My question: My mother’s primary address is in Florida. She's 84 and becoming ill with old age issues. I'm her only caregiver and I live in Ohio. I came down to pick her up and bring her up to Ohio temporarily to get some physical therapy, occupational therapy and other medical attention, all of which I'm told will be covered by Medicare according to Medicare.
After her physical therapy, she will need to be put into skilled nursing or assisted living, I assume Medicaid will have to pick that up bc of her low income threshold. So then I take her back down to Florida after the PT & OT to be placed into a Medicaid Waivered facility... will they still take her home? I do know that her home in Florida is homesteaded there. Thank you very much!
Every state is different in how they handle their Medicaid. One question you may want to ask is if Medicaid in Fla will pay for an Assist. Living. These are usually private pay. In my State u private pay for at least 2 years, then apply for Medicaid.
Homes, unless FL is different, are an exempt asset. Mom can receive Medicaid and have a home. Problem is, her SS and any pension will go to offset the cost of her care. So no money to pay bills and upkeep on the house. So unless her children want to pay out of pocket to keep the house going, it will need to be sold. It may be an exempt asset but Medicare has rules to who can live in it and its usually people who resided there before the owner went into a NH with Medicaid. It can't be rented without Medicaid approval. If it sells, it must sell at Market Value. If the house sells, Medicaid stops, the proceeds are spent down, and then Medicaid starts again.
Five year look back is to see if any large amounts of money have been loaned or gifted. Money cannot be "hidden" within this time. No trusts set up.
Medicaid does not take homes. If my Moms hadn't sold, it would be just sitting there rotting. Actually, the County would probably have taken it and sold it at a Sheriffs sale for unpaid taxes. All Medicaid does is place a lien on it once Mom passes if the house has not sold.
Just giving you an overview so you have an idea how things will work or know what to ask.
I was aware that they will take her SS check and anything else to supplement the costs but would have to leave the home alone...any knowledge of the Florida Homestead Act??
I mention MediCARE & Medicaid as what usually happens w/elder without any real $ resources but “at need” medically for skilled care & “at need” financially is BOTH Medicaid & Medicare will be paying. MediCARE already exists & tends to cover most medical but will not pay for NH custodial room&board costs… that’s LTC Medicaid. She will need to show to be “at need” for whatever Medicaid facility program. She would become a “dual”… aka on both.
Sounds simple, but imo will not be for her situation, as I bet she’s may be too frail to easily move back & need to look at OH to live, if so:
1. Mom will have to be “at need” for whatever program OH LTC covers. If OH only does NH aka skilled nursing care & not waiver AL programs, she has to show need for SNF. Ditto for FL.
I’d suggest that you get a needs assessment done. Most states do NOT do AL waivers at all. AL tends 2 b private pay.
2. if staying in OH for OH Medicaid, home in FL will be a non-exempt a$$et so ineligible financially.
Yes, Medicaid allows them to continue to own home as an exempt asset for their lifetime BUT has to be homestead in State of application. Property records easily found; FL home exists & it’s value will surface.
BUT
States know moves like this happen but new State is going to require her to do something definitive on FL property… like put it up for sale at FMV under MLS Realtor listing to be OH Medicaid eligible or pending. No FSBO nonsense. So FL house sells and what happens next very dependent on OH rules. Might be she then does a spend down of house sale $ & once impoverished at 2K in assets, then apply for OH LTC Medicaid. Or OH may require her to reimburse State for all Medicaid payments on her behalf from house $ then private pay till she’s impoverished & do a new LTC Medicaid application.
Mom cannot gift any $; all $ must go for her care.
3 OH will require her to become a resident. Just how hard this will be is a guess. Like probably need to move banking, get OH ID…
whether she does OH or FL:
4 Medicaid requires copay to facility of basically almost all mo income. Mom will have zero $ to pay on FL house…. property taxes, insurance, utilities. So r u able to easily pay for all FL house stuff & be ok if not reimbursed? Reimbursement looks like “gifting” which Medicaid will penalize. I’d suggest that mom meets with elder law atty to discuss how to perhaps do a personal services contract with you. Mom needs to pay for all legal.
4b if home is FL coastal, she imo has to pay NFIP & windstorm. It’s $$$. If she become OH resident, she moves out of FL resident insurance pool and it will b beyond serious $$$$$. If you r her POA you have a fiduciary duty to look out for her assets. Dealing with coastal property & hurricane season is challenging.
