part 2. For couples, only NH spouse has 2B impoverished. You as CS can retain your own assets & your income really doesn’t count for her to be eligible. But how done & amount is up to your States administrative rules for LTC Medicaid. For most it’s 128K. It’s real in the weeds to find & understand. That’s a part of why it’s not a DIY and you need an atty who knows regulations & how the caseworker looking at her application might interpret financials submitted. Personally in my not an atty opinion, I’d hire a CELA level of atty with Medicaid experience.
5 yr lookback rules on asset transfers do exist. But to me, imo, not quite so important for NH/CS situations as your goal is to maximize your allowable assets & have your own mo living in the community $ costs over your own income so you capture as much as possible of her income, which otherwise becomes NH copay. Totally different type of math problems than kids wanting to keep about to enter a NH dads home with a mortgage. (Btw answer to that is kids happily all pay their % share on all property costs including mortgage till beyond dads grave, then open probate & deal with estate recovery; lol as someone isn’t going to pay; house becomes an albatro$$ to whomever POA).
but I digress…. let’s do an example: on assets, say you & wf have 178K savings at 2 different banks; home 380K owned outright but coastal in location. No 2nd home or land. State has standard 128K allowed for CS to retain. (Placed into fresh bank account only in your name & POD/TOD to someone other than NH spouse, it’s ask the atty how to best set up). Her income is $2200 a mo, yours is $1900, both SSA retirement.
On a separate issue, hazard insurance risen astronomically so flood insurance $1200 yr & homeowners with windstorm $4800 yr. Your health is better than hers but you have out of pocket for infusions for your RA that costs you 1K a mo. In the past, $ taken from savings to pay for these and why now at 178K. Wife has needs assessment done and shows she has sufficient health conditions, so both the in person assessment & her health chart reads that she needs skilled nursing care with 24/7 oversight. She is definitely “at need” medically for a NH which is a requirement for LTC Medicaid eligibility.
You have 2 older cars, paid for. You love your home but could use a new roof. You both are on Original Medicare w/part B premium of $164.90 ea mo. Your actual income is $1735.10 mo.
what atty may suggest as options: -move savings $ to new CS only savings acct $178K -128= 50K (now have a sacred bank account with $128K that’s only yours) -get new roof $24K asap paid from joint 50K - 24K= 26K joint bal - legal $7500, so 26K-7500= $18,500 joint acct balance -LTC Medicaid allows for only one (1) car, so turn in both & buy new car in your name w/financing on it. Car loan $800 a mo - property insurance $500 mo - infusion $1,000 mo - cost of living in your area avg $ 987 mo. You kinda need $3,287 a mo. to cover being a community spouse. But your income is only $1735.10. You have monthly shortfall of $1551.90, OMG! well…. -atty has wife do private pay @9K mo to get a bed at that nice Nh that also takes LTC Medicaid. $18,500 - 9K= $8,500 joint balance -atty get details to be ready to file LTC application NH mo #2 -private pay mo #2 & notify filing for LTC Medicaid by EOM -atty files wf LTC Medicaid & CSRA (resource allowance) waiver for you taken from wife’s $2,200 SSA mo income. -State has Personal Needs Allowance for LTC Medicaid $60 mo Atty shepherds her application, so -Wife ends up $2200 - $1551.90 - $60 = $588.10 copay / Share of Cost. If she still needs to pay Medicare Part B, it’s $423.20. Will only have to pay NH under $600 a mo with everything else billed to LTC Medicaid or “dual” health insurance.
Yeah, eventually estate recovery for heirs to deal with. But till then, you have assets, income & her income! That’s what a good atty does. Not a DIY, really truly. Good luck!
Ok this will be a 2 parter…… As a very 1st suggestion to you, realize that Your State has all sorts of Medicaid programs. The biggie is Medicaid as health insurance, which goes from CHIP for kids, WIC related for those pregnant, MAGI & low income health insurance, ACA Medicaid expansion coverage. Then there’s community based Medicaid programs, like IHHS for in home health & PACE for day centers. And then LTC Medicaid which pays for custodial care room & board costs for those “at need” BOTH medically* & financially for skilled nursing care eg NH care. (Side note, right now lots on social media on low income Medicaid as so many are being kicked off as Covid era easier to get coverage has ended). Your interests should be abt LTC Medicaid and “dual” health insurance coverage. Dual is on Original MediCARE & MAGI or low income Medicaid as that is how health care costs in NH tend to be billed.
