Child - CareGiver - Medicaid estate recovery exemption?

Anon17, please realize that exclusions & exemptions to MERP are an after death process but based on the details & documentation of situation when elder was alive. And just what are exclusions and exemptions will be specific to your state Medicaid program, how it is worded in your states administrative code and laws on property rights and probate. We can give you our thoughts or experiences but you have to do whatever is needed for exactly how your state runs Medicaid. Personally I just don’t see this ever being a DIY... you are going to need an attorney.

In the post death MERP questionnaire I got, for caregiver exemption you needed to provide a document on letterhead from elders MD or SW as to the “at need” for care in detail (like with ICD-10 info) & with documentation you provided that full time care needed & resided in the elders home 2 years prior to their entry into a facility. The issue(s) I see are: You have your own home so your moms eventual death does not place you to become homeless if her home really has to be sold to satisfy Medicaid lien, & as your mom is still living in her home on her own she may not actually be “at need” for skilled nursing care. The “at need” criteria is not something you can say is needed, it needs professional evaluation - like a needs assessment- and sign off on. I think this could be difficult to get as often family & internal medicine docs may not want to sign off on something “legal”. Those neighbors may not want to actually do a witnessed & notarized document. Plus there are other paid caregivers too, right? If so, the argument might could be that’s it’s not only you as the caregiver, it’s not a full time unpaid job for you.

The vibe I got on caregiver exemption is that it is available to compensate for a family member who lives in the home and forgoes a paid job (like you loose years of FICA & therefore take a hit on your eventual SS retirement $) to become the unpaid full time caregiver for the elder, who if not for the 24/7 on call live in family caregiver would be in LTC NH on Medicaid as they need skilled nursing care. As you described the situation, that’s not you or your mom. Your mom living in her own home, living on her own.... well I bet that going to be a beast of a hurdle to get by.

There are other exemptions & exclusions to MERP. Have you looked into these? Your states Medicaid website & state administrative code should have those in detail. Like for TX, if the elder now on LTC NH Medicaid continues to own their vacant home as exempt asset, whomever pays property taxes, insurance & reasonable maintenance costs can file to have those items excluded from overall determined after death Medicaid tally. You have to provide receipts, statements, proof of payment type of document and in pretty tight timeframe to the state or it’s outside contractor for review. There are other exemptions or exclusions, like low income heir; disabled heir; elderly sibling heir; home is site of farm, ranch or business; Lady Bird Deed / enhanced benefit deed; Testamentary trust. Just what’s out there & how heirs establish & can prevail depends on your state laws & your own determination to document whatever needed & in detail & be willing to pay an attorney &/or open probate if need be.

So what’s your endgame in all this?
Pls realize if mom goes into NH, basically property costs will need to be paid by you or others & beyond her death as there will be MERP to deal with in some way. Right now she’s community Medicaid so she keeps income, but once in NH basically that $ is her copay to NH. Do you have the time, wallet & sense of humor to deal with house as well as your mom in a NH for an unknown period of time?
Are there other heirs?
What does moms will read for heirs & assets?
Any idea what your moms community based Medicaid tally is?

anonymous178609, I'm sorry I got your name wrong in my first reply (don't know how that happened).  Also, I sensed that you weren't interested at this point in getting paid to be a caregiver (since after 7 years you're now "overwhelmed"), but I thought that information might be useful for others in this forum who are interested in your question.

     More importantly, I do think you might be able to prove your case to Medicaid for the caregiver child exemption and I don't think doing so would be gaming or "working" the system -- after all you may have saved Medicaid from having to pay for 7 years of care in a facility for your mom, which could be worth several hundred thousands of dollars.  But, it's true that this forum can't give you concrete legal advice, so I again advise that you talk to your state's Medicaid office for that.  And, since you can't afford to pay for an attorney, I suggest you also contact your state's Legal Aid office (or whatever it's called in your state) and if you qualify financially for their assistance, then that office may help you for little or no payment from you.

