Medicaid and LTC question. Any advice?

Way2tired: Your nephew should never be using his own financials for his mother's care as he will need those same SPENT funds for his own retirement/elder years. Perhaps he will want to retain an elder law attorney.

How about you and he have a joint meeting with an Elder Law Attorney?

As others have said, I echo the advice about getting with an elder care attorney licensed in your state as each state is slightly different on some things and then there are federal requirements too: such as the 5-year look back and what she has or had not done with any assets (home if she had one, but any assets IRA, 401K, stocks, on and on) AND fed/state tax considerations (he claims her but what about her own tax filings?) If claiming her as a dependent; hope he has receipts and other documentation not just the DPOA document.

Further, Medicaid long term care coverage is a two step qualification process. The individual has to meet the income and asset limit in your state (average around $2K, but each state is different, but NO more than the state limit). In the 5-year look back window, assets of any type cannot be just gifted, hidden, or otherwise transferred to "protect" such assets (the feds and state will look as they will have access to all bank account records going back 5 years). Future SS payments will go to the nursing home moving forward once qualified and she'll be able to ONLY keep around $90 per month, but nevertheless the total asset threshold has to remain under your state limit (meaning someone w/access to her accounts has to sometimes "spend" something for her, for her care from her account. That could be for personal grooming items, snacks, new clothing if needed (keep receipts and best to pay via a debit card tied to her account so there is a clear record within the bank account, do NOT use cash/her cash, do not use her credit card if she has one, do NOT use your funds).

The second part for Medicaid long term care coverage is meeting your state's "level of care" necessary to qualify. This is not what you/she/nephew say it to be; but it is a "medical review" the state does based on documentation submitted by her physicians and/or the physicians at a SNF is she is already there. Again, an elder care attorney can help navigate this part of the documentation too.

If dementia is part of this, hopefully all the legal documents are in place that DPOA NOT triggered by any "lack of capacity" threshold, medical advanced directive, living Will type documentation AND the nephew has access to all her accounts (bank, retirement accounts if they exist, SSA, Medicare, on and on to "effectively" take over on the paperwork -- there is a lot -- as it is so much easier if all of that can be done online so get it set up now).

Many nursing homes that are Medicare and Medicaid qualified, that is what you will want/need for her to have Medicaid coverage of the long term care costs; start looking asap and if she has some cash to spend down; use it to spend down. Many facilities like this as a "sweetener" before Medicaid kicks in. DO NOT use your own funds!

When entering any facility (again the elder care attorney can help with this) PLEASE review all the documents (about 100 pages of legalese) be careful to NOT check certain boxes such as the nephew agreeing to pay her bills IF Medicaid fails to cover! And for the nephew to NOT agree to "take her back" if Medicaid fails to cover. There are many other boxes to be careful about and the language drafted is tricky so get an elder care attorney to review before checking/signing anything. Not knowing, not understanding or believing the language says one thing but instead is means something entirely different (you got tricked) is NOT a defense....

Good luck with this and hopefully your nephew can get proper legal advice for your State before making any moves on this!

He may want to consider charging her rent and putting it into a special savings account. This would give him extra to use for her if needed once she is on medicaid and she is allowed to keep a small monthly amount.

She may already be eligible. Applying now may be appropriate to get the answers first hand.

Nephew should not spend his funds for your sister. His retirement investment is for His Own Care when required someday. That type of spending may affect Medicaid eligibility.

This same question was asked a while ago. Him claiming her on his taxes will not effect her being able to get Medicaid. Her Social Security and any pension she receives will need to go towards her care. Her getting Medicaid has nothing to do with brothers income only what she herself brings in.

When I decided to place Mom in memory care I went and spoke to a Medicaid caseworker. Looks like offices have not fully open in my area so may have to talk to someone by phone. You need to know what the asset cap is for your State. Moms SS and any pension are not assets they are monthly income and there is a cap for that too. If Mom falls under both caps, the application should be fairly easy. A house and a car are exempt assets while living. You will need to supply certain info. If she is over the asset limit, you can spend that down by getting a prepaid funeral. Life insurance may need to be cashed in if there is a cash value. A caseworker can explain this all to you.

No, although he won't be able to claim her as a dependent once she enters the NH. Sister will need to spend whatever assets she has towards her care until she is under the limit for LTC Medicaid, than LTC Medicaid will be approved and kick in. Nephew should not be paying anything at all of his own money.

A family member should never ever put their own money into paying for LTC for an elder. Who will pay for them when they are elderly, because we all see the sorts of funding it takes.

The DPOA should see an elder law attorney to get his questions all answered now. Sister will go into care and use her funds to pay for that care until they are gone. Her SS will go to that care also. When she no longer has funds the facility will assist in applying for medicaid. When your sister dies, any assets she had in terms of a home, car, etc. may stand to pay for medicaid clawback; when she applies she will list those assets.

Let your nephew know that his POA allows that the help of an attorney to answers his questions as regards her finances, etc. be paid by your sister's fund. If aunt needs clothing and etc. as part of spend down, now is the time to do that. All records are to be kept by nephew as to funds into and out of Aunt's assets; he is a fiduciary who is accountable to the courts for this.

I sure wish him and his Mom, your sister, good luck.