Aid & Attendance , House. Medicaid question

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wayne44:
Please review for some advice and/or observations. This is a maze for me:

   After one financial adviser, one Elder care Annuities underwriter, two lawyers and a
Medicaid/Aid & Attendance advisor, we have not yet come to terms with a
fundamental plan for continued care for Mom & Dad.  The professionals have yet to give solid reccomendations.  All spew forth knowledge, but none give sensible observations.
   Mom is 88. Dad in 90. She has been moved to a Nursing home three weeks ago.
Both had been living together in an assisted living residence. But that ended once her
dementia reached a state (suddenly)  that  only professionals at a nursing home can provide for.
   Dad receives the maximum benefits from Military Pension and Veteran Aid & attendance. Due to the suddenness of her decline, lucky for us (her) we found her a good nursing home. The facility accepts private pay or Medicaid. She is in the NH as a Medicaid resident although we have not yet begun the paper work.
   The couple's only asset is their home. As of now, the title is in both names.
   Unfortunately for us, we re doing a 'spend down' of our assets to help. them. We cannot afford this. It must stop.

   I am unable to do the math, and no full understanding of the following scenarios:

a) House never sold: Have Mom in Nursing home on Medicaid, continue with Dad on Aid & Attendance expecting a reduction in the amount since Mom has moved. Do not sell the house thereby we continue our own 'spend-down' keeping the house maintained (high cost), pay property taxes and insurance, etc. What happens if he passes first? I suppose all Aid & Attendance is stopped since she is in a nursing home. Then the home is sold and Medicaid gets their money and we might get any remainder to help with maintenance costs.
   Or Mom passes first, then Medicaid stops, and then when Dad passes, house is sold and asset is split between Medicaid and us for any reimbursement.  VA will seek no assets.

b) House is sold:  Both continue to live another several years. Probably get disqualified from Medicaid until a spend-down from the proceeds. Then put her back on Medicaid. But does that also makes (maybe) Dad near disqualified for Aid & Attendance? However, proceeds will run out very quickly!  But once the spendown is complete, from then on, they are always Medicaid & Aid & attendance. With these scenarios we do not have our costs associated with the house.

c) House is sold and is converted to some type on SPIA, the contract written
to be administered solely for their benefit.

So as I can best see it, I can avoid all cost associated with fixing up their house for sell (sell as is), and all other expenses associated with a high maintenance, high property tax burden, in effect allowing the asset to converted to their immediate care, letting the spend down be swift, then get them back on Medicaid and Aid & Attendance.  So in effect, It really does not matter what the house sells for! There is the Certainty that no assets will remain.  But perhaps Medicaid goes for my assets should they think I 'took' anything.

So as best I see it, I will certainly have additional costs if I do not sell the house, but may perhaps have a remainder once Medicaid recovers their money from the sold once both pass. But I might get some money I spent back. . 

Are there any other scenarios anybody can think of? Any helpful comments?  All would be appreciated!
How do Aid & Attendance, Medicaid, House sell/not sell work?

Thanks

magnumpi28:
    Have anyone of the people you talked with discussed what they call the "half a loaf"  strategy?
 The new medicaid law may have put a stop to this strategy but they should at LEAST be familiar with the strategy, if not, find a different attorney.

The following link is a EXCELLENT reference, you really need to check it out.

http://www.elderlawanswers.com/elder_info/elder_article.asp?id=701

Medicaid is a complicated mess, Its always easier to plan before they go into a nursing home but, although limited now, you still may have a couple of options.

However, when both husband and wife are in a nursing home you lose a lot of options than if at least one was still in the home.

   Worse case scenerio and you have to spend the money from the sale of the home an attorney told me one time that all the money does not neccassarly have to go to the nursing home, remember you can "spend down" it for non countable assetts like 'home furnishings' so your dad in a assisted living center can have the nicest and the biggest TV on the block! :)

But all joking aside, check out the link, if that doesnt help you then nothing will.
 

jpez:
1. What state are they in?
2.What is the income of each (gross)?
3. what is house worth now (ballpark)
4. what did they pay for it..ballpark?

get these answers and the quess work is over.

If your more comfortable pm ing the info that is fine. I can answer genericly.
I have written Continuing Education Classes on the topic.

wayne44:
1. What state are they in?---------------------Tennessee

2.What is the income of each (gross)?-------him :  11,232 / yr Military Pension, $ 15,000 / yr  SS
                       --------her: $6,350 /y SS

3. what is house worth now (ballpark)----- $185,000

4. what did they pay for it..ballpark? -------$ 31,000

jpez:
you can review the TennCare Meedicaid manual on line.
Page 107 states that the A&A pension does not count as income

If you claim of expenses on the home is legitamate you can place a lien on the home to recover your expenses PRIOR to folks recieving cash from sale.

You can also charge for CARE expenses that are above what is provided by their current providers. this invoice would be submitted priort th the sell of the house. It would be concided a fair market value exchange of an asset so is not concidered a gift.

at this point the remaining cash might be below the spousal impovershiment(sp) level that dad is allowed to have in Tenn.

THere are specific rules on the selling of the house to make sure it is sold at a fair price.

good luck!

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