Can we protect parent's assets when starting the process of applying for Medicaid?

I'll address only the cost of the (first?) meeting. What will you get for $450? That could be about the cost of a 2 hour meeting, depending on the level of experience of the attorney or the cost of an hour meeting if you're meeting with a partner in a law firm. But it also depends on your area; rates are much higher in big cities, such as NYC or DC.

I doubt it would include preparation, filing and follow-through with Medicaid. That's an issue that should be clarified.

I don't have any experience with Medicaid, so I can't offer any other input, but there are plenty of people here who do have Medicaid experience and I'm sure they'll post tomorrow - postings seem to be higher in the mornings.

When it comes to Social Security, SSI, Medicare, and Medicaid applications, these agencies all claim that one does not need an attorney to go through the process of applying.
Contact HICAP (Health insurance and Counseling Advocacy Program).

Applying for Medicaid for a single (that is, unmarried) person is pretty straight-forward. My sister managed to do it for our mother.

Applying for Medicaid for a person who is married and whose partner will become the "community spouse" (person not living in a care center) is far more complicated. I felt I needed a lawyer. Applying for both spouses? Yikes! I have no idea.

Medicaid rules attempt to not leave the community spouse impoverished. Therefore the asset limits for a married person is quite a bit different than for a single person. Reassure your dad on this point. (When you say for mom and dad, do you mean both of them need Medicaid?)

The HICAP program that Sendhelp mentions operates in California. Research whether your state has anything similar. Start by contacting your Area Agency on Aging.

Decades ago anodized aluminum cake pans had labels that claimed they were "dishwasher safe." Well yes, they won't rust. Aluminum doesn't rust. What they didn't mention is that they will discolor and look blotchy. I think the claim that you don't need an attorney to help you through some of these applications is like those old labels. Yes, you can legally do it yourself, but you might not be happy with the results.

(I collect novelty shaped cake pans -- Mickey Mouse, a Lemon Tree, etc -- and I am very familiar with the discoloration from dishwashers. That's why I chose that for an example.)

Thank you. And yes both of my parents need medicaid. Dad is very weak with CHF and COPD and mom has dementia that is worsening. It is becoming to much on me as a care giver. They deserve more help then I can provide.

Racetrac - although financials are important, please pls pls keep In mind that Medicaid is a 2 part “at need” program; they both will each have to clearly show to be medically at need for the specific Medicaid program applied for in addition to financially qualifying for a specific program. Can they qualify medically???

So what are you thinking that Medicaid will provide for your parents?
& is this realistic for what Medicaid has in programs your state?

You can research on your own but a good elder law atty will know the minutiae of details for how Medicaid reviews applications in your state AS WELL as dealing with how to do a spend-down or restructure financials to be totally Medicaid compliant. If the atty you are meeting with just deal with financial, I’d look for another & probably look from those NAELA certified.

I would suggest that before the atty meeting you find out what each of your parents health history is in detail. & if the goal is about getting both of them into a NH in tandem, will their primary MD write orders for skilled nursing care needed with the ICD-10 codes to show need and with a fat health chart to support & document that skilled nursing needed?    Some states are now doing a required pre-admission review for any infacility Medicaid & for those coming in from living at home clearing the review now will not be easy. (I moved my mom in TX from IL to a NH and without an AL stay in between in 2011, & now with TX requiring PRHHS there would be no way she’d ever show the level of need now to qualify for 2017 requirements.) Most NH admits are coming from a hospitalization & discharged to a facility for “rehab” under the mediCARE post hospitalization rehab benefit (usually 21 days but could go to 100) BUT then are found to need to stay in the NH so then apply for Medicaid to start coverage after Medicare stops. I’d ask the atty what the eligibility review is like for Medicaid for your state and if your folks as they are now would both be qualify.

Both medical & financial important for Medicaid.

If it’s such that they both qualify medically for skilled nursing care a NH, the Medicaid financial rules are pretty narrow.... usually 3k in assets, a (1) car, a home. That land would more than likely be a non-exempt asset & need to be sold at FMV with proceeds used in spend down.

Also please keep in mind that once on NH Medicaid all their monthly income - such as SS - will need to be paid to the facility as the required copay or SOC (share of cost) less a smallish personal needs allowance. PNA varies by state from $ 35 - $115 a mo. Realistically if both in a NH & they continue to keep their home & car, there will not be any $$$ ever again to pay for home / car expenses (like taxes, insurance, upkeep). Often the caregiver is living with parents at their home & providing care for free & without compensation & finds themselves unable to really cover property costs, living expenses...... If this is you, pls address this issue with the atty as to how to deal with property costs, the caregiver exemption for estate recovery & caregiver contract till they go into a NH. If your parents home ownership & their income is what is keeping a roof over your head & you cannot cover costs on your own, you may need to rethink NH move and instead look at in the community waiver programs such as PACE. 

