Medicaid eligibility for nursing home

[Bdarr]

Well medicaid requires one to be in poverty does it not, one has to spend down all their money and the medicaid system is there for that purpose. 1 yr ago I had to put my father into nursing home, his only asset was his house. We sold his house and use the assets to pay for his nursing home. The deal made was they would take medicaid after paying 3 years of payments. They are in business so I understand.
One plans for a secure retirement, one also needs to plan for ones exit strategy. I think it is clear what the goal is.

I will leave it at that!

 

[MarieIG]

For OP -

Discuss with your attorney "exempt assets," paying off the house, the sum the non-nursing home spouse can "keep," the income which can be allocated to the non-nursing home spouse to avoid impoverishment and how this would be done.

Regarding Roth conversions, as far as I am aware, your 401k cannot be transferred to you wife (barring death or a QDRO).

Roth conversions might make sense if the converted funds (Roth 401k or Roth IRA) are exempt assets in your state, in that would reduce/ eliminate RMDs, and spouse could be listed as beneficiary. I would suggest you discuss this with your attorney (i.e. if the 401k is exempt - the RMDs may not be).

If 401k is not exempt in your state, discuss using a portion of the funds to buy a 100% joint and survivor SPIA. (Most likely all the funds from that would go towards nursing home care, but after the death of the institutionalized spouse, there would be something left for the surviving spouse.) However, this is dicey - hence the discussion, as there is the potential that it would disqualify you or spouse for certain services.

Good luck!

 

[badatmath]

I had a short thread earlier this year on assisted living (not nursing homes) throwing out Medicaid patients. https://www.early-retirement.org/fo...ing-medicaid-and-evicting-seniors-117646.html

It certainly seems that a lot of care goes into the selection of where to place the patient.

Here is another article that says it is illegal to kick you out of a nursing home when medicare rehab runs out but gee it still happens. https://www.nbcnews.com/news/us-new...cting-elderly-disabled-residents-who-n1087341

Whole topic makes me glad I have LTC though I brought the wrong policy and it is sort of a pitiful amount.

 

[mickeyd]

Have you looked at the nursing homes in your area that take Medicaid versus the private pay /CCRCs? In my area that nursing homes that take Medicaid are pretty awful. That is why I used my money to move into a CCRC with a very nice nursing home.

I'm with harllee on this one folks. It's hard to beat a good CCRC.

 

[LBrowning]

Spoke with a lawyer today. He advised doing nothing with my portfolio at this time, since our assets are all in exempt status. I'm still trying to decide on Roth conversion strategy.

 

[badatmath]

Spoke with a lawyer today. He advised doing nothing with my portfolio at this time, since our assets are all in exempt status. I'm still trying to decide on Roth conversion strategy.

Is the 401k exempt once you start taking RMDs? Or only while you are not.

 

[jim584672]

Is the 401k exempt once you start taking RMDs? Or only while you are not.

At least in NY retirement accounts are not countable resources as long as they are making annual payouts. Payments must be of sufficient amount that is actuarially sound - amortized over life expectancy. Those payouts are counted as income.

 

[LBrowning]

IRA/401k is a protected asset, but must be in monthly payout status, basically RMD divided by 12, which is counted as income. My wife would keep her SS, pension and $1100 of my income. The remainder of my SS, pension and 401k payout would be placed in a trust payable to Medicaid.