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Please note than any trust you may consider should be reviewed if not drafted by an attorney, approved by Medicaid (often requiring trust provision for payback of benefits upon death to Medicaid not your heirs), and considered against a thorough review of all spend-down and gifting strategies (noting Promissory Notes have since been unfavorably considered by Medicaid for planning purposes.) I am not an attorney, and this is not intended to be taken as legal advise only what I would consider when embarking on the complex and situational task of estate and medicaid planning.
Look into the Medically needy program...this is for individuals with assets that exceed standard Medicaid eligibility. In any event, you would be well served to seek out an elder lawyer to help you prepare an asset protection plan to begin a spend down towards eligibility and in payment of care out of pocket until such time.
The key phrase in the question is "...makes too much." This indicates to me that you are concerned about income and not assets.
If the perceived problem is that Social Security + Vet benefits + any other income brings the Medicaid applicant to over $2022 and, therefore, over the qualifying income limit, then here is the solution:
The Irrevocable Qualified Income Trust (aka QIT or Miller Trust), permitted since the implementation of OBRA '93, allows the applicant to gift excess income over the cap to the trust and thereby qualify for Medicaid if all other eligibility requirements are met.
So yes, there is a very effective way to qualify for Medicaid if income is too high.
Wants it all back? What kind of a mother is that??? Next, she'll be saying you abused her emotionally, using undue influence. Get yourself protected, if such a possibility exists. Scary!!!
What about the stuff of mom's that is stored in the garage and the silverware mom gave to my sister and the electric piano that my nephew is using that were moved from my mom's home in September? Is that all considered a gift? According to mom it is not now a gift, she states she wants it all back and wants out of the nursing home. Can't really sell it until we have the court date for guardianship, but will it have to be sold to pay for nursing home since it was within the last five years? Fortunately the money from the sale of my parents' homes was gifted 30 years ago and into an investment in my name. This was done when my dad was sick and mom was afraid he would end up in a nursing home. Turns out he died before having to go to a nursing home.
I think I should have swolled my pride and let the elder lawyer do more of the work since I had paid him a retainer when I was going through the medicaide maze but since my husband died before I was able to get him approved I had almost 4hrs of his time left and he is helping me get 1/2 of his pension which the union has been fighting with me about for over 4 months and medicare wants me to pay a penaty for not getting part D in 06 which I did not need because we were both covered fully for our meds so he is helping me with that also-I have learned sometimes you need to get help so you do not go crazy-I also was not able to get a small life insurance benefit which my financial advisor was able to arrange for me -I never thought that over four months since he died I would be having so much trouble-I think his union thought I would finally give up and let them win but they do not know how stuborn I can be I am sure the husband is looking down and thinking they should know better than to mess with her. I am gaining a lot of knowledge that I never wanted-at least I am trying to make things easier for my kids when my time on earth is over. But I am having a ball throwing out all the junk the husband saved over the years and now he can no longer go to the the trash bin and bring things back into the house as he use to do.
I went through all of this when I had to put my father in a nursing home. Basically, all assets must be "spent down" before Medicaid will kick in.
Income from all sources including pension, social security, life insurance from previous spouse, etc., is expected to be used to pay for nursing home care. Even if you get to the point where you can qualify for Medicaid, any social security payments must go towards nursing home care.
I kept meticulous records of all nursing home expenses as well as his income from all sources - and I advise doing the same.
My father died before his money was all gone, so he never qualified for Medicaid.
The lookback period is five years for Medicaid, so if you are trying to gift away money to qualify for Medicaid, it's very difficult to do. In the past, families used to gift away all kinds of money to relatives to "hide" it from nursing homes. More recent legislation makes this almost impossible to accomplish.
I am in Michigan and I am not applying for Medicaid, but I can tell you that while applying for my father's VA benefits.... they were only allowed to have so many assets. Anything else had to be transferred to me or spent. VA benefits is extremely particular about what a person is allowed and there are a LOT of hoops to jump through, so be careful.
My advice to you is that you need to get an elder attorney. I don't know the facts of what's going on, nor should any of us presume to know better especially with what your mom is doing. There are two sides to every story. Get the advice and counsel of someone who knows the laws. Elders need to be protected, but at the same time watching out for them with tough decisions. It is a very difficult area.
