Bill 2001(1)

Jo C.

Hello Bill; I was unable to find your Post in which you are discussing that Missouri Medicaid will put a lien on your house for Medicaid Recovery of their costs after your spouse dies if she has been in a nursing home .  This raised some questions for me, so I did look up the topic. It turns out that if there is a surviving spouse living in the home, then there is no lien. 

And . . . . if the house is not going through Probate because the NH spouses name has been removed from the deed, there is no problem with Probate, and the state cannot take any portion of the house's worth even after the well spouse who did not have Medicaid dies; there will be no top number of equity for keeping the house.

Each state has their own Medicaid or Medi-Cal laws BUT each state MUST work within the guidelines set by federal govt.  Here is some information which you may well know most or all of it, but wanted to get the 2022 stuff out there: 

https://www.medicaidplanningassistance.org/can-medicaid-take-my-home/

Within that writing is contained:

 Married and one spouse moving to a nursing home

When your spouse moves into a Medicaid-funded nursing home, you are considered the community spouse, and as such, you are entitled to keep your home. There is no home equity value limit. However, it is best to have just your name on the house title. As the non-applicant spouse, the home can be transferred to you without violating Medicaid’s look back period. While your home is safe from estate recovery if your spouse passes away and you are living, it isn’t necessarily safe from MERP following your death if the home isn’t solely in your name. Therefore, transferring the home to yourself will protect it from Medicaid estate recovery. The state will not be able to make a claim against the home, even after your death, to be paid back for the cost of your spouse’s nursing home care. This is because the home will no longer be a part of your spouse’s estate upon their death.

More information from a law practice in Missouri:

https://www.legacylawmissouri.com/medicaid-estate-recovery-missouri/

So; this may give you more latitude than you had figured on IF you find that placement becomes a necessity and Medicaid would be the payor.  Of course, always best to check this with an Elder Law Attorney, but it sounds like a positive.

J.

 

Jo C.

More information:  Here is information re 2022 Missouri Medicaid income criteria for Long Term Care in a care facility:

https://www.medicaidplanningassistance.org/medicaid-eligibility-missouri/

The spouse can keep ALL their income, only the applicant's income is counted.  The at home spouse can keep up to $137,400 in savings which you had mentioned, but there are ways possible to save the assets before application and seeing that Certified Elder Law Attorney would be your best chance at positioning yourself as best as can be. 

NOTE: For Missouri

"When only one spouse of a married couple applies for nursing home Medicaid or a HCBS Medicaid Waiver, only the income of the applicant is counted. This means the income of the non-applicant spouse is disregarded and does not impact the income eligibility of their spouse. The non-applicant spouse, however, may be entitled to a Minimum Monthly Maintenance Needs Allowance (MMMNA) from their applicant spouse. The MMMNA is a spousal impoverishment provision and is the minimum amount of monthly income a non-applicant spouse is said to require to avoid spousal impoverishment. The MMMNA is $2,178 (effective 7/1/21 – 6/30/22). If a non-applicant’s monthly income is under $2,178, income can be transferred from their applicant spouse, bringing their income . . . "

If the NH spouse has too much personal income to qualify for Missouri Medicaid, one can do a "Qualified Income Trust," also known as a "Miller Trust."  If this is a problem issue, do look at the explanation for these trusts in the above link; most states have this approach.  The monthly income allowance for the at home spouse is dreadful, how is one to survive and meet one's needs during one's own elder years is questionable when age related needs and living expenses are higher and higher in cost.

As the dementia advances, it is good to keep current information which may be useful  Your Elder Law Attorney can confirm and position you best.  I share the frustration and it is so very unfair.  We as a country can do much better, but the aged and infirm are not high in the political scheme of things. We need to watch who we vote for and how I wish we had loud, powerful voices - but even though the elder population is very large and most do vote, it has not been near enough.

J.

Stuck in the middle

Jo, that's pretty much what my CELA told me about Missouri law.  Thank you for posting it.

It looks like Bill has deleted his recent posts.  I suspect he doesn't want our advice.  We all hold the keys to our cages, but some of us choose not to use them.

ButterflyWings

I hope he is OK. He has been feeling really down and overwhelmed, understandably. I need to find work again soon if I can only get reliable HHA assistance —but cannot imagine managing full time work outside of the home after wrangling a PWD LO to day care as he does. Super heavy lifting. 

Bill, if you see this we are thinking about you, wishing you well, and sending you strength.

White Crane

Jo, thank you so much for this information.  I will be looking at it as I too live in Missouri.  I had not heard of the trusts that you mentioned.

I hope Bill is ok.  And I hope he knows we all care about him.

Jo C.

Hi White Crane, that Qualifying Income Trust, also called a, Miller Trust can be very helpful and save the day.  If one meets the other criteria for Medicaid Long Term Care, but the income level of the spouse applicant is too high; then the Trust gets set up.  All of the spouse applicant's income goes into the Trust, (Not one penny of the at home spouse's income is touched).  Each month, when the MC or NH bills for their services, the Trust pays out a check to the facility as the applicant's Share of Costs, and Medicaid makes up the shortfall in the billing.

If the at home spouse's income is very low as set up by each state for minimum income, then the at home spouse will receive some of the applicant spouse's income to reach the amount as set forth by the state as minimum income and the rest of the applicant spouse's income goes into the Trust.

This has helped so many families in most states, yet not many people are aware of the Miller Trust's existance.

J.

JoseyWales

I recently set up the Miller Trust - Qualified Income Trust - for DH. His income was just over the limit, so my CELA created paperwork and I opened the trust. There are all kinds of rules to follow regarding bank accounts and income.  I now have 3 different bank accounts to manage (the trust, our joint account and one for just me). But without the trust he wouldn't have qualified for Medicaid. So I jump through hoops, manage money, and save thousands of dollars a month. So glad that trust is an option!

I found it interesting that very few banks in my area work with Miller Trusts. It wasn't hard to find a bank, just surprised that so few want to do it. 

Jo C.

Josey; so glad to hear that!  Good for you - excellent move with a great outcome; thank you for sharing that.

J.

Bill_2001

I have stopped posting for a while because sometimes it simply gets too depressing to read about dementia, Medicaid, etc., all of the time.

I appreciate your thoughts. I am ok, relatively speaking of course.

Re-posted from another concerned thread: (This is what is on my mind now and why I have been away for a while.)

As caregivers of people with dementia, we are truly on our own. Family, friends, the government, the medical community are not coming to the rescue. Not now, not during our miserable lifetimes, and probably not ever.

I love my country (US), but let’s face it. As a nation, we are too selfish and caught up in the “bootstraps” mentality to ever come up with a solution. Taxation, for the betterment of society, is looked upon as socialism. Old people and their caregivers are invisible, and we will never matter.

Yes, this topic is depressing. The sooner we all face up to the truth of our isolation, the better we can cope with another day. I am tired of false hope and lengthy articles about “help.” There is no help and there never will be. The only escape will be the death of me or my dear wife after this hideous disease has destroyed our lives. No one cares.

Now, I must get back to work. It will soon be time to pick my dear wife up from daycare and begin my night shift as a caregiver. I am sure there will be many diapers to change and laundry to do. No rest for the weary.

This is no way to live.

DJnAZ

This is no way to live.

That says it all.

White Crane

Jo, thank you so much for explaining the Miller Trust.  Neither attorney I consulted mentioned this to me.  I am going to tuck this information away for future reference along with the information about putting our home in my name if and when DH needs to go to MC.  I appreciate all the help I receive on this forum.  Thank you.

Brenda