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.
Show:
Articles Question
Question
VA Aid and Attendance and Nursing Home
There must be a miscommunication or misunderstanding in the nursing home business office. The $90 is in addition to the $75/month personal... There must be a miscommunication or misunderstanding in the nursing home business office. The $90 is in addition to the $75/month personal needs allowance (PNA) that the CT nursing home resident gets to keep from his or her monthly income. (the monthly PNA is $72.80 in MA).
The VA reduces the monthly Aid and Attendance (A&A) benefit to $90 per month for veterans or surviving spouses who are in a Medicaid-approved nursing home, and have their care covered by Medicaid. This $90 is a personal needs allowance, IN ADDITION TO the standard Medicaid personal allowance.
From the VA's online manual: Chapter 3. Pension Reductions for Medicaid-Covered Nursing Facility Care
1. General Information on Pension Reductions for Medicaid-Covered Nursing Facility Care
38 CFR 3.551(i) limits to $90 per month the amount of Improved Pension that can be paid to a veteran (or surviving spouse) with no dependents who
· is in a Medicaid-approved nursing facility, and
· is covered by a Medicaid plan for services furnished by the nursing facility.
No part of the $90 monthly Improved Pension may be used to reduce the amount of Medicaid paid to a nursing facility.
https://www.benefits.va.gov/warms/docs/admin21/m21_1/mr/part5/subptiii/ch03/ch03.doc see more
The VA reduces the monthly Aid and Attendance (A&A) benefit to $90 per month for veterans or surviving spouses who are in a Medicaid-approved nursing home, and have their care covered by Medicaid. This $90 is a personal needs allowance, IN ADDITION TO the standard Medicaid personal allowance.
From the VA's online manual: Chapter 3. Pension Reductions for Medicaid-Covered Nursing Facility Care
1. General Information on Pension Reductions for Medicaid-Covered Nursing Facility Care
38 CFR 3.551(i) limits to $90 per month the amount of Improved Pension that can be paid to a veteran (or surviving spouse) with no dependents who
· is in a Medicaid-approved nursing facility, and
· is covered by a Medicaid plan for services furnished by the nursing facility.
No part of the $90 monthly Improved Pension may be used to reduce the amount of Medicaid paid to a nursing facility.
https://www.benefits.va.gov/warms/docs/admin21/m21_1/mr/part5/subptiii/ch03/ch03.doc see more
Question
What would disqualify me from caregiver pay to take care of my mom, who has lived with me 12 years and now nee...
Other community members have already explained how Medicaid paid programs in your state can cover your mother's home care. The care you... Other community members have already explained how Medicaid paid programs in your state can cover your mother's home care.
The care you provide protects her and saves the state from having to pay for care in a skilled nursing facility.
To answer your question "what would disqualify me from caregiver pay," let's focus on who would be paying you: Your mother? The state Medicaid program? or maybe both?
Your mother could pay you from her income and assets, but you will need a written Caregiver Contract with her to document the work you are doing. Your hourly rate of pay should conform to what home health care providers are paid in your state. Set up a payroll with a local accountant or online payroll service to keep track of your income taxes. You'll be contributing to your own Social Security retirement account by complying with the tax laws.
Without these payroll formalities that document your mother's money is being spent for valuable services, the transfers could be considered disqualifying, and your mother could be denied Medicaid in the future.
The Medicaid program in your state could pay for the care you provide, if your mother's income and assets fit under the eligibility limits. If your mother's life savings are over the asset limits, she can spend them down by paying you.
Most states already have a 5-year look-back period for Home and Community-Based Services (HCBS) programs, meaning that an elder can't simply give away assets within five years before applying for Medicaid. My state (Massachusetts) didn't have this transfer restriction for elders needing home care, but beginning in 2026 the 5 year rule is being imposed here. California had a shorter 3 year look back period, but California will also be looking back 5 years starting in 2026.
It's possible you could be paid by both your mother and by the Medicaid program, if you carefully document your services and comply with the program rules. By documenting your care services you protect yourself and your mother's eligibility now and in the future.
