They could lose the house -- to Medicaid

[SouthernDem4ever]

Found this on NPR - This may have been discussed here before but for those who missed it, like me :

PERRY, Iowa — Fran Ruhl's family received a startling letter from the Iowa Department of Human Services four weeks after she died in January 2022.

"Dear FAMILY OF FRANCES RUHL," the letter begins. "We have been informed of the death of the above person, and we wish to express our sincere condolences."

The letter gets right to the point: Iowa's Medicaid program had spent $226,611.35 for Ruhl's health care, and the government was entitled to recoup that money from her estate, including nearly any assets she owned or had a share in. If a spouse or disabled child survived Ruhl, the collection could be delayed until after their death, but the money would still be owed.

The notice said the family had 30 days to respond.

"I said, 'What is this letter for? What is this?'" says Ruhl's daughter, Jen Coghlan.

It seemed bogus, but it was real. Federal law requires all states to have "estate recovery programs," which seek reimbursements for spending under Medicaid, the joint federal and state health insurance program mainly for people with low incomes or disabilities. The recovery efforts collect more than $700 million a year, according to a 2021 report from the Medicaid and CHIP Payment and Access Commission, or MACPAC, an agency that advises Congress.

Henry Ruhl of Perry, Iowa, lost his wife, Fran, in January 2022. A few weeks after her death, he was startled by a notice saying her estate owed a huge bill to Iowa's Medicaid program for her dementia care.
KC McGinnis for Kaiser Health News

States have leeway to decide whom to bill and what type of assets to target. Some states collect very little. For example, Hawaii's Medicaid estate recovery program collected just $31,000 in 2019, according to the federal report.

Iowa, whose population is about twice Hawaii's, recovered more than $26 million that year, the report says.

Iowa uses a private contractor to recoup money spent on Medicaid coverage for any participant who was 55 or older or was a resident of a long-term care facility when they died. Even if an Iowan used few health services, the government can bill their estate for what Medicaid spent on premiums for coverage from private insurers known as managed-care organizations.

the rest is at:

https://www.npr.org/sections/health-shots/2023/03/01/1159490515/they-could-lose-the-house-to-medicaid

[liberal N proud]

1. Everything is working against us

Trying to take us down in every way.

[SouthernDem4ever]

2. I would rather be euthanized than put that burden on my estate

unless, of course I was a millionaire or had the same benefits as the assholes in congress.

[pnwmom]

47. It wouldn't put a burden on your heirs though.

Before my mother went into a nursing home, she sold her house and used the money to enter the nursing home she chose, as a private pay patient. Once her assets ran out she knew she could stay in her same room at the same place and Medicaid would pay for it. My siblings and I were glad she could get good care in a place she liked. We were glad that we didn't have to help pay her bills, thanks to the equity she'd built up in the house. We didn't expect to have Medicaid to pay for everything so that she could leave the house to US.

In the case of married spouses, if one enters a nursing home, the debt can accrue against the spouses' home, but not be due till the death of the second spouse. Depending on how long the spouses needed nursing home care, after the death of both there may or may not be anything left for other heirs. But that's not putting a burden on the heirs -- it's relieving them of worrying about how to pay for the nursing home.

[Gidney N Cloyd]

77. +1

[SouthernDem4ever]

95. So if the 2nd spouse dies, do they get the same deal?

Can the 2nd spouse get medicaid also if needed? Does the house cover both?

[pnwmom]

100. Yes, if there's anything left in the house, it covers both. If the house still

has equity, then once the equity is gone, the second spouse will qualify for Medicaid.

[Hortensis]

11. No, it is an enormous help to many.

But Medicaid's not a pay-into benefit program like Medicare that those who pay into later draw from. Medicaid benefits are for those in need, but they sign up understanding that any assets they may have will later help reimburse for their care. To pay into the fund that will help others.

And of course there is no "they" trying to take "us" down. The opposite of altruism and charitable concern is indifference.

[Marcus IM]

3. The GOP health plan, if you get sick die quickly. n/t

[crickets]

4. What's the point of Medicaid if they can claw it back when you die? Something reeks. nt

[Samrob]

10. Notice it's only for poor people on Medicaid. Anyone know if Medicare does this on wealthy users?

Bet not. Of course, we pay into Medicare but ours is a health system that, like every thing else, works best for the wealthy privileged.

[SouthernDem4ever]

15. Medicare only covers certain illnesses

It doesn't cover long term nursing home care which some people need towards end of life. So people who can't afford nursing homes will turn to Medicaid for assistance. Medicaid will try to recoup some costs from the estate after death.

[Meowmee]

50. Anyone who needs longterm care etc.

Can have their entire savings quickly depleted/ stolen. Medicare does not pay for that. That is why people make up trust to transfer any assets before they end up in the situation. It’s a huge billion dollar scam the whole industry. Whether Medicaid is involved or not.

It’s a very abusive industry a lot of the time they leave people sitting there in feces getting pressure sores etc. There’s also other abuse.

