My sister had a stroke in October 2021 and is now in a nursing home. She still owns a home valued at approximately $90,000. I need to sell her house. Any advice?
I signed letter saying she plans to return to house. Does Medicaid get all the profits from sale of house now or when she dies. Do I have to let Medicaid know I sold house and for what it sold for.
Sissy, The document you did tends to referred to as a “Notice of Intent” as in the elder now in a NH & on LTC Medicaid is providing a document to the State that should things change for them they intend to return to thier home. My experience is that it’s a 1 page document State send out after the inital raft of LTC Medicaid paperwork is done and then the caseworker double checks that yes the applicant does own a home so a Notice of Intent goes out to them or to their DPOA to sign and return. Sometimes the Notice is in the initial paperwork…. It’s all interdependent on how your state manages their programs.
Doing one seems to provide for the house to remain a exempt asset for the elder AND - and to me this is mucho importante- it enables the city / county taxing authority to continue to allow the house to have a homestead exemption. It’s importante cause if there is not a valid homestead exemption, it’s property taxes and any other exemptions or allowances for being over 65 / disabled / aged will increase and will increase significantly. Could be like triple or more in taxes $$$. Some cities have serious deductions on any city services billed for those over 65 or won’t cut off water if it’s elderly, but property needs a current homestead exemption to have these in place.
I have a question for you…. Is the 90K value accurate? Is this figure of 90K from the annual tax bill OR did you hire an actual licensed residential property appraiser to come to the house and do a report? Is the 90K a feasible price that can be paid for the condition of her home or is it likely to be less, as it has all sorts of delayed maintenance issues. Which is it?
And it’s kinda a year now that your Sister has been in a facility….. how have all her property costs - taxes, utilities, property insurance, etc - been paid for? & I do mean every property costs….like $12.34 for light bulb replacement, etc as all this adds up. And is the place technically vacant or do you or others live there?
Are you the only heir? If not are the others heirs siblings and is everybody all kinda elderly and all fixed income residents of the State?
Ok, my bad, the document to have house remain exempt asset is a “Right to Return” not a Notice of Intent (NOI). The NOI is what Medicaid or their outside contractor sends out as a letter to whomever Medicaid had on file as next of kin or was old POA after an elder who has been on LTC Medicaid had died. Intent as in the required attempt to recovery or recoup costs paid.
This question comes up from time to time. What I wonder is, exactly how does this work? Does Medicaid give a bill of what sister owes, the bill is paid from the proceeds and then use the remainder to pay the monthly rent until it is gone? at which time, refile for Medicaid? Could some of the proceeds go to pay an attorney to take care of it for sister? Refresh her wardrobe? Have dental care? Pay for a funeral? Then apply what is left to the bill? I don’t think I’ve ever read on here exactly what the steps are after the house is sold if it is sold after approval for Medicaid the first time. I know it has to be sold at FMV and reported but I don’t know if there are any exemptions. Perhaps Igloo will advise.
My take on this is there’s 2 paths for elder who owns home but goes onto LTC Medicaid: 1. They keep home & all rolls into after death attempt by estate recovery to get a recoup or 2. Elder sells home so become ineligible for LTC Medicare as financially no longer “at need”. They run very differently & interdependent on your states laws on property rights, probate & how the administrative code is for a financial change in “at need” status. Fwiw selling home happens & you can see that & stand in it; but what I’ve been surprised in is the # of elders on LTC Medicaid who inherit $ from well meaning family…. like a cousin who loved Auntie so leaves her a modest amount of 5K in his will…. & horrors! elderly Auntie now ineligible.
But whichever, here’s the rub, LTC Medicaid agreement on reinbursement is between facility & the program. State pays a daily preset room&board cost pretty much in real time, based on daily butts-in-beds count. To me how LTC pays is very similar to what public schools do & why public schools really stress kiddos have to be there by 8:00 bell and not signed out until 9:15 cause in order for school to be paid it’s 9:00 census that gets reported. Anyways because of this, the elder, in my experience, does not get or see a bill during their lifetime. It is only after they die, that a summary or tally of State payments to the NH on the elders behalf is sent to the old and no longer POA on file for the elder. It’s sent by a Notice of Intent (to seek a recoup) and will be a $ amount and not an itemization. Medicaid becomes aware elder has dies, produces the itemization and then it goes to however your state does MERP to do a NOI. Like if done by a division of Medicaid or an outside contractor for MERP and perhaps also Dept of Insurance if there’s a “Estate Of” policy involved.
Ime if you want to see what a NH is being paid by the State, you have to submit this as a request to the State which then sends a letter to the participating NH allowing you a copy of their internal payment document. I did this for 1st NH my mom was in as it was a total clusterF as to her billing first few months, would be corrected then mistakes again. A rinse and repeat, it was part of the reason why I moved her to another NH within her first year.
