Recently, I looked into what to do to get my husband to qualify for Medicaid in a long term memory care facility. I spoke to an eldercare lawyer who assured me I would be able to keep my pension, my social security, my house, my cars (all at least 10 years old) and my savings, which are under $28,000. That is all we have. I decided not to do it yet. However, people keep telling me that the lawyer is wrong, I will lose my house, or 1/2 the value of it, I will have to sell cars. These people are telling me from the position of having to do it for their parents. They are telling me horror stories of what happened to them, and that the lawyer is wrong. This has been very upsetting, to get counsel and then be told that the counsel is wrong, and I must "protect myself." I think these people may have had many more assets than we do. Does anyone of modest means like myself have any experience with putting a spouse in long term care, and losing their house by doing so?
Medicaid is “at need” for eligibility for all programs. Like for those Happy Teeth vans, it’s for low income/TANF elementary school kids, for breast pump rental for nursing moms you have to be on WIC, and for LTC Medicaid the applicant has to show to be “at need” medically for skilled nursing care in a NH.
By & large most states LTC Medicaid is only for placement in a NH. You need to find out if your States LTC Medicaid is purely skilled care in a NH or is also for AL &/or MC just in case hubs actually cannot meet the medically “at need” for skilled. And if it’s AL, MC for hubs, then how truly available a bed will be….. most have situation that you have to be private pay resident for 2 years prior in theory to get a bed. But isn’t guaranteed as $ from State for this type of Medicaid is via waiver within state budget and can change ea legislative session. Plus if it’s only 15 Medicaid beds at the AL and all 15 still living there when it’s your elders 2 yr mark until 1 of them dies or moves out, you remain private pay even if your #1 on the wait list.
Financial stuff you can find, you can work w/elder law atty to shift assets if need be, change beneficiary on banking & investments, do a SPIA if y’all have a lot of nonexempt assets & kinda younger CS. But the medical part is dependent on health care providers to input into hubs health history in detail to show skilled care need & with labs or documentation to establish those needs. Just having dementia or needing help transitioning or w/medication management or being too much for 1 person to deal with at home may not be enough to show “need” for skilled care. I’d suggest that you get a needs assessment done on hubs to see exactly where he is for “need”.
The medically “at need” requirement for LTC is a big reason why vast majority of LTC Medicaid NH admits come from a post hospitalization discharge to a NH.
Here’s usual scenario: dad living in his home falls & breaks a hip; EMS comes & dad admitted to hospital & has surgery (MediCARE pays); dad discharged to a NH that has rehab unit (again MediCARE pays for & up to 100 days if progressing in rehab); week 5 dad realistically is unable to return home so dad stays in the NH and goes from a rehab patient (MediCARE) to a long term custodial care resident and files for LTC Medicaid to pay for this. Medicaid will pay for the daily room&board costs; Medicare will not pay for room&board. Dad has a nice fat file of a health chart filled with Rx’s, labs, MD & RN & therapist & hospital notes so between his hospitalization & his rehab and can totally show “need” for skilled care.
IF your coming from living at home or even living in IL or AL, that fat medical file may not be there. Limited or no documentation to show “need”. Medicaid can review health history & can send out assessment team to do an in person on the applicant at the NH. Medicaid can deny eligibility. This is why IMO a needs assessment is mucho importante.
Dealing with medical at need ineligiblity can be done. POA files an appeal but NH has to do whatever to get the chart to show need and get it up to caseworker. It’s work for the NH & if they start foot dragging, you’re kinda SOL.
I moved my mid90’ yr old mom w Lewy Dementia from IL to a NH w/out a hospitalization & bypassing AL phase. Had medical at need eligibility issues due to RXs & labs left out of her chart. Filed appeal with hearing date like 6 mos out. Meanwhile NH DON got on it, sent up missing stuff, ordered new labs as well so added more comorbidities just for good measure. Mom got medically approved mo 3 and then financially @ 5.5 mos.
Point is, Financial is important but Medical equally so.
Good luck in your quest.
When I was in the process of applying for my dad I was told that as long as Mom lived in their house she retained the rights to the property and she was allowed to keep up to $22000 if their assets to support her plus any Social Security or pension in her name, in the state of Ohio. If she died or moved out of the house then it was expected that some of the proceeds would go to reimburse Medicaid for dads fees.
What people don’t realize is that Medicaid is not a right earned by citizens, it’s not something we pay into like Social Security, it’s a government program to help out people who don’t plan and save for old age or who are truly indigent with no income or savings. The program is designed to recoup any funds possible when the recipient dies. You are protected to provide you with income and a place to live so that you too don’t end up on government assistance.