40k in assets is pretty modest sum. Preneed funeral & burial could be 16k-20k. If atty fees run 5k per parent, that leaves very little $$ to actually have to spend down & maybe could be all used for property costs. Let us know what’s what & good luck.

Igloo.....thank you for your reply. To try and answer some of your questions, I believe that they can both remain in the home at this point with proper care. I have been living in the home with them for 5 years taking care of them. The amount of care they require is growing as time goes on. That being said I probably cannot afford to keep the house going if they were to both be in a NH. IT would be close. And I may be able to pull it off, but yes it is basically my only home and I have no where else to go should they end up in a NH. I will be adressing these issues with the attorney during our meeting.

Race - it’s good you are thinking of this now & before there’s a fall & broken hip and they need a facility like yesterday......

The situation you find yourself in is common. Yeah you qualify for the caregiver exemption to MERP (Estate Recovery) but if you flat cannot afford the house, not a lot of good in the exemption. There was a poster on this site who ended up loosing her parents house as had no funds of her own, it was heartbreaking. It can become a crisis which can likely be avoided or minimized. Hopefully the atty know what to do AND your folks are still pretty competent & cognitive to understand or go along with the attys suggestions to do things that enable them to qualify for Medicaid and you to transition from free labor to paid caregiver. Everybody’s finances- mom, dad & yours - come into play on this. Your Folks have income each mo that they could use to pay you for care... all legit with W2 and taxes. You most likely want to do whatever to continue to build your SS funds so you can delay drawing SS as close to 70 as possible.

If your area is doing PACE, that imo could be ideal..... community based system of whole day care which they go to 2-4 days a week. Even if dad goes 4 days but mom only qualifies for 2 days, it all helps. For PACE, they have to be “duals”, that is both on Medicare & Medicaid. PACE gets paid from both & I think they must be duals to enroll. The PACE center gets paid via the M&Ms but as it’s community situation, they get to keep their income so they can pay you for caregiving provided the nonPACE time via a personal care contract that the atty sets up that will pass a Medicaid review. It’s not 24/7 oversight & care like in a NH but PACE just may be enough of a break so keep you from being always overwhelmed.

The land will in all probability need to be sold. If dad gets all emotional on this, well dear your gonna have to get him past it. So take the tax assessor records for land & house to atty meeting. Also find parents awards letters, those are the trifold mailings SS and most retirements send out around now (November) as atty need to know how much income coming in for 2018. Ask atty what may be needed to get them eligible for Medicaid before land sold. It may just be that IF land is listed with a Realtor, all is needed is a MLS listing number for Medicaid. Then when it finally sells, you deal with spend down as per the plan discussed with atty now. 

Atty will cost but the right one really will be priceless to successfully planning the next few years. Ideally whatever is done is set in place to start JAN 2018 so next year is off & into the Medicaid for the future phase & all done correctly. There is an expert on this site, Gabriel Heiser who has a book on the M&Ms that is really great. You can buy it or get it from your library as it’s kinda the gold standard for basic but comprehensive info on what Medicaid is (& isn’t).

Another thought, ask, - if for when they both go into a NH, - how the Medicaid caregiver exemption on the house can be done. If your state allows for it to go into place simultaneously with thier application so house transfers to you then, to me, this is better than waiting to deal with it as an after death estate asset. Like if they live another 2 years for 1 and 4 years for the other, that’s a long time to document, keep detailed records and what if something happens to you in this period of time..... Now house may loose some of its over 65 perks of ownership, if your still on the younger side, but maybe worth it as House is yours so you can get lending on it or sell it or whatever’s.

Igloo.......thanks again. Your saying I may end up being able to be paid to take care of them like I have been? They have been paying a family friend to be with them during the day. Its minimum wage but it ads up. At one time we had a private company coming in but it just grew to be way to expensive. I also have a sister who lives in the house with us. To say the least she isnt much help. Comes and goes as she pleases and really has checked out on the whole caregiving aspect. But I know she expects her half of the assets, and I cant control any of that or what my parents leave to either of us, but I do know she cant afford the house or insuing bills on her income. I believe I can though. So knowing that situation what do you believe could happen between me and my sis as far as who ends up with the house or being able to afford it. Can she say she has been a caregiver also and end up with half? Or get into a situation where I would have to buy her out of her half? Im not saying I dont have a decent relationship with my sister, but I will say I have some resentment for her lack of effort over the past few years.