Your question indicates that you already own the house you are living in. For other people reading this, it's worth mentioning that Medicaid has exceptions that allow an elder to transfer their house to a disabled family member or to a caregiver child who lives in the house. But there are strict requirements for using these exceptions. see more
The care you provide protects her and saves the state from having to pay for care in a skilled nursing facility.
To answer your question "what would disqualify me from caregiver pay," let's focus on who would be paying you: Your mother? The state Medicaid program? or maybe both?
Your mother could pay you from her income and assets, but you will need a written Caregiver Contract with her to document the work you are doing. Your hourly rate of pay should conform to what home health care providers are paid in your state. Set up a payroll with a local accountant or online payroll service to keep track of your income taxes. You'll be contributing to your own Social Security retirement account by complying with the tax laws.
Without these payroll formalities that document your mother's money is being spent for valuable services, the transfers could be considered disqualifying, and your mother could be denied Medicaid in the future.
The Medicaid program in your state could pay for the care you provide, if your mother's income and assets fit under the eligibility limits. If your mother's life savings are over the asset limits, she can spend them down by paying you.
Most states already have a 5-year look-back period for Home and Community-Based Services (HCBS) programs, meaning that an elder can't simply give away assets within five years before applying for Medicaid. My state (Massachusetts) didn't have this transfer restriction for elders needing home care, but beginning in 2026 the 5 year rule is being imposed here. California had a shorter 3 year look back period, but California will also be looking back 5 years starting in 2026.
It's possible you could be paid by both your mother and by the Medicaid program, if you carefully document your services and comply with the program rules. By documenting your care services you protect yourself and your mother's eligibility now and in the future.
Your question indicates that you already own the house you are living in. For other people reading this, it's worth mentioning that Medicaid has exceptions that allow an elder to transfer their house to a disabled family member or to a caregiver child who lives in the house. But there are strict requirements for using these exceptions. see more
Question
Is an elder care attorney necessary if you have a will/trust?
As another responder mentioned, it's important to have your attorney review your circumstances and existing documents every few years.... As another responder mentioned, it's important to have your attorney review your circumstances and existing documents every few years.
If you have modest or substantial life savings and you own real estate, you can get accurate advice from an Estate Planning Attorney who also keeps up with Elder Law planning in your state.
The attorney will review your existing will/trust, and explain how your existing document(s) work during your lifetime, and upon your death.
You'll begin to understand whether your existing documents are designed to accomplish what you want.
Many people want to avoid Probate during their lifetime and upon death, and also be eligible for Medicaid paid care if they need it in the future.
An explanation of these 2 goals requires Estate Planning, Real Estate and Elder Law expertise. The other important circumstances in your life must also be considered: your current health, resources needed now and in the future, and the health and needs of other people who are important to you.
When I meet with a client, we create an inventory of their asset values and how they own each asset (example: Individually Owned? Jointly Owned? owned by them as Trustee? etc.) Each asset is entered into the asset category that is relevant to the IRS, our state's Probate Court, and to a Medicaid case worker who would review an eligibility application in the future.
The Will, Trust and Power of Attorney documents are then designed to accomplish and protect your goals for your lifetime, and the legacy your you want to leave for your family.
You may find that your existing documents continue to do what you need them to do. Or if law and circumstances have changed, updated documents will give you the confidence you need to manage life now and in the future. see more
If you have modest or substantial life savings and you own real estate, you can get accurate advice from an Estate Planning Attorney who also keeps up with Elder Law planning in your state.
The attorney will review your existing will/trust, and explain how your existing document(s) work during your lifetime, and upon your death.
You'll begin to understand whether your existing documents are designed to accomplish what you want.
Many people want to avoid Probate during their lifetime and upon death, and also be eligible for Medicaid paid care if they need it in the future.
An explanation of these 2 goals requires Estate Planning, Real Estate and Elder Law expertise. The other important circumstances in your life must also be considered: your current health, resources needed now and in the future, and the health and needs of other people who are important to you.
When I meet with a client, we create an inventory of their asset values and how they own each asset (example: Individually Owned? Jointly Owned? owned by them as Trustee? etc.) Each asset is entered into the asset category that is relevant to the IRS, our state's Probate Court, and to a Medicaid case worker who would review an eligibility application in the future.
