John L. Roberts
Certified Elder Law Attorney
John L. Roberts, J.D., is an Elder Law Attorney serving clients in Hampden County, MA. After practicing for 15 years, he confronted the challenges of family caregiving when his own father developed dementia. The experience transformed his practice, enabling him to help clients who are family caregivers from a place of true understanding.
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Question
Husband won't help with making our wills. How do I proceed?
It is amazing to read your story, which so clearly explains the way that many (if not most) people think about legal things and lawyers:... It is amazing to read your story, which so clearly explains the way that many (if not most) people think about legal things and lawyers: avoid and keep life simple.
You can honestly congratulate the person who is cautious and doesn't want to waste money. And you can also honestly explain to him how Estate Planning ends up saving money.
If you give up the opportunity to prepare the basic planning documents, state law and judges will decide how assets are managed and distributed, and how health care decisions are made. Those legal proceedings are not simple and cost thousands of dollars more than what you spend to have things written the way YOU want.
The DIY form documents you mentioned often won't save money. Without the insights of the Estate Planning Lawyer who takes the time to review the data you gather on your Inventory forms, and then to listen and understand what you want, you'll never know about ways you can avoid Probate and other traps that consume time and money.
You can promise your husband that he wouldn't like the default decisions that result under your state's laws for people who don't have Will, Power of Attorney, health care, and other documents that are prepared just for him by the Estate Planning Lawyer. see more
You can honestly congratulate the person who is cautious and doesn't want to waste money. And you can also honestly explain to him how Estate Planning ends up saving money.
If you give up the opportunity to prepare the basic planning documents, state law and judges will decide how assets are managed and distributed, and how health care decisions are made. Those legal proceedings are not simple and cost thousands of dollars more than what you spend to have things written the way YOU want.
The DIY form documents you mentioned often won't save money. Without the insights of the Estate Planning Lawyer who takes the time to review the data you gather on your Inventory forms, and then to listen and understand what you want, you'll never know about ways you can avoid Probate and other traps that consume time and money.
You can promise your husband that he wouldn't like the default decisions that result under your state's laws for people who don't have Will, Power of Attorney, health care, and other documents that are prepared just for him by the Estate Planning Lawyer. see more
Question
Medicaid look back window?
As other people have posted here, Medicaid planning with an Elder Law Attorney in your state now can bring benefits that you hadn't... As other people have posted here, Medicaid planning with an Elder Law Attorney in your state now can bring benefits that you hadn't imagined, and prevent problems in the future.
If your mother in law needs Medicaid eligibility in future years, a Caregiver Contract in put in place now can be used to document the payments to your wife.
Does the Medicaid program in your state provide hours and services for home care? That's another question to ask the Elder Law Attorney.
In my practice, we always look to keep the client in the least restrictive setting, and Medicaid paid home care can help do that.
If the client needs to transition to a nursing facility in the future, the application is converted to Long Term Care with updated records that verify the client and family have been complying with the income and asset regulations. see more
If your mother in law needs Medicaid eligibility in future years, a Caregiver Contract in put in place now can be used to document the payments to your wife.
Does the Medicaid program in your state provide hours and services for home care? That's another question to ask the Elder Law Attorney.
In my practice, we always look to keep the client in the least restrictive setting, and Medicaid paid home care can help do that.
If the client needs to transition to a nursing facility in the future, the application is converted to Long Term Care with updated records that verify the client and family have been complying with the income and asset regulations. see more
Question
Medicaid look back window?
As other people have posted here, Medicaid planning with an Elder Law Attorney in your state now can bring benefits that you hadn't... As other people have posted here, Medicaid planning with an Elder Law Attorney in your state now can bring benefits that you hadn't imagined, and prevent problems in the future.
If your mother in law needs Medicaid eligibility in future years, a Caregiver Contract in put in place now can be used to document the payments to your wife.
Does the Medicaid program in your state provide hours and services for home care? That's another question to ask the Elder Law Attorney.
In my practice, we always look to keep the client in the least restrictive setting, and Medicaid paid home care can help do that.
If the client needs to transition to a nursing facility in the future, the application is converted to Long Term Care with updated records that verify the client and family have been complying with the income and asset regulations. see more
If your mother in law needs Medicaid eligibility in future years, a Caregiver Contract in put in place now can be used to document the payments to your wife.
Does the Medicaid program in your state provide hours and services for home care? That's another question to ask the Elder Law Attorney.
In my practice, we always look to keep the client in the least restrictive setting, and Medicaid paid home care can help do that.
If the client needs to transition to a nursing facility in the future, the application is converted to Long Term Care with updated records that verify the client and family have been complying with the income and asset regulations. see more
Question
Is it ever a good idea to sell my mother's home causing her to lose her Medicaid then have to spend down to be...