Maybe someone from North Dakota can tell of their experience?
I have my mother in a nursing home in North Dakota. I have applied for Medicaid, about six weeks ago initially. They are still dragging the feet, evidently her life insurance policies are slowing this up. I assume she will have to empty out her life insurance policies. What do I do about the $10,000 bill that I just got. I paid the one for September with the money that she had in her account, then they told me I shouldn't have. All she has now is $3,000. Will she qualify for medicaid if she has the $3,000 in her account? She also get VA benefits from her first husband dying in WWII. Will she have to give those up? They told me at the VA to reapply for benefits, as there is an extra $100 they will give her that the nursing home can't take, is this really true? With all this paperwork and worry about finances, I am thinking twice now about behing honest about being burned out from caretaking for 5 years and having health problems, and mom is all upset about behing in the nursing home and trying to sue me and my sister.
Our office for the ageing has an elder lawyer who works there one day a week and he was the one I hired-I did not know this at the time I hired him he was recommanded by our accountant. I did have to pay a retainer for 5 hrs of his time but if I did not need all the time I would get some money back and when my husband passed he offered to pay the whole amount back even though I was in his office for over an hour and have called him a few times but I told him to keep the check because I will probably need him as I go forward getting my husbands' life insurance and changeing the investments into my name.At our first visit he gave me a list of everything I would need for medicaide and lots of advice I tried to do all the leg work myself to save money because I knew medicaide would get every penny from me they could and did work on it for 3 weeks before my husband got very ill and then passed, do make the appointment with social services ahead before you get everything together because it takes up to weeks for an appointment and they will send you an application-first you sit down and cry then you get up and start the task and it is daunting even if you do not have everything in order keep your appointment because no matter how prepared you are they will want one more thing-this was told to me by my daughter who works in another county for social service in a different dept. and a lawyer does cost but if they know you have a lawyer on board they will take you more seriously-and even after he passed they wanted my to keep my appointment saying the nursing home would be sending some bills-I called the nursing home and found out what I owed which was not much and then firmly told social service I WAS not coming in. Do not spend every waking hour on the task it will drive you crazy just work on it part of the day every day, You may have to spend down before they get om medicaide but they will be cared for during this time in a nursing home and it will not take long for their extra money to be used up you can prepay their funeral expenses which is between $8000.00 and $14,000.00 in my state. Do not listen to anyone even a lawyer that you can hide money they know more about you accounts than you do and any addition or withdrawal of $1000.00 sends up a red flag going back 5 years and it will come back to haunt you if a lawyer tells you something that does not sound right run no matter how important he thinks he is-I wish I had the guts to name names but the lawyer I did use knew of him from what I had said about him and someday I am going to confront him maybe at one of his semiars after I eat the meal he provides I owe to to my husband who belived in him. If you can get a social worker to help you do it-take all the honest help you can and someday you will be able to help others they should give out degrees for getting medicaide and you will get it but it may be painful at the time-good luck
I consulted several Elder Law Attorneys, who offered some direction, but cost a LOT of money. My favorite was a volunteer for a Senior Center who said I could do all the work myself. He was such a blessing, that I'd pay for his services if I needed one for real. While you can do it alone, it is a great amount of work!!! The learning curve is great, as well. I sought resources, organized, applied, spent down, liquidated, applied again, and received a tremendous amount of help, from some wonderful people along the way. Some advice was poor, but most was helpful. Be careful who you listen to, including lawyers (no offense if you are one). Not all are ethical, but unless you have good discernment and counsel, you find out the hard way. Prayer helps. If you have the time, the benefits are worth the tiring effort. If not, there's many who will help along the way.
"There are 2 standards that need to be met. 1-Be Nursing Home eligible as determined by a doctor and/or state social worker. 2-Receive no more that $2,022.00 in income per month and have no more that $2,000.00 in assets/resources."
Dragonflower writes:
This is absolutely correct! Medicaid is intended for the "medically indigent" which basically means "low income and limited resources." I cannot stress this enough. It was never intended for middle-class people who own a house, a car and have a middle class income arriving into the household every month from any sources (pension, dividends, IRA, Social Security, interest income).
