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Update on my first question where i was told by the nursing home where i am moving my aunt. Someone asked why i did not sell her house to keep her in Assisted Living.
Quite frankly we did not think my aunt was going to live long with her medical conditions. This is why we didn’t sell the house. So i placed her in a nice assisted living facility using her retirement to pay for it and used her SS for her house bills. We so wanted to keep the home in the family since it was built by my grandfather! Also we wanted to bring my aunt home when the time came to pass on.
So in PA you cannot apply for medicaid until you have less than $8,000 in liquid asset. She is under this now and panic set in. Also the house is left to myself and 2 brothers. We planned on giving the home to my one brother who does not have a home of his own. Everything is so terribly screwed up now. “best laid plans” right!
Im very concerned now because the “planner” at the nursing home for admission/Medicaid said she never heard of medicaid putting a lien on the house. She said they would seize it or force me to sell it.
I have secured a lawyer. But i wanted to hear feedback here from others who have gone through similar situations.

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Others will know about the MERP program.

However, you started a second thread asking the same question?
It's okay, but did you see the answers there?

"Medicaid seizing house?"
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Is your Mom 76, or is that you (in your profile?).

See the search icon above-looks like a magnifying glass-in the green navigation bar, next to your avatar, upper right?

Enter this:
Can Medicaid Take a Senior’s House to Pay Their Nursing Home Bill?
Gabriel Heiser is an attorney who wrote it.
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MERP is administered in each state according to its own laws.

See an elder law attorney.

You will no longer be able to use her SS for household expenses. In my state Medicaid places liens on the house if it is not sold. See an elder law attorney in your state. If you are the POA this could be done with auntie's cash.
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You and your brothers cannot inherit the house if your aunt is on Medicaid. The house should be sold for fair market value and used for her care. If it is not sold, Medicaid will place a lien on the house and when it is sold the money will go to Medicaid. If you want to keep the house in the family, buy the house from your aunt.

See an elder law attorney. Medicaid is for the poor not to allow inheritances for family members.
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Expectations and promises of inheritances causes caregivers and LOs to make a lot of mistakes in planning and management. In many states Medicaid does not cover AL, or has a waiver program instead, so make sure you know the rules for your Aunt's state of residence.

I agree that consulting with an estate planning attorney or Medicaid Planner for your aunt's home state is the safest strategy. You do not want her to become delayed or disqualified for Medicaid when she needs it. In my state they will put a lien on the home which must be satisfied at sale.

If your Aunt still has her mind, then she needs to be the main decision-maker (and she needs to also know the state's rules when she makes her decisions).

If she is cognitively impaired enough, the person who is her PoA will need to review what authorities are granted in the PoA document (i.e. the ability to perform real estate transactions is a separate line item that can be added).

If she is cognitively incapacitated and no one is her PoA, then it will be more complicated. It may require guardianship.
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In Texas, they file a lien against the estate. In my mom's case, since the house was herons asset, the lien was filed against the house.
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The person in admissions is wrong and I hope you are not using her to to help fill out an application for Medicaid. Maybe a lawyer, and they need to be versed in Medicaid Law, is a good idea. We did have a poster say that her state was changing the law when it came to houses and having to sell them for a person's care. Maybe you state has done this. But Medicaid will not seize a house. They are not in the reality business. They may require it be put up for sale, though. If it doesn't sell by the person's passing, a lien will still be put on the house. Its a law that Medicaid has to try and recover money's they have spent.

Grandma's house is an exempt asset at this point. But when she passes it becomes an asset that Medicaid can and will put a lien on to recover monies they have put out. You inheriting it means nothing. Either the house gets sold to satisfy the lien or someone pays the lien to be able to keep the house. Meaning if brother wants the house he will need to pay Medicaid what is owed by getting a loan or paying out of pocket.