You and your aunt would benefit from a meeting with an Elder Law Attorney in your state, who could review the facts of your mother's... You and your aunt would benefit from a meeting with an Elder Law Attorney in your state, who could review the facts of your mother's case and explain how the Medicaid eligibility regulations in your state can protect you and your family.
You mentioned that you are a Medicaid member yourself, and that you have cared for your mother for several years. These facts could fit several exceptions to Medicaid asset transfer rules that would allow transfer of the house with no penalty to your mother. Even if you don't want to keep the house there are ways to sell it and allocate the real estate sale proceeds without disqualifying your mother from Medicaid.
But we can't guess here about the specifics, your best options, and how to the facts must be presented to the Medicaid agency in your state. That's what an Elder Law Attorney in your state does for you.
A bonus for you and your aunt is the objective view that the Elder Law Attorney gives both of you, after he or she has listened to all sides of your story.
Everyone here understands the grief that goes with your mother's declining mental and physical health, so we know it's not easy to budget the time and money to find the Attorney who is best suited to help you.
After you get the clear picture of how the Medicaid regulations can help in your specific circumstances you may find the effort has brought you greater peace of mind. see more
You mentioned that you are a Medicaid member yourself, and that you have cared for your mother for several years. These facts could fit several exceptions to Medicaid asset transfer rules that would allow transfer of the house with no penalty to your mother. Even if you don't want to keep the house there are ways to sell it and allocate the real estate sale proceeds without disqualifying your mother from Medicaid.
But we can't guess here about the specifics, your best options, and how to the facts must be presented to the Medicaid agency in your state. That's what an Elder Law Attorney in your state does for you.
A bonus for you and your aunt is the objective view that the Elder Law Attorney gives both of you, after he or she has listened to all sides of your story.
Everyone here understands the grief that goes with your mother's declining mental and physical health, so we know it's not easy to budget the time and money to find the Attorney who is best suited to help you.
After you get the clear picture of how the Medicaid regulations can help in your specific circumstances you may find the effort has brought you greater peace of mind. see more
Question
Can I get paid for caring for my dad at my home? I've been caring for my dad (84) for six months now, I give h...
By filing the application for frail elder waiver, you have taken the step toward qualifying for the home care program best suited to keep... By filing the application for frail elder waiver, you have taken the step toward qualifying for the home care program best suited to keep your father safely at home.
Select the program that fits from the list of your state's caregiver reimbursement programs. Here are links to the stories of some other community members who asked about home care and caregiver contracts:
https://www.agingcare.com/questions/were-trying-to-draw-up-a-care-agreement-what-is-the-proper-pay-to-receive-for-a-full-time-caregiver-443143.htm?orderBy=helpful
https://www.agingcare.com/questions/i-have-4-parents-that-im-caring-for-at-the-same-time-they-dont-have-a-lot-of-money-but-they-dont-qualify-for-medicaid-can-i-get-paid-as-a-caregiver-440163.htm?orderby=helpful
https://www.agingcare.com/questions/mother-gave-me-access-to-checking-account-did-we-need-contract-431262.htm?orderby=helpful
https://www.agingcare.com/questions/borrow-on-one-of-moms-annuities-179213.htm?orderby=helpful see more
Select the program that fits from the list of your state's caregiver reimbursement programs. Here are links to the stories of some other community members who asked about home care and caregiver contracts:
https://www.agingcare.com/questions/were-trying-to-draw-up-a-care-agreement-what-is-the-proper-pay-to-receive-for-a-full-time-caregiver-443143.htm?orderBy=helpful
https://www.agingcare.com/questions/i-have-4-parents-that-im-caring-for-at-the-same-time-they-dont-have-a-lot-of-money-but-they-dont-qualify-for-medicaid-can-i-get-paid-as-a-caregiver-440163.htm?orderby=helpful
https://www.agingcare.com/questions/mother-gave-me-access-to-checking-account-did-we-need-contract-431262.htm?orderby=helpful
https://www.agingcare.com/questions/borrow-on-one-of-moms-annuities-179213.htm?orderby=helpful see more
Question
What happens to your private insurance if you are eligible for Medicaid insurance after you go into a nursing...
Your mother's Patient Paid Amount (PPA) is calculated by your state's Medicaid agency. The Medicaid agency will add up your... Your mother's Patient Paid Amount (PPA) is calculated by your state's Medicaid agency.
The Medicaid agency will add up your mother's gross monthly income from Social Security Retirement
+ Pensions
+ Annuities
+ any other source.
Subtracted from the gross income are:
- the small Personal Needs Allowance that the facility business office mentioned to you,
- Medicare premiums, and
- any other allowable expenses.
Health Insurance premiums may be an expense allowed by Medicaid, but you must provide the premium information to the Medicaid caseworker who is calculating the PPA.