Personally unless u have time & $ to deal w/all OH / FL stuff inevitably involved, would be simpler to b in FL asap. If anyway to get her to have more time on current MediCARE rehab & get it wrapped up in FL, that would b ideal. You have her place to stay in & figure out if feasible for you to afford her homes costs and if feasible for her to return home & set up in-home care or if not find her a facility w/open Medicaid bed and file FL LTC Medicaid. Then make a decision on her home.
All States are required to do an attempt on Estate Recovery on all after death assets. Home exempt asset till death. FL is pro-property rights state so imo heirs can get exemption. Discuss this with experienced FL probate atty.
Please please pls take a hard look at the FL property costs and see if it’s easily affordable for you and all the other heirs. And if everybody will do whatever they promise to do - like check on it regularly - for an indeterminate period of time. Mom could live another 5 months or 5 years. I’ve been on this forum for quite awhile and what inevitably happens is that within the first year, the local sibling who checked on house and did yard completely stops doing this; the sibling who was responsible for taxes and insurance doesn’t pay; yada yada… so everthing fall to you or the POA to pay and do. But all benefit equally as per moms will on that house as an asset of her Estate should you get exemptions or exclusions to Estate recovery. It’s something that you might want to think about. You will be some kinda peeved if you do this for 10 months and then cannot afford her property taxes and it goes up for annual delinquent tax sale or insurance premium isn’t paid and there's a fire. Someone has to be able to ride this out no matter what to make this work ime.
There is someone on this forum who has a erratic / addiction problem sister. The two girls were to benefit equally from moms estate. Mom went on LTC NH Medicaid and the dutiful POA Sister did all needed to have empty house kept up for abt 2 years their mom was in a NH and then to work w atty to clear Estate recovery, get house sold, etc…. LSS she was ok financially on fronting $ and doing the whatevers; she knew how to distance herself from Sissy’s chaos. But not everyone can or will want to do this. Really take the time to carefully evaluate the situation. Good luck.
How is she on Medicaid if she still has a home?
She has not yet applied for Medicaid. In Florida I know her home is homesteaded but in Ohio your home has no protection from them. In Ohio they have a 5yr lookback that applies if you have tried to sell it or turn it over to a family member for less than the market value.
So i was told by another family member that if she did Physical Therapy in Ohio under Medicare and then returned to Florida to apply for Medicaid and be put into assisted living that Medicaid would either turn her down or take her home....? True? Thx :)
Her house should be sold to pay for her care. A vacant property is expensive to insure, many things aren't covered and an unused house deteriorates quickly. She will not be able to pay for anything, so you would be stuck having to pay ALL house expenses and not know if her care will exceed the value, because you won't be getting these expenses back, Medicaid doesn't allow for that. Only the excess value would go to you after is sells and satisfies the Medicaid lien.
Every state has a look back period.
Vacant property can be beyond challenging. If that FL home is anywhere in hurricane wind / velocity zone so in FL state wind pool for windstorm or in a community that has required participation in National Flood Insurance program, those insurance premiums really have to, have to, get paid. And it will not be inexpensive even with state pool or federal flood. The rates all are getting reset big time for right now.
Personally I think OP needs to be really cautious on feasibility of keeping the moms house - no matter how much mom wants to have her home - if it’s in or nearby a flood or velocity zone. NFIP max is 250K property and 100K contents, so if her home is valued at 400K the POA or someone in the family is going to have to pay the excess flood coverage. It will be $$$$. The coastal states have all had insurance providers leave and have tightened up the application process and send out outside contractors to verify the property and that the owner is living there full time. Like they run the plates on cars parked on the property and do a cross check on registration. There’s alot of coastal property up for sale in my area due to a couple of things - the insurance costs are flat not affordable unless you can show that yes it is your full time primary residence and alot of folks had claims filed for H Zeta & H Ida and insurers did a drill down on policyholders and alot of folks were claiming FT residence in more than 1 home and their claims got denied.
For the OP if their mom moves into a NH or AL, she then will have the NH or AL as her residence so she’s going to face either her policies getting cancelled or big time increases. Her homestead exemption stays for her taxes & Medicaid asset exemption but not necessarily for insurance.
The POA has a legally required fiduciary duty to maintain the security and value on the elders assets. If that means the OP pays out of their own wallet $$$ a year to fully insure their moms house, it is what it is. Medicaid allows the elder to continue to keep their home as an exempt asset but elder due to the copay has zero $ to pay a penny on that still in her name house, so someone in the family better have the wallet to do and pay for all property costs for an indeterminate period of time and then deal with estate recovery and / or probate after death.