Yes, there are circumstances where a Community Spouse can remain in the house but at the time they pass, the lien needs to be satisfied. A disabled child that was living there prior to the person receiving Medicaid maybe able to remain or a family member who was the Caregiver for over 2 years maybe able to remain there but both have to prove they can maintain the house. Upon their passing or selling of the house, the lien needs to be satisfied. There will always be a lien.
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So glad that you have secured the Lawyer. This is where your answer will come from. No matter what has happened to others on Forum, or what happens in our own states, much depends of the "fine print" of deeds, assets, timing, and etc. This is as individual as your thumbprint. Hope you will let us know what you learn from your Lawyer, so it will give people ideas going forward of what works well. Everything on Forum comes mostly from lessons we have learned the harder or the easier way. Good luck. Hope you keep us updated.
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My Mom's house was not seized. I had it for sale before she even went on Medicaid so not sure if they would have required it. I gave the caseworker the Sale agreement. Mom was only on Medicaid 3 months and the house did not sell in that time. Knowing that Medicaid would now put a lien on the house, I called the caseworker and requested a letter telling me what now was owed so I knew how much I had to get for the house. In 3 months Mom owed Medicaid 6k. I received a letter of recovery a few months later asking what assets Mom had. I listed the house. A lien followed. When the house sold, the Medicaid lien was satisfied as were the taxes I let go and water bills. The utilities I paid to keep the house open for showing I was able to recoup at closing.

If Moms house had not sold I was willing to walk away. The house needed a lot of work. I was just about to turn everything off. If I had done this, the Township would have eventually seized it for unpaid taxes and water. If that hadn't been done, it would have sat there till it rotted. Medicaid would have never stepped in. The lien would just be satisfied when the house and land was finally sold by Sheriff sale.

I was very involved in the Medicaid application. I sat with tge caseworker and he filled in the information. I had 90 days from the date of application to get everything to the caseworker he needed. That included spending down Moms assets, getting caseworker all info needed and placing Mom. Mom had 20k that paid for May and June. In June I proved that Mom was under the 2k asset cap and that all info was received. Her Medicaid started July 1st. I allowed the NH to become her payee for her SS and pension. This way I didn't need to worry about writing a check for them. These will be required to offset the cost of her care.

I did have a lawyer but he was mainly for negotiating with Medicaid if I got an offer on the house under what Medicaid felt was Market Value. The house was not in good shape, it was 125 yrs old. I needed to be able to take what I could get. The lawyer was paid out of Moms money. Medicaid allows this.
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What your states laws are for property rights, probate, real estate & the administrative codes for Medicaid will make a difference as to exactly what can happen now & what happens after Auntie dies. Medicaid requires her 2 b “at need” both medically & financially. financial part of LTC Medicaid, that imo you really need to work w/attorney experienced with Medicaid, MERP, probate, real estate. Or has associates they work with.

But I’m somewhat concerned about her being medically eligible…. so what type of facility is she in now? I ask as you mentioned she moved into AL / memory section & then later mention NH “planner”.
So is it that she is in AL but will move 2 a NH? If so, do you know absolutely positively that Auntie meets medically “at need” criteria for skilled nursing care facility aka a NH? Just being old or needing some help with ADLs or at the point of out of $ to private pay may not mean “at need” medically. Most states LTC Medicaid do not ever pay for AL, some pay for MC, but most only have LTC Medicaid available for those clearly & w health chart documentation that shows need for skilled.

A NH will admit an elder who may not need skilled but if the elder cannot pass the scrutiny of Medicaid LTC needs assessment review, Medicaid will not pay for their care. Vast majority of NH admissions come from post hospitalization (MediCARE) discharge to rehabilitation (again MediCARE pays) in a facility like a NH (that does rehab) & after rehab ends and they cannot feasibly return home, then they stay at the NH but go from a rehab patient (MediCARE) to LTC resident (private pay, LTC insurance or Medicaid). If they come in via this route they have thick health file that shows “at need” for skilled so no problems. But coming in from living at home, or in IL, AL or MC may not have the documentation. NH will accept a resident who doesn’t necessarily need skilled nursing if it’s private pay. Please pls pls clearly find out if Auntie will be totally beyond ok to show medically “at need”. You may want to get a independent assessment done as I’m getting the vibe this NH is somewhat casual in details.

By & large States cannot require a widowed LTC resident who applies for Medicaid to have to sell their home. But Auntie or her dPOA will have to:
- include detailed info on it (tax assessor bill, Release of Deed of Trust),
- details as occupancy & by whom
- property has 2b under a max value (some states have this at 500k, which in current market a house could be over)
- file an “intent to return (home)”
- sign off acknowledgment that MERP exists & State is required to attempt to do a recoup.
Depending on your state laws (like does TEFRA), Medicaid can place a proactive lien. Whatever the case, MERP is an after death process. That is why atty who does probate work is needed.