After the allowed expenses are subtracted from the gross income, the PPA is paid to the facility, and then Medicaid pays the balance of the facility's monthly bill (based on a discounted Medicaid rate the facility is allowed to charge).
Some questions for you: how are the Health Insurance premiums being paid now? Are the premiums deducted from an employer pension payment (reducing your mother's monthly income)? Are the premiums paid by a check that your mother sends in to the Health Insurance company?
Decide how you will be handling your mother's monthly income going forward.
You could have all of your mother's income directly deposited to the care facility. The Medicare premiums are already being deducted from Social Security Retirement. But if the Health Insurance premium isn't being deducted from an income source (like an employer pension), the care facility probably won't be willing to manage the Health Insurance premium payments.
If not (and you decide to keep the Health Insurance) you would continue to receive the monthly income, continue to pay the monthly Health Insurance premium, and then write a check for the PPA to the facility.
Any health care costs not paid by the Health Insurance or Medicare are paid by Medicaid. see more
The Medicaid agency will add up your mother's gross monthly income from Social Security Retirement
+ Pensions
+ Annuities
+ any other source.
Subtracted from the gross income are:
- the small Personal Needs Allowance that the facility business office mentioned to you,
- Medicare premiums, and
- any other allowable expenses.
Health Insurance premiums may be an expense allowed by Medicaid, but you must provide the premium information to the Medicaid caseworker who is calculating the PPA.
After the allowed expenses are subtracted from the gross income, the PPA is paid to the facility, and then Medicaid pays the balance of the facility's monthly bill (based on a discounted Medicaid rate the facility is allowed to charge).
Some questions for you: how are the Health Insurance premiums being paid now? Are the premiums deducted from an employer pension payment (reducing your mother's monthly income)? Are the premiums paid by a check that your mother sends in to the Health Insurance company?
Decide how you will be handling your mother's monthly income going forward.
You could have all of your mother's income directly deposited to the care facility. The Medicare premiums are already being deducted from Social Security Retirement. But if the Health Insurance premium isn't being deducted from an income source (like an employer pension), the care facility probably won't be willing to manage the Health Insurance premium payments.
If not (and you decide to keep the Health Insurance) you would continue to receive the monthly income, continue to pay the monthly Health Insurance premium, and then write a check for the PPA to the facility.
Any health care costs not paid by the Health Insurance or Medicare are paid by Medicaid. see more
Question
Dad passed on 1/3 after being in SNF since last June. He was recently approved for Medicaid and SNF says our a...
Your question illustrates the value of hiring an Elder Law Attorney to promptly plan and prepare the application for Medicaid Long Term... Your question illustrates the value of hiring an Elder Law Attorney to promptly plan and prepare the application for Medicaid Long Term Care.
It's true, as the nursing home told you, that the monthly Patient Paid Amount ("PPA") stays the same no matter how many (or how few) days the resident was in the skilled nursing home facility. But that's only part of the story when it comes to your father's income (which determines his Patient Paid Amount).
Your question indicates that your mother has little income, and that makes her entitled to keep a Minimum Monthly Maintenance Needs Allowance (Minimum MMNA) from your father's income. The monthly minimum, with no questions asked, is $2,113.75 9 (through June 30, 2020, when it gets a COLA raise).
https://www.medicaid.gov/sites/default/files/2020-01/ssi-and-spousal-impoverishment-standards_0.pdf
If your mother's housing and heat expenses are higher, there is Maximum Monthly Maintenance Needs Allowance (Maximum MMNA) of $3,160.50 that could allow her to keep even more of your father's income.
A spouse can keep even more than that upper limit if the healthy spouse shows exceptional circumstances at a Fair Hearing proceeding.
Ask the person who prepared the application to explain how these allowances fit into your parents' case, and your father's PPA. see more
It's true, as the nursing home told you, that the monthly Patient Paid Amount ("PPA") stays the same no matter how many (or how few) days the resident was in the skilled nursing home facility. But that's only part of the story when it comes to your father's income (which determines his Patient Paid Amount).
Your question indicates that your mother has little income, and that makes her entitled to keep a Minimum Monthly Maintenance Needs Allowance (Minimum MMNA) from your father's income. The monthly minimum, with no questions asked, is $2,113.75 9 (through June 30, 2020, when it gets a COLA raise).
https://www.medicaid.gov/sites/default/files/2020-01/ssi-and-spousal-impoverishment-standards_0.pdf
If your mother's housing and heat expenses are higher, there is Maximum Monthly Maintenance Needs Allowance (Maximum MMNA) of $3,160.50 that could allow her to keep even more of your father's income.
A spouse can keep even more than that upper limit if the healthy spouse shows exceptional circumstances at a Fair Hearing proceeding.
Ask the person who prepared the application to explain how these allowances fit into your parents' case, and your father's PPA. see more
Question
My sister has been approved for clinical eligibility for Mass Health, it has been 4 months waiting for financi...