While each state manages its own Medicaid, there are certain things that are fairly uniform from state to state. You are required to "spend down" your assets to qualify for Medicaid, as others have pointed out. Your entire "asset package" is examined to determine if you qualify. Start making a list of all assets that could be liquidated from all sources.
Social Security income and pension can be put towards the cost of either assisted living or nursing home care - I know, because when I had to put my late father in a home, these were used to pay for his care in addition to money from his personal savings, IRA income, etc. I was in charge of his financial arrangements, so I was very aware of every penny.
At the time when I was in charge of this stuff, the look-back period for assets was only 3 years. Since then, it has been extended to five years and will probably be further extended as people keep living longer.
As others have advised, you probably need to consult an attorney who specializes in this type of thing.
Of course you can't do it all! Don't let anyone put guilt on you. Get in touch with your county aging services to see what can be done. A lot depends on finances, but it could be your parents and sister should all be on Medicaid. You need professional help to figure this out - people who know your state laws and Medicaid laws. Medicaid is different from Medicare. It's for low income folks with disabilities. Please check with your county aging commission or adult social services. You can also go to your state's Web site and find a phone number for aging services. They should be able to direct you to local services.
Good luck. You definitely need help with all of this. Carol
Yes, RHaley, there is plenty of help available for you. Appropriating it is the hard part. It takes a lot of time, phone calls, and paperwork. Your local County Commission on Aging can provide resources. (Depends what direction you want to go.) What happens when you can no longer keep up, and their needs become greater? There's respite care, day care, in-home care, and professional managers. What do you think best fits your situation and needs?
My name is RHaley, I live in Strasburg, VA. I am sending this on behalf of my Mom, Dad, and sister. All 3 are disabled and live in the same house, my sister is confined to a hospital bed (I pay for my sisters home care), my mom is in a wheel chair unable to walk, stand, or get herself in and out of bed or off the toilet, she is on Medicare. My father recently fell several times, he is retired disabled, he also has Medicare. He fell on Monday and now will not walk because he is saying he can't. They are now in a hardship in there home due to no help. I am married, I have to commute 124 miles a day to my job. I get up at 2:30 am in the morning and I am at work by 4:45 am, I do not get home until 6:00 or 6:30 pm in the evening. I have one friend who is helping them a little but she has a life also. Is there any way that we can get assistance for them???? My father is mad at me because I told him I could not do everything and he said I was just abandoning them. Which I have not, I am just so frustrated because I do not know what to do or who to call. Can someone please help me???
Austin, hang in. Mitzipinki recognizes, as do I, that some of our phrases seem trite. "Easy for you to say, etc." But you do know we've all "lost it." Most of us have been through these red-tape nightmares, and most of us have seen the good, bad and ugly of people we hire. Some are angels, however. So don't give up. We don't like asking for help and appearing vulnerable, but we are, in fact human. Humans are meant to help each other. Take care and know you are in our hearts. Carol
Well Austin, that is roughly $19/hr which is actually a low end cost (if I did the math correctly).
Hopefully things will work out for you. I know I never saw all this provisions responsibility happening to me, and I've had to learn legal, financial, AL, caregiving all on the fly. Fortunately God has put some awesome help around me.
Sometimes social workers can be a great resource. Some I've encountered are a waste, but there are some extremely helpful people out there and if you go in grateful to them and thanking them, they tend to open up a bit more and find additional resources.
Austin, just take care of you. The rest will work out!! Your husband is covered for now. Don't let these stressors get to you (D'OH... I hate that phrase!). We want to see you around for a long time!
Mitzipinki Thank you for your information every bit helps and working on it every day the social worker has been very helpful esp. since I lost it the other day inher office and cried but I was at the end of my rope and have called the lawyer a few times- I hate to have to ask for help but he told me it was wise to let the social worker help my appointment with the the social service in our county is 7/2 I wanted to see the lawyer again before I went there but he said to keep that appointment and the husband can stay in the nursing home because he is on medicaide pending I know I will have to eventualy pay something but hope it is less than the $8000.00 for 2 months for 7 hr. daily aides.
