How do I know which is better for my Mom - spend down or pooled trust fund?

I'm glad that your wrote and I hope that people more educated in Medicaid law than I am will chime in.

All I can suggest is that you work with an elder law attorney who knows your state's Medicaid laws well. This is very tricky and states differ. You'll want to get this right.

Good luck,
Carol

A "Pooled Trust" is a trust managed by a local charity that, pursuant to federal law, "pools" all contributions from the various people who contribute to the trust, and in exchange, pays out to the contributors/beneficiaries on an as-needed basis. Upon the death of the contributor, the trust will either retain any unused funds left from the original contribution amount to add to the "pot," or possibly allow distribution out to named individuals (varies by state). Note, however, that some states only allow contributions to a Pooled Trust if the contributor is under age 65.

A spend-down is simply spending any excess assets of the individual whose money it is and who is planning on applying for Medicaid, on things that benefit that individual. As such, should the individual need some of that money later, it will not be there. With the Pooled Trust, that money continues to be available to benefit the individual for the rest of their life.

I have a section of my book that discusses Pooled Trusts in more detail, as well as other trust-planning techniques (www.MedicaidSecrets.com).

NYC - you are on a way very fortunate to be able to have some decision making ability in medicaid by living in NYS. Most states do not have groups or non-profits out there pulling together to do pooled trusts.

To me this is more a management & availability issue that you as your parents dpoa & mpoa need to decide upon. A pooled trust is going to mean dealing with moms asset-based finances on a continuous basis from day 1 of medicaid eligibility till possibly whenever mom dies or the income ceases. Is the PT paperwork & compliance & provider network that the pooled trust, something you can easily deal with? Also another factor to consider is will your parent be keeping & staying in their home and so they could better need & use the flexibility with their income that a pooled trust is more flexible to allow for. Spend down in assets for Medicaid eligibility is just that....all extra $ has to be spent down so gone forever from their bank account.

So how much $ are you talking about? Would it be better done in a spent down on other things first & foremost (before the PT or medicaid) is in control?......what I'm getting at is: has your elder already done & fully paid for a preneed funeral & burial?; have they gotten all legal done (will, DPOA, MPOA , etc) and paid for this?; have they gotten done & paid for any needed & neglected dental work? Ditto on eyeglasses & hearing aids and with a backup pair on these too?...as these will go MIA in a facility; If they have their home & plan to stay in it, have they gotten all maintenance or total replacement on the majors (roof, AC, heat) done & fully paid for? if there is a mortgage (horrors!!) is this going to be paid off?; If she's staying in her home, how much can she pay for in advance on house costs (like insurance, utilities, taxes) from those funds? Medicaud either doesn't cover or covers minimally dental, hearing & vision, so if you want ths done, it's all out of pocket by family. For my mom, she did a huge amount of spend down in dental and on retrospect was most excellent as good oral health & their ability to bite down & eat whatever really does mean a healthier & more enjoyable life.

My point in this is if mom has 50/80k in savings (this unfortunately really isn't very much $), all could be pretty easily spent down in a couple of months on the above (dental alone could swallow - LOL - the whole 50/80k), then mom applies for Medicaid and all her income goes to pay for the NH with just her little personal needs trust at the NH ($60 I think is the amount for NYS) to deal with. This could be a lots more manageable for you than dealing with a PT if she's moving into a facility. If your elder is staying at their home, my understanding is that the PT allows them around $800 a mo for living costs, which either you or your elder needs to be able to manage on that amount.

It's a lot to think about as its not a "one fits all" as your elders needs and capabilities is unique for them as well as what your (& the other members of your family) can do for the elder is as well (both in actual time to help them out or in your own ability to help financially). Good luck and let us know what you all decide to do, as we learn from each other.

After reading Mr. Heiser's answer, I would change my response to avoiding a pooled trust, especially one managed by a charity. Some are well run, others are not. Adding another entity in the mix removes a lot of control over spending that you would otherwise have.

Have you considered spending down while applying as Medicaid pending, if that's an option? I'm not anywhere near as knowledgeable as others on Medicaid issues, but I think I'd rather have control over a spenddown than surrender control and disbursement of fudns to a charity.

Also, you have to consider how much she has and how much her care, including meds, hairdresser, clothes will cost for the next 5 years. We set up a trust 3 years ago and now My Mom needs that money to pay for the nursing home so I am now trying to disolve the trust. Do not waste her money if she does not have substantial assets. My mom had $300,000 when I set up the trust. and the trust must be in effect for 5 years to work.

You've gotten good responses on a variety of issues that will affect your decision. Now it's time to sit down and do projects, such as a cost-benefit analysis and break-even analysis to quantify which would be better. That can help put the decision on less of an emotional basis.

Nycguy, I am not familiar with the term "pooled trust". From the sounds of it all Mom's assets are deposited/transferred to a trust that, since you are talking about applying for Medicaid, will somehow be excluded from calculation for eligibility. You ask what is better for Mom. Are her assets significant? Is the purpose of the trust to setup a way to pay for care when needed?

What is best for Mom? I do not think there is a question there. When a person is self paying for care they have an option for nearly any facility based on their care needs only. If on Medicaid choices for care are severely limited to only facilities that accept it. Some of them are not very nice places. There are some nice Medicaid facilities but many require a period of self pay first. Most common in my area a person must self pay for usually two or three years before the facility will agree to assist with the Medicaid application.

Also Medicaid limits choice on type of room. Nearly everybody on Medicaid must share a room with another resident unless there is a contagious medical condition requiring a private room. Keep your mother's options open and plan on self paying. Maybe she has a long term care policy that would pay for her for awhile? If so, that should be taken into consideration too.

A pooled trust in a Trust that makes people eligible for Medicade by taking their money and "pooling" it in a Trust with other people's pooled trusts to get a bigger return on your investment. I also recommend a certified elder law attorney in your state. You can also do annuities and have other options. In our state it is difficult to find a Medicaid bed in a good nursing home. Sometimes spend down in a good facility that accepts Medicaid after the money runs out is the best option in our state but finding the most experienced certified Elder Law attorney in your area is your best option.

That should have been ...do projections, not projects!

And the financial breakeven point is going to be a major factor.

We choose spend down for my mom. She doesnt have much money and it works great