Lile, if you have Power of Attorney for mom, seeing an Eldercare Attorney who is well versed in your State's medicaid program would be a great boon to you. It would give you access to someone who knows the rules and who will be in your corner.
If you think that mom is going to be on Hospice for a while, it could be a very good use of some of her money.
Igloo, my husband did not withdrawl any money from his IRA at 70.5. Our financial advisor set up that taxes are taken out each year so we can leave the IRA in place.
This is what I found concerning Medicaid and IRAs
If the IRA is not in payout status, the IRA is a non-exempt asset, which means the total amount in the IRA will probably be counted as an asset, affecting your Medicaid eligibility. In order to qualify for Medicaid, you will need to cash out your IRA and spend down the assets.
JoAnn, Yeah, I get it. But you & hubs have your broker / FA actively making sure to be paying attention to the various details of the requirements of IRA. Like what kind of IRA, what his EOY “factor” is, tax implications and how it all syncs in with all other $ & future plans. Your FA is doing his / her job & that’s why you have one. Most folks do not have a FA.
In theory, IRAs are supposed to be held within some sort of responsible institution- bank, wire house, etc. - that’s paying attention to this stuff. But every so often, you hear some horror story where the RMD was not done & it’s a 50% tax penalty. That’s why I’m asking..... 93 and low income seems kinda late to me to be starting the RMD from a IRA. I’d think they’d need the $ years before from the IRA. But then whaddaIno!
Lileesa - you posted “she just took the RMD”, is that right??? So Is this the situation: at age 93, she has an 75k IRA. AND she did not start RMD from that IRA at the required age 70.5. Is this the actual situation? OMG! Did doing RMD from age 70.5 to age 93 get overlooked? Was she possibly working way into her 70’s or 80’s and she had an 401k which became an IRA when she finally finally retired? or was the IRA not actually her but she inherited it?
Please, please please post whatever you kinda know abt the IRA (like if it’s her IRA, what type of financial institution is doing oversight, what her EOY “factor” is, ever gotten a 1099-R). IRA that didn’t do RMD correctly is a whole other super sticky clusterF.....
You do know that IRA $ is taxable, right? ********* But back to hospice, my experience with my mom’s & mils hospice was that it’s all about each of their individual care needs assessment as to # of hours of care & how to best provide. My mom was on hospice 18 mos in a NH. Her hospice hours changed over that time as her health changed, also equipment changed as her needs did. Evaluation was on a rolling 90 or 60 day basis & done on site by a hospice RN then written up by hospice MD who was the medical director for the hospice group & then sent over to the MD medical director & the DON (director of nursing) of the NH so hospice & NH worked as a team for care. Imo DON is the power center for a NH). For MIL, she went from a NH to a hospitalization (pneumonia & got septic atop other preexisting heart stuff) and then discharged to a free standing hospice with 24/7 care - she was very very sick, super septic, cascading organ failure situation, died within a month. So 2 ladies but very different use of Medicare hospice benefit. One thing to keep in mind that it’s a balancing act..... you want the max # of hours possible (as per evaluation) BUT if the hours truly needed go above a certain point (this varies but in the 34- 39 hr range) then doing at home care won’t work as viewed as needing full time oversight.... which means 24/7 in a facility. Ditto for if they “need” care above a certain point that is beyond the range of what in-home hospice can do or what in a NH hospice can do (like what happened with my mil).
In home hospice sounds all ideal, as folks say “I wanna stay in my home” & it certainly can be that. But all not-provided-by-hospice Group time & care must be done by spouse or family or by additional privately paid caregivers. I think hospice requires someone to be available for oversight on premises for the time when hospice staff isn’t there. If so and if it’s just you & mom (in her home or in your home), with no other family to absolutely be able to rely on, and you still work or have other time commitments, then imho in-home hospice won’t work unless there paid caregivers from elders $ to be there when you can’t.
Thankyou again. I’m sorry to hear that you have tooo much experience with hospice..
