My mother-in-law was recently divorced. In the divorce decree, her ex husband was awarded the house and she was awarded a piece of land. The plan was that she would sell the land, my husband and I would sell our home and we would buy a new home jointly with first floor bedroom and bathroom for her. However, she recently had a health problem that is requiring short-term 24 hour care. This has caused us to consider the potential need for Medicaid in the future. We know that the Medicaid 5 year year look back period will be in effect if she gifts us money to put into another home. Our concern is, what is the best way to use her money to get into a home that a large enough for all of us? Our current home is definitely not a good long term solution. We have considered:

1. Put her name on the house as "tenants in common" with my husband and I as beneficiary upon her death. Concern is that if she does need Medicaid in the future, will they put a lien on our home for her portion of the home?

2. If she gifts money toward the home to us, we know there will be a "look back" period that will cause her to be disqualified for a period of time. After her death, does the Medicaid Recovery Act allow for the state to sue us to return the gift?

3. If she cannot put money toward the house, can we have her pay rent/expenses as "spend down?" If so, what is considered reasonable?

4. If she uses her money toward making improvements to the home (such as an accessible shower, accessible steps, etc.) is that considered a gift because the improvements are for her care, even though we own the home?

How can we keep her in our home (meaning we will need a bigger home to do so) and get the resources we need?

Need ideas -- appt with lawyer is pending.

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Oh and yes you can charge her room and board and is eligible for spend down but it needs to be by lease or contract. Elder Law attorney to prepare any documents.
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The best thing you can do for yourself is to hire an elder law attorney.
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I would think any for her use should be okay - so a fireplace in her bedroom because she is cold would possibly pass the sniff test but 1 in tv room would be a maybe - anything for mobility or shower safety should be fine -

Even a work station in kitchen if it's for her sitting down could be okay - a outside ramp, parking pass, even having someone do a closet arrangement so that she could find her own thing from a wheel chair -

If I were you I'd get advice from an occupational therapist before you buy a place because you would have that as not only a guide but for future use & any expense would be hers

However that divorce could be tricky, because if she had dementia at that time then that agreement could be reopened if it is too favoured for FIL because divorcing someone with dementia is not legal in some places because they can't fully understand the results of signing the paperwork - just something else to ask the lawyer
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Call Medicaid - they will advise you on the necessary spend-down.
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Please consult with an elder law attorney now to see all your options. It sounds like you've got some time before anything drastic happens, but since you are investing your home and your lives into helping your MIL, it's good to know your options now. Medicaid look back is 5 years, so if you utilize her money from the land and live with MIL for 5 years, you are probably good. Also, start thinking about care facilities NOW -- look at some, ask questions -- have a long term plan. Again see an elder law attorney...
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You need to consult with an elder law attorney. Laws vary based on the state you live in. In some states the home will go to you if you provide medically necessary care for a period of two years. Her doctor would have to document the 24/7 is necessary.

If there is not that provision then you would have to buy mom out of the house for her to have cash for her care until that is spent down. Not a do it yourself by any means.
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Your elder law attorney can best advise you about your options but you might be better off setting up a "granny" house if you need to use MIL's funds. In my rural area, you can purchase a house with some land and use MIL's funds to purchase a mobile home that you place near your house. I like the smaller double wides with an open floor plan and a master suite with a large bath that includes a separate shower. You can order mobile homes constructed with your choice of wide doorways and ADA compliant fixtures. Or you can purchase a used mobile home off a repo lot and remodel to elder requirements.

There are "granny pods" designed for urban environments if your city code allows them, but they seem to be about twice the cost for half the space.

If it's affordable, it maintains privacy for both you and your MIL and keeps her funds separate from yours for Medicaid. You own the home and land and she owns her mobile home, or she could also own the land where her mobile home resides.
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