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The transfer penalty is kinda sticky in that there can be exemptions to value of assets or the assessed value is higher than what the reality of selling the property is (so there is a whole fair market value issue to deal with), so if he applies for Medicaid, you will need an elder care attorney to sort the penalty out and possibly represent you in an appeal.
How the transfer penalty works is based on your states Medicaid NH reinbursement rate. My mom is in TX and TX rate is about $ 143.00 a day, which is pitiful low. This is kinda how it works: house valued & or sold at $200K; and 1/2 of the $ Dad is using to private pay for AL and 1/2 went to brother which brother has totally spent. Dad's AL uses up 95K and now Dad is in a NH @ 5K a mo. and about to qualify for Medicaid. Dad stays in the NH but is Medicaid Pending. All looks good for qualifying as his assets (100K) have been spent on AL and now on NH. Dad has no more assets. But about 3 - 6 months later, the asset sale or transfer of the house, will come up when the state does the routine search on the application. Then you or whomever signed dad into the NH, will get a transfer penalty letter from the state with the amount needed to be private pay before Medicaid will pay. The NH gets the letter also. So if the penalty is 100K and if you are in Texas, it is roughly 700 days that someone needs to private pay @ the NH.
This is a total panic situation 4 u & an awful situation to place your elder in.
The transfer penalty is such that the individual still qualifies for Medicaid but is ineligible for Medicaid's payment to the NH during the penalty period. Confused - yes; confusing - hell yes. Penalty set on each states' management of Medicaid, each state has it's own formula as to how they figure out the day rate and if it is set by the start of the month or exact date of transfer etc. It's a hot mess to figure out.
Realistically you'll need someone legal to deal with this if it becomes an issue.
The NH or facility is usually the one who submits the Medicaid application on your elders behalf along with their NH bill to the state. BUT the family or responsible party fills out and submits the elders individual Medicaid application to the NH along with the financial documentation required. The NH will give you a 1 or 2 page list of the documents needed - my mom's list was 1 page and her documents ended up being over 100 pages, while my MIL NH list was 2 pages but her documents were maybe 40 pages. Both NH were in TX but each approached it differently. The NH usually does an initial look over of what your submit and I think bases whether or not they accept your elder as "Medicaid Pending" for payment by looking at their financials. NH has an assigned state caseworker for that facility and you do not deal with them unless there is a specific issue with your elders application. My mom was in IL for a couple of years before NH, so her banking showed a clear & consistent pattern via automated payment of how the vast majority of her monthly income was spent. The caseworker may ask to see documentation or receipts on checks if they were not written to a business.
For at home care paid for by Medicaid, you would need to see if your state even does this via a waiver and how the waiver for this is structured. My mom is in TX in a NH and on Medicaid - her state has a very small and limited elder waiver program for nonNH situations and the waiting list is long. In TX it's much easier to get them into a NH than getting a waiver.Waivers tend to be called "community based services" and I'd suggest you contact your local Area on Aging to see what your state & your community provides. This site has a drop down list for AoA by state. Good luck and keep a sense of humor, you'll need it.
Until recently this hasn't been a issue but is so now. At my mom's NH, there actually have been issues with ladies who were war brides and never became citizens and so get ineligible for state Medicaid but can get VA aid & attendance. In speaking with one of their kids, it has been a real nightmare of paperwork as they have dementia too far gone to go and do the citizenship classe & test to be naturalized. My mom lives in a big city with a huge military presence so this situation is not unique and the NH knows how to deal with this issue. But I doubt that other places would be able to work through it. Good luck.
Medicaid rules determined by each state & are state specific even though it is a federal & state program. Medicaid is needs-based. You are expected to spend your assets first and foremost before the state will pay. There are things you can do to reduce assets but these need to be done by someone qualified to do this that will pass your state's review. An certified elder law attorney is best.
For NH Medicaid eligibility, an individual must show that:
1) are 65+ (can be younger if qualified disability),
2) medical condition requires skilled level of nursing care,
3) monthly income at or below their states max (about 2K),
This is the “income test”– how much $ do you make. TX is $2,094.
4) all countable assets are at or below 2K
This is the “asset test” – how much $ do you own.
5) not gifted away anything of value during 5yr look-back period.
If you do, could be a “transfer penalty” when items are gifted. Penalty different for each state as it’s based on each state’s NH reimbursement rate. For Texas, it is $ 142.92 a day rate (2011).
Look-back is 5 yrs. Most states require 3 – 6 mo. of financials with initial Medicaid application. Can require more financials if something pique’s interest. Financials are bank statements, social security and retirement statements, insurance policies, etc. Your assets are subject to MERP (estate recovery) after death.
ASSETS: All assets are counted, unless the assets fall within the short list of "noncountable" assets:
- personal possessions,
- a vehicle (some states have a limit on the value)
- their principal residence, provided it is in the same state in which the individual is applying for coverage & the house may be kept with no equity limit if the "community spouse" lives there; otherwise the equity limit is 500K (750K in some states)
- prepaid funeral (irrevocable, NCV, usually 10K max)
- small amount of life insurance (usually $1,500 & NCV)
All other assets (savings, stocks, whole life, rental property) are counted.Must “spend down” to get below their states maximum to qualify.
The financials are what most folks focus on. But remember that they also need to medically qualify for needing skilled care for Medicaid.