[pnwmom]

58. For seniors, Medicaid is the backup plan for Medicare. People on Medicare

can owe deductibles and premiums, depending on their plan. When a person on Medicare runs out of assets to pay for those things, then Medicaid kicks in -- and it covers everything. But you don't qualify until you've spent down all your assets and don't have the funds to pay for regular Medicare.

[RobinA]

28. This Is A Bit

hazy in my head because my knowledge of this was two careers ago, but... At one point, to qualify for Medicaid you could have little but the clothes on your back, provided they were cheap clothes. It changed in some states to where you could have a house not to exceed a certain value and a car. The thought being that if you had to sell everything to qualify for Medicaid you could never get off Medicaid. At around that time, I remember reading something from my state, PA, that Medicaid was being made more flexible, but there were some pitfalls you had to be aware of, them coming to get your assets being one of them. There were limits to the circumstances under which they could come get stuff, but I remember thinking at the time that this could be a disaster for some people if they weren't careful.

[Ilsa]

74. Yes, I believe most states have pretty big limits on

home values, assets (1 car), cash.

[pnwmom]

57. The point of Medicaid is to make sure there's care for everybody, that no one will lack for care

because they've outlived their assets.

So every single person on Medicaid in a nursing home is at the same point -- they've all reached the end of their assets.

The exception is for spouses. In the case of spouses, the second spouse can keep their home till they die or need nursing home care. But when both spouses have died, then the Medicaid bills for both of them are deducted from the sale of the house.)

Medicaid is not an insurance program, protecting your house or other assets. It's a government program to pay for your nursing home or medical bills when you've run out of your other assets.

[crickets]

59. Having read up on it a bit, it makes more sense to me now.

It's better than nothing, and at least the remaining spouse isn't kicked out of their home.

[pnwmom]

65. I know it's confusing because we're used to thinking about insurance,

and Medicaid isn't insurance.

But it sure made me feel better not to have to worry about my mother. The key, I understand, is to find a nice place while they still have some assets, rather than waiting till they are penniless to look for a nursing home. Then they can spend down their remaining funds in the nursing home, and when they run out Medicaid will take over.

[LonePirate]

5. This is absolutely insane. Governments should not be acting as health debt collectors for the poor.

This is some Dickensian bullshit right here.

[Nictuku]

8. From their relatives?

This is kind of scary. My 81 year old mom was looking into seeing if she qualified for Medicaid for some things for her supplemental insurance to Medicare. I'm not yet sure what the decision is, I will ask her about it. But if that means they will come after me and our house.... I'm kind of freaked out. Need to find out more about this, and California's laws.

Medicaid is a state thing? If it is different in different states, that is what I'm taking away from this.

[W_HAMILTON]

13. There is a Caregiver Child Exemption that would possibly protect her home:

It basically arises where certain categories of relatives can move in with the parent in a home that the parent owns to provide care, which forgoes nursing home coverage, which technically saves the state money, so they consider it an even trade-off and let the allowed relative that moved into the home to provide care to have the home. Usually the period the child must have lived with the parent and provided care must be at least two years prior to them moving into a nursing home/getting on Medicaid. Here is an article that provides some more basics, but your best bet is to consult with a reputable eldercare attorney in your area to help navigate your potential situation -- yes, Medicaid rules vary from state to state -- and to avoid any potential pitfalls like you are worried about:

https://www.payingforseniorcare.com/medicaid/caregiver-child-exemption#:~:text=What%20is%20the%20Caregiver%20Child,Back%20Period%20on%20asset%20transfers.

[Captain Zero]

30. Yes seek an Eldercare Attorney, everyone listen to this

It will be different from state to state and from person to person AND ALSO depending on assets and relationships.

Just because Betty Lou at church was telling you what they did for her father-in-law and his Medicaid case DO NOT EXPECT IT TO APPLY THE SAME FOR YOUR FAMILY MEMBER !!

GET Your OWN ATTORNEY TO TALK TO About YOUR OWN SPECIFIC CASE.

[Ilsa]

75. And in this case the spouse is alive.

I believe he has a life estate in the home.

[RobinA]

29. Medicaid

is administered differently in different states, so know your own state rules. In PA you can transfer assets, but not close to the time that you apply for the benefit. Also, in PA, at least several years ago before expanded Medicaid, if you could afford a Medicare supplement they were not going to approve you for Medicaid. But again, states are different, so don't listen to me.

[inthewind21]

33. They won;t come after

YOUR house, they will have claim to hers. Assets that are in HER name.

[Mariana]

35. No, not from their relatives. They can take from the estate.

[pnwmom]

48. What is insane? People who enter nursing homes with fully paid-for homes aren't "poor."

Last edited Sat Mar 4, 2023, 02:28 PM - Edit history (1)

Medicaid has a spend-down requirement. I'm not sure what the amount is, but when my mother qualified I think she'd had to "spend down" to about $5000.

