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My mother recently had a stroke and is in a nursing home care now and will need long term care. My brother has always lived with my mother has always helped her out and taken care of her after some medical issues. She never did anything with the house, it is still in her name as an asset. Is the only thing we can do now is buy the house for fair market value or under an assessment value on the house and then work on the spend down process to eliminate asset value for her?

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At least in my state, your brother would be allowed to keep living in the house if he had been helping to care for your mother for at least three years. The problem is whether he can afford it on his own.
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Sorry, I'm not well versed in the details, hopefully some of the others will chime in soon, but don't sell until you speak with a lawyer versed in medicaid, if brother was her caregiver it may be possible that he can remain in the house....

You might try to search the forum for discussions of "medicaid exemptions".
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