You didn't mention who prepared and filed the Application for Medicaid, so it's not clear from your question whether you are... You didn't mention who prepared and filed the Application for Medicaid, so it's not clear from your question whether you are "in the loop" with the Application Process.
When MassHealth sends out a Request for Information, the Notice lists the name and phone number of the case worker assigned to the case. That is the person you need to help in every way possible to help process and complete the case.
When preparing a Medicaid Long Term Care Application, I include all the relevant financial data and information that a case worker will need to approve the Application. I use color coded categories for the financial accounts and statements, so the case worker can easily find what they need to grant approval.
I always include the family member who is in charge of the case on the list of people with Permission to Share Information, so they get copies of the MassHealth Notices.
If you are not getting copies of the Notices, ask whoever prepared the application to prepare and submit a PSI, so that you can keep track of what's going on.
If you explain your experience to your friends, they may remember the value of professional application preparation if a family member needs Medicaid care in the future. see more
When MassHealth sends out a Request for Information, the Notice lists the name and phone number of the case worker assigned to the case. That is the person you need to help in every way possible to help process and complete the case.
When preparing a Medicaid Long Term Care Application, I include all the relevant financial data and information that a case worker will need to approve the Application. I use color coded categories for the financial accounts and statements, so the case worker can easily find what they need to grant approval.
I always include the family member who is in charge of the case on the list of people with Permission to Share Information, so they get copies of the MassHealth Notices.
If you are not getting copies of the Notices, ask whoever prepared the application to prepare and submit a PSI, so that you can keep track of what's going on.
If you explain your experience to your friends, they may remember the value of professional application preparation if a family member needs Medicaid care in the future. see more
Question
Mom and step dad have a decent retirement income and savings, but in the past year have started withdrawing la...
Sadly, your story is not uncommon, and the Elder Care Attorney is providing accurate advice. In cases where an elder's finances are... Sadly, your story is not uncommon, and the Elder Care Attorney is providing accurate advice.
In cases where an elder's finances are minimal and a single bank account can be restricted, it may be possible to manage an elder's decline in capacity with a POA document.
But you are describing a case where the work involved with gaining Probate Conservatorship can save your parents and your family from much greater stress in the future. Conservatorship is the only way you can compel third party financial institutions to comply with restrictions needed to stop the drain of funds to financial predators.
Beyond the tragedy of lost resources that could have been used for care, the end game if Medicaid eligibility becomes necessary involves a severe accounting nightmare. A Medicaid application will require you to explain the transfers of drained funds.
Chaos during the 5 year look back period makes the Medicaid Application preparation 100x more burdensome than if a Conservator starts right now with the tasks of managing and accounting for your parents' life savings. see more
In cases where an elder's finances are minimal and a single bank account can be restricted, it may be possible to manage an elder's decline in capacity with a POA document.
But you are describing a case where the work involved with gaining Probate Conservatorship can save your parents and your family from much greater stress in the future. Conservatorship is the only way you can compel third party financial institutions to comply with restrictions needed to stop the drain of funds to financial predators.
Beyond the tragedy of lost resources that could have been used for care, the end game if Medicaid eligibility becomes necessary involves a severe accounting nightmare. A Medicaid application will require you to explain the transfers of drained funds.
Chaos during the 5 year look back period makes the Medicaid Application preparation 100x more burdensome than if a Conservator starts right now with the tasks of managing and accounting for your parents' life savings. see more
Question
Mom's in nursing home. Sister has "Life Estate" nearly 8 years. Nursing home takes all Soc Sec & rent. If we...
You can see from the posts by community members here, there are a variety of viewpoints about how to handle real estate when a parent moves... You can see from the posts by community members here, there are a variety of viewpoints about how to handle real estate when a parent moves to a Medicaid paid skilled nursing facility.
Although your question says that your sister "has the life estate" it seems like you really mean to say that your sister has a "remainder interest" in the property and your mother is the Life Tenant. (It sounds like that's what you mean, because you are aware of Medicaid's 5 year Look back period and you explain that your mother transferred the interest to your sister in 2012.)
This is a situation where you don't want to rely on guess work or make decisions based on what you read online. Visit an Elder Law Attorney in your state who can handle Medicaid planning and real estate transactions.
The Attorney will explain the regulations in your state, and the percentage interest owned by your sister and your mother. (The % is based on your mother's age, which determines her actuarial life expectancy. The % gets smaller with every birthday.)
Once you understand how much value from a house sale would be assigned to your mother (and be required as private payment for care), your family can then make a decision about the timing of the sale, or whether you want to keep renting the property. (As you said in your question, any profit netted from the rent is income to the Life Tenant and goes to pay for care).
Having an Elder Law Attorney on your team will make the transaction easier to explain to your family, the broker and buyer of the property, and the Medicaid agency in your state.