Anyways I digress, in LTC Medicaid application, there should & will be a section that states that any change in financial status has to be reported to the state within X period of time. Someone signed off legally on this and it’s subject to penalties if ignored. If it’s 30 days, then, the POA has to report it in writing to the State and State sends back paperwork to be filled out along with copies of the checks, deposits, probate court distribution document (like for that 5K @Auntie got). What happens next to me seem to be totally dependent on your state. I think if you’re in a TEFRA state they can capture the house sale $, apply it to the tally and you spend down till impoverished once again. Other States have elder use the $ to private pay from this point forward. So on a spend down and should they die before using it all up, the remainder goes to the state under estate recovery rules. Just what happens is State by State dependent.
Yeah it’s a maddening maze, an add to this that what’s involved is very much legal and folks you are dealing with on this tend not to be attorneys….. the caseworker, a Realtor, me as a not-an-attorney poster on AC, a well meaning neighbor….. are giving you their opinion or experience…. but it may not be valid for your elders or your situation. That’s why it’s always good to run whatever contemplated with an atty with experience.
Glad, not making light of your answer but if it’s a state that lets the elder keep their house sale $, so become ineligible and have to do a fresh “spend down”, I bet they have to use it first and foremost to private pay for their NH but if they do not have a preneed funeral and burial, they can use some of the $ to buy one of those. It’s have to be within whatever limits Medicaid has on those - maybe under $7,500. Also they might be able to spend on things the LTC Medicaid will never ever pay for like dental care. Dental can be just so expensive and no coverage usually via Medicare so they do without it for years.
if they have to, have to, exclusively spend done on mo private pay Nh that’s one thing, but if their state allows a wider use of the $, that’s another. It falls to the POA to be proactive in all this, which can be challenging.
The letter- a Right of (to) Return - allows the home to stay considered an exempt asset for LTC Medicaid. So when the caseworker is evaluating the Sisters application that 90K home will not be counted as an asset. NonExempt Assets for an individual for NH Medicaid for most states are a maximum of $2,000. So it the “right of return” isn’t signed, she will have $92,000.00 in nonexempt assets so will not be eligible.
NH sister can continue to own her home if she wants to and family can decide to do whatever to enable all that to happen. The rub is that the NH sister is required to do a copay of almost all her monthly income to Nh as a copay. All Nh Sis will have for her own $ will be a smallish personal Needs Allowance which tend to avg $50-60 a mo. PNA tend to maybe be enough to pay for onsite beauty shoppe & some toiletries replacement. The required copay often comes as a total surprise to family. The NH become the heavy in all this as they want that mo income; and they know if there’s still a home that unless they POA absolutely understands this, there’s going to be an issue in getting the copay.
NH Sis can keep her home BUT Nh Sis has zero $ for home. So someone’s else is going to have to pay all property costs on Nh Sisters home. It’s on the elder and their family to make a decision and stick to the decision even if it means years.
I’ve been on this forum a long time, what tends to happen is siblings are all “guvmint not gettin’ maws place” for about 6-8 months, then Sister who was to pay property taxes, doesn’t & Brother who was to pay insurance, doesn’t and your kid who was going to cut the grass every month has left the State with new girlfriend. If your the POA dealing with all this is on you and your wallet. Parents house becomes an albatross. So goes up for sale. As NH mom still owns it, all the $ from the Act of Sale is all moms. She cannot easily give you $ from house sale as it looks like gifting. Medicaid imo tend to take the position that what we do for our folks we do out of a sense of familial responsibility and without repayment. It can get expensive and complicated to try to establish otherwise.
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Doing one seems to provide for the house to remain a exempt asset for the elder AND - and to me this is mucho importante- it enables the city / county taxing authority to continue to allow the house to have a homestead exemption. It’s importante cause if there is not a valid homestead exemption, it’s property taxes and any other exemptions or allowances for being over 65 / disabled / aged will increase and will increase significantly. Could be like triple or more in taxes $$$. Some cities have serious deductions on any city services billed for those over 65 or won’t cut off water if it’s elderly, but property needs a current homestead exemption to have these in place.
I have a question for you…. Is the 90K value accurate? Is this figure of 90K from the annual tax bill OR did you hire an actual licensed residential property appraiser to come to the house and do a report?
Is the 90K a feasible price that can be paid for the condition of her home or is it likely to be less, as it has all sorts of delayed maintenance issues. Which is it?
And it’s kinda a year now that your Sister has been in a facility….. how have all her property costs - taxes, utilities, property insurance, etc - been paid for? & I do mean every property costs….like $12.34 for light bulb replacement, etc as all this adds up. And is the place technically vacant or do you or others live there?
Are you the only heir? If not are the others heirs siblings and is everybody all kinda elderly and all fixed income residents of the State?
Does Medicaid give a bill of what sister owes, the bill is paid from the proceeds and then use the remainder to pay the monthly rent until it is gone? at which time, refile for Medicaid?