I couldn't agree more Carol! My elder law attorney came highly recommended. I also questioned him because he talked about things I had never heard of. He said it was because so many people do not hire those to use the law correctly.
I asked my acct questions my atty told me about. So far, although I'm still not through this, he hasn't lied to me yet.
Find elder specialists. Just because they deal in an area does not make them elder specialists.
Austin, I've been working on VA benefits for the past 9 months. Even that is a PITA.
Eric - I very much apprecate all your information on medicaide if my husband had been realistic about his condition we could have avoided what mess I am going through now and if we had not listened to our first elder lawyer telling us as late as one year ago that our debts of credit card balances would be subtracted from our assets we would be better off or I would because my husband refuses to help me out at all with this mountain of redtape I did get a good local elder lawyer and the social worker at the nursing home he is in is helping me because I am overwhelmed esp, since I had silent strokes a few years ago, I had no idea applying for it was going to be so hard,
Well said, Mitzi. There are trusts that work and those that don't. Everything needs to be set up just right. It's scary business, and people need to know who they are hiring.
Well all I know is thank God for the elder law attorney and financial advisor I have.
I am working on getting VA benefits for dad and of course dealing with Medicaid isn't too far behind.. The one thing that my ELA told me is that due to my parent's assets we had to create a trust in my name and transfer all but the minimum assets allowed to my trust. I was really nervous about being taxed as my income and I was told that my accountant needs to file a 709 indicating the transfer which also states taxes have been paid on it. They also suggested in liquidating the life insurance that I should take taxes out due to present government administration then when its in my trust acct just put it in a money mkt to draw the same interest over time.
I think its all in the professionals that are hired. Don't take one person's word for it either. Do some research on your own.
This is all an ugly process so get as informed as you can.
When shopping for an Elderlaw attorney look for those that are credentialed by the National Academy of Elder Law Attorneys (NAELA). All of the referrals we make in our work are to those credentialed by the NAELA. It is critical to receive the best representation because certain of the documents filed effect others such as when an individual applies for the Veterans Administrations Aid and Attendance Pension and Medicaid or Medicaid Waivers, especially in this order. Many states for instance are now asking that a person apply for the VA Aid & Attendance Pension or stipulate that they are not eligible. If eligible you are required to make application so the state may leverage other dollars to reduce their contribution to Nursing Home care. If a person is deemed ineligible for the Pension it may, and I repeat may raise a red flag as the elgibility standards are similar. SO it is so very important to consult with an Elderlaw Attorney so that every allowable dollar that can be "Sheltered" can be legally. This will also provide piece of mind that when applying for the various entitlement programs we can be certain of our answers and the impact they will have.
Carol you are a Godsend and I an grateful for any and all advice and am keeping a running log of everyone I talk to at least I know he is getting the care he needs that has been too much for me for so long, I am sure my son will not be happy about him not commimg home and I feel sad and quilty for my part but the lawyer said I could get guardenship over him and so disapointed that our debts are not subtracted from our assets he said there is a way ti handle it but I would lose all my credit but he is allowing me to take a small CD that has matured to pay down our debt some and will everyone helping me and my trust in God some day this will just be a large experience-thank you again and for all those who build up my spirits.
Austin, my heart is breaking for you. Yes, life insurance (any cash value) is an asset in the eyes of Medicaid, therefore there is no insurance left for those you got it for. Everything is an "asset."
The other thing is what you learned the hard way: Not every elder attorney or person who calls themselves an estate attorney is up on all of the intricacies of Medicaid. References are vital. Credentials are vital. Trust is vital. Even then, one can get an attorney that isn't as in tune with changes in Medicaid law as he or she should be. You want someone who specializes in estate work and Medicaid law, not someone to whom it is a side issue. Bad legal advice can, as you know, be worse than none. It's a tough world out there. Hang in and please do pass what you learn on to others. It will give you some satisfaction, anyway.
I am slowly becoming an expert on medicaide -my eyes were opened to day I can not understand why my life insurance is condidered an asset for me I would have to die and then it would not be my asset I can not take it with me-it is a long hard proccess but maybe someday I will be able to help others at least give them some tips and why oh why did the husband buy so many policies and why is my 401k an asset I sacraficed for years for it- why did I not spend it before now-I was too frugal -my co-workers had another word for it. And why did the first elder lawyer give me bad advice and we paid him plenty upfront.