Mom has been taking her rmd since she was 70ish and some of the ira is from when my father passed away and she inherited.
I decided to just use the 75k and private pay. I have so many questions about Medicaid - spoken to 4 social workers and human resources administration and now the stress of the application process and my confusion is just making this time exponentially more difficult. I feel a sense of relief not to have to understand this.
I’m not sure it would be beneficial unless she still is actually seeing MDs outside of the MD who is the hospice physician, & getting specific care from them that have big copays, as Medicaid could pay the copays for those bills. It would be like if she needed to see a retinal specialist type of ophthalmologist, as their fees are high and so are treatments; what you’d see them for is outside of whatever their terminal diagnosis is, so would be allowed (I’m pretty sure) under how hospice works.
The issue would be that IF she is receiving the maximum # of caregiving hours needed via the hospice group, Medicaid probably won’t send out In-home health providers for their own hours as it’s double coverage.
Shes been evaluated for an in home care plan by hospice. If it’s like 4 times a week @ 4.5 hrs per hospice visit, that’s 18 hrs of caregiving weekly. If 18 hrs is her care “needs”, getting community based Medicaid to pay for an extra 18hr of caregivers for her will be unlikely imo. It’ll be viewed as double/ duplicate payment.
Before filling out the application, please try to clearly find out if this is what will happen. Also as a FYI, if she’s living in her home and over 55, applying for & getting on community based Medicaid will mean that after death, the state has to do the required attempt for MERP/ Estate Recovery. It is not just LTC in a NH for Medicaid MERP system but any program that Medicaid pays. Your gonna be some kinda unhappy if mom owns her home & you live there and find after she dies couple of years from now that state has several thousand $ placed as a lien or claim against her Estate and it make it a beast to sell it or transfer it as per her will to her heirs.
For in-home hospice, family is expected to pick up the non-hospice oversight. Medicare- which is paying for hospice - does not have a required copay. Medicare is covering all bills from the hospice group. The elder still totally have their SS or other income or assets to use to private pay for additional caregivers if family can’t be there for all non-hospice shifts.
Thankyou so much for taking the time for your very thoughtful reply. I never heard of MERP but now I googled it. She has very little money in the bank but does have an IRA with $75k. In it. She just took the RMD. It seems to still qualify her for Medicaid but if they will recover the ira after her passing then maybe I will just spend that money on private care for her. I am worried that involving a government agency in her care (Medicaid) will be difficult and intrusive.
She does receive 20 hours of care through hospice. I thought that was all hospice offers. I didn’t think it was based on her need. So it makes sense that if Medicaid feels the same way then it is a useless exercise.
I much appreciate your response and will seriously look further into the points you brought up.
6 Answers
Helpful Newest
First Oldest
First
If you think that mom is going to be on Hospice for a while, it could be a very good use of some of her money.
This is what I found concerning Medicaid and IRAs
If the IRA is not in payout status, the IRA is a non-exempt asset, which means the total amount in the IRA will probably be counted as an asset, affecting your Medicaid eligibility. In order to qualify for Medicaid, you will need to cash out your IRA and spend down the assets.
In theory, IRAs are supposed to be held within some sort of responsible institution- bank, wire house, etc. - that’s paying attention to this stuff. But every so often, you hear some horror story where the RMD was not done & it’s a 50% tax penalty. That’s why I’m asking..... 93 and low income seems kinda late to me to be starting the RMD from a IRA. I’d think they’d need the $ years before from the IRA. But then whaddaIno!
ADVERTISEMENT
So Is this the situation:
at age 93, she has an 75k IRA.
AND
she did not start RMD from that IRA at the required age 70.5.
Is this the actual situation?
OMG!
Did doing RMD from age 70.5 to age 93 get overlooked?
Was she possibly working way into her 70’s or 80’s and she had an 401k which became an IRA when she finally finally retired?
or was the IRA not actually her but she inherited it?
