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My parents moved into my home a few months ago due to declining health. Dad has been in and out of skilled nursing with increasing cognitive and physical problems, and I am worried he may need to transition to long term skilled nursing care in the next few months. They have good pension income but no savings or assets aside from their home and a car. The home has a mortgage with approx. 40k of equity. Home is in dad's name only and now they want to sell it. I am concerned that having the home is fine, but once sold the cash will be problematic for Medicaid purposes, and am worried about dad being ineligible for Medicaid if he needs to be in skilled nursing long term. If they sell the home, what do we need to do with the money in order to maintain his ability to qualify for Medicaid?

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First, the house will need to be sold (and the car) at Market Value. The proceeds of that sale can only be used for your parents care. No giving of large gifts. As said, Medicaid has caps. In my state its 2200 but I think that is a single person. Married with a spouse maybe different. If Dad goes into a facility but Mom doesn't then the money received from the sale of the house maybe split between Mom and Dad. Mom will receive enough of the SS and pension so she can pay bills ect. Maybe pay you rent. Dads split of their savings will need to be spent down and his part of the SS/pension will go to his care.

At this point I wouldn't hire an elder lawyer. And if you do, make sure he/she is well versed in Medicaid. We have had members say they have consulted with a couple with different answers. I would make an appt with Medicaid first. Each situation is different. Then if you feel a lawyer is needed OK. Medicaid allows for ur parents money to be used for this.

If it does come out that Dads pension/SS is over the cap, ur State may allow a Miller Trust (or something similar). Lets say the cap in ur state is 2200. Dads income is 2400. With a Miller Trust that xtra $200 goes into the trust. When Dad passes, the Trust reverts back to Medicaid.

Medicaid is federally funded and as such there are basic rules that each State needs to follow. But each State can implement their own rules making each State a little different in how certain things are done.
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Is there some reason why proceeds from the sale of the house wouldn't be used for private pay at a facility? Maybe also set up a funeral trust. We've done this for a relative for whom my husband is poa. When funds are close to being depleted, then apply for Medicaid. Some of dads pension income might be able to be sheltered from being counted for Medicaid eligibility if it's used to help support your mom as the community spouse.
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Go to www.nelf.org and find a certified elder law attorney in your area that can help you understand how all of this works.

They will not leave your mom impoverished but, it needs to be set up properly. It is well worth them spending some money to get it sorted.
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If he has a pension, and receives social security, he may not qualify. Medicaid rules vary from state to state. Also, there can be a 2.5 to 5-yr lookback period when he applies. Where I live it's 5 years. So, any financial transactions your parents execute within his state's Medicaid rules will be scrutinized. His best option right now is to spend some money to consult with an elder law attorney who is experienced with estate planning and Medicaid applications. FYI Medicaid puts a lien on the house so that when it sells they can recoup what it cost the the government (and hence us taxpayers) to cover the cost of your dad's care.
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