The elder attorney that I deal with is helping us to do things accordingly. First he said due to my father's service and his VA requirements, he does qualify for VA benefits. Next the paperwork for that... nightmare!! Especially when a parent does not keep good records or does not share information.
Then he sent off our information to a VA specialist that reviews applications. They tell us depending on assets or investments what balance my parents are allowed to keep in assets before applying for VA benefits.
I'll say this.... my elder law attorney was able to define the asset requirement for my parents, set up a legal transfer of any excess funds based on that requirement, and then file the VA benefits.... he has a list of letters of thank you's from his clients out on the front desk. Its nice to see he makes the process as painless as possible.
It is not a quick process to do, but if you have the right people assisting you (typically not government help), then they make the process a lot easier. Plus an attorney that deals in elder law is going to know more of the in's and out's than a regular attorney. Mine has been a huge help!!!
Did you also know for Michigan that attorneys cannot charge for helping with VA benefits? If they do they can be reported. Veteran's are able to receive that help at no charge. Now what they may charge for is any additional paperwork needed outside of the VA benefit aspect, but still it saves a lot of money in the long run.
Good for you, Austin. Eric has a lot of information. The numbers may be a bit different for different states, as nursing home care costs are different. Also, in-home care costs and benefits may be different. But Eric has the general numbers.
Look up the Medicaid waiver for your state, too, and make sure the elder attorney checks into that. Generally, the spouse can keep the house if one of a couple goes on Medicaid, but a lien will be placed on it by Medicaid if money spent gets that far. The elder attorney will know rules for your state (make sure this person knows Medicaid very well - you don't want any nasty surprises). You'll feel better once you've had legal counsel.
Eric thank thank you so much for your information I will take this information to the Elder Attorney and have been crunching the numbers and plan to tell the social worker that I will decide how many hrs aide coverage I will get for my husband it is too bad there is no rules on how much a nursing home can bend the rules for their benefit thanks to you and Carol I am not going into this blindfolded and since things are getting down to the line you are so good to help me out when you are so busy yourself I sure hope I will be able to pay this forward some day.
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If the perceived problem is that Social Security + Vet benefits + any other income brings the Medicaid applicant to over $2022 and, therefore, over the qualifying income limit, then here is the solution:
The Irrevocable Qualified Income Trust (aka QIT or Miller Trust), permitted since the implementation of OBRA '93, allows the applicant to gift excess income over the cap to the trust and thereby qualify for Medicaid if all other eligibility requirements are met.
So yes, there is a very effective way to qualify for Medicaid if income is too high.
Income from all sources including pension, social security, life insurance from previous spouse, etc., is expected to be used to pay for nursing home care. Even if you get to the point where you can qualify for Medicaid, any social security payments must go towards nursing home care.
I kept meticulous records of all nursing home expenses as well as his income from all sources - and I advise doing the same.
My father died before his money was all gone, so he never qualified for Medicaid.
The lookback period is five years for Medicaid, so if you are trying to gift away money to qualify for Medicaid, it's very difficult to do. In the past, families used to gift away all kinds of money to relatives to "hide" it from nursing homes. More recent legislation makes this almost impossible to accomplish.
Hope this helps.
"dragonflower"
My advice to you is that you need to get an elder attorney. I don't know the facts of what's going on, nor should any of us presume to know better especially with what your mom is doing. There are two sides to every story. Get the advice and counsel of someone who knows the laws. Elders need to be protected, but at the same time watching out for them with tough decisions. It is a very difficult area.
Maybe someone from North Dakota can tell of their experience?
"There are 2 standards that need to be met. 1-Be Nursing Home eligible as determined by a doctor and/or state social worker. 2-Receive no more that $2,022.00 in income per month and have no more that $2,000.00 in assets/resources."
Dragonflower writes:
This is absolutely correct! Medicaid is intended for the "medically indigent" which basically means "low income and limited resources." I cannot stress this enough. It was never intended for middle-class people who own a house, a car and have a middle class income arriving into the household every month from any sources (pension, dividends, IRA, Social Security, interest income).
