to see if any of the items needed by the State to accompany her application look like or actually show gifting. Like if she owned a car but sold it or transferred it to a family member within the past 5 years. Or if there are obvious checks to family that look like or are gifting; or large cash withdrawals or large checks that do not have a receipt somewhere to show why it’s a legit spend down.
You mention your POA has “broad power gifting”, well POA may allow this but Medicaid is going to penalize her eligibility if she did gifting. If there are in fact issues on gifting or questionable spends, I would not try to do this as a DIY but have a CELA level of elder law attorney shepherd her application.
The way you mentioned the past kinda implies there were mistakes made… so is there gifting of $ or assets that happened from 2017 to today? & you mention the stock market, so mom has / had investments as well as her home? This gets way complex for an application! and is this correct?….. she has been in a NH 6 years but continued to keep her home. So for 6 years she has been paying all property costs? Anyone living in the home? Anyone paying rent? Were they living there prior to her ever moving into NH (so there 6+ yrs ago) and/or do they have any type of disability? Or has house been shuttered and vacant? Heres why I ask….. LTC Medicaid allows elder to have a home and even to continue to own their home; but Medicaid will be interested if others living at house and under what situation.
Once she applies for Medicaid, she will not have any $ to pay property costs. Medicaid will require her to copay basically almost all her mo income to NH. So you will have to out of pocket pay for whatever needed at house while on the market…. utilities, yard work, insurance, cleaning, repairs if needed to be able to safely show the house. Could be a tidy sum. Please try to find a Realtor who has experience in dealing with owner with no $ or deal with family who have wallet limitations if that is your situation. For you to be reimbursed from the Sale will be not easy as it flat looks like gifting as mom owns the home and sake $ is hers. Things like this are something to clearly discuss with an attorney before you get too into the weeds on property costs. If her home is on the market for months to be able to actually be sold at FMV, could be alot of $ paid.
NH can have discretion as to lowering a bill for a resident. Some places have a indigent fund. But if Medicaid determines a transfer penalty and ineligibility, the NH will be cc’d this info. I think it will be a hard reach for a NH to keep a resident who cannot pay due to penalties.
You apply for Medicaid before the money runs out. In my State, at least 90 days before. So now is the time. Even if the house sells, and it must at Market Value so have it accessed, it will take 2 months for settlement. Once sold the money needs to be out in a separate acct for only use for Grandma's care. Medicaid will stop and you will need to spend the money down and when that is done, have Medicaid reinstated. I would be leery in having the NH help with the application. If you do, keep on top of everything. Have them cc u in in any emails between them and the Medicaid caseworker. You should get a list of info Medicaid will need. Like I said, my State allows 90 days to apply, spend down and get info to them. The sooner the better. If you want and the Social Service office is close, I would hand deliver all info getting a receipt it was excepted. If mailed do it certified, you will get a tracking number. When you have done your part, you call the caseworker and confirm they have what they need.
You are allowed to do a prepaid funeral with proceeds of the house sale. Be sure its a Trust allowed by the State for people on Medicaid. This means the money is placed with a Federal Bank and has nothing to do with the Funeral home who helped set it up.
Im in michigan and plan on doing it through michigan bridges.com. She's 97 and basically disabled from late stage dementia alzheimer's so they will accept atleast at first but if they come after records I could be in trouble. I'm dpoa with broad power gifting but I don't think they will kick her out no matter what. Nursing home she's at is managed by women who was married to my step brother long ago and we've communicated few times since covid started with good dialog and reminiscing but nothing bout transfers. I had no idea about dpoa when it was put on me in 2015 and made lot of mistakes but whatever happens happens can't go back in time.
I don't know a SNF in the country that would allow THIS to happen, so it's quite the story. Yes, go ahead with medicaid, because if that house does sell it will be scooped up quick by the money owed to SNF. As to anything else, Grandma is without money at this point pure and simple. Bill collectors whether from SNF or anywhere else will be eating that cost and passing it on to paying customers, just as is the case everywhere, and grandma's credit will be ruined. The good news here is that SS cannot be attached for payment, and there are no assets, and grandma NOT having any credit is an excellent thing for her and for us all. If you are POA be certain to get good legal advice now, in this sale and through the completion of it all. Grandma's funds pay for that.