Please, please please post whatever you kinda know abt the IRA (like if it’s her IRA, what type of financial institution is doing oversight, what her EOY “factor” is, ever gotten a 1099-R). IRA that didn’t do RMD correctly is a whole other super sticky clusterF.....
You do know that IRA $ is taxable, right?
*********
But back to hospice, my experience with my mom’s & mils hospice was that it’s all about each of their individual care needs assessment as to # of hours of care & how to best provide. My mom was on hospice 18 mos in a NH. Her hospice hours changed over that time as her health changed, also equipment changed as her needs did. Evaluation was on a rolling 90 or 60 day basis & done on site by a hospice RN then written up by hospice MD who was the medical director for the hospice group & then sent over to the MD medical director & the DON (director of nursing) of the NH so hospice & NH worked as a team for care. Imo DON is the power center for a NH). For MIL, she went from a NH to a hospitalization (pneumonia & got septic atop other preexisting heart stuff) and then discharged to a free standing hospice with 24/7 care - she was very very sick, super septic, cascading organ failure situation, died within a month. So 2 ladies but very different use of Medicare hospice benefit.
One thing to keep in mind that it’s a balancing act..... you want the max # of hours possible (as per evaluation) BUT if the hours truly needed go above a certain point (this varies but in the 34- 39 hr range) then doing at home care won’t work as viewed as needing full time oversight.... which means 24/7 in a facility. Ditto for if they “need” care above a certain point that is beyond the range of what in-home hospice can do or what in a NH hospice can do (like what happened with my mil).
In home hospice sounds all ideal, as folks say “I wanna stay in my home” & it certainly can be that. But all not-provided-by-hospice Group time & care must be done by spouse or family or by additional privately paid caregivers. I think hospice requires someone to be available for oversight on premises for the time when hospice staff isn’t there. If so and if it’s just you & mom (in her home or in your home), with no other family to absolutely be able to rely on, and you still work or have other time commitments, then imho in-home hospice won’t work unless there paid caregivers from elders $ to be there when you can’t.
Mom has been taking her rmd since she was 70ish and some of the ira is from when my father passed away and she inherited.
I decided to just use the 75k and private pay. I have so many questions about Medicaid - spoken to 4 social workers and human resources administration and now the stress of the application process and my confusion is just making this time exponentially more difficult. I feel a sense of relief not to have to understand this.
The issue would be that IF she is receiving the maximum # of caregiving hours needed via the hospice group, Medicaid probably won’t send out In-home health providers for their own hours as it’s double coverage.
Shes been evaluated for an in home care plan by hospice. If it’s like 4 times a week @ 4.5 hrs per hospice visit, that’s 18 hrs of caregiving weekly. If 18 hrs is her care “needs”, getting community based Medicaid to pay for an extra 18hr of caregivers for her will be unlikely imo. It’ll be viewed as double/ duplicate payment.
Before filling out the application, please try to clearly find out if this is what will happen. Also as a FYI, if she’s living in her home and over 55, applying for & getting on community based Medicaid will mean that after death, the state has to do the required attempt for MERP/ Estate Recovery. It is not just LTC in a NH for Medicaid MERP system but any program that Medicaid pays. Your gonna be some kinda unhappy if mom owns her home & you live there and find after she dies couple of years from now that state has several thousand $ placed as a lien or claim against her Estate and it make it a beast to sell it or transfer it as per her will to her heirs.
For in-home hospice, family is expected to pick up the non-hospice oversight. Medicare- which is paying for hospice - does not have a required copay. Medicare is covering all bills from the hospice group. The elder still totally have their SS or other income or assets to use to private pay for additional caregivers if family can’t be there for all non-hospice shifts.
She does receive 20 hours of care through hospice. I thought that was all hospice offers. I didn’t think it was based on her need. So it makes sense that if Medicaid feels the same way then it is a useless exercise.
I much appreciate your response and will seriously look further into the points you brought up.