Mother sold house to help pay for full time private nursing care. If she applies for Medicaid does she have to spend down the proceeds from home sale (now less than 30K) or can it be exempted as if she still owned home?
Also on the co-pay or SOC, it will be whatever thier monthly income is less $ taken out for Medicare (abt $100 from the SS income) and whatever your state has as its personal needs allowance. PNA varies from $ 35 - $ 105 a mo. My mom was TX and the PNA was $ 60 a mo.
So $ 1k pension, plus $ 900 SS means $ 1800 income less $60. So every month mom will need to do a copay to the NH $ 1,740 a mo. Must be paid. So if mom has any other debt (life insurance premium, funeral premium, house costs) she will have no-none-nada-zero $ anymore to ever pay those debts.
Often a NH will charge for cable & phone with no opt-out and neither are in the Medicaid reinbursement & could easily be the whole PNA. This is a total scam & I would run not walk from a NH who does this. PNA is really just enough for beauty shoppe or barber shop at the NH & some toiletries or bare minimum clothing replacement.
For my mom MP meant that while her Medicaid application & it's over 100 pages of supporting financial documentation was being reviewed by the Medicaid caseworker (he was assigned by area by the state & moms NH #1 was in his area) that she could be a resident of the NH BUT only required to do her co - pay (also called the SOC / share of cost) to the NH each month as her payment.
Neither mom nor I had to sign off on a private way contract as she was MP.
Now I will say the NH can review the documents internally first to determine IF MP seems to be fine. What the NH did was provide a list of items needed to be submitted to the state for the Medicaud NH application in advance of mom moving in. I did it a couple of week beforehand & actually sat with a regional admissions gal who did a look through on the documents & she did a calculation of what $ amt mom would need by day to close out the month of her admission. TX at the time (2011) was paying a paltry $145 a day for Medicaid room & board. Mom was waiting for a bed which NH was on the brink of 2 beds to be open as 2 ladies were abt to die. Yeah not pretty but that is the reality of aging....
My mom was in IL & still had her home so it was obvious just where moms $$$ over the recent years had gone to. & being in AL or IL required only a 3 yr look back on monthly bank statement financials. The one thing that was a time consumer was I needed a letter from moms bank as to the disposition on all accounts closed the past 5 years. This took the better part of the morning with a bank officer. Now as moms CD, TBills, etc came up for renewal, they were stopped not rolled over and put into her savings or checking account and for the entire amount to the penny. So no ? as to where every cent went. If a CD had just been cashed out, I'm pretty sure there would have been a transfer penalty inquiry. It was really hard to see those old old CD with 10% plus interst rates go away too but thank goodness mom had them to rely on till then!
Also I'm assuming that the caseworker has a formula or algorithm on how they look for gifting or income issues. They have the elders info on income from SS, pensions (their "awards letters") plus info on their living situation. An elder getting say $ 1900 a mo income plus a smallish savings of 50k 5 years ago but living in an AL or IL, well it makes sense they are now down to 2k & impoverished. But an elder living rent free at their daughters house, there should be $$ that needs to be spent down, & where did all that $$ go to. $1900 x12 = $ 23k a year plus that 50k savings?!?. The latter situation probably triggers a alert to look more are fully at bank statements. If they sold thier home or car, that info & to the penny is recorded within the states database & will just be there for the caseworker to uncover eventually...... & hello transfer penalty inquiry!
Personally I do think the caseworker -since they are local - have an idea of what areas are more affluent so can spent a bit more time on those. Also I do think there is a bias on NH to take in residents as MP with a higher monthly income. My mom - in her 90's - had a monthly income of about $ 1900 a mo. The NHs I toured were positively giddy when they found that out. So many advanced age elderly have an income of maybe $700/800 a mo of just SS. The lady at $1900 is a better resident risk than the $ 700 one as that is all the $ the NH will get till they clear eligibility for Medicaid. & a lot of residents die within the first few months as they come in pretty infirm, so the NH can be SOL on getting paid if the resident gets denied Medicaid but they have died and there no family to be responsible for dbt or can have debt placed personally on them.
My mom's MP took almost 6 months. I have a high school friend who's moms application took 10 months due to appeals. Both in TX & same city and similar resources. At 8k a month average NH cost, it can be a lot of $$$ for family to front if the facility will not take them as a MP resident.
Igloo572 - Sorry for lapse in time to respond. Have first session with new nursing home this week for mom. Your information is outstanding and most helpful. One follow up - can you elaborate a bit on a Medicaid Pending bed...