The Will, Trust and Power of Attorney documents are then designed to accomplish and protect your goals for your lifetime, and the legacy your you want to leave for your family.
You may find that your existing documents continue to do what you need them to do. Or if law and circumstances have changed, updated documents will give you the confidence you need to manage life now and in the future. see more
Question
Parents quit claimed their home to their children that can't agree on how to sell or manage the property. How...
Other responses have already touched on the important legal things your need to think about such as: > capital gains tax if the... Other responses have already touched on the important legal things your need to think about such as:
> capital gains tax if the children sell the house,
> whether you want to launch a Probate Court "Petition to Partition" that could force the children to sell their interest to one of them, or to another buyer,
> the ownership status of the children if one of them dies (Is it "Tenants in Common", meaning the deceased child's interest survives them and passes to the decedent's heirs or is it "Joint Tenants", meaning the deceased child's interest evaporates and is absorbed by the surviving children.)
Also, your question doesn't say whether Parents are still alive, and if they are, where they are living and what is their health status?
If Mom and Dad are still living, protecting them is most important, correct? The decision on how to handle the house they gifted depends on what's best for them.
If they're still living, a previous response pointed out how it matters to Medicaid eligibility whether the house transfer was within the past 5 years.
Another response pointed to the Principal Residence Exclusion, which wouldn't shelter the profits if the house is sold during the Parent's lifetime, since the children don't live in the residence.
But if the Parent's are deceased, and the deed they had signed reserved a Life Estate for the Parents, the children
do get a step up in tax basis that covers the capital gain. Holding onto the house becomes a business decision if both Parents have passed.
With all these insights, you now have what you need for an intelligent conversation with a Real Estate / Elder Law attorney in your state who can consider all the facts and advise you on the costs and benefits of all your options.
Others reading this may reckon that simply signing a Deed that transfers immediate ownership of a house to several children is a step that often oversimplifies a significant decision. Using a Trust to hold ownership of a house can accomplish the goals you have in mind, keep more options open, and save the family from misunderstandings and expense in the future.
Links to info on Principal Residence Exclusion:
https://estateplansplus.com/html/real_estate_income_tax.html see more
> capital gains tax if the children sell the house,
> whether you want to launch a Probate Court "Petition to Partition" that could force the children to sell their interest to one of them, or to another buyer,
> the ownership status of the children if one of them dies (Is it "Tenants in Common", meaning the deceased child's interest survives them and passes to the decedent's heirs or is it "Joint Tenants", meaning the deceased child's interest evaporates and is absorbed by the surviving children.)
Also, your question doesn't say whether Parents are still alive, and if they are, where they are living and what is their health status?
If Mom and Dad are still living, protecting them is most important, correct? The decision on how to handle the house they gifted depends on what's best for them.
If they're still living, a previous response pointed out how it matters to Medicaid eligibility whether the house transfer was within the past 5 years.
Another response pointed to the Principal Residence Exclusion, which wouldn't shelter the profits if the house is sold during the Parent's lifetime, since the children don't live in the residence.
But if the Parent's are deceased, and the deed they had signed reserved a Life Estate for the Parents, the children
do get a step up in tax basis that covers the capital gain. Holding onto the house becomes a business decision if both Parents have passed.
With all these insights, you now have what you need for an intelligent conversation with a Real Estate / Elder Law attorney in your state who can consider all the facts and advise you on the costs and benefits of all your options.
Others reading this may reckon that simply signing a Deed that transfers immediate ownership of a house to several children is a step that often oversimplifies a significant decision. Using a Trust to hold ownership of a house can accomplish the goals you have in mind, keep more options open, and save the family from misunderstandings and expense in the future.
Links to info on Principal Residence Exclusion:
https://estateplansplus.com/html/real_estate_income_tax.html see more
Question
Where can I find out if I qualify for financial support? I am a caregiver for my 96-year-old mom who lives wit...
If you Google: "mediciad paid care for family members" the Artificial Intelligence will tell you that:... If you Google: "mediciad paid care for family members" the Artificial Intelligence will tell you that: "Yes, Medicaid can pay family members for caregiving through state-specific programs."