In my state (Massachusetts) the Medicaid agency and the State Auditor review Medicaid files years after a transaction has been completed, using bank and income tax data swaps that filter through their systems. To avoid the anxiety of wondering whether the transaction was properly planned, get the peace of mind that an Elder Law Attorney can provide if you receive an inquiry notice years from now asking about how the real estate proceeds were distributed. see more
Although your question says that your sister "has the life estate" it seems like you really mean to say that your sister has a "remainder interest" in the property and your mother is the Life Tenant. (It sounds like that's what you mean, because you are aware of Medicaid's 5 year Look back period and you explain that your mother transferred the interest to your sister in 2012.)
This is a situation where you don't want to rely on guess work or make decisions based on what you read online. Visit an Elder Law Attorney in your state who can handle Medicaid planning and real estate transactions.
The Attorney will explain the regulations in your state, and the percentage interest owned by your sister and your mother. (The % is based on your mother's age, which determines her actuarial life expectancy. The % gets smaller with every birthday.)
Once you understand how much value from a house sale would be assigned to your mother (and be required as private payment for care), your family can then make a decision about the timing of the sale, or whether you want to keep renting the property. (As you said in your question, any profit netted from the rent is income to the Life Tenant and goes to pay for care).
Having an Elder Law Attorney on your team will make the transaction easier to explain to your family, the broker and buyer of the property, and the Medicaid agency in your state.
In my state (Massachusetts) the Medicaid agency and the State Auditor review Medicaid files years after a transaction has been completed, using bank and income tax data swaps that filter through their systems. To avoid the anxiety of wondering whether the transaction was properly planned, get the peace of mind that an Elder Law Attorney can provide if you receive an inquiry notice years from now asking about how the real estate proceeds were distributed. see more
Question
Does a will that was signsd sealed and delivered to the courts over 5 years ago protect the assets from nursin...
Your question blends two concepts that are distinctly different: Probate Wills and Medicaid look back. The 5 year time period you are... Your question blends two concepts that are distinctly different: Probate Wills and Medicaid look back.
The 5 year time period you are thinking of is a "look back period" that requires you to list on a Medicaid application any transfers you have made up to 5 years before you apply for Medicaid payments to a skilled nursing facility.
If you transferred an asset 5 years + 1 day before you apply for Medicaid, the transfer doesn't count and you don't have to list it on the application.
A Will is a document that transfers assets upon death. Your question indicates that the person who signed the Will still owns some assets. (They haven't transferred the assets; the assets are still owned by the person.)
If the person needs to apply for Medicaid, and they own "excess assets" (assets worth more the $2,000 for a single person) the Medicaid application will be denied.
It doesn't matter if they signed a Will leaving assets to someone else upon their death if they still own the assets when they apply for Medicaid.
A Will is a probate document. Probate laws for all states are at:
https://www.law.cornell.edu/wex/table_probate see more
The 5 year time period you are thinking of is a "look back period" that requires you to list on a Medicaid application any transfers you have made up to 5 years before you apply for Medicaid payments to a skilled nursing facility.
If you transferred an asset 5 years + 1 day before you apply for Medicaid, the transfer doesn't count and you don't have to list it on the application.
A Will is a document that transfers assets upon death. Your question indicates that the person who signed the Will still owns some assets. (They haven't transferred the assets; the assets are still owned by the person.)
If the person needs to apply for Medicaid, and they own "excess assets" (assets worth more the $2,000 for a single person) the Medicaid application will be denied.
It doesn't matter if they signed a Will leaving assets to someone else upon their death if they still own the assets when they apply for Medicaid.
A Will is a probate document. Probate laws for all states are at:
https://www.law.cornell.edu/wex/table_probate see more
Question
How do I ensure my mother remains eligible for Medicaid now that my father has died and left her a small life...
Your question is a valuable reminder for married couples, and anyone else who has a loved one who needs Medicaid to cover nursing home... Your question is a valuable reminder for married couples, and anyone else who has a loved one who needs Medicaid to cover nursing home care.
The reminder is: to check on your beneficiary designations and provisions in your Will and Trust documents to make sure that you are not leaving any assets to the individual person who needs Medicaid eligibility.
The assets resource standard for an individual is $2,000.
https://www.medicaid.gov/medicaid/eligibility/downloads/spousal-impoverishment/ssi-and-spousal-impoverishment-standards.pdf
Leaving the Life Insurance policy proceeds, and the house, outright to your mother puts the value of those assets in her ownership. She now has excess assets (assets over $2,000)!
The assets will have to be spent down on her care, unless there are non-countable assets (an irrevocable funeral contract, a car, a burial account) that can be purchased for your mother.
Talk with an elder law attorney in your state to learn about other solutions that may be open to your mother in your state that could continue her eligibility for Medicaid, rather than spending down the excess assets.