While each state manages its own Medicaid, there are certain things that are fairly uniform from state to state. You are required to "spend down" your assets to qualify for Medicaid, as others have pointed out. Your entire "asset package" is examined to determine if you qualify. Start making a list of all assets that could be liquidated from all sources.
Social Security income and pension can be put towards the cost of either assisted living or nursing home care - I know, because when I had to put my late father in a home, these were used to pay for his care in addition to money from his personal savings, IRA income, etc. I was in charge of his financial arrangements, so I was very aware of every penny.
At the time when I was in charge of this stuff, the look-back period for assets was only 3 years. Since then, it has been extended to five years and will probably be further extended as people keep living longer.
As others have advised, you probably need to consult an attorney who specializes in this type of thing.
Good luck. You definitely need help with all of this.
Carol
Carol
Hopefully things will work out for you. I know I never saw all this provisions responsibility happening to me, and I've had to learn legal, financial, AL, caregiving all on the fly. Fortunately God has put some awesome help around me.
Sometimes social workers can be a great resource. Some I've encountered are a waste, but there are some extremely helpful people out there and if you go in grateful to them and thanking them, they tend to open up a bit more and find additional resources.
Austin, just take care of you. The rest will work out!! Your husband is covered for now. Don't let these stressors get to you (D'OH... I hate that phrase!). We want to see you around for a long time!
I asked my acct questions my atty told me about. So far, although I'm still not through this, he hasn't lied to me yet.
Find elder specialists. Just because they deal in an area does not make them elder specialists.
Austin, I've been working on VA benefits for the past 9 months. Even that is a PITA.
Do what you need to and we're here to listen!
Carol
I am working on getting VA benefits for dad and of course dealing with Medicaid isn't too far behind.. The one thing that my ELA told me is that due to my parent's assets we had to create a trust in my name and transfer all but the minimum assets allowed to my trust. I was really nervous about being taxed as my income and I was told that my accountant needs to file a 709 indicating the transfer which also states taxes have been paid on it. They also suggested in liquidating the life insurance that I should take taxes out due to present government administration then when its in my trust acct just put it in a money mkt to draw the same interest over time.
I think its all in the professionals that are hired. Don't take one person's word for it either. Do some research on your own.
This is all an ugly process so get as informed as you can.
The other thing is what you learned the hard way: Not every elder attorney or person who calls themselves an estate attorney is up on all of the intricacies of Medicaid. References are vital. Credentials are vital. Trust is vital. Even then, one can get an attorney that isn't as in tune with changes in Medicaid law as he or she should be. You want someone who specializes in estate work and Medicaid law, not someone to whom it is a side issue. Bad legal advice can, as you know, be worse than none. It's a tough world out there. Hang in and please do pass what you learn on to others. It will give you some satisfaction, anyway.
Carol
Then he sent off our information to a VA specialist that reviews applications. They tell us depending on assets or investments what balance my parents are allowed to keep in assets before applying for VA benefits.
I'll say this.... my elder law attorney was able to define the asset requirement for my parents, set up a legal transfer of any excess funds based on that requirement, and then file the VA benefits.... he has a list of letters of thank you's from his clients out on the front desk. Its nice to see he makes the process as painless as possible.
It is not a quick process to do, but if you have the right people assisting you (typically not government help), then they make the process a lot easier. Plus an attorney that deals in elder law is going to know more of the in's and out's than a regular attorney. Mine has been a huge help!!!
Did you also know for Michigan that attorneys cannot charge for helping with VA benefits? If they do they can be reported. Veteran's are able to receive that help at no charge. Now what they may charge for is any additional paperwork needed outside of the VA benefit aspect, but still it saves a lot of money in the long run.
Look up the Medicaid waiver for your state, too, and make sure the elder attorney checks into that. Generally, the spouse can keep the house if one of a couple goes on Medicaid, but a lien will be placed on it by Medicaid if money spent gets that far. The elder attorney will know rules for your state (make sure this person knows Medicaid very well - you don't want any nasty surprises). You'll feel better once you've had legal counsel.
Take care, Austin,
Carol