The first step is getting Medicaid Eligibility for your mom: "The person needing care must qualify for Medicaid Long-Term Care (LTC) benefits by meeting state income and asset limits, plus a clinical 'level of care' requirement (needing help with activities like bathing, dressing).
In the lingo of Medicaid Eligibility, your loved one at home needs to qualify for the "Frail Elder Waiver."
The waiver is granted to help keep people out of nursing homes. It's much cheaper for government to contribute to care at home.
Your elder law attorney can show you how to arrange your mother's assets so they fit into the waiver. Also, her income has to be below 3x the federal benefit rate.
In my state (Massachusetts) there are several programs that can pay family members (but not the person's spouse) to provide care. The 2026 monthly income limit for Frail Elder Waiver, PACE, and Moving Forward Plan (Money Follows the Person) Waiver is $2,982 [calculated by multiplying the SSI Federal Benefit Rate of $994 x 3 = $2,982 / month].
If Mom's Social Security Retirement + Pensions + other income is above these monthly income limits you would have to comply with an elaborate spend down - deductible procedure based on money she spends on care and medical bills.
And, I made a video explaining why family members need to sign a Caregiver Contract if they are taking money from their parent as payment for caregiving. Without the Contract documentation the parent can end up being disqualified from Medicaid in the future, or become ineligible for bankruptcy protection:
https://youtu.be/59DmNClGl3M?si=bi2Ng06JENaFCtCc
Also it's possible to get some coverage from Medicare. Here's a Q & A on that:
https://masshealthhelp.com/pdf/2022%2001%2012%20Home%20Health%20%20&A.pdf
Finally, if you decide to have homecare people come into your home, you need to be aware of the risks and responsibilities of hiring paid caregivers. These articles talk about the tax and tort problems that people get into if they try to go under the table:
https://masshealthhelp.com/pdf/Sustainable_Home_Care_1_NAELA_News.pdf
https://masshealthhelp.com/pdf/Sustainable_Home_Care_2_NAELA_News.pdf see more
The first step is getting Medicaid Eligibility for your mom: "The person needing care must qualify for Medicaid Long-Term Care (LTC) benefits by meeting state income and asset limits, plus a clinical 'level of care' requirement (needing help with activities like bathing, dressing).
In the lingo of Medicaid Eligibility, your loved one at home needs to qualify for the "Frail Elder Waiver."
The waiver is granted to help keep people out of nursing homes. It's much cheaper for government to contribute to care at home.
Your elder law attorney can show you how to arrange your mother's assets so they fit into the waiver. Also, her income has to be below 3x the federal benefit rate.
In my state (Massachusetts) there are several programs that can pay family members (but not the person's spouse) to provide care. The 2026 monthly income limit for Frail Elder Waiver, PACE, and Moving Forward Plan (Money Follows the Person) Waiver is $2,982 [calculated by multiplying the SSI Federal Benefit Rate of $994 x 3 = $2,982 / month].
If Mom's Social Security Retirement + Pensions + other income is above these monthly income limits you would have to comply with an elaborate spend down - deductible procedure based on money she spends on care and medical bills.
And, I made a video explaining why family members need to sign a Caregiver Contract if they are taking money from their parent as payment for caregiving. Without the Contract documentation the parent can end up being disqualified from Medicaid in the future, or become ineligible for bankruptcy protection:
https://youtu.be/59DmNClGl3M?si=bi2Ng06JENaFCtCc
Also it's possible to get some coverage from Medicare. Here's a Q & A on that:
https://masshealthhelp.com/pdf/2022%2001%2012%20Home%20Health%20%20&A.pdf
Finally, if you decide to have homecare people come into your home, you need to be aware of the risks and responsibilities of hiring paid caregivers. These articles talk about the tax and tort problems that people get into if they try to go under the table:
https://masshealthhelp.com/pdf/Sustainable_Home_Care_1_NAELA_News.pdf
https://masshealthhelp.com/pdf/Sustainable_Home_Care_2_NAELA_News.pdf see more
Question
How do we proceed handling our aunt's finances?