Perhaps your state would allow your mother to use the money to open a pooled trust account, or to pay you for services under a Caregiver Contract. Also, if you have a disabled person in your family, there are ways to set aside excess assets for that person without causing a disqualifying transfer.
The elder law attorney in your state can also help you learn whether there are a ways to use the money to pay necessaries arising from your father's passing.
For future planning, remember that a healthy spouse living at home can use their Will, and Will substitutes such as beneficiary designations, to direct their assets to anyone other than the nursing home resident, to protect the Medicaid recipient from disqualification. (It may also be possible to set up a Supplemental Needs Trust for a survivor that would make assets non-countable by Medicaid.)
Only a few states aggressively seek to take Medicaid recovery by demanding a spousal share of assets left by the community spouse to other people. see more
The reminder is: to check on your beneficiary designations and provisions in your Will and Trust documents to make sure that you are not leaving any assets to the individual person who needs Medicaid eligibility.
The assets resource standard for an individual is $2,000.
https://www.medicaid.gov/medicaid/eligibility/downloads/spousal-impoverishment/ssi-and-spousal-impoverishment-standards.pdf
Leaving the Life Insurance policy proceeds, and the house, outright to your mother puts the value of those assets in her ownership. She now has excess assets (assets over $2,000)!
The assets will have to be spent down on her care, unless there are non-countable assets (an irrevocable funeral contract, a car, a burial account) that can be purchased for your mother.
Talk with an elder law attorney in your state to learn about other solutions that may be open to your mother in your state that could continue her eligibility for Medicaid, rather than spending down the excess assets.
Perhaps your state would allow your mother to use the money to open a pooled trust account, or to pay you for services under a Caregiver Contract. Also, if you have a disabled person in your family, there are ways to set aside excess assets for that person without causing a disqualifying transfer.
The elder law attorney in your state can also help you learn whether there are a ways to use the money to pay necessaries arising from your father's passing.
For future planning, remember that a healthy spouse living at home can use their Will, and Will substitutes such as beneficiary designations, to direct their assets to anyone other than the nursing home resident, to protect the Medicaid recipient from disqualification. (It may also be possible to set up a Supplemental Needs Trust for a survivor that would make assets non-countable by Medicaid.)
Only a few states aggressively seek to take Medicaid recovery by demanding a spousal share of assets left by the community spouse to other people. see more
Question
Both parents with varying degrees of dementia live with my husband and myself now. Any advice about lookback?
Your parents can pay you for the housing, services and valuable geriatric care management you are providing now, without affecting their... Your parents can pay you for the housing, services and valuable geriatric care management you are providing now, without affecting their eligibility for Medicaid in the future, IF they comply with the eligibility regulations in your state.
Make it easy on yourself by talking with an Elder Law Attorney in your state who can show you how to make all the payments from your parents' funds conform to what a Medicaid case worker will expect to see when the time comes to apply for benefits.
If you invest the time and money needed now for Medicaid care planning, you won't be in panic mode if time runs out on your ability to provide at home care for one or both of your parents.
A written caregiver contract and rental agreement, documented with receipts for supplies and itemization of services you provide during the lookback period, are the foundation for a successful application.
You can't expect the Medicaid case worker to approve a retrospective agreement with disjointed records that are difficult to understand. see more
Make it easy on yourself by talking with an Elder Law Attorney in your state who can show you how to make all the payments from your parents' funds conform to what a Medicaid case worker will expect to see when the time comes to apply for benefits.
If you invest the time and money needed now for Medicaid care planning, you won't be in panic mode if time runs out on your ability to provide at home care for one or both of your parents.
A written caregiver contract and rental agreement, documented with receipts for supplies and itemization of services you provide during the lookback period, are the foundation for a successful application.
You can't expect the Medicaid case worker to approve a retrospective agreement with disjointed records that are difficult to understand. see more
Question
Who deems someone as mentally competent or incompetent?
Your question is important and well worth talking about with your family members, and the people who care for your mother. A NIH summary... Your question is important and well worth talking about with your family members, and the people who care for your mother. A NIH summary explains how our legal system protects "the principle that all persons are competent to make reasoned decisions unless demonstrated to be otherwise."
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC181079/
The protection is based on our Bill of Rights, and on law and medical practice in the state where your mother lives. Also, the terms written into her Power of Attorney document determine what powers she has granted to your sister and any powers that she has withheld. Health Care documents can also be tailored to limit and agent's authority and provide directions.
There are different categories of capacity that you have to consider. Capacity to make health care decisions, manage finances, or sign a will document each require different levels and types of capacity.
