Before doling out money to an eldercare attorney, I want to ask my question here first. When my husband learned of his dementia diagnosis 3 years ago, at the urging of our estate planning attorney, he transferred the house to me so that there won't be any problems for him to apply for Medicaid later. I am now the sole owner of the house. According to my eldercare attorney when I spoke to her last year, as long as I live in it, Medicaid won't disqualify him. But here is a question for you all: What if I sold the house now and bought a condo for us to live near the hospital, shops, public transportation, etc., would Medicaid go after the profit?
Estate planning not Medicaid planning. There is an expert on this site Gabriel Heiser, an atty, who has a book on this that is priceless as to how their different yet dovetail. You can order it but it's also at most public libraries. For CS situations, if it was me I'd get a NAELA level of elder law atty. not estate atty.
It's my understanding that if your married, all assets count for Medicaid. Moving casa into just your name doesn't remove it from the asset base for Medicaid as you all are married. Medicaid does NOT expect or require the CS - community spouse & that's you as your staying living in the community - to themselves become impoverished. Only hubs has to. Your home & a car are an exempt asset for your lifetime & whether or not MERP will come after that house to repay for hubs care depends on how your state does MERP. Your income does not count for hubs Medicaid, and this lil factoid be can be very VERY important.... more on this below.
Most states do not do recovery on surviving spouse. But state knows probability is that the spouse is themselves old & infirm & will enter a NH in near future, so house is getting sold & $ used as a spend-down.
To me, if your in a may/dec marriage or hubs has early onset dementia so he & you are both relatively young (not in 80's or 90's), you need to be lots more creative for planning. If your dependent on hubs monthly income to make ends meet, then your atty needs to work on getting you the max CSRA or MMNA & figuring out what it is so it's applied for simultaneously with hubs Medicaid application. Basically either takes $ from hubs monthly income & instead of that $ being paid to facility as hubs required SOC (share of cost in Medicaid speak, his monthly income paid to NH), it instead goes to you to enable you to live in your community. CSRA Income level varies by state. Like for TX. MMNA max is about $2800. So in theory if hubs income is $3200 a mo, & you get max MMNA, his SOC to NH is only $ 500 a mo. Think of it kinda like alimony for the nonNH spouse.
Has the atty or anybody mentioned your doing a SPIA? It's an annuity & normally I hate hate annuities as their so often sold to fearful elderly with outrageous commission structure paid to the insurance guy who sold it...... but a SPIA is a very unique creature. Your income is not a factor for hubs Medicaid. You as a CS are allowed about 118k in non-exempt assets also. Now what to do IF there's more than 118k??? Say 250k, less 2k as hubs Medicaid asset max & 118k as your asset max, then the remaining 130k becomes the SPIA. The SPIA pays you (you not hubs) an income each month. Again your income NOT a factor for his Medicaid. SPIA has to be done just right, meet certain actuarial tables and it should be structured so that your taxes aren't terribly affected & has to be Medicaid compliant. It's speciality underwriting, not done by any insurance guy. Really a good NAELA atty will have FAs they work with to do this. It has to be in place & funds moved before hubs Medicaid application submitted. If you want to downsize, sell big house & doing this ends up with you having $$, your doing a SPIA with the overage $$ could totally make sense. You might even want to have a mortgage too, so you capture CSRA/MMNA. The devil in in the details & you really need legal that understands how Medicaid runs and can present options to you. To me it means NAELA level of elder law atty.
If a person is not indigent, a person pays for his or her care. Like it or not.
Medicaid policy prevents the impoverishment of a spouse. This is actually sensible as well as gracious. It is a lifeline, a godsend, not a pickpocket.
You are NOT talking to an adult child who is trying to save their inheritance.
Two VERY different situations. I'm sorry for your mistake.
- have a disability or blindness that occurred prior to age 26
- receives SSI or SSDI based on it
- or self-certifies they qualify on SSA “compassionate allowances conditions” list with qualifying disability diagnosis with code written by a physician. The “compassionate” list is long and includes Lewy Body Dementia & FTD & early onset dementia (before 65). BUT devil is in the details..... for early onset they have to have the medical chart with years of documentation done before age 65 to support it - like 9 different ICD codes, MMSE studies over time, etc. There’s an outside adjudicator who reviews & determines IF covered.
For most of us, dealing with elder parents with general aging and dementia ABLE is of no use as they don’t qualify for compassionate list.
My mom had Lewy, and entered a NH in her 90’s when diagnosed with pretty intense testing done at a university teaching hospital & health science center so could have gotten solid documentation. But to me doing ABLE would make no sense as the max annually is 14k. Plus Medicaid requires their monthly income copay to NH & so only a tiny $ 60 a mo as usable $ to add to ABLE then when she died whatever $ left state as beneficiary. Now IF she was 60 with Lewy & needing a NH in another 3 - 6 years, then it could maybe possibly could make sense.
I’m actually somewhat concerned that ABLE’s being touted by “advisors” as a way to invest that income stream of SS$$ plus 14k annually & it’s on you “self-certify”; that accounts are being done that really won’t stand up to scrutiny. If you self-certify and the adjudicator determines you don’t qualify, it’s on you & not Fidelity (they advertise doing these).
Also for my cousin, he had a SNT set up by his parents with his brother & myself as trustees. Now he is totally competent, his issues are physical as he has secondary polio degeneration, so he does whatever on his own w/Trust $. We looked into AbLE, it seemed ideally great if your under 40 & can for sure put ideally the 14k annual max into it for 7 consecutive years as it maxes out at 100k. But he’s 70.5 this year so defund SNT is best. Each persons situation is unique....
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