SHAME ON YOU FOR TRYING TO SHAME MEDICAID RECIPIENTS!
Some illnesses are so catastrophic that no amount of planning short of Jeff Bezos can prepare. Medicaid requires that you spend down assets. A catastrophic illness can wipe out hundreds of thousands of dollars in assets - even with great insurance.
At some point perhaps our society will recognize that a citizen of the wealthiest nation on earth has a right to not have their entire life’s work wiped out due to the misfortune of a catastrophic illness.
I have had relatives in nursing homes for 10 years. What I saw there was hard working families who had life savings decimated by an illness. These were not folks who did not plan.
How about parents of 28 year old young woman who had Huntington's and had to go on Medicaid because her parents still had children at home, were both working, and in no way could afford $8,000 month nursing home.
How about 30 something trapped in a fire at a friend’s house with 3rd degree burns over 90% of his body. Could he have “Planned” for this?
Or the double amputee that worked 2 jobs most of his life to provide for his family but could not save enough to outrun Type 1 diabetes?
Hopefully you are saving for a heart transplant as you need one now.
In the case of a husband and wife. When one party enters a nursing home, the other party is referred to as the "community spouse." As long as the community spouse (CS) lives in the house, the state will not put a lien on it for the Medicaid benefits received by the institutionalized spouse. If the CS laters sells the property, the CS receives all the funds.
Each state has a specific Monthly Maintenance Needs Allowance (MMNA). If you tell me your state, I will give you the specifics.
You can have any amount of income. As long as it comes in your name, you keep it. If your total is less than the MMNA, you get the difference each month from your husband's income. The balance of his income is paid to the nursing home, less a small monthly amount so he can get personal items; it is known as his share of costs.
Take what has been said here and see a lawyer.
Your response that between spouses, particularly that an unhealthy spouse can give everything to a healthy spouse is correct, with the exception of IRAs.
If you think there is a good chance that he will make it 5 years, your plan works. Make sure the POA allows you to make gifts to yourself; if it does not, you could face a claim that you breached your fiduciary duty to him.
As the community spouse, you retain all the monthly income that comes in your name. If your monthly income does the Monthly Maintenance Needs amount for your State - which amount is $2,739.00 in Illinois, the difference is shifted from your husband's income to you. What remains of his monthly income goes to the nursing home as his Medicaid co-pay, with the exception of $30, which he gets to keep for haircuts, etc.
Advice from general people, like us here, are helpful for figuring out what questions to ask the experts. Advice from general people, like us here, should never be taken as the final word.
For example, my parents listened to family and friends about how to pay for my mom’s terminal cancer treatment. My parents went completely broke - no house, no retirement savings. They lost everything and then she died.
When my dad got sick I asked experts about how to pay for his care. That’s when I learned the truth: my parents never had to loose their house, never had to loose their savings, never had to become a destitute burden on me. By then it was too late.
They listened to well intentioned family and friends and we suffered for it. Get your advice from multiple experts so you don’t end up like them.
You could probably get by with one car, so sell the other one(s) (You'll save on the associated costs, such as Insurance, maintenance, etc). That is a start.
Do this sooner rather than later as assisted living or memory care will rapidly deplete your funds. You are allowed savings that are different per state.
Most states have a recovery program that will put a lien on your house once you pass and as long as their is nonfamily member living in home.
An attorney absolutely best person to listen to. Paperwork is arduous - would get attorney to file first time. Then you will have to file yearly. Massive paperwork.
I would start the process. You have enough information at this point to ask questions if something doesn't seem inline with what the attorney told you.
I am so sorry that you are being bombarded with different case scenarios at a most difficult time for you.
One thing I highly recommend, send copies to Medicaid, number the documents when you get it all together, ie 1 of 100, 2 of 100. Keep a complete copy for yourself and in the event something goes missing you can ask the social worker to tell you what pages are missing. This will help tremendously in the case of careless handling but, it also stops alot of carelessness because it is obvious that they are responsible, as they received a set number of numbered documents.
You can do it! Best of luck!
If your attorney is well recommended and specializes in eldercare and Medicaid, please continue to work with him. The well being friends are coming from a different view.
The elder law attorney advised you correctly. I, too, am an elder law attorney.
As the healthy spouse and to qualify your husband for Medicaid, based on your facts, you retain the family home, one car, furniture and personal property found in the house, a prepaid funeral arrangement, and all the savings.