That meant she could enter the nursing home as a private pay patient, and pay for it with her savings till she ran out. Then she was allowed to stay in the same room at the same place and continue as a Medicaid patient.

The monthly charges accrued and eventually surpassed the amount she'd had from her house -- but all of her adult children were fine with that. We were just grateful that she'd had a nice place to live in her final years, close to loved ones, that she'd been able to pick out herself.

Not having to worry about her was a gift to us. We didn't expect an inheritance, too.

[Ilsa]

76. Well-said. This is pretty much how it works. When we were getting ready to

place my mother-in-law in a nursing home, the state didn't even care that she had a pair of small term life insurance policies. They were only interested in six-figure payouts and whether the policies had any cash value.

[Zorro]

6. Seems fair

The deceased have no need for their estate, and recovering the cost of their Medicaid support helps keep the program going.

[leftstreet]

9. Caregiver families can't recover their costs either

Working class families are highly likely to have devoted labor and money to help parents stay in their homes and avoid longterm care. There's no recovering those costs for the caretakers. Fuck Medicaid

[W_HAMILTON]

14. Amen!

[pnwmom]

79. It's not true that Medicaid doesn't help caregivers. In my state, even a family member

can get certified as a caregiver -- and paid by Medicaid to care for the person who requires care.

The family and/or elderly person can choose who they want to be the caregiver (including one of themselves or someone they hire) and Medicaid will pay for the cost.

I know someone who took care of her own mother in her home this way. See page 9.

https://www.dshs.wa.gov/sites/default/files/ALTSA/hcs/documents/22-619.pdf

Needing help with personal care means you need assistance with things such as bathing, dressing, or toileting. Programs such as Medicaid Personal Care (MPC) or Community Options Program Entry System (COPES) pay for personal care services.
A caregiver can be hired to help you with personal care if you meet the eligibility requirements. Depending on your income, DSHS will pay for all or part of these caregiver services (see page 6 for more information). DSHS also pays for basic caregiver training for any qualified caregiver(s) hired.
It is your choice who your caregiver(s) will be. You can find a caregiver yourself, called an Individual Provider (IP), get one through a home care agency, or a combination of both. If you want a family member to be your caregiver, he or she can only be hired as an IP. Your social worker can help you with this process.
Medicaid and Long-Term Care Services for Adults
It is your choice who your caregiver(s) will be.
9
Medicaid and Long-Term Care Services for Adults
Individual Provider (IP)
With an IP, you decide who comes to your house and provides your care. You set your caregiver’s work schedule and determine how and when the tasks will be done.
You are the IP’s employer. This means you choose, hire, and supervise the caregiver. You may also want to find a backup caregiver when your regular IP has time off. To find an IP, you can:
• Choose a friend or family member (with some exceptions). • Use the Home Care Referral Registry (see below).
• Look for someone in your community.
DSHS will do a background check on anyone you select.

[W_HAMILTON]

80. Medicaid is administered by the states themselves and, as a result, vary widely by state.

I don't know someone that went through this process -- I am someone GOING THROUGH this process.

I applied for this type of Medicaid back in the summer. My mother was only just recently finally approved for it, after months and months of jumping through hurdles. In that time, she had a stroke and became fully bedridden and in need of essentially almost around the clock care, outside of a few hours at night when she settles down pretty much only because of medication that calms her near-constant agitation and restlessness and allows her to sleep for a bit.

When I finally got to discuss with a caseworker what sort of outside caregiving (or a family member as a paid caregiver) we would be entitled to, she told me two hours.

Two hours a day.

And it may go up in a few months to four hours, after they see whether two hours a day is sufficient or not. And the most it can go up to is around six hours a day -- not even enough for me to return to my career outside of the home -- at which point they recommend putting her into a nursing home.

The point the other poster was making that this does not count the foregone income that a family caregiver has by taking care of their loved one so that the state does not incur even greater costs by someone putting them in a nursing home at their expense. I am a licensed professional and have now missed out on several years of my career and gone into debt looking after my mom until she was able to finally qualify for this two-hour/day care.

My mother won't have much of an estate besides her home, which I should qualify at the child caregiver exemption since I moved back in with her years ago to help provide care for her, but if she did, should I be allowed to bill her estate (like Medicaid would) for all the lost income *I* incurred in looking after her as well to offset Medicaid's claims?

It's a ridiculous situation and it's only going to get worse as the baby boomer generation hits this terrible predicament. And it's probably only going to be worse, as their younger kids that it will fall upon to handle all of this are in even in a worse shape financially than previous comparable generations. It will reach a breaking point.

[pnwmom]

90. Your mother is bedridden and requires round the clock care. It's insane

that they think she only needs 2 hours of help a day. I'm so sorry.

When it came to this time for my mother (who was not bedridden, and could have been accepted at an assisted living facility at the high level of care) my siblings and I investigated the nursing homes in our separate cities. The nicest one was a couple miles away from my midwestern sister.

