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Grandpa will need to be competent to do a Will, no Dementia. I was told my Moms Will meant nothing. Any assets people have, except the house, needs to be spent on the recipients care before Medicaid kicks in. Houses are exempt.
Once grandpa passes away, a lien will be placed on the house to try and recover what Medicaid put out on Gpa's care. Gma will remain in the home but the lien will need to be satisfied when she passes or sells the house.
If your grandparents have nothing but the house and monthly income of SS and pension. You may not need to split assets. But you need to make it clear to Medicaid that there is a Community Spouse and that she will need the monthly income to live on.
With our Wills its what urs is mine. The survivor will need to make a new Will up.
My dad didn't have a will. I was fortunate that there was no probate required because there wasn't a will. He didn't have anything worth paying a court to decide who got what.
I agree that everyone should have a will. Especially, people with young children and seniors but, it is not a common thing, unfortunately. It should be taught in high school, IMO.
That being said... generally speaking, Medicaid does not "take" someone's home. At some point (in the future when both grandparents are passed) Medicaid has a lien on the home which needs to be satisfied when it is sold.
Medicaid won't impoverish your Grandmother, and if she never needs Medicaid herself there may be assets left from her estate when she passes, but I really am not sure how it would work in their state. Whatever remaining personal possessions (artwork, furniture, jewelry, books, etc.) are left can be designated in a Will and not touched by Medicaid.
If they don't leave a Will then their estate goes through probate. Others on this forum will correct this if it isn't accurate. Again, we're not attorneys so this is just very general info that you need to have verified by an actual attorney.
Best way now, IMO is to do payable and transfer on death for all assets. This keeps them available for grandma and grandpa but, bypasses any probate because it is no longer their asset at death.