Will Medicare pay for my mother’s nursing home or will they take away the home we live in to pay for her care?

This is going to be a bit long.......................
Medicare does not pay for long term care.AK is spot-on in her answer.

You need to figure out what mom's assets are so that you can figure out what needs to be done to have her qualify for Medicaid. All the regulations are state specific. Most states have it so their monthly total asset is under $ 2,000. If she is over that then you need to start to spend down her money. The look back is 5 years - this is the critical thing to remember.

You mention a living will - is it a real living will done so that all her assets have already been placed in a trust with her named as the trustee? And a change of the title on the house deed and all other assets to reflect the trustee ownership? Are you her successor or grantor in the trust? If so then you don't need to worry as
her assets don't go thru probate which is how most homes have a lien put on them when Medicaid pays for LTC or NH. But you should go back and meet with the estate attorney who drew up her living will if it really is an accurate living will.

But if this isn't the case & If the home is in her name (and not as trustee) then you both have a decision to think over:
1) she can sell it to you for a nominal amount and then say she needs to go to a NH/LTC within the next 5 years. She needs to go on Medicaid as she has no real $$. Then you will have to private pay for whatever the amount is disallowed due to the "nominal" sale. The amount will be based on the property tax & comparable real estate sales at the time of the transfer. This can be good OR very bad depending on what mom's house is really worth. If the tax is for a 300K but actually the house was totally run down and maybe could have gotten only 180K then it's bad as the disallowance will be 300K as that is what is legally recorded.

2) she sells the house to you for a real sum or money. Go back to the 300K value, you go an get an appraisal done to show that the house has lots of problems (foundation, bad roof, whatever) and the appraisal is $ 180 K. You buy it for that. She gets the money. She uses the money to pay for her daily needs & also does
a personal services contract to pay you monthly for her care base on rates in your area. An elder care attorney really has to do these as they are sticky. Say Mom needs to go into NH and it's only 3 years. You may have to spend down whatever $$ is left from the sale to 2K but you legally own the house & have money paid to you from her. Then she goes on Medicaid and there is no penalty.

3) Mom keeps the house in her name. She does not have to sell her home in order to qualify for Medicaid. She owns the house outright. However, the property has to be under $ 500,000.00 in valuation (some states have it at $ 750,000). Yes I know that seems high but you'd be surprised at what the county has properties at especially if your parents bought it in the 1950's and their taxes are frozen and they never bothered to see what the new value is because that didn't matter.....

So you chose to do the above & her assets are under 2K and she qualifies for Medicaid. She goes into the NH for 4 years then dies, you are living at the house. Now when she dies MERP (Medicaid Estate Recovery Program) can place a lien on the home through probate (this is how most states do it - this is why it's important to know what was exactly done in her "living will"). So if the executor of her estate wants to transfer property ownership that lein has to be released.

Once mom is in LTC there will be none of her money to be used to pay for anything at the home as all her money less her personal needs of $ 30 - 60 a month MUST be paid to the facility. So you have to personally pay for everything for the house even though it is in not in your name. If you do this, it is CRITICAL
that you keep track of every $ spent as you will file a reinbursement request with your state's MERP program within 30 - 90 days of her death. Say you have been paying tax, insurance, maintenance for 4 yrs @ 8K a yrs. $ 32K total spent.

Say mom's monthly in the NH is $ 3K mo but her SS is $ 1,700. So her Medicaid
payment to the NH is $ 1,300 mo or $ 15,600K a year X 4 years is $ 62,400.
But you are asking for $ 32K. So the most MERP can get is 30K and in this real estate market it could take years to sell the house. So MERP declines to place a lien on the estate. You finish out probate and get the house and Medicaid paid for her NH stay for whatever her SS and other retirement didn't.

My gut feeling is that MERP doesn't do estates unless they can recoup over $100,000. MERP is done by state contractors so small estates with expense documentation and no significant life insurance is going to take too much time to be worth it.

If any of your $$ and mom's SS are co-mingled, then you need to separate those accounts. Have her account all done POD (pay on death) to you or whomever is the executor named in her will. Also if you don't have MPOA and a "guardianship in case of incapacity" done then you need to get those done to add to the DPOA and living will.

None of this is simple but doing it now when there is no demands or need it NOW requests are just so much easier and less stressful. Good Luck.

You can also petition MERP for an exemption if you have been living at the house and you would go onto the public dole if you couldn't live there.Also the house is exempt from MERP is there is a family business at the home. There are other exemptions. All of these are state specific.

Most states did MERP in 2005-2007 before the real estate meltdown, it wasn't very well thought through because many homes now aren't worth what their value is so why would family members upkeep a house that you will never see a cent of profit from. In my mom's neighborhood there are at least 6 abandoned homes because their owners are in a NH and the family doesn't have the $$ for upkeep or agreement as to who's responsible to do what.

Medicare will only pay for a temporary stay in a nursing home, and that is after a 3 day hospitalization stay. It will pay for things like rehab, g-tube care, and other qualifying conditions. Medicaid is the program that pays for nursing home stay for those with low income. One must meet certain income standards before one qualifies. In certain states, a DFS worker also visits the client in home to assess the need for nursing home care. Typically, assets such as homes and vehicles are exempt and do not need to be cashed in until a certain length of time, usually around 2 years so it is verified that the person will not be able to live at home again. Is your name on the title of the house? That may make a difference. It may be helpful to discuss this with a lawyer specializing in Medicaid regulations in your state. I commend you that you are planning ahead instead of waiting for a crisis.