Contact your county office for aged and disabilities… they will guide you in the Medicaid process…
hopefully your grandmother has all the wills, POA, living will in place. If not this needs to happen as well
If you find you need to move her, Try to locate a placement specialist. I recommend an independent company. I used Care patrol… they are a franchise. Maybe one is near you. My specialist arranged tours, met with the director of the facilities with me. This person knows the area, what’s available , cost , what you are able to work within, admittance requirements. I placed my mom with an independent in another state..when I moved her hereby me , used Carepatrol to place her. A few months prior used CarePatrol to place my in laws…
You should ask the SNF if they accept Medicaid recipients (not all do). If they don't, then this is an issue and you'll need to move her somewhere that does (assuming she will qualify for Medicaid).
It may be wise to consult a Medicaid Planner first, before you apply. Do you live in the house currently?
FYI if you have been co-mingling funds with hers, or she's been paying you, Medicaid may see this as "gifting" which would endanger her ability to qualify. Many states have a 5-year "look back" period on the Medicaid application. Each state runs their own Medicaid program with their own rules, so be careful about taking advice from people who don't live in your same state and even county.
I wouldn't count on her not being kicked out for non-payment because the manager use to be married to a family member, it is not within her ability to let anyone stay without payment, only the owner(s) can make that kind of call.
- if Moms house is probably not what the tax assessor/ collector has as it’s value and it is significantly below their value, please try to get the property appraised. Not a Realtor “value” but an appraisal done by a licensed and registered appraiser. Their report will have some sort of state seal and it is a legal document.
Medicaid - as others have mentioned- will want the property sold at FMV and FMV usually is whatever the tax assessor has as property value. But if her home is in an area with lots of new builds or renovations, the comparables the assessor uses will reflect all the sales of these new builds / new renovations. It will not be accurate for an old unrenovated years of delayed maintenance home. The appraisal will be specific to her home and it is a more accurate legit value. If it comes in thousands and thousands of $ under the tax assessors value, doesn’t matter. You can show Medicaid why it sold for $250K vs tax assessor value of $325K.
- house needs “arms length” type of sale if it’s not sold at FMV or it’s Appraisal value. Which means it’s a MLS type of Realtor listing. No FSBO nonsense as Medicaid can have issues with these.
- should mom become “Medicaid Pending” or fully go onto LTC Medicaid, the month the Act of Sale on the house happens she then becomes ineligible for Medicaid. She will have to private pay for the NH and legitimately spend down all the $ to her from the Act of Sale and only when she becomes impoverished again can she apply to Medicaid. Please keep a binder in detail with receipts as to exactly where all sale $ goes. All the $ from house sale is her $ as home in her name & used on her care & her needs. Should she gift any of this money & should she run out of $ and need to once again apply to LTC Medicaid, the $ will be viewed as gifting and penalty applied.
- If your state allows for Medicaid to place a proactive lien on the property, Medicaid will require to be repaid from the Act of Sale $ for the lein to be lifted. So if she’s on Medicaid 5 months and then house sold, Medicaid can place a lien for all the $ they paid on her for 5 months. Please please ask your Realtor what happens in your state and how title companies do their discovery on liens. A proactive Medicaid lein is somewhat subterranean but will surface in the title search. It could add a bit of time to actually closing. Realtors who have experience with liens understand how to position this to smooth out the sale so the buyers & their lenders don’t get worried.
Again, if you just know there are gifting issues that most definitely will surface in the 5 yr lookback on moms financials, & if mom has had stocks or other more involved investments that she zeroed out or sold off in the past 5 years, personally I would not try to DIY her LTC Medicaid application. Find a CELA level of elder law attorney to deal with her application as well as freshen up her old legal and be moms attorney for the house sale paperwork. Good luck.