Could some of the proceeds go to pay an attorney to take care of it for sister? Refresh her wardrobe? Have dental care? Pay for a funeral? Then apply what is left to the bill?
I don’t think I’ve ever read on here exactly what the steps are after the house is sold if it is sold after approval for Medicaid the first time.
I know it has to be sold at FMV and reported but I don’t know if there are any exemptions.
Perhaps Igloo will advise.
2. Elder sells home so become ineligible for LTC Medicare as financially no longer “at need”.
They run very differently & interdependent on your states laws on property rights, probate & how the administrative code is for a financial change in “at need” status. Fwiw selling home happens & you can see that & stand in it; but what I’ve been surprised in is the # of elders on LTC Medicaid who inherit $ from well meaning family…. like a cousin who loved Auntie so leaves her a modest amount of 5K in his will…. & horrors! elderly Auntie now ineligible.
But whichever, here’s the rub, LTC Medicaid agreement on reinbursement is between facility & the program. State pays a daily preset room&board cost pretty much in real time, based on daily butts-in-beds count. To me how LTC pays is very similar to what public schools do & why public schools really stress kiddos have to be there by 8:00 bell and not signed out until 9:15 cause in order for school to be paid it’s 9:00 census that gets reported. Anyways because of this, the elder, in my experience, does not get or see a bill during their lifetime. It is only after they die, that a summary or tally of State payments to the NH on the elders behalf is sent to the old and no longer POA on file for the elder. It’s sent by a Notice of Intent (to seek a recoup) and will be a $ amount and not an itemization. Medicaid becomes aware elder has dies, produces the itemization and then it goes to however your state does MERP to do a NOI. Like if done by a division of Medicaid or an outside contractor for MERP and perhaps also Dept of Insurance if there’s a “Estate Of” policy involved.
Ime if you want to see what a NH is being paid by the State, you have to submit this as a request to the State which then sends a letter to the participating NH allowing you a copy of their internal payment document. I did this for 1st NH my mom was in as it was a total clusterF as to her billing first few months, would be corrected then mistakes again. A rinse and repeat, it was part of the reason why I moved her to another NH within her first year.
Anyways I digress, in LTC Medicaid application, there should & will be a section that states that any change in financial status has to be reported to the state within X period of time. Someone signed off legally on this and it’s subject to penalties if ignored. If it’s 30 days, then, the POA has to report it in writing to the State and State sends back paperwork to be filled out along with copies of the checks, deposits, probate court distribution document (like for that 5K @Auntie got). What happens next to me seem to be totally dependent on your state. I think if you’re in a TEFRA state they can capture the house sale $, apply it to the tally and you spend down till impoverished once again. Other States have elder use the $ to private pay from this point forward. So on a spend down and should they die before using it all up, the remainder goes to the state under estate recovery rules. Just what happens is State by State dependent.
Yeah it’s a maddening maze, an add to this that what’s involved is very much legal and folks you are dealing with on this tend not to be attorneys….. the caseworker, a Realtor, me as a not-an-attorney poster on AC, a well meaning neighbor….. are giving you their opinion or experience…. but it may not be valid for your elders or your situation. That’s why it’s always good to run whatever contemplated with an atty with experience.
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What else would the money be used for?
if they have to, have to, exclusively spend done on mo private pay Nh that’s one thing, but if their state allows a wider use of the $, that’s another. It falls to the POA to be proactive in all this, which can be challenging.
Medicaid will want the money for her continued care, assuming her NH stay is permanent.
NH sister can continue to own her home if she wants to and family can decide to do whatever to enable all that to happen. The rub is that the NH sister is required to do a copay of almost all her monthly income to Nh as a copay. All Nh Sis will have for her own $ will be a smallish personal Needs Allowance which tend to avg $50-60 a mo. PNA tend to maybe be enough to pay for onsite beauty shoppe & some toiletries replacement. The required copay often comes as a total surprise to family. The NH become the heavy in all this as they want that mo income; and they know if there’s still a home that unless they POA absolutely understands this, there’s going to be an issue in getting the copay.
NH Sis can keep her home BUT Nh Sis has zero $ for home. So someone’s else is going to have to pay all property costs on Nh Sisters home. It’s on the elder and their family to make a decision and stick to the decision even if it means years.
I’ve been on this forum a long time, what tends to happen is siblings are all “guvmint not gettin’ maws place” for about 6-8 months, then Sister who was to pay property taxes, doesn’t & Brother who was to pay insurance, doesn’t and your kid who was going to cut the grass every month has left the State with new girlfriend. If your the POA dealing with all this is on you and your wallet. Parents house becomes an albatross. So goes up for sale. As NH mom still owns it, all the $ from the Act of Sale is all moms. She cannot easily give you $ from house sale as it looks like gifting. Medicaid imo tend to take the position that what we do for our folks we do out of a sense of familial responsibility and without repayment. It can get expensive and complicated to try to establish otherwise.