Your aunt's life savings can be set aside and protected in a pooled trust account, if your state's Medicaid regulations allow this.... Your aunt's life savings can be set aside and protected in a pooled trust account, if your state's Medicaid regulations allow this. In my state (Massachusetts) we obtain Medicaid eligibility for the nursing home resident by transferring his/her excess assets to the pooled trust and immediately applying for MassHealth. The MassHealth rate is much lower than the private paid rate. An elder law attorney can explain how this could benefit your aunt's heirs in the future.
Also, there are several categories of people who can receive transfers of your aunt's assets without disqualifying her from Medicaid paid care.
To do this planning you need the POA authority, but if you don't have that, your elder law attorney can get you legally authorized using a Probate Process called (in my state) conservatorship.
If you haven't spent down all or your aunt's life savings it's worth the effort to get the legal authority and do the planning. The sooner you get started the more of her life savings can be set aside for her supplemental care and special needs. You'll save her from becoming completely impoverished, and you'll be able to provide her with things to make her life better.
https://www.masshealthhelp.com/pdf/pooled-trusts-massachusetts.pdf see more
Also, there are several categories of people who can receive transfers of your aunt's assets without disqualifying her from Medicaid paid care.
To do this planning you need the POA authority, but if you don't have that, your elder law attorney can get you legally authorized using a Probate Process called (in my state) conservatorship.
If you haven't spent down all or your aunt's life savings it's worth the effort to get the legal authority and do the planning. The sooner you get started the more of her life savings can be set aside for her supplemental care and special needs. You'll save her from becoming completely impoverished, and you'll be able to provide her with things to make her life better.
https://www.masshealthhelp.com/pdf/pooled-trusts-massachusetts.pdf see more
Question
What is a Medicaid waiver?
Home Care paid by Medicaid is called a "Waiver" program, because the federal government waives the requirement that... Home Care paid by Medicaid is called a "Waiver" program, because the federal government waives the requirement that Medicaid pay only for care inside a nursing home.
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
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
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
Mom's nursing home sent bill for 2 months while Medicaid is almost finalized.
Unfortunately, people procrastinate and wait to apply for Medicaid nursing home coverage, instead of filing an acceptable application as soon as they know the need for nursing home is going to be permanent. They don't understand how to bring their assets into compliance so the application can be allowed.
When filling out the application for Long-Term Care, the Medicaid agency (MassHealth in my state) asks whether you have bills for medical services you got during the three months before you sent in the application. Does this mean that Medicaid will always pay retroactive nursing home bills going back 3 months? Not always.
Let's say that Mrs. Rose is admitted to a nursing home on January First, but she procrastinates, and does not apply for Medicaid until April 1st when she still has $12,000 in her savings account.
If Mrs. Rose uses her savings to buy a $10,000 prepaid funeral contract, that leaves her with only $2,000. She submits a copy of her funeral contract to the Medicaid agency and becomes eligible for Medicaid starting 3 months before her application. Buying the funeral contract doesn’t violate the MassHealth transfer rules.
In my example, Mrs. Rose is fortunate. She gets eligibility “as of the date the applicant reduces his or her excess assets" to the allowable $2,000 asset limit without violating the transfer of resource provisions for nursing-facility residents. Mrs. Rose will only pay the Patient Paid Amount: all of her monthly income except for a small Personal Needs Allowance.
What if Mrs. Rose had assets worth more than her funeral contract, or if she had a Spouse at home who has assets worth more than his Community Spouse Asset Allowance?
If she has unpaid medical bills, those could reduce the value of her excess assets, opening up eligibility during the retro period. But when medical bills are less than the applicant’s excess assets it won't matter because her excess assets are still too high during the retro period.
There are other ways to comply without violating the asset transfer rules. But the nursing home business office won't take time to explain. They need residents to continue paying privately.
In your case, if your mother reduced her life savings below the asset limit (without violating the transfer regulations), she can be asset eligible for her previous 90 days of care. She'll owe only the Patient Paid Amount, based on her monthly income.
Getting professional help to prepare and file the application promptly is worth it. By December 31, 2026, the retroactive eligibility period for Medicaid coverage of nursing home and medical expenses will be shortened to only 60 days!
https://www.ama-assn.org/system/files/changes-to-medicaid-and-chip-enrollment-eligibility-and-cost-sharing-summary.pdf see more