B - a homesteaded property is an exempt asset for NH/LTC Medicaid for the elders lifetime in most states, BUT upon their death the property goes from being a non-exempt asset to an asset of the estate AND then goes into whatever system your states Medicaid program has for MERP (estate recovery) and within your states probate & property laws as to how it can or cannot be done.
Babalou is spot -on that IF a property is sold the proceeds from the sale become an asset which will need to be spent down. It seems that is your situation and what you / mom are doing. All - & I do mean ALL - of the $ from house sale must be going towards moms needs and costs of care. Otherwise there will be possibly a transfer penalty issue to deal with to get mom eligible for Medicaid. The details on the house sale will be recorded locally by tax assessor and then dovetailed to state records so the info is there for state to look at. So say house sold to a nephew for under FMV, then it's going to be a problem for Medicaid;…..or that you took $ 8,700 from the proceeds of the sale to reimburse for costs to get the house Realtor ready/have plumber do work, these too will pose a transfer problem. You better have documentation & in detail on repairs, etc paid to show why. Medicaid tends to - in my experience - look at whatever family pays for or does on the behalf of their elder to be done for free so any payment to family is a transfer of assets and subject to penalty.
You know the situation you are in - that there are NO Medicaid beds supposedly available - seems to be more & more common. Personally I think a lot of this is a push by facilities to make family step up to private pay for care with a contract done between kids & facility leaving the parent totally out of the equation. If mom lived in a nicer area or more affluent zip code or family is viewed as being of means, the facility will press upon family that…" well you just don't want your sweet mom to be in one of those places with those Medicaid residents" blather. The beds are there but if a facility can fill it with a private pay then that means one less Medicaid bed to deal with - the facility does not have to hold open a Medicaid eligible bed for a Medicaid applicant.
personally if you live in the same state as mom, I'd go ahead and just find a NH with a "medicaid pending" bed closer to you asap. Even if its not an ideal location. The goal being getting mom into a Medicaid bed & Medicaid eligible. Then you put her name on waiting lists for a Medicaid bed at a facility that you like better. Moving them from one NH to another is not easy peasy but can be done. I moved my mom from NH #1 at about month 10 to another & much better NH. If you do this, you do need to kinda plan ahead a bit. The biggest item is to keep control of mom's income so you DO NOT have the NH become the payee for mom's monthly income (like her SS or other retirement). The NH will likely press upon you to have them get the check but don't. Under Medicaid rules this does NOT have to be done. Mom can still keep her checks getting direct deposited to her account & then you write a check to the NH each mo for exactly the amount required as mom's co-pay. (This is also called the SOC - share of cost). Each mo mom's bank account will build by whatever amount your state has as the "personal needs allowance" (it was $ 60 a mo for my mom in TX). You do need to make sure her bank account does not go over 2K as it makes her go over the 2K in assets allowed. If you keep control of her income, you can set up a NH personal trust account to pay for things mom needs at the NH - like to pay for the on-site beauty shoppe. I did this for mom with about $ 200 to start & a good NH will send you an accounting statement of the personal trust account every 90 days. My mom's first NH didn't ever but NH #2 did and like clockwork every 90 days with interest - that is the sign of a well run business office imho. Then you plan on moving mom as close to the beginning of the mo as possible with each facility getting paid just the exact amount required as her SOC for the month of the move. You also want to make sure you get all of mom's medications - NH#2 told me to make sure to do this as this is a big issue for moving. Medciaid / Medicare and insurers will only pay for a set amount of RX's….then add in that often for NH residents RX's are done in 60/90 day blister packs, so IF you don't leave with their meds, you will have to private pay to get another set of RX's. This could be very very expensive depending on what meds mom takes. When I moved my mom, NH#1 nursing staff were especially hostile about doing this…literally dumping stuff on the countertop of the nursing station. I whipped out my Sharpie marker and Ziplocs to pack & label mom's meds.
About Medicaid Pending, my mom was Pending for almost 6 months.
There are no facilities in her county which participate in Medicaid. Looking to bring her to county near me or older brother where there are Medicaid facilities. Plan to contact facility here direct and I will contact Medicaid lawyer - in meantime was trying to get educated on house exemption vs funds received from a house so I could ask questions correctly. You have at least confirmed I was on right track and her funds from house sale would have to be consumed. What I did not know was that there is a Medicaid Pending path - I will follow up and therefore you have provided much value and I appreciate you taking time to respond.