When you get the document list, please please carefully look to see if any of the items needed by the State to accompany her application look like or actually show gifting. Like if she owned a car but sold it or transferred it to a family member within the past 5 years. Or if there are obvious checks to family that look like or are gifting; or large cash withdrawals or large checks that do not have a receipt somewhere to show why it’s a legit spend down.
You mention your POA has “broad power gifting”, well POA may allow this but Medicaid is going to penalize her eligibility if she did gifting. If there are in fact issues on gifting or questionable spends, I would not try to do this as a DIY but have a CELA level of elder law attorney shepherd her application.
The way you mentioned the past kinda implies there were mistakes made… so is there gifting of $ or assets that happened from 2017 to today? & you mention the stock market, so mom has / had investments as well as her home? This gets way complex for an application!
and
is this correct?….. she has been in a NH 6 years but continued to keep her home. So for 6 years she has been paying all property costs? Anyone living in the home? Anyone paying rent? Were they living there prior to her ever moving into NH (so there 6+ yrs ago) and/or do they have any type of disability?
Or has house been shuttered and vacant?
Heres why I ask….. LTC Medicaid allows elder to have a home and even to continue to own their home; but Medicaid will be interested if others living at house and under what situation.
Once she applies for Medicaid, she will not have any $ to pay property costs. Medicaid will require her to copay basically almost all her mo income to NH. So you will have to out of pocket pay for whatever needed at house while on the market…. utilities, yard work, insurance, cleaning, repairs if needed to be able to safely show the house. Could be a tidy sum. Please try to find a Realtor who has experience in dealing with owner with no $ or deal with family who have wallet limitations if that is your situation. For you to be reimbursed from the Sale will be not easy as it flat looks like gifting as mom owns the home and sake $ is hers. Things like this are something to clearly discuss with an attorney before you get too into the weeds on property costs. If her home is on the market for months to be able to actually be sold at FMV, could be alot of $ paid.
NH can have discretion as to lowering a bill for a resident. Some places have a indigent fund. But if Medicaid determines a transfer penalty and ineligibility, the NH will be cc’d this info. I think it will be a hard reach for a NH to keep a resident who cannot pay due to penalties.
You are allowed to do a prepaid funeral with proceeds of the house sale. Be sure its a Trust allowed by the State for people on Medicaid. This means the money is placed with a Federal Bank and has nothing to do with the Funeral home who helped set it up.
Yes, go ahead with medicaid, because if that house does sell it will be scooped up quick by the money owed to SNF.
As to anything else, Grandma is without money at this point pure and simple. Bill collectors whether from SNF or anywhere else will be eating that cost and passing it on to paying customers, just as is the case everywhere, and grandma's credit will be ruined.
The good news here is that SS cannot be attached for payment, and there are no assets, and grandma NOT having any credit is an excellent thing for her and for us all.
If you are POA be certain to get good legal advice now, in this sale and through the completion of it all. Grandma's funds pay for that.
hopefully your grandmother has all the wills, POA, living will in place. If not this needs to happen as well
If you find you need to move her, Try to locate a placement specialist. I recommend an independent company. I used Care patrol… they are a franchise. Maybe one is near you. My specialist arranged tours, met with the director of the facilities with me. This person knows the area, what’s available , cost , what you are able to work within, admittance requirements. I placed my mom with an independent in another state..when I moved her hereby me , used Carepatrol to place her. A few months prior used CarePatrol to place my in laws…
I wish you peace as you go thru this…
It may be wise to consult a Medicaid Planner first, before you apply. Do you live in the house currently?
FYI if you have been co-mingling funds with hers, or she's been paying you, Medicaid may see this as "gifting" which would endanger her ability to qualify. Many states have a 5-year "look back" period on the Medicaid application. Each state runs their own Medicaid program with their own rules, so be careful about taking advice from people who don't live in your same state and even county.