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I am my mother's POA. She has bank accounts separate from my step-father although she does share a joint checking account with him. She also has her own investments, plus owns a lot of land which produces a little income, and receives some social security and a tiny teacher's retirement. The best thing she has for her being in a nursing home is her long term care policy which is one of those few that lasts for the remainder of her life, (she will be 82 in July).
If she dies before needing medicaid, the accounts and the securities that she made me joint owner with right of survivorship will be a major part of my inheritance.

However, if she lives to the point where all of her accounts are spent and her securities are gone, I'll have to sell the land before I can apply for medicaid and use that money for her care until it is about depleted. Now, if her husband dies first, then those funds, etc. will need to be used for her nursing home care. I understand all of that and I'm keeping all of her bank statements for each year with a copy of her tax return, so that when I need them, those documents will be there.

What will medicaid do in this situation? Will it pay for what the long term care policy does not? My nursing home claims it will.

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The short answer is that, from an income standpoint, mom will qualify for Medicaid if her income and long-term care policy benefit are not sufficient to cover nursing home expenses. Simply add up all of mom's income, add the insurance benefit, and if that does not meet the cost of care you might consider applying for Medicaid (if otherwise eligible).
Some questions:
1. Does the policy currently pay the full cost of care?
2. Does the policy have an inflation rider?
3. Does all or a portion of mom's income support the husband (or vice versa)?
4. What state do they live in?
Some facts and ideas:
1. Incoming producing property is not a countable asset for Medicaid eligibility purposes if net income is going to cost of care.
2. Although they retain mostly separate assets, the state will consider the husband's assets when evaluating eligibility. In some states all assets can be transferred without penalty to the community spouse who can then retain up to $115,920. In other states half the couple's total assets are attributable to each partner and the penalty-free transfer is not permitted (depending on the level of assets). Proper planning can contend with these limitations.
3. Some states permit “spousal refusal” whereby the Community Spouse can simply refuse to support the institutionalized spouse, others do not.
4. If the policy plus her income is currently paying the cost of care it may make sense to move her assets now to an irrevocable trust with you as trustee. This will start the clock on the “five-year look back” for asset transfers. This may be a good move for two reasons: a) as joint holder her assets are subject to the claims of your creditors and b) her assets may be preserved to assist her while receiving public benefits down the road.
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This is why our country is going bankrupt. It sounds like the bottom line here is that you feel the government should pay for your mother's care because you want to have a nice inheritance.
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Pfischer, your assumption is wrong. I'm talking about after all of her money is spent, plus I doubt my step-dad will support her after all of her money and securities are spent because he does not like her being in a nursing home. He's 87 and she's 82. Who knows, he may die before she does.
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1. The policy does not cover the full cost of her care. The rest is being paid from her money.

2. The policy does have an inflation rider.

3. None of her money supports her husband and none of his supports her.

4. She lives in NC.

Also, she currently receives social security as well as a very small retirement check as a former teacher.
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If her long term care policy and retirement including SS is currently covering her care, I wouldn't worry too much. Sounds like even if the cost of care rises, it shouldn't be that much more. Just count your blessings that she has long term care insurance and a retirement to pay for her care.
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Her retirement and social security is paying about $8,000 per year of the $30,000+ a year extra that is being paid that the long term care policy does not carry. Yes, I am very thankful for that part, but I'm trying to look at the big picture as her POA.
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If you haven't already, shop around and look at all your options for nursing homes. Check assisted living communities, too, if your mom's long term care insurance will cover them. An AL cannot accept a resident with certain conditions, but beyond that, there's a wide latitude of who they'll take on and it differs from one to the next. Not only will it be a more stimulating and pleasant atmosphere for your mom, it will be a way to make her LTC insurance go a lot further and make her assets last should she need years of care. Also, be open about your mom's finances when you meet with the representative of each community. If your mom is likely to be a long term resident, they will want to do everything they can to make her money last so she doesn't have to move out.
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Thanks IsntEasy. My mother is way beyond AL and is completely bedridden in a nursing home where she has been for 4 years. One thing I had to consider in selecting that nursing home was being near to my step-dad so that he can visit plus the quality of the place. She went to that nursing home initially for rehab following surgery for a broken hip. The month before, she had a stroke, but had regained the ability to walk. However, possibly her vascular dementia played a part in this and etc., but she did not work with PT and regain the ability to walk, but became totally bedridden. Sometimes she complains about being bored, but refuses to attend any of the activities there, and my step-dad sees her almost daily brought there in his wheelchair by his helper.
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The short answer is yes. There is no one cookie cutter approach as it does vary by state. Separate finances doesn't matter. The long term care purchase was a smart investment. Here is the best piece of advise I can offer. Run and not walk to an Eldercare Aty and NOT an Estate planning Aty. Don't listen to the social workers or even your friends. Many people in your situation get "well intended" mis-information. If your Eldercare attorney is worth their salt, they can re-allocate parents assets - even in a crisis moment. If she hasn't pre-funded the maximum amount allotted for a funeral for both herself and her husband...and for that fact even her children who are adults she can. Funeral plans are not considered an asset and are transferable across the country.
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Thanks for the updated info. The suggestions I am making are based on your mother and step-father living in the State of North Carolina. In my view you have two choices and both involve applying for Medicaid NOW. In one instance you can do planning that will be seek benefits in the near term and in the other you will be planning to receive benefits at least some point in the future. (North Carolina does not have a Spousal Refusal option).
The immediate goal should be to obtain a financial “snapshot” (believe it or not that is the technical term) of the couple presently. The total assets of the couple are then added together and then half attributed to the nursing home spouse and half attributed to the at home spouse (Community Spouse).
For example, if a couple owns $90,000 in countable assets on the date the applicant enters the hospital and stays in it or a nursing home for 30 days or more, he or she will be eligible for Medicaid once their assets have been reduced to a combined figure of $47,000 – $2,000 for the applicant and $45,000 (one-half of $90,000) for the at-home spouse. If the couple owned $250,000 in assets, the spouse in need of care would not become eligible until their savings were reduced to $117,920 ($2,000 for the nursing home spouse and the maximum $115,920 for the community spouse).
Confusing, isn’t it? The bottom line is that assets can be preserved for both spouses to be used for their benefit. It is to their advantage to get started now. You definitely need to seek professional help with this matter.
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Thank you Ralph for so much information. I've tried to get my step-brother to look into getting benefits for his dad as a WWII vet with a purple heart, but he is a lazy POA. I'm glad to know that NC does not have the spousal refusal offer for I think that my step-dad would do that in a heartbeat. I think my mother has made things complicated by over a decade ago making me joint owner with right of survivorship for all of her private accounts and securities. I'm not even sure that my step-dad has ever seen mom's will for until recently it has been in a safety deposit box in another state looked after by her brother. Unless my mother ever told my step-dad, he does not know that I'm the executor of the estate and the sole benefactor. His will on the other hand leaves things to him and then if she's already dead to his children. Strange I know but that is how it is.
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