It made more sense to have our mother (who was actively involved in the decision) move to be near that sister, who was able to visit her multiple times a week, and to bring her home for visits on weekends. My mother was clearly happier in that nursing home, even as her health declined, than she had been in her last couple years at home (with some help). And she didn't have to worry about money anymore, knowing she could continue there on Medicaid after her assets ran out.

If there are any nursing homes using the "Greenhouse model" in your area, or run by the Otterbeins, we can strongly recommend them.

[W_HAMILTON]

91. I am not sure what the "Greenhouse model" is, but I will look into it.

I think this whole time I had been banking on Medicaid at least providing the same sort of care that we were paying for out-of-pocket to spend down her assets so that she would qualify for Medicaid in-home care, which was about eight hours a day, five days a week. This allowed someone to be here with here most of the day and allowed me to work outside of the home. This was my hope. It was crushed when I found out that they would only allow two hours a day, MAYBE going up in a few months as they reassess her. I don't know why they can't simply assess her now and see that she is in need of much more than care for just two hours a day. But like I said, while Medicaid has to operate under some basic federal guidelines, states have a lot of leeway in determining how it is administered; unfortunately, we live in a very red state and when this all became an issue -- both her deteriorating health and the need for possibly going on Medicaid -- it was far too late to simply up and move. She's lived in this state all of her life and I have almost as well, only leaving to go to graduate school and start my career before giving that up to move back here to help her with her increasing healthcare needs.

I don't know what the answer is and I know help at the national level probably won't be coming anytime soon due to Republicans obstructing any such help, but I can only say to anyone reading this that thinks this may be in their eventual future, please address it as early on as possible and have plans in place. Providing such care for a family member is not easy and it will probably destroy you; if it doesn't, you are a much better person than me and many other people I've since talked to that have been put in this position. And it will be tougher to grieve, because you almost don't even get to come to grips with the fact that your loved one is wasting away because you are so focused on trying to administer care to them, get them medical supplies, pay their bills, sign up for their healthcare insurance, get their meds in order, changing their diaper, arranging nurse visits -- the list goes on and on. You almost don't have time to grieve, which I am sure will make it even harder when she inevitably passes away, because even though all those responsibilities will be lifted off your shoulders, you are just left with a shell of your former self. I described it to someone else here that I feel broken in a way that I don't think I can ever fix. And I will be left to confront that head on once the day-to-day "business" of taking care of my mom with advanced dementia and a recent stroke is mercifully over...

Oh well, sorry for venting and sorry if I came across as rude in my other post. It has just been such a disappointment in seeing how my state's Medicaid as let my mother and me down. This was the one thing I was banking on to return to somewhat of a normal life while still making sure my mom was safely taken care of, and now that has pretty much been thrown down the drain...

[pnwmom]

93. Here's some info about The Greenhouse Model: small nursing homes,

with private bedrooms/baths arranged around a central living/dining/kitchen area. Usually, clusters of these homes are grouped together. The care is designed to be more personal than in a typical institutional setting.

https://ariadnelabs.medium.com/a-nursing-home-lessons-from-the-greenhouse-model-of-care-90dcf5085c8f


One of the organizations that has built Greenhouse style nursing homes is the Otterbeins, a non-profit connected to the United Methodist church. My mother lived in an Otterbein home. I don't remember if they even asked her religion, but I know they didn't care she wasn't Methodist.

https://otterbein.org/about/

[sarisataka]

17. Fuck medicaid?

So fuck poor people and their families? They just don't get care if they can't afford it?

[leftstreet]

40. Yes. They force people into poverty before helping

Ask thousands and thousands of caregiver adult children how much time, labor and money they've lost because the state wouldn't exempt even the smallest inheritance.

Yet we have billions for war

[Celerity]

42. Trillions for war. Tens of trillions as the river of time flows by.

The American apple is rotting out from the core.

[sarisataka]

43. Preserving inheritance over medical care

That's cold.

[leftstreet]

53. Now do both n/t

[pnwmom]

87. No one is entitled to an inheritance. I got nothing financial from my parents

but I was glad they had the care they needed in their final years. In my mother's case, that was thanks to Medicaid fully paying for care at a good nursing home.

I'm glad that adult children aren't being held responsible for their parents bills; that was the case before Medicaid came along.

[leftstreet]

88. But a nursing home is entitled to saved earnings

Okay. sure

[pnwmom]

89. Why shouldn't people pay for their own nursing home care with earnings they've saved,

or investments in their home or other property?

Medicaid is for people with no significant assets; it's not for people who can pay for nursing home care themselves.

[leftstreet]

96. So, no student loan forgiveness then?

Pay with your own earnings...

[pnwmom]

99. Biden's decision on student loans was based on a law passed after 9/11

Last edited Mon Mar 6, 2023, 03:15 PM - Edit history (1)

which allowed a President to forgive student debt during a war or other national emergency. The pandemic was a national emergency.

