Medicare and Medicaid PACE in getting into nursing home?

Medicaid is required to make an attempt to recover costs paid from the assets of the Medicaid recipient after they die. Just how this gets done really is interdependent on your state Medicaid rules for MERP (Medicaid Estate recovery) and imo just how much of a property rights state you’re in. But whatever the case, MERP is after death AND there are all kinds of exemptions, exclusions and cost/benefit analysis that can factor in to just what happens.

Again, If mom keeps her home & Sissy predeceases mom, not an issue as she did not get an inheritance.
if mom dies, and you 3 inherit house, Sissy can own a home or a % of a home and be ok for Medicaid asset rules as long as house is under 550k for most states (Upper East coast allow for higher like 750/850k). Sissy won’t have any $ to pay her share of upkeep (cause Medicaid requires her to basically pay almost all the NH her SS $ each month) so you & Bro will have to cover all property costs for your share & Sissys share. & then you & bro will have to deal with MERP lien / attempt on Sissys 1/3 ownership after she dies. I bet you two will have your own exemptions to file to MERP, like low income heir or sibling over 75. Most states have these 2 as exemptions.
If mom sold house, to me, that the only scenario that’s problematic as the $ Sissy will get as the % of the remainderman interest from the sale will be income / asset for her & she will have to do a spend down to be impoverished.

If she became handicapped while young, she might just fall under the ABLE Act for assets; Able allows for them to keep $13k a year and build to 100k and it’s doesn’t affect their Medicaid eligibility. Able started abt 3 years ago for most states. My cousin had 1950s polio, his folks did a SNT for him which I was cotrustee on. We got Able mailings as he would have qualified since ABLE is childhood to age 26 illness. He didn’t need it as he had a trust. That ABLE existed was totally a surprise; I didn’t recall ever reading anything it. But if she can do ABLE, it might be a way to have home sale $ go into that type of account rather that a spend down to 2k. Able account need like a disability rights type of attorney to set them up, the paperwork was several pages and there’s likely to be only 1 or 2 banks that open them in coordination with a State Disability Office. I think state becomes beneficiary of Able should they die and there’s still $ left in the account & why it’s certain banks that are partnered for ABLE. Family members can gift $ to existing Able account too but like a max of like $13K a year overall (like 1 grandparent gifts $13K this year & another gifts $13k next year).

Remember if Sissy name isn’t on title, it’s not her home. Not her asset.
If she needs placement in a NH ASAP, she needs to apply for LTC Medicaid. Fretting about the possibility of a lien, months or years from now being an issue doesn’t make sense imho. She needs SNF ASAP it sounds like and she has no $ so can be eligible for Medicaid to pay for it. If she’s in PACE she’s already a “dual”. Just make sure that whomever does her LTC Medicaid application understands what Sissys income and assets are & more importantly are not. Good luck and let us know what happens, ok!

Mary195 - Is it that someone has told your Sister that since she is to inherit her yet-still-living moms home under your moms Life Estate terms, that she (Sissys) share of the “remainderman interest” or eventual inheritance from your moms Life Estate is the problem?

If so, I don’t think that’s accurate.
If your mom has her home in an LE, that home remains in her name & her ownership until either she’s dies & only then (after death) does it transfer to whomever named in the LE. If mom - at 98 - is still alive, that home is hers, it is not yet divvied up. She’s alive; that the home is in an LE doesn’t yet matter for the kids. Moms still here.
BUT
If she (mom) sells the LE property, when she (mom) is still alive, then whatever the % that is Sissys proportional share / % of her remainderman interest in the property needs to be paid to her (Sissy). & you & your bro get y’all’s share too. That $ to Sissy & likely will affect her LTC in a NH Medicaid eligibility as she’s gonna have assets over 2k in the bank. Figuring out remainderman is a math problem that is based on actuarial tables. Actuarial tables are based on age & sex & get derived from the owners age at the time they sell the property while they are alive & sale $ amount. IRS has actuarial tables to reference. But I gotta tell you, it is not simple math - well at least not to me. And it’s got to based on what the property actually sold for. Like the final proceeds amount paid at the act of sale & after a realtor commission, deducted fees, etc AND NOT the listing price. But if mom hasn’t sold her home, the LE as I understand it, should not matter as she’s still owner of her home, there is not yet any division of $ or transfer of ownership. It hasn’t been sold & mom hasn’t died.

if your Sis is on PACE, she is already a “dual”, right? By dual I mean she’s on MediCARE and community based Medicaid. If PACE is / has evaluating her & determining that she’s now needing higher level of care in a LTC facility, someone at the PACE should be helping her get placed & helping her do the application for LTC Medicaid. It might be that there's a misunderstanding on how LE is structured that is the confusion & Sissy is including an asset that she actually does not have.

Really until mom dies or mom actually sells the house, there is no $ or ownership both for you, your brother & Sissy. And since there’s 3 kids, it’s gonna be split into 3 equal ownership for new title if it’s after mom dies OR its $ split 4 ways if it’s sold while she’s still alive & the split (the remainderman) is determined by actuarial tables.
But moms alive & house not sold, so should not matter imho.

Remainderman interest will be a wonky figure with a decimal. Usually it’s a CPA or the Real Estate Atty or maybe the Title company who runs the #s to determine the % & the checks cut to the exact penny a few days after Act of Sale to the owner/seller & the remainderman kids from the escrow account that the Realtor or attorney holds.

My mom 98 and she living at her house which is life estate . My sister is sick with ALS and needs to go to nursing home now. She has no money and on pace program. But because she on my mom estate with me and my brother she can not get Medicare to get to a nursing home. Need help fast because she so sick now and has no one at home and needs 24 hour care.