Long Term Care

I wish more people knew this, but by law, the entire U.S. is divided into regions, each served by their own "area agency on aging" (I used to work for the one covering Indianapolis). They each have an "Aging and Disability Resource Center," staffed by people whose job it is to help people navigate these complicated systems, especially things like Medicaid-funded long-term care, or the Medicaid Waiver program, which essentially helps pay for in-home care for people who would otherwise need to be in nursing homes, but could get by with lower-cost care at home. Even Medicaid will try to save a buck if they can!

I strongly, strongly suggest looking yours up! Go to the Elder Care locator website. Search for your ZIP code or city/state, then in the dropdown box, select "Aging and Disability Resource Centers."

Give the nearest one a call and talk with them about your options!

I spent about 16k and a lot of time helping my parents qualify for Medicaid before they needed assisted living. Once they needed assisted living I could not find a facility that took Medicaid so we are going to sell their house to pay for their care (11k a month and expected to go up) They will probably net 500k from the house. Also, they only qualified for share of cost because my father has a small pension. My parents didn’t plan for LTC and in fact started spending lots of money in their 70’s that they could not afford to spend. Medicaid has reduced some medical bills but not by much and as I said their facility won’t take Medicaid. If you haven’t done so already, I definitely recommend starting to look at facilities ASAP. My heart goes out to anyone going through this. Best wishes to you and your family.

I hired an elder care attorney and it was the best decision. He quickly helped me figure out several options. Both of my parents were declining. One thing we did was put the house in my dad's name. Then when he passed away, his will created a trust which the house and assests went into to care for my mom. I wish you the best during such a challening time!

I have personal experience with this topic for both of my parents and two of my aunts. There is a 5-year (except possibly in NY and in CA where it was 30 months) lookback (aka payback) period for gifts in order to qualify for Medicaid (Title 19). I provided copies of 5 years of all financial statements including tax returns. A single person must reduce assets to a small amount (was $4K) before they can qualify. For a married couple, the healthy spouse can qualify for "Spousal Impoverishment" which means that spouse can keep ~$100K and a house and car and prepaid funerals for both and enough monthly income to live on (according to Medicaid tables). Once the sick spouse is qualified for Medicaid, all that person's income is paid to the LTC provider after first paying health insurance (in most cases: Medicare Parts B & D and a supplemental plan). If the healthy spouse does not have enough income to cover basic needs, they are allowed some of the sick spouse's income (SS, pension, annuity, other) before it is used for LTC. After the spousal impoverished spouse dies, the state can try to collect what it paid in Medicaid LTC costs from the inheritor of the house. In my family's case the state left us alone, but it was 15 years ago and policies may have changed. Medicaid is a Federal program run by the states. Each state may have slightly different policies and procedures. I do not have experience but there is a “Child Caregiver Exemption” designed for adult children who live with Medicaid applicants (their parents) for a minimum of two years prior to Medicaid application and serve as their primary caregivers. Under this exemption, the parent can transfer their home to their child without penalty. Good luck.

I don't know much about the details of this area of law/finance. However, I do know that Medicare is very well aware that people go through all sorts of contortions to try to shield assets from being considered under means testing. So, you want to make sure that you know what lookbacks apply. As in, you buying the house from them may need to be separated by some number of years (2?, 5?, who knows?) in time form the point of Medicare means testing being applied otherwise Medicare could still count it. This same general concept is true for most transactions that result in the Medicare beneficiary essentially transferring an asset away. The idea is that they are trying to ensure that transactions are performed without "hide this from Medicare because I may need lots of Medicare services in the near future and I don't want that to wipe me out" being part of the calculus.