Medicaid was a different law.

[pnwmom]

61. They haven't forced people into poverty. When a person's assets have run out,

Medicaid will pay for the persons medical and nursing home bills.

Medicaid wasn't designed as a program to make sure adult children get an inheritance.

[leftstreet]

71. When assets run out...

Do you even hear that? That's a punish-the-poor mentality

The average working class senior doesn't expect to leave much inheritance. But they probably don't expect to live in care with a monthly allowance that will hardly cover their needs. This is also where caregiving families continue to invest their money and labor with no recovery. It's happening to thousands of people

[pnwmom]

72. When my mother needed the care in a nursing home, we were grateful she could obtain it

through Medicaid. It wasn't Medicaid's fault that, in her 80's, she didn't have enough assets to pay for several years in a nursing home.

If your family is trying to care for someone at home, you should look into what benefits Medicaid will pay for there. In our case, we were glad we didn't wait till her situation was desperate. We had more options to choose from at the time she entered than if we'd had to make a last minute decision.

[Hortensis]

81. Thanks for your informative comments. A lot of us

may find ourselves needing to learn more, as you have, about how Medicaid works.

[pnwmom]

83. The big take away for me

is that we were lucky we started looking before we were desperate.

Mom had been living on her own, with significant help. We started looking at assisted living, and realized she'd need the highest level of care -- which would mean when her Alzheimers got worse, she'd have to be transferred to a nursing home.

But she was also eligible to go straight to a nursing home, and we found one everybody, including her, liked; which was near a daughter and her family. The home accepted both private pay patients and Medicaid (not all do). You have to apply to homes like this, and we knew Mom's chance of getting in increased if she still had assets. This place wanted the private pay patient to have enough assets to last for six months. Mom had 8. (The nursing home was committed to keeping on all its Medicaid patients for as long as they lived; so, in effect, the private pay patients were helping to subsidize the high level of care for the Medicaid patients.)

So she moved in; and when she ran out of money, the transition was seamless. Same room, same everything. And she didn't have to go through the anxiety of two major changes, which would have happened if we'd tried assisted living first. Also, if she'd run out of money in the assisted living place, which many people do, then she would have been lower on the list of getting into nursing homes that accept both private pay and Medicaid.

So I hope you keep that in mind going forward. The highest level in assisted living might not be the best option, if money is a consideration. For a number of reasons, Mom was happier in the nursing home than she'd been for the last couple years in her own house. She got to see my sister and her family several times a week, and she no longer had the anxiety of worrying about what would happen to her when her money ran out.

P.S. If your parent's area has an Otterbein nursing home, or another one using the Greenhouse model, that's what we were happy with. All the residents have single room/baths, which are arranged around a large, cheerful living and dining room. Instead of looking like a hospital, the nursing home was made up of five separate cottages, each serving 10 or 12 residents. The staff providing special services (rehab, etc) moved around the cottages -- the residents didn't have to be transported. So the nursing home had a neighborhood feel, not an institutional feel.

[Hortensis]

85. "start looking BEFORE we were desperate." :) You did get that across!

I remember reading about this and realizing it was important info to have and be able to share, but it's been awhile.

“It does not do to leave a live dragon out of your calculations, if you live near him.” ~ The Hobbit

And these days a lot of us do, one way or another.

[pnwmom]

78. I know a woman who provided her mother care at home and Medicaid paid for it.

Maybe this is the kind of thing that varies from state-to-state, but you should look into it.

This is from my state's Medicaid program, page 9.


https://www.dshs.wa.gov/sites/default/files/ALTSA/hcs/documents/22-619.pdf

Needing help with personal care means you need assistance with things such as bathing, dressing, or toileting. Programs such as Medicaid Personal Care (MPC) or Community Options Program Entry System (COPES) pay for personal care services.
A caregiver can be hired to help you with personal care if you meet the eligibility requirements. Depending on your income, DSHS will pay for all or part of these caregiver services (see page 6 for more information). DSHS also pays for basic caregiver training for any qualified caregiver(s) hired.
It is your choice who your caregiver(s) will be. You can find a caregiver yourself, called an Individual Provider (IP), get one through a home care agency, or a combination of both. If you want a family member to be your caregiver, he or she can only be hired as an IP. Your social worker can help you with this process.
Medicaid and Long-Term Care Services for Adults
It is your choice who your caregiver(s) will be.
9
Medicaid and Long-Term Care Services for Adults
Individual Provider (IP)
With an IP, you decide who comes to your house and provides your care. You set your caregiver’s work schedule and determine how and when the tasks will be done.
You are the IP’s employer. This means you choose, hire, and supervise the caregiver. You may also want to find a backup caregiver when your regular IP has time off. To find an IP, you can:
• Choose a friend or family member (with some exceptions). • Use the Home Care Referral Registry (see below).
• Look for someone in your community.
DSHS will do a background check on anyone you select.