Issue ime is that although it sounds simple, it becomes cumbersome & costly. Not 4 Auntie but you. Costly as LTC Medicaid requires Aunt to have basically almost all her mo income (SS $) to NH as a copay. All she will have is a sm (avg $50-60) mo personal needs allowance that is for beauty shoppe, toiletries. So all property costs - utilities, taxes, insurance, maintenance, yard- will need to be paid by family & paid till beyond the grave till probate and MERP whatevers r done. At an absolute minimum, prop taxes must be paid & maintenance done to keep city/HOA/ county blight fines from happening. Average NH stay is 2.5 years plus 2 yrs for post death legal. So do you & your bros have the $ to for sure pay all property & future legal costs for 2-4 years on an place that may have a lien placed on it? And will you keep meticulous records & receipts on every cent y’all paid for years? And all this on a place supposedly only 1 of u “inherits”?

if u rent it, must be FMV rent unless special circumstances. Rent less some costs is income to Auntie & so gets added to her copay. If rent is $$$$, could take her income over Medicaid max.

Can be done, but not simple.
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Also if there is any legal that needs to be done or updated, try to do this now while your mom still has her own $ to pay for legal work and is totally competent and cognitive to do changes.

If mom wants to continue to own her home yet be on LTC Medicaid, speak w the atty as to what PA has as exclusions and exemptions to MERP (estate recovery) and how probate runs for MERP claim or lien. If one of the heirs could qualify for exemption, then mom may want to do a codicil to her will to have that one become the only heir and one of the other siblings becomes the Executor.

I’ve been on this forum a long time and what seems to happen is that family / heirs are all “guvmint not gonna take Maw’s place” for about 6 -8 months. So for a few mos, grandkid cuts the yard, Sissy pays for utilities on the empty house, etc. Then something of significance happens…. Property taxes due, tree falls onto neighbors property, house is broken into…. and family is no longer at all agreeable on paying their% share or doing their part on a likely old house with old house issues that they do not currently own, do not live in and may not ever own/ inherit due to MERP. What ends up happening is that 1 of the kids ends up being the one to pay & do on everything house plus deal with moms clothing and toiletries replacement costs in the NH and any Medicaid renewal paperwork. If that’s likely to be you, look at moms bills past 5 years to see what costs are plus add on for vacant dwelling insurance policy. Add 25% for emergency funds. So do you have this amount of $ to easily & always pay for anywhere from 2-4 years absolutely & you (& perhaps more importantly your spouse) are ok doing this on a place you do not & may not own? You know your siblings best, will they (or thier spouse) close their wallet if they know you’ll pick up the slack & pay?

If this is likely to be a problem, try to have mom sell if b4 applying. It will make things simpler. Realize if mom goes onto LTC Medicaid and you or your siblings end up paying for things for the house to keep empty or get it market ready for Realtor showing (as mom now has no $)….. that you cannot be easily reinbursed from the sale of the house while she is alive. House is still in moms name and all $$$ proceeds from Act of Sale is her $. If mom pays you $ it looks like gifting. Gifting not allowed by Medicaid.

Medicaid tends to take the view that whatever we do for our folks we do out of a sense of familial responsibility without expectation of compensation. Ask the atty how PA looks at this situation and if there is anything that could be done ahead of a Medicaid application to deal with this by your mom. Good luck and let us know what happens.
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igloo572 Jan 2022
another issue for you is that it’s your Aunt’s home, it’s not your mothers. I forgot that aspect in the above post. sorry abt that but to me it’s important….. as it’s Aunties home, you & your brothers are not her direct lineal heirs. Auntie has to have a will - again has to have a will or a codicil to an old will - specifically naming you & your bros as her heir or naming just the brother that y’all r planning on being the one inheriting the house (should Auntie go this route on keeping her home and y’all r all in on dealing w the constraints of what LTC Medicaid involves).

A valid will existing is necessary otherwise heirs (lineal) have to be established & till that is done her estate escheats to the State. A direct lineal would be her children & if predeceased then thier children. Even if her kids have no contact with her, they still are lineal; them not niece & nephews. If her estate ends up having to go lineal, the probate atty hired will have do a search to find them…. there’s a pretty set process on lineal, it can take months…. if the search finds a grandkid somewhere they r the heir. Too bad, so sad for y’all. A will / codicil keep this from happening.
Again please please right now while she has $ and before she ever applies for LTC Medicaid, have the atty review all her existing legal - especially her will & her POA - so that it will be set up to allow you to be her POA and for her plan on the disposition of her home after death. Auntie herself needs to do this; not you or your brothers
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