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Old 02-21-2019, 09:36 AM   #21
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As noted above, most states have a program structured around these characteristics:

- Nursing homes can choose to have or not have “MediCAID” (Not Medicare) certification, meaning they have a certain number of Medicaid beds
- Medicaid certification means that the facility must accept what Medicaid pays, after the resident has met the asset/income tests (IOW, cannot self pay) in that particular state (IOW, the resident cannot be evicted for nonpayment)
- Most states have some form of asset recovery (Including the primary home) if Medicaid pays for care
- Medicaid will typically not pay for “Assisted Living” but, some (most?) states have some sort of graduated program to help with ADL when necessary.

I see you’re in Warren, Michigan. You may want to check out the PACE program, which includes services in Warren, if your in-laws are there (or in another area served by PACE).

https://www.michigan.gov/mdhhs/0,588...7437--,00.html

ETA: I went through this process in another state and, I found the State Agency on Aging VERY helpful. Suggest you contact them if you’ve not already done so.

https://www.michigan.gov/osa/1,4635,...5815--,00.html
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Old 02-21-2019, 09:45 AM   #22
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Bolded - Agree although I don't believe this concept works 100% of the time. Nevertheless if my parents need LTC, the plan is to spend down some assets to zero while protecting other assets in an irrevocable trust.
Yes, I'll bet none of of this works 100% of the time anywhere.

The other big deal killer is, as someone else mentioned, the never-popular waiting list. Depending on your location and "Druthers" you can have all the money in the world but if there's no room at the inn.... you're out. And you have to hold on until you find something
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Old 02-21-2019, 10:17 AM   #23
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I give you the "medicaid rates" but I can speak to my personal experience.

My mother got into a nice one. In fact it was rated 5 stars by some place that rates these things. She had nothing except her rather meager social security a small pension and medicaid.

My own research, which includes reading of other people's experiences on this forum, indicates that most decent, perfectly reasonable nursing homes will accept medicaid but not right from the Day #1. Those would be the less desirable ones. But if you can fund the first year or two from private funds at retail rates, if you're still around and the money has run out, you will continue on as resident/patient with no changes and will not be thrown out. They will continue to collect your social security and any pensions or annuities you might have and just file to have medicaid pay the difference.

Sounds like a reasonable approach.

I cannot say for sure, but I suspect the nursing home my mother got into takes a certain number of "medicaid only" patients every year as a sort of pro-bono thing and she pulled the lucky number.

As a Nursing Home Administrator, if someone had over a year of private assets to spend down prior to transitioning to Medicaid, we would usually accept that person as a new resident so long as the our ability to care for them on the medical side checked out.




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Old 02-21-2019, 10:21 AM   #24
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Yes, I'll bet none of of this works 100% of the time anywhere.

The other big deal killer is, as someone else mentioned, the never-popular waiting list. Depending on your location and "Druthers" you can have all the money in the world but if there's no room at the inn.... you're out. And you have to hold on until you find something

There is a five year look back period on assets. Believe me that the feds and nursing homes have seen every trick in the book to shelter, transfer, or hide assets. My advice is to play it straight or you could find yourself in the Klink.
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Old 02-21-2019, 10:26 AM   #25
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It appears OP that you asked what Medicaid pays a nursing home to care for your loved one. The answer is that each year the nursing home files a cost report prepared usually by a CPA firm that has people specifically trained to do these. The report can be very long and details every aspect of the homes costs, occupancy rates and much more. The homes are sometimes audited by the state and / or the feds to ensure the accuracy of the report. From that a "Medicaid rate" is assigned for the next 12 month period. The facility is paid this rate per day for each resident on Medicaid.
Awesome info, thanks
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Old 02-21-2019, 10:33 AM   #26
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OP-

As noted above, most states have a program structured around these characteristics:

- Nursing homes can choose to have or not have “MediCAID” (Not Medicare) certification, meaning they have a certain number of Medicaid beds
- Medicaid certification means that the facility must accept what Medicaid pays, after the resident has met the asset/income tests (IOW, cannot self pay) in that particular state (IOW, the resident cannot be evicted for nonpayment)
- Most states have some form of asset recovery (Including the primary home) if Medicaid pays for care
- Medicaid will typically not pay for “Assisted Living” but, some (most?) states have some sort of graduated program to help with ADL when necessary.

