I need a second opinion on a "spend down". They want me to spend $57,000 real quick. Advice? - AgingCare.com

I need a second opinion on a "spend down". They want me to spend $57,000 real quick. Advice?


It's a big step and once done it can't be undone.My wife is going to need in home care and going the Medicaid route seems the only way. And later placement will ,be necessary. My brother and sister wanted me to get a second opinion before I spend a lot of my annuity. .

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Also, take into consideration that you could preplan both of your funerals. That would cut the $57,000 down considerably.
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See an experienced elder law guy asap. The 57K amount, who is saying that specific amount? If it's the Medicaid caseworker, they really do not have the ability to vett the more complex financial agreements. For a community spouse, which you would be, the whole assets allowed structure is very different than for an individual Medicaid recipient (they have to be impoverished, but Medicaid does not expect the CS to be impoverished).

For CS in most states, they are allowed 113K in liquid assets. But what is included in the asset list can vary. Like some states totally allow for SPIA's to be exempt asset. So if that could work for you that would be better than a spend-down on care that Medicaid will pay for. Or like if you all still have a mortgage, then using the 57K to reduce that could be a very good done in a single action idea. As it reduces what expenditures you will face in your future. Really for CS situations it's pretty complicated and you are likely also very distracted in trying to deal with the myriad of issues with the minute to minute care for your wife. You need someone to work with you in all this - a good elder law guy is also going to know others who can help in other aspects of planning for your long term needs and her more immediate needs.

Also since you mentioned her probably needing a higher level of care in the future, you want to clearly speak with legal on your being able to get MMNA. Monthly maintenance needs allowance - which is like alimony for the NH set. MMNA varies by state, but what it basically does is divert the Medicaid NH residents co-pay to the community spouse to enable them to have more funds to stay living in the community (rather than pay all the co-pay to the NH). For TX, the MMNA max is about $ 2,300 and that is a good bit of $ to have to live on. But you have to apply for MMNA.
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It sounds like you are planning to keep your wife at home and use in-home care. That can often be done if you have enough help. And once she is on Medicaid that can be used for a care center if it ever becomes necessary. You are on the right path!

Maggie is spot on -- you need an opinion from an attorney who specializes in Elder Law. Then, when you are certain of the amount you need to spend down, try to use the money for things that will enhance your lives. Do you need some doorways widened to accommodate a wheel chair better? Is you house almost ready for a new roof? Be sure you have money set aside for funerals (the lawyer can explain how to do that). Would some new furniture make your lives easier? Some small renovations in the bathroom? How about upgrading your wardrobes so you won't have to buy new coats and shoes and bathrobes for a few years?

Pam has a good point on a practical note. If Wife is going to eventually need placement, getting her placed now as private pay may have some advantages in what is available now and will be later. But $57,000 may not be enough to make much difference. On an emotional level, placing your wife before it is absolutely necessary might be extremely difficult for both of you.

First, get that second opinion from a qualified lawyer. Balance the practical with the emotional.

Best wishes to you as you struggle with this difficult challenge.
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Far better to get her to placement as a private pay entry. More doors open if you can private pay for two years and then convert to Medicaid. If you wait until she is Medicaid only, your choices will be limited and there are long waiting lists.
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The second opinion you need is from a elder law attorney. Don't wait. There may be ways to shield at least part of that money. If you haven't already consulted one, now is most definitely the time.

Spending down $57,000 (if that's REALLY what you need to do) won't take long with in-home care. But do NOT-NOT-NOT do this until you've talked with an expert.
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