[inthewind21]

36. WOW

You want reimbursement for labor and money helping your parents? And fyi, there' a tax deduction for family caregivers. Care for your parents, get a tax credit. Also, the daughter in this very article was her mothers caregiver and she was getting paid to do it. It's tight there in the article.

[pnwmom]

86. Right. And I know another woman who got certified (took a first aid class) to be

a caregiver for her mother, and then Medicaid paid her to give the care in her own home.

[pnwmom]

49. But the caretakers can be paid, if the parent has a paid-for home, which is what the OP is about.

If a parent is being cared for by one of their children, they can deed the house to them, to be fully inherited up on death.

OR, the parent can get a home equity loan and use the proceeds to pay a salary to caretakers, whether they're in the family or someone else.

People who have fully paid for homes have options. And Medicaid as a back-up plan, for after their other assets run out, is one of the options.

[leftstreet]

52. Does nothing for renters

Not everyone owns a home

[pnwmom]

55. Of course Medicaid does something for renters! Renters without assets qualify for

fully paid nursing home coverage through Medicaid; and they also qualify for help at home. If renters have financial assets, they have the same spend-down requirement that homeowners do -- i.e., Medicaid will pay all costs after you've spent your assets except for whatever the limit is (I think it's 5,000, but it's been awhile since we needed to know this.)

[pnwmom]

60. Yes, they can. Medicaid also reimburses costs for in home care,

for those who qualify because they are below the asset limit (it was $5K when my mother qualified).

[WhiskeyGrinder]

22. States recover .55 percent of what they spend on Medicaid. Not 55 percent: about half a percent.

[Fullduplexxx]

7. Eat the rich

[area51]

12. All this because our govt. refuses to fund healthcare out of general taxation.

[xmas74]

16. Considering the average cost of a nursing home is between

$250-500 per day it's not the worst thing to happen.
I'd rather have them sell my parents home after their death, knowing they received assistance while they were alive.

[pnwmom]

51. EXACTLY. That's how my siblings and I felt after my mother died.

She spent all her assets in her time in the nursing home, but she could stay in the same room even after she ran out.

And she liked the nurses and was well cared for, and near family who loved her.

That was a blessing to us. We weren't resentful that she hadn't been able to leave us an inheritance. We were just glad that Medicaid could step in when she ran out.

[xmas74]

56. I work with patients every single day, helping them apply for Medicaid.

Is it a perfect program? No, but it's there. It saves lives and makes people more comfortable in their final years. I'd rather my loved one was comfortable while they're alive instead of inheriting their house after death.

[maxrandb]

18. Yes! Long term care is a nightmare

We were able to sell mom's home when she had to go into long-term care for age related dementia. The proceeds from the house and her Social Security and $900 a month pension from her job will pay for about 4 years of this care.

If she lives beyond that, we will need to apply for Medicaid and move her to a facility that accepts Medicaid (current facility doesn't).

You usually can have no more than $1K in total assets to qualify for Medicaid.

We were lucky, and my mom is in better financial shape than a lot of elderly.

If we were unable to sell her modest home, we would basically have to sign the home over to medicaid. Her current facility is over $6,500 a month. There is simply no way she could play that. Her savings would have covered about 4 months.

So, if mom outlives the proceeds from her house, she will be penniless and eligible for Medicaid.

Meanwhile, we need to maintain meticulous records of what her funds are used for. She can't "gift" $10K or so to the great-grandkids, because our state has a 5 year look back for Medicaid.

Every expenditure for 5 years prior to applying for Medicaid better be for her care and maintenance, or the states will come after your for that money.

My mom is 93. She worked from age 16 to 70, contributed taxes for all of those years, and raised three children that became great contributors to society. Doesn't matter.

I'm not sure what the answer is, but I don't think our current way of long term care is it.

BTW-what Elon Musk and Jeff Bezos make in a minute, would be enough to pay 10 years of long term care for about a 1,000 elderly.

Greatest country in the world my ass!

[pnwmom]

62. Instead of moving her to another facility, you could have chosen a facility

from the outset that accepts both private pay and Medicaid patients.

My mother had enough assets when she entered to pay for about 8 months of care. And when she ran out, she stayed in the same room at the same home, and the transition to Medicaid was seamless, from her point of view.

No, she didn't get to gift any grandchildren 10K checks because her money was going to pay for her nursing home bills, till she ran out. But I was glad that she was in a comfortable place and would be able to stay.

And all of her children, including me, were relieved that she was well taken care of. We didn't expect an inheritance on top of that.

[sarisataka]

19. There seems to be a lot of misunderstanding

Of the purpose of medicaid.

Also it appears individual states are doing a poor job of educating patients and their families for what they will be responsible to repay.

[Mariana]

23. You mean Medicaid doesn't exist for the purpose

of ensuring the heirs of the recipients receive an inheritance? Whoever could have guessed?