A Merk manual summary explains how people who have clinical and legal capacity are considered able to make health care decisions. But even if a patient lacks clinical capacity, a physician cannot override a patient's treatment preference unless a court gets involved and finds the patient lacks legal capacity to make the decision.
https://www.merckmanuals.com/professional/special-subjects/medicolegal-issues/capacity-competence-and-incapacity
The NIH Summary does acknowledge that:
"One of the most vexing issues facing physicians is the management of medical treatment when an individual's rational decision-making ability is questionable." But you indicate that your mother is able to express herself rationally, so it is difficult to understand why your mother is being excluded from care meetings.
Regulation of Assisted Living facilities in your mother's state of residence will be according to state or municipal regulations. Federal law protects people who live in a more restrictive nursing home setting. Specified rights include:
"The right to choose a personal attending physician, to be fully informed in advance about care and treatment, to be fully informed in advance of any changes in care or treatment that may affect the resident’s well-being, and (except with respect to a resident adjudged incompetent) to participate in planning care and treatment or changes in care and treatment."
https://www.law.cornell.edu/uscode/text/42/1395i-3
It may be worth contacting an Elder Law Attorney or Geriatric Care Manager in your mother's home state to get some objective guidance and advocacy for your mother. see more
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC181079/
The protection is based on our Bill of Rights, and on law and medical practice in the state where your mother lives. Also, the terms written into her Power of Attorney document determine what powers she has granted to your sister and any powers that she has withheld. Health Care documents can also be tailored to limit and agent's authority and provide directions.
There are different categories of capacity that you have to consider. Capacity to make health care decisions, manage finances, or sign a will document each require different levels and types of capacity.
A Merk manual summary explains how people who have clinical and legal capacity are considered able to make health care decisions. But even if a patient lacks clinical capacity, a physician cannot override a patient's treatment preference unless a court gets involved and finds the patient lacks legal capacity to make the decision.
https://www.merckmanuals.com/professional/special-subjects/medicolegal-issues/capacity-competence-and-incapacity
The NIH Summary does acknowledge that:
"One of the most vexing issues facing physicians is the management of medical treatment when an individual's rational decision-making ability is questionable." But you indicate that your mother is able to express herself rationally, so it is difficult to understand why your mother is being excluded from care meetings.
Regulation of Assisted Living facilities in your mother's state of residence will be according to state or municipal regulations. Federal law protects people who live in a more restrictive nursing home setting. Specified rights include:
"The right to choose a personal attending physician, to be fully informed in advance about care and treatment, to be fully informed in advance of any changes in care or treatment that may affect the resident’s well-being, and (except with respect to a resident adjudged incompetent) to participate in planning care and treatment or changes in care and treatment."
https://www.law.cornell.edu/uscode/text/42/1395i-3
It may be worth contacting an Elder Law Attorney or Geriatric Care Manager in your mother's home state to get some objective guidance and advocacy for your mother. see more
Question
Where do I get help interpreting my mother's long-term care insurance policy?
An Elder Law Attorney in your mother's state of residence can help you understand the policy, and you'll get other insights on care... An Elder Law Attorney in your mother's state of residence can help you understand the policy, and you'll get other insights on care options and planning.
To get up to speed on the policy terms and features, check the LTC Ins Guide published by the National Association of State Insurance Commissioners:
https://www.ltcfeds.com/epAssets/documents/NAIC_Shoppers_Guide.pdf see more
To get up to speed on the policy terms and features, check the LTC Ins Guide published by the National Association of State Insurance Commissioners:
https://www.ltcfeds.com/epAssets/documents/NAIC_Shoppers_Guide.pdf see more
Question
My mother sends my brother $500 a month to assist with the rent. Will this be an issue when she has to go on M...
Suggest that your mom talk with an elder law attorney in her home state, so she can continue to stay in the least restrictive living... Suggest that your mom talk with an elder law attorney in her home state, so she can continue to stay in the least restrictive living setting (such as her own home).
Your role as POA makes you responsible for disbursing substantial amounts of her money to your brother. It wasn't clear from your question whether your brother is living with your parents. Future Medicaid eligibility will at minimum be complicated by the payments you describe, and at worst could be found to be disqualifying transfers that you are responsible for. see more
Your role as POA makes you responsible for disbursing substantial amounts of her money to your brother. It wasn't clear from your question whether your brother is living with your parents. Future Medicaid eligibility will at minimum be complicated by the payments you describe, and at worst could be found to be disqualifying transfers that you are responsible for. see more
Question
My mother sends my brother $500 a month to assist with the rent. Will this be an issue when she has to go on M...
Suggest that your mom talk with an elder law attorney in her home state, to talk about ways she can continue to stay in the least... Suggest that your mom talk with an elder law attorney in her home state, to talk about ways she can continue to stay in the least restrictive living setting (such as her own home).