Sounds straightforward, & it kinda is if she dies with LE in place and there is no encumbrance, like a lien or claim on it.
But should something happen that the LE property need to be sold or the remainderman changed while mom is alive, then it gets in the weeds on determining the % of ownership of the elder and the remainderman as all this has to be done by IRS criteria & actuarial tables. It is not simple and imho is work for a tax attorney to do and sign off on. The paperwork will be attached to tax filings, the Act of Sale document and probably also at the courthouse for property transfer.
We bought a nearby LE property post Katrina. Property was vaporized by the hurricane, was debris filled land. The mom was in her early 80’s and remainderman were her 3 kids. All had to sign off on the paperwork. 2 out of state and the youngest had the mom living with him. Mom assumed that she would get all the $ from the sale so she could rebuild. The 2 out of state kids wanted their remainderman / actuarial table determined share of the $ paid to them directly. Held up the sale. They were not budging either. As remainderman on the LE that was their right. Dutiful son was aghast. Was not pretty.
i mention this cause dutiful later had to deal with Medicaid issues for his mom to show that it was not “gifting” when she sold it. My point is that LE may not be as straightforward as they sound…. some states Medicaid regs may allow an LE totally and with no MERP, others may want the LE removed, others some type of change to the LE…. Like add the State as a remainderman or have the grantor (the mom) % as of the date to the application to have transfer penalty placed on the moms application or have the grantor % placed as a lein. LE need really good legal expertise and that means all of this gets discussed with attys in the state where property located and before a Medicaid application is filed. Please dont put this off, if mistakes were made, it is was it is and get things reset to be correctly done. Good luck.
Like this done in March 2022?
So how was this done….. like she was still at the time in FL before any hospitalization and b4 she was under rehab care and she went and spoke w a FL estate attorney to draw up the paperwork and it has FL notary seal and FL address witnesses on the documents???? OR….. has this been done while she is up with you in Ohio? And it was / has been a DIY project with forms taken off the web?
if its the latter, to be quite frank, there likely will be issues for the documents to meet the standards for FL real estate laws and more importantly, it looks like self-dealing. If a caseworker sees things that look like self dealing, the application gets reviewed at a higher level and in detail…. Like 5 full years on answers on expenditures over $200. As your aware theres a 5 yr lookback. So the dates as to when things were done matters. Ime anything recent red flags the elders application.
fwiw $200 is the threshold for a lot of lookback. How far back depends on the state. There is someone on this forum right now who is working with an attorney in doing her hubs Auntie’s LTC Medicaid application (transitioning from private pay in the NH to LTC Medicaid at the same NH) & she is having to provide in detail on anything spent $200 or over for last 6 months. For my mom it was 2 years expenditures in detail and my mom was private pay in an IL prior to going into a NH. I mention this because what seems to happen is if they have been already in a facility for a while, Medicaid knows that serious $$$ has been paid for their stay - in IL, or AL, or NH - so the in-detail review is less. But if the elder has been living in their home or a family members home, Medicaid can require a full 5 yr in-detail look back. It’s cumbersome and what seems to happen now is the elder or their POA will need to submit the past year on every month on all financials and then every 6 months prior back to 2017. Medicaid has the elders income info; so it’s basically a math problem as to what their resources should likely be at for the caseworker.
So say a mom gets $1500 income in SSA, sold her home for 100K in 2019 and lives with family and has no personal needs contract to be paying for care each month, and now this mom is down to under 2K in assets….. well to paraphrase the words of the Uber handsome and talented Ricky Ricardo “Lucy! jewed got some esplain’ to ju”. That mom should still have plenty of $$$ left from the house sale to private pay for care. If that mom is down to under $ 2,000.00, the State can ask as to where the $ went and with documentation. No documentation = no eligibility. My mom spent a good amount of $$$ on dental; there was a lady in her IL who got face and neck left; my MIL (quite the financial terrorist) went an a trip on the QE2. As long as they r spending their money on themselves, it’s ok no matter how ridiculous it is. But they cannot gift $ or assets to others.
Your Mom needs to work with a FL atty that is experienced with FL real Estate and estate recovery and soon. She’s only 84, she could live another decade. FL has a huge over 65 population & there will be lots of law firms who can deal with her situation. Please please pls do this for her and soon. We - on the forum - can share our experiences, but it’s all anecdotal. Ya gotta have an attorney in some way to do things correctly.