[pnwmom]

63. LOL. I am also surprised by the lack of information many have -- even people with older relatives.nt

[RussBLib]

20. Pay it back?

If you're on Medicaid, you are already poor, and chances are good you family isn't very well off either. I do not understand how the surviving families should be required to pay ANYTHING back. What kind of program is this?

https://russblib.blogspot.com/

[Mariana]

24. The surviving families aren't required to pay anything back.

The estate of the deceased is required to pay.

[maxrandb]

37. This is wrong

Most state have between a 5 - 10 year look back for Medicaid.

They go back 5-10 years from the date of application for Medicaid and any assets the person applying had, had better been used for their care.

This is to prevent mom from giving her house to her children and then applying for Medicaid. Even a car, or anything of value within that 5-10 year period can be used. States will come after you to recoup those assets.

Of course, the top 1-5% don't have this concern. They have lots of loopholes to ensure their assets can be passed down. It's how "generational wealth" works.

The system simply isn't built for the middle-class and working poor.

[Mariana]

38. I imagine very few of the top 1-5% rely on Medicaid.

They go to the best private nursing homes, or have 24/7 skilled care at home.

[RobinA]

31. Well, Let's Say

you are an 75 year old widow. Husband worked, you tended house and raised kids. Your family had a decent middle class existence at the time. Hubby dies, leaves a small pension and and some SS. You hold onto the house for awhile, but the pension and SS don't allow for taxes and upkeep, so you have to sell. Once you sell you need a place to live, which costs money, and a car too. You use the house money for this. You have straight Medicare because you can't afford a supplement. Now you're 85 and you need help with living. While you were still independent you managed to save, because Mom and Dad always said to save, a small amount of money, maybe a couple thousand.

So your straight Medicare is not going to cover your assisted living, because you're left holding the bag for 20% of the cost. You have no assets except the $3000 you managed to save since hubby died. You have too much money for Medicaid, so everybody tells you to spend the money down so you can qualify for Medicaid. But that's the money you socked away, $10 at a time, because you're supposed to save for an emergency! You can't imagine just blowing it, you grew up during the Depression. That's your hard-saved $3000 standing between you and nothing. But ya gotta blow it if you want someplace to live, which goes against every fiber of your Depression era being.

That's what kind of program this is.

[pnwmom]

70. The way my Depression-era mother did it wasn't as painful as some might think.

She spent down her money, as a private pay patient, while she was in a nursing home that she helped pick out.

She'd been at an in-between stage, where she could have picked an assisted living with lots of help, or a nursing home -- and never have to move again. So we found a nice one that accepted both private pay and Medicaid patients, and she moved in. At that point she had enough money left from selling her house for about 8 months. When that money ran out, she was already content in the place (one of her children lived a couple miles away and visited frequently); and when she was shifted to Medicaid nothing changed. She stayed in the same room with the same friends and caregivers. (This was a place with all private rooms and a living room for everyone in the middle.)

She'd been a saver all her life, too, but she was fine with how this all worked out. The important thing to her was to not be a burden on any of us. Thanks to a good nursing home and Medicaid assistance, she was just a blessing, living there for several years.

[Sky Jewels]

21. This is a good incentive for people to commit suicide rather than receive longterm care.

A lot of people would rather die than impoverish their families.

What a sick, twisted country we live in.

[Mariana]

25. They don't impoverish their families.

The families aren't on the hook to pay anything. The estate of the deceased pays. If there's no estate, no one pays.

[Sky Jewels]

26. But the heirs won't get what they take from the estate

which could impoverish family members.

[Mariana]

27. Lots of people don't get inheritances.

[pnwmom]

68. The parent's estate is being spent on the parent's care, till the parent runs out of assets,

and Medicaid pays for the care.

As an heir who inherited nothing, because Mom ran out of her assets while in her nursing home, I was grateful that when Medicaid took over, she was able to continue in the same room with the same staffers that she had before her money ran out.

[inthewind21]

32. Not sure

why this is a surprise. It's right there in black and white when you sign up for medicaid. If you are on SS and go on medicaid and go in to a facility, they take most of your SS and leave you with a monthly allowance. That is also crystal clear when you sign up. Property, Bank accounts, stocks, cars, planes whatever property and any whole life insurance policies in the name of the person receiving medicaid benefits can be taken after death by the state to re-reimburse for what they spent on care. This is why it's best to get it all sorted out BEFORE entering a facility and death

[MayReasonRule]

34. Nazis often deemed infirmed as useless eaters.... Nat-Cs do the same today... More later...

When the law disregards mankind, mankind rightly disregards the law.

I was obeying orders!!

... is no excuse, ever.

Welcome to AmeriKKKa...

[pnwmom]

67. What are you talking about? Medicaid is a government program that takes care of people's

medical bills and nursing home care when they've run out of their assets.

This isn't some sinister plot. It's part of the safety net that most Democrats support.

[MayReasonRule]

69. I'm referring to the state suing the family after the fact. It's abhorrent.

[inthewind21]

97. Except

the state IS NOT suing the family after the fact.