Have you spoken to her current facility about this? Will they not acept her Medicaid and SS after this period of private pay?
At the very least, the social worker should be assisting you in this.
And please look into spending some of that remaining money on a qualified lawyer, which I'm not! I'm hoping of of our legal eagles will fly over this way!
Thank you Babalou. Mother did not consult attorney - her physical condition deteriorated so quickly she went from fall to rehab to assisted living to full nursing care within 3 mos. Having been a widow for 30+ yrs she had little in way of assets/savings so sale of car/house was mandatory to fund her support immediately. No Medicaid facilities in her county. Looking to move her to new location knowing funds will soon be exhausted. So you are saying while spending down her funds go ahead and get her into Medicaid pending status. This helps.
Did your mother consult an eldercare attorney before she sold the house? If she did, she would be well served by asking that question of her/him. If not, i think that seeing a cerified eldercare attorney who knows and understands Medicaid in mom's state would be money well spent.
My understanding that the house itself is an excempt asset during the life of the owner and spouse, but the proceeds are not.
If mom is seeeking to enter a nursing home, you'd be wise to get her in "medicaid pending" meaning that she private pays until her money is diminished to the point where she can apply.
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So $ 1k pension, plus $ 900 SS means $ 1800 income less $60. So every month mom will need to do a copay to the NH $ 1,740 a mo. Must be paid. So if mom has any other debt (life insurance premium, funeral premium, house costs) she will have no-none-nada-zero $ anymore to ever pay those debts.
Often a NH will charge for cable & phone with no opt-out and neither are in the Medicaid reinbursement & could easily be the whole PNA. This is a total scam & I would run not walk from a NH who does this. PNA is really just enough for beauty shoppe or barber shop at the NH & some toiletries or bare minimum clothing replacement.
Neither mom nor I had to sign off on a private way contract as she was MP.
Now I will say the NH can review the documents internally first to determine IF MP seems to be fine. What the NH did was provide a list of items needed to be submitted to the state for the Medicaud NH application in advance of mom moving in. I did it a couple of week beforehand & actually sat with a regional admissions gal who did a look through on the documents & she did a calculation of what $ amt mom would need by day to close out the month of her admission. TX at the time (2011) was paying a paltry $145 a day for Medicaid room & board. Mom was waiting for a bed which NH was on the brink of 2 beds to be open as 2 ladies were abt to die. Yeah not pretty but that is the reality of aging....
My mom was in IL & still had her home so it was obvious just where moms $$$ over the recent years had gone to. & being in AL or IL required only a 3 yr look back on monthly bank statement financials. The one thing that was a time consumer was I needed a letter from moms bank as to the disposition on all accounts closed the past 5 years. This took the better part of the morning with a bank officer. Now as moms CD, TBills, etc came up for renewal, they were stopped not rolled over and put into her savings or checking account and for the entire amount to the penny. So no ? as to where every cent went. If a CD had just been cashed out, I'm pretty sure there would have been a transfer penalty inquiry. It was really hard to see those old old CD with 10% plus interst rates go away too but thank goodness mom had them to rely on till then!
Also I'm assuming that the caseworker has a formula or algorithm on how they look for gifting or income issues. They have the elders info on income from SS, pensions (their "awards letters") plus info on their living situation. An elder getting say $ 1900 a mo income plus a smallish savings of 50k 5 years ago but living in an AL or IL, well it makes sense they are now down to 2k & impoverished. But an elder living rent free at their daughters house, there should be $$ that needs to be spent down, & where did all that $$ go to. $1900 x12 = $ 23k a year plus that 50k savings?!?. The latter situation probably triggers a alert to look more are fully at bank statements. If they sold thier home or car, that info & to the penny is recorded within the states database & will just be there for the caseworker to uncover eventually...... & hello transfer penalty inquiry!
Personally I do think the caseworker -since they are local - have an idea of what areas are more affluent so can spent a bit more time on those. Also I do think there is a bias on NH to take in residents as MP with a higher monthly income. My mom - in her 90's - had a monthly income of about $ 1900 a mo. The NHs I toured were positively giddy when they found that out. So many advanced age elderly have an income of maybe $700/800 a mo of just SS. The lady at $1900 is a better resident risk than the $ 700 one as that is all the $ the NH will get till they clear eligibility for Medicaid. & a lot of residents die within the first few months as they come in pretty infirm, so the NH can be SOL on getting paid if the resident gets denied Medicaid but they have died and there no family to be responsible for dbt or can have debt placed personally on them.