Also, I took the time to review the article cited by Rosered6 at
https://www.payingforseniorcare.com/medicaid/caregiver-child-exemption#What-is-the-Caregiver-Child-Exemption?
Below I've pasted a few quotes from that article. Noteworthy, I didn't see anything in it about a requirement that the child-caregiver not own any other home.  Instead, what seems to matter to Medicaid is that the parent needed the child-caregiver to avoid having to move to a facility. To wit,
     "......To qualify for the Caregiver Child Exception, the caregiver child must live in the home with his or her parent for at least two years immediately prior to the parent’s admittance to a nursing home or assisted living facility. In addition, the adult child must provide a level of care that prevents the senior from needing to relocate to one of the above mentioned facilities during this time period.
......The care provided by the adult child must have enabled the senior to continue to live at home, rather than require relocation to an assisted living facility or nursing home. Documentation indicating that this is the case is required. Providing care for an elderly parent may include monitoring medications, preparing meals, providing assistance with Activities of Daily Living (ADLs), such as bathing, dressing, and using the bathroom, and ensuring the health and safety of the parent.
......The adult child caregiver must have resided in the home of his or her parent for two years immediately prior to institutionalization and provided a level of care preventing the parent from having to live in an assisted living facility or a nursing home. They also must be resident in the home when making the home transfer or have filed an "intent to return" statement.
......While all 50 states honor this exception, it’s important to note that some states take a stricter approach than others to the Child Caregiver Exception. Rules and documentation may vary based on the state......"

Those last two sentences are very important, so please get expert advice in your state. Again, kudos to you for providing your mom's care for 7 years.  As I said, I was exhausted after just 3.5 years of care for my dad of about the same age and probable condition as your mom.

Really, I don't know what u want. Even if there is a lawyer on this forum, he/she would have to be versed on Medicaid in your state. Each state has different requirements. You need to take the info you got here to help you understand how it may work and get the right answers in your state.

Your chance of having the house transfer approved under the child caregiver exemption will be higher if you use a lawyer. I suggest doing a cost-benefit analysis: How much is the house worth? Will you be able to get a paying job if you stop taking care of your mom? How much will a lawyer charge to help you pull together the paperwork for the transfer? Then, make your decision.

Thanks for your responses.
With that, I give up.
No more advice needed.
Not helping.

Are you sure your response is accurate legally or are you just guessing?
Makes a difference!
Don't guess please. I am at the end of my rope.

Okay - I did not make myself clear. I've been living in my my mom's home - full time for 7 years. So am I eligible for caregiver child medicaid exemption or not? Just want to know what to do from here?

NancySk, regardless of whether or not you'll be able to qualify for your state's Medicaid Estate Recovery Exemption, www.AgingCare.com has information on getting paid as a caregiver, in which there is a link to a template for creating your own Personal Care Contract. It's at: https://www.agingcare.com/articles/how-to-get-paid-for-being-a-caregiver-135476.htm Unfortunately, a caregiver contract can't be made effective retroactively.

I also suggest that you make an appointment with your local Medicaid office to get rules and advice specific for your state -- it probably won't matter that your husband lives in a nearby home that you both own.  I've found my state's Medicaid office quite helpful in explaining it's rules.

Kudos to you for providing your mom's care for the past 7 years -- I became overwhelmed after just half that time.  Best wishes.

I agree with the first two comments. Because you have not been residing with your mom, you are not eligible for the home to be transferred using the child-caregiver exemption. This webpage provides thorough and helpful information: https://www.payingforseniorcare.com/medicaid/caregiver-child-exemption#What-is-the-Caregiver-Child-Exemption?

You had to have lived in her home full time for 2 years and provided her care....doesn’t sound like you did that. You have caregivers coming in and your own home. It will be best to sell the house and use the proceeds to pay for the nursing home. To be blunt Medicaid doesn’t care how overwhelming this has been for you. We here understand how difficult it has been but Medicaid isn’t in the business of compensating family members while also paying for nursing home care.

Don't think you can. You have a main place of residence.

I received a letter from Medicaid after Moms passing concerning her house. One question was: is there someone residing at that address? If so, is this considered their main address? Was it Moms main address before she was placed on Medicaid? It then said if there is someone residing there (think it needs to be a family member), a lean will be put on the house but not recouped until after that person leaves the house, sells or dies. So, what this means to me is that resident needs to live in the house. They never really own it.

At the time I filed for Medicaid, I was told any money I put towards Moms house like upkeep, utilities, taxes I probably would not be able to recoup if the house sold while she was alive. I would have to keep imaculate records and even then Medicaid may not allow the deductions.

If you sell Moms house after her passing, Medicaid's lean will be need to be satisfied. If any proceeds are left over, then that would be divided between her beneficiaries.