When the time comes to place mom in a nursing home, and Medicaid takes 2 pensions & SSI; who handles the month to month expenses of the home?

@Joann29, I think the limit varies by state and by what type of Medicaid. My mom could have up to $15,150 in the bank and still qualify. I am in NY.

Red - the house in a Living Trust is still in your mom’s name, right? It was probably done like this so that in theory when she dies it will Pass outside of probate to you and your 2 sisters are equal heirs. That’s it right?

The issue will be that if she goes on Medicaid, is that Medicaid is required to attempt a recoup of all $ paid by Medicaid for her care. It’s done through MERP. A living Trust or Life Estate doesn’t necessarily protect the property from MERP as some states allow for MERP action on trusts or LEs now. Based on what others have written NYS MERP goes after living trusts and life Estates. But you should speak with a NAELA atty to see where NYS laws shake down for the trust already done. 

However there are all sorts of exemptions and exclusions to MERP. One of which is the caregiver exemption, which is that you provided full time care for your mom for 2 -3 years which kept her from entering SNF. But doing whatever is needed to get an exemption is entirely on heirs or family to provide and respond to the state or its outside contractor. Like for caregiver exemption a state can require you to get a letter from their old pre NH MD or SW as to what care was needed and provided. That could be easy to do or very very difficult. If mom lives a few years in the NH, thats years since she saw her old MD.....

But these are after death issues. The more immediate will be that although mom can keep her home as a exempt asset for Medicaid, she will have no $ to pay anything on house. If you & your sisters want to have mom continue to keep her home, then you all will need to pay all the costs on the property from day 1 of medicaid till after she dies and you/executor deal with MERP and perhaps open probate if need be.

Can it be done? Yeah but imo you have to be able to afford all on a property, keep meticulous records on property expenses & be comfortable with risk that you may never own property. As you live in the house, & likely qualify for caregiver exemption, it makes sense to pay property costs. But your Sisters may not feel that way for their possible future 2/3 share. If they do not have their own exemptions, their % share of could be placed as a MERP lien or claim. If you needed to buy them out, could you?

Personally I think that if your mom wants to keep her home & you stay in it, its best to have it where you are the only heir and have it such that you get the caregiver exemption & property transfer to you done in tandem with her Medicaid application if your state allows for that. Mom will need an elder law att to shepherd all this for her (& you). It’s a lot of different things to mull over before ever doing a Medicaid application. 

When a person goes on Medicaid they r only allowed 2000k in the bank. All insurance policies need to be cashed in. They can be used for a prepaid funeral but anything left over needs to be spent down. Spend down can include private pay. Not sure how the living trust comes into it. Normally, Mom can keep the house but there will be no money for its upkeep. Medicaid puts a lean on the house when the person passes. They try to get back what they paid out for persons care. Like I said, not sure how this works when there is a trust involved. Usually there is a trust to protect assets. If done before 5 yr look back should be OK.

You mention a 'living trust' naming 3 children. This is a very general description. You will need to consult an attorney to determine to determine if the property is exempt from medicaid laws.

Medicaid does exempts your house from qualification; however, they do place a lien against the house in the event she dies and it needs to be sold so they recover their costs. That is why I'm questioning why you would want to bear the expenses of taxes, insurance, and maintenance. The fact that the house is paid off does not matter. The house does not have to be sold while mom is alive.

If mom does sell her house - she will need to use the funds to pay for her care as she will be ineligible for Medicaid for that period of time until she impoverishes herself again.

rocketjcat, one house and one car are exempt from calculating the value of assets for Medicaid purposes. The state can/must get reimbursed from the sale of the house after the Medicaid recipient (and spouse) dies.

Red, it would be very good for you to use some of mom's money to consult an attorney specializing in Elder Law before you make decisions about assets and before you apply for Medicaid. There are some exceptions to the Medicaid lien, and one of them involves a family member who has lived in the house and cared for the recipient a certain length of time.

Getting old shouldn't be this complicated, but it is. See an Elder Law attorney. It can save you a lot of grief down the road.

BTW, even if you can keep Mom at home until the end (and I hope that is the case) you may need to consider Medicaid's waiver program. The lawyer can explain that, too.

Red rose, why do you believe the house is not part of the Medicaid calculation? Just curious.

Why would they place a lien on the house, when she has owned the house and it is paid for; and when it is not included in the calculation of approval for NYS Medicaid?

I am not selling it now as mom has not reached that point and there is no place around here that can give her the care that she is getting here in her own home. BUT, when the time comes your answers have truly been eye opening and I have some work to do.

If your mom is on Medicaid - they will place a lien against the house for the costs of her care they are paying. Why pay taxes, insurance, and upkeep on a house that you will get nothing back out of? Medicaid will get it all for their costs of caring for your loved one. You will not get reimbursed out of the sale of the house. Sell it now as the other posters agree.

Selling the house seems like the best idea, agree with Jan.  

If you are hoping to keep the home so that it passes through the trust to you and your sisters, I supposed you should plan to return to work and ask your sisters to split the cost of maintaining the house with you.

All states require folks with assets to pay for their care as they are able.

If possible, agree to sell the house. Use the money to pay your mother's share of the nursing home bill. One plus, you'll all feel good that you have helped your mother pay for her care. You, being the one closest to the house, could end up being the landlord (if you rent it out), the repairman and the person who pays the taxes and insurance. I was able to do this with my sister after she was diagnosed with Alzheimer's disease. I am still using the house sale money to make up the difference that is left after her Medicare benefit and her retirement benefit are applied to her monthly Assisted Living fee is paid.

Once this plan takes its course and uses up her money, she will be eligible for Medicaid and they will pay all. I can't thank the Virginia Medicaid enough for all the care they provided for my mother. Just be sure the place your Mom lives in will ensure the same level of care when they are receiving a much lower reimbursement from Medicaid.