I see you’re in Warren, Michigan. You may want to check out the PACE program, which includes services in Warren, if your in-laws are there (or in another area served by PACE).

https://www.michigan.gov/mdhhs/0,588...7437--,00.html

ETA: I went through this process in another state and, I found the State Agency on Aging VERY helpful. Suggest you contact them if you’ve not already done so.

https://www.michigan.gov/osa/1,4635,...5815--,00.html
thank you and thanks for the reminder about PACE, I read a bit about it before and even bookmarked the site but forgot about it
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Old 02-21-2019, 10:36 AM   #27
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There is a five year look back period on assets. Believe me that the feds and nursing homes have seen every trick in the book to shelter, transfer, or hide assets. My advice is to play it straight or you could find yourself in the Klink.
My statement was not addressing assets vs medicaid vs applicable rules. It was aimed solely at finding a place to get into even if you had a ton of money and medicaid was not a factor.
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Old 02-21-2019, 12:49 PM   #28
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My statement was not addressing assets vs medicaid vs applicable rules. It was aimed solely at finding a place to get into even if you had a ton of money and medicaid was not a factor.
No problem. I was not addressing any single person with this comment. I should have perhaps used the word "one" or "people" instead of the word "you".
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Old 02-21-2019, 01:02 PM   #29
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There is a five year look back period on assets. Believe me that the feds and nursing homes have seen every trick in the book to shelter, transfer, or hide assets. My advice is to play it straight or you could find yourself in the Klink.
Like the reference.
But as you mentioned in another post, if one can pay for a years' worth.......
So if the irrevocable trust is set up legally and a 5 year window has passed with the current assets not being touched, that should work, no?
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Old 02-21-2019, 01:30 PM   #30
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OP-


ETA: I went through this process in another state and, I found the State Agency on Aging VERY helpful. Suggest you contact them if you’ve not already done so.

https://www.michigan.gov/osa/1,4635,...5815--,00.html
This is very true. When I contacted the Agency on Aging in my State they sent me a very comprehensive list of facilities with notations on which accepted medicaid and which did not. From that list I was able to make contacts and determine what options were available for my Mom.


Another comment someone has made here about protecting assets in a Trust, will only work if the transfer is made 5 years in advance of the need. If not the ¨lookback period¨will force a reversal of the trust. States are very careful about making sure that there are no assets overlooked going back 5 years. They will even disallow cash gifts to family members for birthdays etc. if the sums are more than nominal.
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Old 02-21-2019, 02:15 PM   #31
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This is very true. When I contacted the Agency on Aging in my State they sent me a very comprehensive list of facilities with notations on which accepted medicaid and which did not. From that list I was able to make contacts and determine what options were available for my Mom.


Another comment someone has made here about protecting assets in a Trust, will only work if the transfer is made 5 years in advance of the need. If not the ¨lookback period¨will force a reversal of the trust. States are very careful about making sure that there are no assets overlooked going back 5 years. They will even disallow cash gifts to family members for birthdays etc. if the sums are more than nominal.
So referring to your above comment, if one has 1mm in an irrevocable trust and there are earnings 150k of total interest in 5 years which is passed through to a regular taxable account.
The "principle amount of 1mm is not touched for those 5 years.

Isn't the 1mm principle still protected?
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Old 02-22-2019, 02:54 AM   #32
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https://www.agingcare.com/articles/h...ity-207367.htm
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Old 02-22-2019, 05:26 AM   #33
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Can you please give us a snippet or explanation?
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Old 02-22-2019, 05:37 AM   #34
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I have found that the folks who seek out a good attorney that specializes in eldercare usually get really good results on behalf of their loved one's. They can tell you what financial moves are appropriate and complete those arrangements. The long term care facilities (at least in CT.) know that a prospective resident represented by one of these respected lawyers is going to have an accurate financial disclosure statement. The really good one's will do educational seminars for Nursing Home Administrators groups to help the administrators fulfill continuing education requirements. Often they will consult with the associations that represent long term care facilities in each state. These might be good questions to ask the attorney prior to engaging them.
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Old 02-22-2019, 07:41 AM   #35
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So referring to your above comment, if one has 1mm in an irrevocable trust and there are earnings 150k of total interest in 5 years which is passed through to a regular taxable account.
The "principle amount of 1mm is not touched for those 5 years.

