My sister had a stroke in October 2021 and is now in a nursing home. She still owns a home valued at approximately $90,000. I need to sell her house. Any advice?

The letter- a Right of (to) Return - allows the home to stay considered an exempt asset for LTC Medicaid. So when the caseworker is evaluating the Sisters application that 90K home will not be counted as an asset. NonExempt Assets for an individual for NH Medicaid for most states are a maximum of $2,000. So it the “right of return” isn’t signed, she will have $92,000.00 in nonexempt assets so will not be eligible.

NH sister can continue to own her home if she wants to and family can decide to do whatever to enable all that to happen. The rub is that the NH sister is required to do a copay of almost all her monthly income to Nh as a copay. All Nh Sis will have for her own $ will be a smallish personal Needs Allowance which tend to avg $50-60 a mo. PNA tend to maybe be enough to pay for onsite beauty shoppe & some toiletries replacement. The required copay often comes as a total surprise to family. The NH become the heavy in all this as they want that mo income; and they know if there’s still a home that unless they POA absolutely understands this, there’s going to be an issue in getting the copay.

NH Sis can keep her home BUT Nh Sis has zero $ for home. So someone’s else is going to have to pay all property costs on Nh Sisters home. It’s on the elder and their family to make a decision and stick to the decision even if it means years.

I’ve been on this forum a long time, what tends to happen is siblings are all “guvmint not gettin’ maws place” for about 6-8 months, then Sister who was to pay property taxes, doesn’t & Brother who was to pay insurance, doesn’t and your kid who was going to cut the grass every month has left the State with new girlfriend. If your the POA dealing with all this is on you and your wallet. Parents house becomes an albatross. So goes up for sale. As NH mom still owns it, all the $ from the Act of Sale is all moms. She cannot easily give you $ from house sale as it looks like gifting. Medicaid imo tend to take the position that what we do for our folks we do out of a sense of familial responsibility and without repayment. It can get expensive and complicated to try to establish otherwise.

Glad, not making light of your answer but if it’s a state that lets the elder keep their house sale $, so become ineligible and have to do a fresh “spend down”, I bet they have to use it first and foremost to private pay for their NH but if they do not have a preneed funeral and burial, they can use some of the $ to buy one of those. It’s have to be within whatever limits Medicaid has on those - maybe under $7,500. Also they might be able to spend on things the LTC Medicaid will never ever pay for like dental care. Dental can be just so expensive and no coverage usually via Medicare so they do without it for years.

if they have to, have to, exclusively spend done on mo private pay Nh that’s one thing, but if their state allows a wider use of the $, that’s another. It falls to the POA to be proactive in all this, which can be challenging.

My take on this is there’s 2 paths for elder who owns home but goes onto LTC Medicaid: 1. They keep home & all rolls into after death attempt by estate recovery to get a recoup or
2. Elder sells home so become ineligible for LTC Medicare as financially no longer “at need”.
They run very differently & interdependent on your states laws on property rights, probate & how the administrative code is for a financial change in “at need” status. Fwiw selling home happens & you can see that & stand in it; but what I’ve been surprised in is the # of elders on LTC Medicaid who inherit $ from well meaning family…. like a cousin who loved Auntie so leaves her a modest amount of 5K in his will…. & horrors! elderly Auntie now ineligible.

But whichever, here’s the rub, LTC Medicaid agreement on reinbursement is between facility & the program. State pays a daily preset room&board cost pretty much in real time, based on daily butts-in-beds count. To me how LTC pays is very similar to what public schools do & why public schools really stress kiddos have to be there by 8:00 bell and not signed out until 9:15 cause in order for school to be paid it’s 9:00 census that gets reported. Anyways because of this, the elder, in my experience, does not get or see a bill during their lifetime. It is only after they die, that a summary or tally of State payments to the NH on the elders behalf is sent to the old and no longer POA on file for the elder. It’s sent by a Notice of Intent (to seek a recoup) and will be a $ amount and not an itemization. Medicaid becomes aware elder has dies, produces the itemization and then it goes to however your state does MERP to do a NOI. Like if done by a division of Medicaid or an outside contractor for MERP and perhaps also Dept of Insurance if there’s a “Estate Of” policy involved.

Ime if you want to see what a NH is being paid by the State, you have to submit this as a request to the State which then sends a letter to the participating NH allowing you a copy of their internal payment document. I did this for 1st NH my mom was in as it was a total clusterF as to her billing first few months, would be corrected then mistakes again. A rinse and repeat, it was part of the reason why I moved her to another NH within her first year.

Anyways I digress, in LTC Medicaid application, there should & will be a section that states that any change in financial status has to be reported to the state within X period of time. Someone signed off legally on this and it’s subject to penalties if ignored. If it’s 30 days, then, the POA has to report it in writing to the State and State sends back paperwork to be filled out along with copies of the checks, deposits, probate court distribution document (like for that 5K @Auntie got). What happens next to me seem to be totally dependent on your state. I think if you’re in a TEFRA state they can capture the house sale $, apply it to the tally and you spend down till impoverished once again. Other States have elder use the $ to private pay from this point forward. So on a spend down and should they die before using it all up, the remainder goes to the state under estate recovery rules. Just what happens is State by State dependent.

Yeah it’s a maddening maze, an add to this that what’s involved is very much legal and folks you are dealing with on this tend not to be attorneys….. the caseworker, a Realtor, me as a not-an-attorney poster on AC, a well meaning neighbor….. are giving you their opinion or experience…. but it may not be valid for your elders or your situation. That’s why it’s always good to run whatever contemplated with an atty with experience.

Ok, my bad, the document to have house remain exempt asset is a “Right to Return” not a Notice of Intent (NOI). The NOI is what Medicaid or their outside contractor sends out as a letter to whomever Medicaid had on file as next of kin or was old POA after an elder who has been on LTC Medicaid had died. Intent as in the required attempt to recovery or recoup costs paid.