Your role as POA makes you responsible for disbursing substantial amounts of her money to your brother. It wasn't clear from your question whether your brother is living with your parents. Future Medicaid eligibility will at minimum be complicated by the payments you describe, and at worst could be found to be disqualifying transfers that you are responsible for. see more
Your role as POA makes you responsible for disbursing substantial amounts of her money to your brother. It wasn't clear from your question whether your brother is living with your parents. Future Medicaid eligibility will at minimum be complicated by the payments you describe, and at worst could be found to be disqualifying transfers that you are responsible for. see more
Question
I am 66 taking care of my 84 year old mom. Can I get paid to care for her?
An elder law attorney in your state can explain the Medicaid programs that can pay for care in your Mom's home. If you don't... An elder law attorney in your state can explain the Medicaid programs that can pay for care in your Mom's home. If you don't qualify as a caregiver host under your state's program, you mom could qualify for a program that pays other caregivers to come into the home, allowing you some time off from the duties. Your mom's monthly income, and her need for care, determine eligibility.
If your mom is a veteran who served during time of war, or was married to a veteran who served during time of war, she can get reimbursement for care expenses with a VA Aid & Attendance pension. The hours that you provide care services every month can qualify as reimbursable Aid & Attendance expenses. The calculation factors in your mom's income with how much she has to spend on medical expenses and care to determine whether she can get a portion of or the full monthly pension amount. ($1,258 during 2019). see more
If your mom is a veteran who served during time of war, or was married to a veteran who served during time of war, she can get reimbursement for care expenses with a VA Aid & Attendance pension. The hours that you provide care services every month can qualify as reimbursable Aid & Attendance expenses. The calculation factors in your mom's income with how much she has to spend on medical expenses and care to determine whether she can get a portion of or the full monthly pension amount. ($1,258 during 2019). see more
Question
Paying for assisted living?
In my state (Massachusetts) some assisted living centers have subsidized slots for low income residents who are on SSI. The program in my... In my state (Massachusetts) some assisted living centers have subsidized slots for low income residents who are on SSI.
The program in my state is called Group Adult Foster Care (GAFC) and it pays for services for elders in subsidized senior housing and in assisted living centers such as daily personal care, homemaking, meals, and transportation.
The assisted living center may combine the GAFC services with the room and board which is paid by the resident, and another program called SSI-G. But you do not have to be eligible to receive SSI-G in order to qualify for GAFC.
You may be able to find a housing facility that participates in Senior Care Options (SCO), a Medicaid/Medicare funded program that provides services, benefits and treatments authorized by the primary care physician.
PACE, a Program of All-Inclusive Care for the Elderly, is another program for patients who are eligible for Medicare and Medicaid. The purpose of the program is to help prevent nursing home admissions. If a nursing home admission becomes necessary, the PACE plan pays for the long-term care in the facility. Until that time, PACE can cover costs of assisted living that the resident's income doesn't cover. All services are provided or authorized by the PACE Interdisciplinary Team, except emergency services.
An elder law attorney in your state can guide you to the options and combinations of resources that are available in your area. see more
The program in my state is called Group Adult Foster Care (GAFC) and it pays for services for elders in subsidized senior housing and in assisted living centers such as daily personal care, homemaking, meals, and transportation.
The assisted living center may combine the GAFC services with the room and board which is paid by the resident, and another program called SSI-G. But you do not have to be eligible to receive SSI-G in order to qualify for GAFC.
You may be able to find a housing facility that participates in Senior Care Options (SCO), a Medicaid/Medicare funded program that provides services, benefits and treatments authorized by the primary care physician.
PACE, a Program of All-Inclusive Care for the Elderly, is another program for patients who are eligible for Medicare and Medicaid. The purpose of the program is to help prevent nursing home admissions. If a nursing home admission becomes necessary, the PACE plan pays for the long-term care in the facility. Until that time, PACE can cover costs of assisted living that the resident's income doesn't cover. All services are provided or authorized by the PACE Interdisciplinary Team, except emergency services.
An elder law attorney in your state can guide you to the options and combinations of resources that are available in your area. see more
What is a Medicaid waiver?
The Corona Virus Crisis made it especially important to know about home care options for your loved ones.
If you live in a state that has a “Money Follows the Person Demonstration Program” the money that would have been spent on a nursing home follows you home, if you are able to move out and get elder care in your home. To apply for MFP, the person must 1) be living in a Skilled Nursing Facility now, 2) Need a clinical level of care, and 3) be safely cared for in their home in the community.
The application would be screened by the MFP Waiver Unit in your state. Since MFP is for people who have been in a nursing home for 90 consecutive days or longer, you’re not eligible for MFP if you are at home now, and want to continue living at home.
So, other waiver programs pay for care for frail elders who can put together a plan to stay safely in their homes. Call your Aging Services Access Point (ASAP) for a list of waiver programs. An Elder Law Attorney in your state can explain how you can qualify for waiver program, under the income and asset regulations in your state. see more