Ok then so they have the funds to pay as they’ve already done so. Find those bills as they can be used by the atty to establish what is realistic care needs for your folks & solidly determined by others in the past. If it were me, I’d set your payment for a lesser amount as you, as the dutiful daughter, want to do what you can to s...t..r..e..t..c..h out their $.

Sissy, geez..... that is going to be it’s own drama.

If your dpoa and named executor for each of them, with Sissy left out totally, it should lessen the drama as your in control. Get their legal all updated to have this done. If folks insist to leave everything as per their will 50/50 between you & Sissy & it kinda needs to stay this way for family peace, I’d let it happen. Ask the atty about who they do probate referrals with as probate probably is how you are going to successfully deal with her.

Also folks need to have bank accounts to you as POD. Pay on death to you as your the dpoa & will be executor. Not Sissy.

I am actually the dutiful son lol Thank you for the information I will be bringing up these issues with attorney. I try to include my sister in these decisions, and invited her to the meeting. I mean she does care somewhat. And its not my job to try and decide for my parents what their will should say. It just bothers me that someone who is basically no help at all, and gets a free ride will in the end be treated the same as me who has been bearing all the burden these past few years.

Wait if it ends up in probate wouldnt they just give everything to medicaid estate recovery if the end up on medicaid that is? Another thing about sis, she would like to see them put in a NH because she doesnt want to deal with it. She thinks in home care is invasive? Its not even her house! Just a sample of what I deal with

Dutiful, MERP has all sorts of exemptions and exclusions plus a cost-benefit determination. Probate imho can actually be your friend imo if your a very organized executor with probate atty who understands estate recovery and property is either very lower value OR very high value (like right about at the edge of your states Medicaid allowed property value) and your state views unsecured &/or nonexecutor claims / debts against the estate as not priority payment or lower on the level of claim list. Like for TX, it’s a Level of Claim by Class for probate; MERP is a Class 7 claim; CC Class 8. All those in class 1- 6 paid priority before 7. So recovery rates lower than in a state where all claims equal for probate asset distribution. 
But not everybody named executor is cut out for the pitbullie OCD needed &/or has the purse or wallet to stay in probate if time is needed. Or they are just too still grieving or too exhausted to deal with probate.  Those “we buy houses” flippers will relentlessly contact executor (all on file all public records) to buy assets of the estate for a song and it happens as Sissy or Bro executor is beyond over dealing with “estate”.
Let us know what options the attys suggest, if you would. We all learn from each other!

At the advice of a social worker I applied for Medicaid for my husband, thinking he would need a care center to manage his dementia soon. I wanted to be ready when that came up. As it turned out, he remained home for the entire 10 years. Medicaid was an extremely helpful program for in-home care. They provided incontinence supplies, to name one small benefit. They covered hearing aides. They paid for him to attend a great day-health program. They later paid for 32 hours of in-home care. These things allowed me to keep working to minimize the impact on my financial future. As his wife, I was not eligible for pay for his care. His children or grandchildren would have been. We opted to go with a person from an agency.

We got my mother signed up for Medicaid, and the services (along with the help of us children) kept her in her apartment for probably a year longer than she could without the help. When her dementia worsened she lived with my sister. Mom was qualified for a certain number of care hours per week. My sister opted to take that pay herself, rather than bring in an agency person. The pay was a pittance compared to the high-paying job she had just retired from, but my sister said it validated that she was doing something important. This arrangement kept Mom out of a nursing home for another 14 months. Paying for some care at home is far more cost-effective for Medicaid/counties than paying for nursing home. The longer they can put off the nursing home placement, the better for all concerned.

I think you are very wise consulting an expert to help with the Medicaid decisions. And it is great to have questions in mind before the first consultation.

I don't think "protecting your parents assets" is the real issue here. They really don't have a huge pile of assets. But getting them situated to get the care they need without costing you funds for your own retirement is a very important goal.

Im glad to hear that medicaid can help with in home care thank you for your insight. Im not sure about my dad his condition worsens monthly. He may need NH care before my mother at this rate. Do you know if since they may both qualify for home care will they give more hours since its the 2 of them?

I don't know that, racetech, but an elder law attorney would have the answers for your state.