Isn't the 1mm principle still protected?
I'm not an attorney, so this response is worth what you paid for it, but I would think that in the situation described the 1MM is safe, however, if the person who received the $150,000 is the potential medicaid patient, I would think that the continued receipt of funds from that trust would be analyzed by the State and either disqualify the patient from medicaid or be forfeited to the state, if less than the medicaid payment threshold. IOW, the trust could not arbitrarily stop distributing funds to that beneficiary.
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Old 02-22-2019, 08:18 AM   #36
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Can you please give us a snippet or explanation?
https://www.agingcare.com/articles/h...ity-207367.htm

This link shows how to use a Miller Trust for Medicaid Eligibility.

Sorry it was late when I posted it. In the case of my mother going to a nursing home. For a number of reasons my mother wasn’t a saver and didn’t have significant assets enough to private pay a nursing home for a very long. She was a few hundred dollars short per month. I hired an elder care lawyer and he assisted in mom’s Medicaid application, setting up a Qualified Income Trust to send her social security and retired VA widow benefits to pay the nursing home. This is not a way to shelter the money just a legal avenue from a Supreme Court case is my understanding Miller Trust. At the time all the Medicaid rules apply, less than $2000.00 assets in the bank, less than $2250.per month etc. In her case her pension and social security was $3367.00 per month. Again, she still has to spend all her applied income to the facility with the exception of $60.00 personal needs. My mom lives in Texas and this Miller Trust may not apply in all states. I can’t stress the importance of getting a lawyer that specializes in elder care in similar situations.
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Old 02-22-2019, 08:20 AM   #37
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I'm not an attorney, so this response is worth what you paid for it, but I would think that in the situation described the 1MM is safe, however, if the person who received the $150,000 is the potential medicaid patient, I would think that the continued receipt of funds from that trust would be analyzed by the State and either disqualify the patient from medicaid or be forfeited to the state, if less than the medicaid payment threshold. IOW, the trust could not arbitrarily stop distributing funds to that beneficiary.
Okay thanks. I am dealing with their trust attorney on the setup, etc, but haven't made any distributions yet, so that concept was not discussed yet.
They don't need the income from the trust and likely would not need it in an LTC situation either.
My angle was the protection of the monies contrasted with minimizing taxes.
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Old 02-22-2019, 08:28 AM   #38
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I have found that the folks who seek out a good attorney that specializes in eldercare usually get really good results on behalf of their loved one's. They can tell you what financial moves are appropriate and complete those arrangements. The long term care facilities (at least in CT.) know that a prospective resident represented by one of these respected lawyers is going to have an accurate financial disclosure statement. The really good one's will do educational seminars for Nursing Home Administrators groups to help the administrators fulfill continuing education requirements. Often they will consult with the associations that represent long term care facilities in each state. These might be good questions to ask the attorney prior to engaging them.
Luckily the administrator at the facility my mom lives directed me to this lawyer. From what I have seen all residents get the same treatment private pay or not.
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Old 02-22-2019, 08:48 AM   #39
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I have found that the folks who seek out a good attorney that specializes in eldercare usually get really good results on behalf of their loved one's. They can tell you what financial moves are appropriate and complete those arrangements. The long term care facilities (at least in CT.) know that a prospective resident represented by one of these respected lawyers is going to have an accurate financial disclosure statement. The really good one's will do educational seminars for Nursing Home Administrators groups to help the administrators fulfill continuing education requirements. Often they will consult with the associations that represent long term care facilities in each state. These might be good questions to ask the attorney prior to engaging them.
We spent the money and hired an elder care attorney. She was knowledgeable and efficient. All the running around I did prior trying to get answers was not necessary. She gave us a written outline of her recommendations as well as sat with us to explain all the details. She was thorough. In the end, you do have to do a lot of work gathering info, but at least you’ll have a true answer to all of your questions. Especially for your state.
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Old 02-22-2019, 08:53 AM   #40
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[QUOTE=Col. Klink;2194701]As a Nursing Home Administrator, if someone had over a year of private assets to spend down prior to transitioning to Medicaid, we would usually accept that person as a new resident so long as the our ability to care for them on the medical side checked out.


This. My mother was accepted into the nursing home that was also a Medicaid NH. She had a years worth ($8000 a month) to pay for her care privately. She will then transition to Medicaid. I hired an elder care attorney who helped me get ready for the huge undertaking of applying for Medicaid. The 5 year look back is extremely time consuming, unless the person had no assets during that time. My mother did.
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