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Tresha Asked August 2023

Mom has an irrevocable trust. She is in MC paying out of pocket. What happens at the 5 yr mark and we apply for medicaid and we've messed up?

Everything except her personal bank account is in the trust.
Home is in trust and we rent on VRBO. We pay expenses out of the VRBO account we have set up in the trust.
We take out $10,000 twice a year from the VRBO acct. for personal expenses but of course write the check to ourselves, not to her. Her SS and teacher retirement do no cover the MC payments.
We are not sure we can make it until next August paying out of pocket. What should we do to keep the 5 yr lookback ok.
We are terrified to do anything because we don't understand what happens if the look back has issues.
Thank you for your help.

AlvaDeer Aug 2023
Thank goodness for Igloo and her spot on advice on this sort of thing.

I am pounding into her head the advice "don't even THINK of DIY on this".

You can't do this stuff alone. You need the advice of an attorney. Please get it.

igloo572 Aug 2023
If she files an application and gifting surfaces, she gets a penalty on her application. It’s by # of days based on what her State pays for day rate room&board custodial care. Let’s say’s day rate is $200 and mom gifted 75K. That’s roughly 375 day penalty. So slightly over a year ineligibility from the date of the filing of the application.

Rental income & expenses is a hornets nest of tax filings to do.
So it’s a Trust owned VBRO paying mom & you income. This is alot of unthreading to do.

Don’t even attempt to DIY this. Find an elder law attorney with Medicaid experience and imho you want one who has a relationship with real estate attorney. You’ll need both and a CPA. This is way waaaaay too sticky to deal with on your own.

Trust is irrevocable so it’s fixed. Good, bad or indifferent, it’s a done deahl. If errors in judgement and transfers were done and it’s looking like a Medicaid transfer penalty will be placed, imo, it’s best that you know this up front asap. And that’s what an experienced attorney should be able to help you with.

but maybe you can do things now to reduce her bill…. Like if she’s in a single room, can she share a room for less cost? Is there a comparable MC maybe in the country that charges less, she could move to? Things you can do to stretch out $.
igloo572 Aug 2023
Also please pls make sure this MC has readily available LTC Medicaid beds. State Medicaid are required for federal share of funding to have dedicated beds for custodial care in a skilled nursing facility for those “at need”. The LTC Medicaid program. But State funding for care in a MC or a AL - if a State chooses to do this - is done via a waiver program.

Waivers pose a whole host of challenges, which I’m not going to go into except for this, for a facility to participate in waivers, it will be limited #. May be just a few beds which are currently occupied. Mom may need to be on a waiting list with no precise guarantee butts in Medicaid bed date. Find out about this clearly.

For my mom, she moved from her home to a tiered facility (went from IL to AL to NH and had a separate hospice wing). Mom was in IL and their AL did have AL Medicaid waiver beds. I was blithely led to believe that mom would moved along the system and onto Medicaid as she impoverished and her health changed. Did NOT happen. Those AL waiver beds used as placeholder beds for residents who were ready for NH side but really just waiting for someone to die in the Nh to move over and into a LTC Medicaid bed. For the facility, this really made sense. They stayed at 100% occupancy for anything Medicaid. These were all residents who had been residents for a while, (some were IL with my mom then into AL) so staff knew them & their needs. But from the outside, yeah this place had AL waiver beds, but realistically it didn’t. I ended up moving mom from this IL to a different facility NH, bypassing Al phase.
My point is clearly make sure a bed will be available and if not budget accordingly.

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Ohwow323 Aug 2023
You will need to talk to an elder attorney, and your moms social worker.

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