My mom's MP took almost 6 months. I have a high school friend who's moms application took 10 months due to appeals. Both in TX & same city and similar resources. At 8k a month average NH cost, it can be a lot of $$$ for family to front if the facility will not take them as a MP resident.
Good luck & try not to get too too overwhelmed!
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Babalou is spot -on that IF a property is sold the proceeds from the sale become an asset which will need to be spent down. It seems that is your situation and what you / mom are doing. All - & I do mean ALL - of the $ from house sale must be going towards moms needs and costs of care. Otherwise there will be possibly a transfer penalty issue to deal with to get mom eligible for Medicaid. The details on the house sale will be recorded locally by tax assessor and then dovetailed to state records so the info is there for state to look at. So say house sold to a nephew for under FMV, then it's going to be a problem for Medicaid;…..or that you took $ 8,700 from the proceeds of the sale to reimburse for costs to get the house Realtor ready/have plumber do work, these too will pose a transfer problem. You better have documentation & in detail on repairs, etc paid to show why. Medicaid tends to - in my experience - look at whatever family pays for or does on the behalf of their elder to be done for free so any payment to family is a transfer of assets and subject to penalty.
You know the situation you are in - that there are NO Medicaid beds supposedly available - seems to be more & more common. Personally I think a lot of this is a push by facilities to make family step up to private pay for care with a contract done between kids & facility leaving the parent totally out of the equation. If mom lived in a nicer area or more affluent zip code or family is viewed as being of means, the facility will press upon family that…" well you just don't want your sweet mom to be in one of those places with those Medicaid residents" blather. The beds are there but if a facility can fill it with a private pay then that means one less Medicaid bed to deal with - the facility does not have to hold open a Medicaid eligible bed for a Medicaid applicant.
personally if you live in the same state as mom, I'd go ahead and just find a NH with a "medicaid pending" bed closer to you asap. Even if its not an ideal location. The goal being getting mom into a Medicaid bed & Medicaid eligible. Then you put her name on waiting lists for a Medicaid bed at a facility that you like better. Moving them from one NH to another is not easy peasy but can be done. I moved my mom from NH #1 at about month 10 to another & much better NH. If you do this, you do need to kinda plan ahead a bit. The biggest item is to keep control of mom's income so you DO NOT have the NH become the payee for mom's monthly income (like her SS or other retirement). The NH will likely press upon you to have them get the check but don't. Under Medicaid rules this does NOT have to be done. Mom can still keep her checks getting direct deposited to her account & then you write a check to the NH each mo for exactly the amount required as mom's co-pay. (This is also called the SOC - share of cost). Each mo mom's bank account will build by whatever amount your state has as the "personal needs allowance" (it was $ 60 a mo for my mom in TX). You do need to make sure her bank account does not go over 2K as it makes her go over the 2K in assets allowed. If you keep control of her income, you can set up a NH personal trust account to pay for things mom needs at the NH - like to pay for the on-site beauty shoppe. I did this for mom with about $ 200 to start & a good NH will send you an accounting statement of the personal trust account every 90 days. My mom's first NH didn't ever but NH #2 did and like clockwork every 90 days with interest - that is the sign of a well run business office imho. Then you plan on moving mom as close to the beginning of the mo as possible with each facility getting paid just the exact amount required as her SOC for the month of the move. You also want to make sure you get all of mom's medications - NH#2 told me to make sure to do this as this is a big issue for moving. Medciaid / Medicare and insurers will only pay for a set amount of RX's….then add in that often for NH residents RX's are done in 60/90 day blister packs, so IF you don't leave with their meds, you will have to private pay to get another set of RX's. This could be very very expensive depending on what meds mom takes. When I moved my mom, NH#1 nursing staff were especially hostile about doing this…literally dumping stuff on the countertop of the nursing station. I whipped out my Sharpie marker and Ziplocs to pack & label mom's meds.
About Medicaid Pending, my mom was Pending for almost 6 months.
At the very least, the social worker should be assisting you in this.
And please look into spending some of that remaining money on a qualified lawyer, which I'm not! I'm hoping of of our legal eagles will fly over this way!
My understanding that the house itself is an excempt asset during the life of the owner and spouse, but the proceeds are not.
If mom is seeeking to enter a nursing home, you'd be wise to get her in "medicaid pending" meaning that she private pays until her money is diminished to the point where she can apply.