Second turn a deaf ear to anyone, ANYONE, who has ideas as to what to do or heard what others did for a parent to get onto LTC Medicaid. Why? It’s bc rules and regulations for eligibility for an individual applicant (whether widow, widower or never married) are beyond completely different than challenges faced by a married couple.
Fwiw for an individual, imo, if fairly organized in their life, made a kid or a sibling DPOA (so authority to do stuff) w/ banking access, can be DIY as rules pretty fixed: mo. income under $2742 & nonexempt asset max 2K for vast majority of States. If “over resourced” for income (Medicaid speak for too much $), do Miller Trust or pooled income Trust or get a waiver. If too much nonexempt assets, sell problematic asset(s) & “spend down” to get to $2,000 nonexempt allowed asset max. Basically it’s become impoverished 2B ok for LTC Medicaid “at need” fixed & firm financial requirements.
But for couples it’s way more challenging & imho never ever a DIY. You need to find an elder law or estate attorney who is experienced with how Medicaid LTC program runs for your State. Does not have to be in your city necessarily but in your State. Each State runs its Medicaid program uniquely but under overall federal guidelines. Your & your wife’s situation is going to make the attorney to be its own long term relationship as LTC Medicaid has a required attempt to recover costs which goes beyond the grave. Based on your post, you’re aware of this and want to do something for “asset protection”.
I think this is way easier for couples than for an individual but you need Medicaid savvy attorney to give you options. Why is it easier? Well you would be the community spouse (Medicaid speak for the one NOT going into NH & filing for LTC Medicaid) and State is required to allow CS to have resources they need to continue to be living in their home & community. CS themselves does NOT need to become impoverished, only your bride does. Your income does not count by & large for her eligibility; only her income factors in for her eligibility. AND!!! if you need some of her income (her SS retirement income) to continue to live in the community then atty files to attach / waive some of her income to go to you. Called CSRA or MMNA. It’s a resource allowance to you; & reduces her required copay or SOC (Share of Cost) she would otherwise have to pay NH each month. Amount varies by State. Think of it as kinda like old school alimony to you…. should you need it. And this is where a savvy atty comes in, to structure or change both of you alls income and assets BEFORE she ever files for LTC Medicaid to clearly show you - the CS - need to keep as much $ as possible. Not a DIY.
Plus other legal changes to happen b4 she files. Probably codicil to both wills, changing POD/TOD in banking, changing beneficiaries for life insurance. An experienced atty should have a list of changes needed for CS / NH spouses situation as so much of this is State specific. I’ll do an example in another post.
An Elder Lawyer can help you more than we can. Basically your assets will be looked at and split. Spouses half going towards their care until almost gone and Medicaid is applied for. You will remain in the home, get a car and enough or all of ur monthly income to live on. An Elder lawyer can go into more detail.
These are all question for the attorney office itself. Any certified elder law attorney will have the information you need at his or her own fingertips. I have heard it said on Forum that it's often good to have an attorney in practice with other attorneys with other practices, say Trust and Estate or Probate attorneys as they can share information, have access easier if there's anything they need to check on.
Be sure to gather together all your spreadsheets or ledgers with all records of all assets and history of your marriage so that the visit can go more quickly, thereby saving you money. A family member or friend may help you with this.
I wish you the best, and sharing you journey HERE will so help others.
Find an attorney and see if you can protect assets with what’s called a personal service contract. It bypasses Medicaid five-year look back. There are two types of Medicaid which people don’t understand. The long-term care Medicaid covers for the persons care but you are still responsible for the room and board. ICP Medicaid is institutionalized care and covers nursing homes at 100% but your parent must Qualify for a nursing home care and must be eligible for Medicaid via asset limits. If they are over the asset limits then look into having personal service contracts drawn up (if your state allows) call around to various elder law attorneys and get price quotes …. I would not necessarily rely on trusts because they work differently and once the parent passes that money will go back to the state. Personal service contracts allow the individual to keep the money however there is the downside of taxes whereas if a person passes there is no inheritance tax. Also a Home that is homesteaded is protected from Medicaid, keep that in mind. There may be other investments that are as well. Please note - This is coming from Florida so your state may be different - As we know, all state laws are different . Good luck!
“Home that is homesteaded is protected from Medicaid”
If only it was that simple. Yes, LTC Medicaid by & large allows for LTC Medicaid applicants, whether individual or married, to continue to own their home as an exempt asset for their lifetime. But property value must be under your States LTC Medicaid value max & property must have someone willing & able to pay its costs. Most States have property limit at 550K-650K with couple of east coast States higher. So if house is above that as per tax assessor / collector value, won’t be allowed as an exempt asset for LTC Medicaid filing. House would have to be sold with $ from the sale used as a spend down till impoverished. For alot of areas, values have risen big time & dramatically.
