We have a mother who is needing long term care in Florida. Her husband, has decided to deny her spousal support, as he does not want to spend any of his funds on her care. She has given her daughter almost $50,000 in the past 2 years, which could be a reason to deny her Medicaid coverage, but we also know that may not be a reason to deny her Medicaid. The question we have is, if Florida decides to place her on Medicaid, what assets can they go after in recovery, including money, after she dies? Also, since we live in another state, can Florida cross state lines to try to recoup any money? She has no real assets, other than the money she has given to her daughter. Sadly, the husband has the money to offset her Medicaid costs, but refuses to do anything.
To be an individual on LTC Medicaid you have to be basically impoverished with no more than 2k in non exempt assets. They certainly have no $ or savings beyond the 2k. Unless they die still owning thier home or have a life insurance policy that has the beneficiary as their estate, there isn’t going to be any need for probate as there’s no assets to probate.
To me the issue to be concern about like today is that your mom gifted 50k within the past 2 years. It will surface in the financials required & submitted routinely for Medicaid LTC applications. She won’t be eligible for Medicaid.
If your state did Medicaid expansion, then there would be insurance available that was affordable & racked to your income as to your premium. Perhaps with a % or other adjustments paid to the insurer by the state and the adjustment was partially paid by the feds to the state. Not all states took Medicaid expansion done through existing state run Medicaid program. Most often R governor states did NOT take Medicaid expansion. For those states, nonprofits set up marketplace expansion programs.
The answer to why Medicaid expansion does NOT apply to “older” people is that by & large most over age 65 qualify for MediCARE as they or their spouse contributed to Medicare via thier FICA during thier working years. So they can get Medicare and so no need for a Medicaid expansion program. They have health insurance = Medicare. But since Medicare does NOT pay for facility’s LTC / room&board costs, BUT old school Medicaid will pay for LTC, so “older” folks find that they need to apply to Medicaid as they do not have enough income or assets to private pay the R&B for a facility. To afford a facility, they become “duals”, that is on Medicare & Medicaid. And they meet the strict income/asset levels for LTC Medicaid. Between the M&Ms in theory all costs should be covered if they are in a NH. Many community based programs - like PACE - actually need you to be a “dual” as the program is set up to have everything paid between the M&Ms. So like say flu shot or high blood pressure screening is paid 65% by Medicare and 35% by community based Medicaid, you can’t easily private pay for any of it as the system is set up for Co sharing between the M&Ms.
Medicaid expansion basically is all about those too young for Medicare and too old for being on CHIP and without health insurance or uninsurable.
About the “having billions”, Medicaid expansion programs usually are affiliated with health systems as it contains costs. So if you take expansion coverage within system “A” you are limited to that system or network. Similar to how Medicare Advantage plans work. Someone with billions in my experience isn’t going to want or ever accept being told you can’t go to MD Anderson or Cleveland Clinic or Mayo, they have the $$$ and will go and private pay for whatever care needed beyond what baseline Medicare pays. They are not going to go and sit and wait with the great unwashed at the neighborhood clinic. They have $$$, they want service. But for the rest who were uninsured or uninsurable, Medicaid expansion has been very much needed. Ok & that’s it for my health planning & policy rant of the day.....