Google "Caretaker Child Exemption". Each state is different but here in NJ if you have been living in your mother's house for more than two years and you've been acting as her caretaker (that's important!) you may be able to have the deed transferred from her to you, making it exempt from Medicaid (a non-countable asset).

To do this, you need a VERY detailed letter from your mother's doctor saying that if you weren't living there as her caretaker, your mother would have HAD to go into a nursing home. The letter should list all the duties you perform for your mom: feeding, bathing, giving out meds, maintaining the house, driving her to the doctor, etc etc etc. The important point of the letter is to state that your mother couldn't have stayed in her house without you living there as her caretaker, and that you have been living there doing those duties for more than two years.

This all has to be done through an attorney, so find a good one specializing in elder care. It will cost approx $200 - 300, with the consultation and transferring the deed. A caveat here: this is in NJ and it's MY own experience - other states and lawyers and even situations may vary. I'm POA for my mother and my brother was her live-in caretaker for MANY years. My mother went into a NH in January and my brother and I met with an attorney immediately. My mom's doc wrote up a wonderful letter for my brother and the lawyer said we shouldn't have any trouble having Medicaid accept the house as legitimately his when we apply for Medicaid for mom. The lawyer did say that Medicaid was getting more stringent on the Caretaker Child Exemption in recent years, but with our letter we shouldn't have a problem.

As a personal note: I'm very happy with the care my mother is getting at the NH and she's been happy and healthy there for the past six months. It was a rough road and the stress of caring for her at her own home was extremely difficult for me and my brother. I've been worried (an understatement) about applying for Medicaid for her for years now (a tale too complicated to go into here) and I've found a lot of relief by deciding to have the lawyer do the application for me. It's gonna cost some bucks, but that'll be from my mother's finances. It'll be the last chunk of change before we spend her down to 2K.

I hope this helps. Please take my advice: get a good elder care attorney - SOON! Even if your mom doesn't go into a NH right away, talking to a lawyer will ease for worries and help you get all your ducks in a row for when the time comes.

Love - I'd see an elder care attorney so that whatever you do passes Medicaid review. So you have your own home & mom also has a home but she moved in with you about a year ago? Is that the case? My comments below are based on that: My mom still has her home and is in a NH and on Medicaid. Her home is an exempt asset and the annual homestead exemption is filed on it and she does an annual "I plan on returning home when I am better" letter which was done by her attorney. I live in another state and my mom's house sits empty and I and another family member pay for all on the house (insurance, taxes, yard, etc). Keep in mind that once they go on Medicaid, ALL THEIR income less whatever is your state's "personal needs allowance" ($ 30 - 90 a mo) must be paid to the NH. So you or others will have to pay for all for mom's house. Because of my mom's advanced age of 95, doing a 5 yr plan wouldn't work.

Now for us, her house would be a most difficult sell and it would cost a good bit to get it buyer ready in this current market and it could be on the market for months and months. So in meeting with her attorney before she went into NH, we figured the best use of her $ was to spend down on IL, pay for a caregiver so she could stay in IL longer (she has Lewy Body Dementia and is episodic in her cognitive ability) and other medical or dental that Medicaid doesn't really cover till she met the Medicaid income maximum. Which luckily was about the same time she needed to go to NH.

For us, it works and when she dies, I will have MERP to deal with on the house but that's another issue. If my mom was younger, like in her 80's, we could be looking at a decade plus of outlay on her house, I'd sell it for whatever and use $ to private pay for IL, AL or NH.

You mention quit claim. I know Quit Claim Deeds seem like a simple & cheap way to change property ownership but there are issues with it especially as to guarantee. I've had to deal with QC deeded property (divorce & tax sale property) and QC can be sticky in that: you really have to have solid knowledge of the property history and the situation of the property owner as there could be liens or other clouds on the property. If you know absolutely for sure that there is nothing on the property to queer ownership, then QCD can work and I'd have a real estate attorney do it.

Remember a Quit Claim Deed is not a Warranty Deed. A Warranty Deed establishes & guarantees that there is a clear and valid ownership on the property
and that is backed by title insurance. With a QC property often if you should ever need to use it as collateral or get a mortgage on the property - say you want to build on it years from now and need a loan (mortgage) to do it - mortgage companies won't usually accept a QC as there is no assurance of good title. Also should you want to sell it later on and the buyer needs a mortgage to buy it, most banks now will not loan on a QCD property as there is no warranty as to ownership. Just something to think about.

I live in California and I can tell you that all of the above are good advice but as to the house you really, really need to talk with an attorney or group that deals with
life solutions and estate planning for medicaid. I spent quit a bit of time working for
social services and processing medicaid. It can become quite intense. Please seek legal advise before transferring any assets.

This question is a very good one. It's good to think ahead and plan for such a situation. You should contact your local medicaid office (county). I would explain your living conditions, ask for income and asset and income amounts to qualify. If you can or will be able to meet these requierments prior to a NH situation without sale of house and you have been careing for Mom and living in the house for a certain time period and can prove this as fact and her money was spent down on her care in her benefit only. You may be allowed to keep the house. The rules and laws are different according to location. May I also suggest researching with senior services for possible assistance.

Mom lives with me for over one year now..she has dementia and i have no plans on placing her in a nursing home. I do have POA but if i need to place her in NH will i have to pay down her monies and sell her home? I know there is this 5 year deal...but can she quit claim the house to me now? or is it too late?

thanks so much for your information.....i truly feel i would rather have mom stay with me...and get help if need be.....i was just wanted some info....and you guys really helped! thanks again...God Bless!!