And for those with a widow or widower parents, someone other than the parent on LTC Medicaid will need to pay all costs on the vacant but still owned by the parent now living in the NH. And pay costs from Day 1 of LTC Medicaid till beyond their grave as it could take 1-2 or more years to go thru the after death process to deal with the Estate and the required attempt for recovery that Medicaid does via MERP and heirs filings on this and on probate if they decide to go that route.
Elder has no $$$. As elder is required to basically have all their monthly income less a smallish personal needs allowance go to the NH as a copay or Share of Cost. LSS realistically elder has zero $ to pay insurance, utilities, maintenance etc on old house still in their name. If it has a mortgage, could be quite a tidy sum $$$ paid every month by others on a property they do not own and have the risk of perhaps never owning it due to MERP. Even if your State is one of 6 that allow for a Lady Bird deed to happen, the costs still have to be paid by others. It’s something to pause and think about if it makes sense to do and if the potential heirs will do and pay their % share for an unknown period of time.
I’ve been on this forum a long time, what seems to happen is everybody is all “guvmint not gonna take grannies house” for a few months….. then a Sister doesn’t pay property taxes…., the Brother who was to do the yard fails to, yada yada… and all costs, time and energy fall to the POA. And POA can’t afford any of this so house goes up for sale. Or if there’s a mortgage, it goes into foreclosure. An especially important detail in this is…… all the $ spent on the house by family isn’t really easily reimbursed when it sells. As the house is still in the elder’s name, all - ALL- $ from the act of sale technically is theirs. Sale reported and to the penny. So any $ paid looks like “gifting” which would pose transfer penalty issues should the elder get impoverished again and file for LTC Medicaid. Also for some States that allow for proactive lien placement, these could file to get all payments LTC Medicaid paid taken out of the final Act of Sale amount.
If famiy lives in the house, they would need to have been there prior to application filing or have a disability or dependency. Otherwise rented & at FMV rate. Rent is additional taxable income for the elder. You have to imho be careful on this as FMV rent plus their regular income, like their SSA $, could take them over the income maximum that most States have at $2742. If they’re in a low income State, like IL & MA, it’s $1215 income maximum.
House can be kept. It can be done. But imo will never be simple. And someone in the family has got to have the wallet, energy and sense of humor to do and pay whatever needed for whatever length of time and don't mind risk.
Average NH stay is 2.5 years, add year or 2 to settle stuff, that’s like 3-5 years on paying property costs. To me it’s like having a second home but one you don’t own. For most of us having a 2nd home, isn’t feasible. It something to carefully think about and having a clear discussion with family beforehand.
Medicaid is VERY State-specific. I'm not sure we have any Virginia posters.
The above organization certifies lawyers in the area of elder law.
A good estates attorney --IF they understand Medicaid regs-can also be a good choice.
I chose a NELF firm and then sent their list of associates to a lawyer friend. One of her law school classmates was able to endorse the skills of two of them.
If you are talking about substantial assets (mid to high 7 figures and up) recommendations from www.Bogleheads.org may be useful.
The answer to your question is very individualized, because it does all depend on location and what exact assets you have. Many states have a special trust (like a Miller Trust) where one can "offload" assets to qualify for Medicaid, but then of course when the LO passes, those funds revert to the state, as they should.
Put this in your browser's search field "find a certified elder law attorney near me" and much will come up to choose from.
FYI in most states the Medicaid financial app "look back" is 5 years.
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5 yr lookback rules on asset transfers do exist. But to me, imo, not quite so important for NH/CS situations as your goal is to maximize your allowable assets & have your own mo living in the community $ costs over your own income so you capture as much as possible of her income, which otherwise becomes NH copay. Totally different type of math problems than kids wanting to keep about to enter a NH dads home with a mortgage. (Btw answer to that is kids happily all pay their % share on all property costs including mortgage till beyond dads grave, then open probate & deal with estate recovery; lol as someone isn’t going to pay; house becomes an albatro$$ to whomever POA).
but I digress…. let’s do an example: on assets, say you & wf have 178K savings at 2 different banks; home 380K owned outright but coastal in location. No 2nd home or land. State has standard 128K allowed for CS to retain. (Placed into fresh bank account only in your name & POD/TOD to someone other than NH spouse, it’s ask the atty how to best set up). Her income is $2200 a mo, yours is $1900, both SSA retirement.