[MayReasonRule]

98. The state uses a private contractor to collect through "legal proceedings"...

Generically referred to as a law-suit.

[NowISeetheLight]

39. This is Normal

I've seen this in just about every state I've lived in. When I was in Arizona taking care of my parents I actually researched this topic. If my Dad had passed first my Mom would've only received half his pension. Since she was already in early Alzheimers I knew she'd be placed somewhere at some point and looking at costs it was a concerned. She had Medicare but no long term care insurance. She ended up passing before my Dad and his pension was significant enough to actually keep the house and place him later in a really nice assisted living home. I moved in with them near her passing and one reason was Arizona had a "caretaker child" exemption to the Medicaid seizure rules. I could've stayed in the home and not have to sell it. If I later sold it I'd have to pay back what Medicaid would've paid for her.

Nursing homes are crazy expensive. When my Dad broke his hip and had to leave assisted living for a month he was placed in a double room. I enquired about a single room for him and was told it was like $9200 a month. The double room would've been $7800 a month (still ridiculous). His insurance paid for most of the stay because it was "rehab". I know one reason they're so expensive is because Medicaid doesn't pay enough to cover the stay for poor patients so they end up gouging patients who can pay. It's like of like how private health insurance companies actually overpay hospitals for services because Medicare and Medicaid won't cover what those patients use. It's such a shell game.

[Celerity]

41. Some of the replies in this thread are archetypal examples of why the US is a ferociously unjust

society on balance for huge swathes of the population.

[sarisataka]

44. Some of the replies are acknowledging

The reality of what medicaid is today.

That does not necessarily equal anyone's belief of what medical care in this country should be.

[Celerity]

45. The ones I was referring to are doing more than acknowledging reality. nt

[pnwmom]

64. Medicaid is actually something that isn't unjust.

Every nursing home patient on Medicaid is there on the same basis -- no matter how much they had before in assets, they only qualify for Medicaid when they've run out.

[Hortensis]

82. :) Some who dream of economic equality for everyone

should be glad to hear at least some are achieving it.

Of course it isn't unjust, it's a lifesaver.

[pnwmom]

84. Some people think that a parent's assets should not be spent on the parent while they're alive,

if that denies them an inheritance.

And they're irked because their parent signed a contract when they entered a nursing home, allowing Medicaid to recover the costs of their nursing home care after they die.

When my mother ran out of assets in a nursing home, I was very grateful that the Medicaid system allowed her to stay in her same room, with nothing changed. She had exactly the same care before and after her assets ran out, thanks to Medicaid.

[Volaris]

46. The for-profit nursing home industry has a term for this process..

It's called 'unwinding'.. as in, the unwinding of one's personal assets to make up for our charge that the feds won't pay...and yeah, fuck your kids we couldn't care less about a lifetimes effort at generational wealth building.

THATS the real price we pay for NOT wanting to deal with end of life care, and the death that comes with it, as a culture.

Don't get me wrong, I get it...I don't want a real dementia patient in my house, either (I'm not qualified to deal with it day to day)...but SOMEONES gonna get paid for it for sure..

Yes, it's gross. But it's also reality until we find a workable cure.

[MissB]

54. My mother doesn't own the home she lives in

My brother bought the house and owns it; she’s famously bad with money (and her late husband was actually worse).

When she dies, my brother simply no longer gets her rent $, and can sell the house.

She’s already on a step down Medicaid plan. She is unlikely to end up in a care home, as she absolutely will not go to the dr, so she’ll probably die at home. She’s managed to survive two rounds of Covid (still not vaccinated).

[Texasgal]

66. Unfortunately, this is not uncommon

My husband faced the same situation when his elderly parents passed. Good thing, the MEAGER and I mean MEAGER assets were changed prior to their deaths.

[Ilsa]

73. The spouse is alive and may remain in the home.

Estate recovery is part of every state's Medicaid program. I believe the "look-back period" is five years in most states. That's why it's so important to plan ahead.

[ecstatic]

92. I could be wrong, but I don't even think you're allowed to own a home

in certain medicaid programs in GA. Georgia's program gives folks the opportunity to distribute property to family ahead of time. But they do look back on the previous 5 years or so.

[pnwmom]

94. The problem in trying to distribute most of the property ahead of time

is that the parent who needs nursing home care will have more and better options if they can enter a home as a private pay patient, instead of a Medicaid patient. In the state where my mother entered a nursing home, they wanted to see enough assets to pay for 6 months as private pay. After that, if a patient runs out, then the nursing home will do the paperwork to switch them to Medicaid.

Luckily my mother had more than the required months in assets. And so she settled into a good home, where she was happy, and when she ran out of money nothing changed. She still had the same single room with the same caregivers, etc.

I think all the states allow a spouse to remain in the family home even if the other spouse is on Medicaid. But after both spouses die, then the house will be sold to reimburse Medicaid -- per the amount that is in the contract signed when the patient entered the nursing home.