On a separate issue, hazard insurance risen astronomically so flood insurance $1200 yr & homeowners with windstorm $4800 yr. Your health is better than hers but you have out of pocket for infusions for your RA that costs you 1K a mo. In the past, $ taken from savings to pay for these and why now at 178K. Wife has needs assessment done and shows she has sufficient health conditions, so both the in person assessment & her health chart reads that she needs skilled nursing care with 24/7 oversight. She is definitely “at need” medically for a NH which is a requirement for LTC Medicaid eligibility.
You have 2 older cars, paid for. You love your home but could use a new roof. You both are on Original Medicare w/part B premium of $164.90 ea mo. Your actual income is $1735.10 mo.
what atty may suggest as options:
-move savings $ to new CS only savings acct $178K -128= 50K
(now have a sacred bank account with $128K that’s only yours)
-get new roof $24K asap paid from joint 50K - 24K= 26K joint bal
- legal $7500, so 26K-7500= $18,500 joint acct balance
-LTC Medicaid allows for only one (1) car, so turn in both & buy new car in your name w/financing on it. Car loan $800 a mo
- property insurance $500 mo
- infusion $1,000 mo
- cost of living in your area avg $ 987 mo.
You kinda need $3,287 a mo. to cover being a community spouse.
But your income is only $1735.10.
You have monthly shortfall of $1551.90, OMG! well….
-atty has wife do private pay @9K mo to get a bed at that nice Nh that also takes LTC Medicaid. $18,500 - 9K= $8,500 joint balance
-atty get details to be ready to file LTC application NH mo #2
-private pay mo #2 & notify filing for LTC Medicaid by EOM
-atty files wf LTC Medicaid & CSRA (resource allowance) waiver for you taken from wife’s $2,200 SSA mo income.
-State has Personal Needs Allowance for LTC Medicaid $60 mo
Atty shepherds her application, so
-Wife ends up $2200 - $1551.90 - $60 = $588.10 copay / Share of Cost. If she still needs to pay Medicare Part B, it’s $423.20. Will only have to pay NH under $600 a mo with everything else billed to LTC Medicaid or “dual” health insurance.
Yeah, eventually estate recovery for heirs to deal with. But till then, you have assets, income & her income! That’s what a good atty does. Not a DIY, really truly. Good luck!
Second turn a deaf ear to anyone, ANYONE, who has ideas as to what to do or heard what others did for a parent to get onto LTC Medicaid. Why? It’s bc rules and regulations for eligibility for an individual applicant (whether widow, widower or never married) are beyond completely different than challenges faced by a married couple.
Fwiw for an individual, imo, if fairly organized in their life, made a kid or a sibling DPOA (so authority to do stuff) w/ banking access, can be DIY as rules pretty fixed: mo. income under $2742 & nonexempt asset max 2K for vast majority of States. If “over resourced” for income (Medicaid speak for too much $), do Miller Trust or pooled income Trust or get a waiver. If too much nonexempt assets, sell problematic asset(s) & “spend down” to get to $2,000 nonexempt allowed asset max. Basically it’s become impoverished 2B ok for LTC Medicaid “at need” fixed & firm financial requirements.
But for couples it’s way more challenging & imho never ever a DIY. You need to find an elder law or estate attorney who is experienced with how Medicaid LTC program runs for your State. Does not have to be in your city necessarily but in your State. Each State runs its Medicaid program uniquely but under overall federal guidelines. Your & your wife’s situation is going to make the attorney to be its own long term relationship as LTC Medicaid has a required attempt to recover costs which goes beyond the grave. Based on your post, you’re aware of this and want to do something for “asset protection”.
I think this is way easier for couples than for an individual but you need Medicaid savvy attorney to give you options. Why is it easier? Well you would be the community spouse (Medicaid speak for the one NOT going into NH & filing for LTC Medicaid) and State is required to allow CS to have resources they need to continue to be living in their home & community. CS themselves does NOT need to become impoverished, only your bride does. Your income does not count by & large for her eligibility; only her income factors in for her eligibility. AND!!! if you need some of her income (her SS retirement income) to continue to live in the community then atty files to attach / waive some of her income to go to you. Called CSRA or MMNA. It’s a resource allowance to you; & reduces her required copay or SOC (Share of Cost) she would otherwise have to pay NH each month. Amount varies by State. Think of it as kinda like old school alimony to you…. should you need it. And this is where a savvy atty comes in, to structure or change both of you alls income and assets BEFORE she ever files for LTC Medicaid to clearly show you - the CS - need to keep as much $ as possible. Not a DIY.
Plus other legal changes to happen b4 she files. Probably codicil to both wills, changing POD/TOD in banking, changing beneficiaries for life insurance. An experienced atty should have a list of changes needed for CS / NH spouses situation as so much of this is State specific. I’ll do an example in another post.
*Medical “at need” on Pt 2.
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An Elder lawyer can go into more detail.
Be sure to gather together all your spreadsheets or ledgers with all records of all assets and history of your marriage so that the visit can go more quickly, thereby saving you money. A family member or friend may help you with this.
I wish you the best, and sharing you journey HERE will so help others.
If only it was that simple. Yes, LTC Medicaid by & large allows for LTC Medicaid applicants, whether individual or married, to continue to own their home as an exempt asset for their lifetime. But property value must be under your States LTC Medicaid value max & property must have someone willing & able to pay its costs. Most States have property limit at 550K-650K with couple of east coast States higher. So if house is above that as per tax assessor / collector value, won’t be allowed as an exempt asset for LTC Medicaid filing. House would have to be sold with $ from the sale used as a spend down till impoverished. For alot of areas, values have risen big time & dramatically.
And for those with a widow or widower parents, someone other than the parent on LTC Medicaid will need to pay all costs on the vacant but still owned by the parent now living in the NH. And pay costs from Day 1 of LTC Medicaid till beyond their grave as it could take 1-2 or more years to go thru the after death process to deal with the Estate and the required attempt for recovery that Medicaid does via MERP and heirs filings on this and on probate if they decide to go that route.
Elder has no $$$. As elder is required to basically have all their monthly income less a smallish personal needs allowance go to the NH as a copay or Share of Cost. LSS realistically elder has zero $ to pay insurance, utilities, maintenance etc on old house still in their name. If it has a mortgage, could be quite a tidy sum $$$ paid every month by others on a property they do not own and have the risk of perhaps never owning it due to MERP. Even if your State is one of 6 that allow for a Lady Bird deed to happen, the costs still have to be paid by others. It’s something to pause and think about if it makes sense to do and if the potential heirs will do and pay their % share for an unknown period of time.
I’ve been on this forum a long time, what seems to happen is everybody is all “guvmint not gonna take grannies house” for a few months….. then a Sister doesn’t pay property taxes…., the Brother who was to do the yard fails to, yada yada… and all costs, time and energy fall to the POA. And POA can’t afford any of this so house goes up for sale. Or if there’s a mortgage, it goes into foreclosure. An especially important detail in this is…… all the $ spent on the house by family isn’t really easily reimbursed when it sells. As the house is still in the elder’s name, all - ALL- $ from the act of sale technically is theirs. Sale reported and to the penny. So any $ paid looks like “gifting” which would pose transfer penalty issues should the elder get impoverished again and file for LTC Medicaid. Also for some States that allow for proactive lien placement, these could file to get all payments LTC Medicaid paid taken out of the final Act of Sale amount.
If famiy lives in the house, they would need to have been there prior to application filing or have a disability or dependency. Otherwise rented & at FMV rate. Rent is additional taxable income for the elder. You have to imho be careful on this as FMV rent plus their regular income, like their SSA $, could take them over the income maximum that most States have at $2742. If they’re in a low income State, like IL & MA, it’s $1215 income maximum.
House can be kept. It can be done. But imo will never be simple.
And someone in the family has got to have the wallet, energy and sense of humor to do and pay whatever needed for whatever length of time and don't mind risk.
Average NH stay is 2.5 years, add year or 2 to settle stuff, that’s like 3-5 years on paying property costs. To me it’s like having a second home but one you don’t own. For most of us having a 2nd home, isn’t feasible. It something to carefully think about and having a clear discussion with family beforehand.
Medicaid is VERY State-specific. I'm not sure we have any Virginia posters.
The above organization certifies lawyers in the area of elder law.
A good estates attorney --IF they understand Medicaid regs-can also be a good choice.
I chose a NELF firm and then sent their list of associates to a lawyer friend. One of her law school classmates was able to endorse the skills of two of them.
If you are talking about substantial assets (mid to high 7 figures and up) recommendations from www.Bogleheads.org may be useful.
Put this in your browser's search field "find a certified elder law attorney near me" and much will come up to choose from.
FYI in most states the Medicaid financial app "look back" is 5 years.