My Mom just qualified for Medicaid to pay for a Home Attendant. Using "Pooled Trust" method. Any advice?
Mother is ninety years old and still in the house she purchased sixty years ago in New York. Because she was an Educator her pension and SSA (Medicare) make it appear she makes a lot of money when, in-fact, it all goes to house necessities, basic living and maintenance emergencies. Therefore our Social Worker advocate got her qualified using the "pooled income trust". I'm still unsure how it works, even though I have read about it and she has explained it to me. So I am asking the Aging Care community for any advice, experiences or pitfalls you have gone through. I am mom's oldest and currently staying with her until the home attendant is solidly in-place. We already have a person in-mind who mom likes, but are open to interview one or two more candidates. ThanQ!
If there is a spouse living in the home, they should get a diversion of the nh residents monthly income as their CSRA or MMNA. But if family is living in the home - even if they were caregivers before the move to the nh - they will have to pay for all costs on the home. But they can try to get the caregiver exemption to MERP's claim or lien.
Some states have it in their administrative code such that normal costs of maintaining the empty home are exclusions to MERP's claim or lein.
Now paying for the costs on the home....well that falls to family to pay for everything for as long as they are in the facility and on Medicaid.
Lady bird deeds are a way to transfer a home after death outside of probate. BTW it has nothing to do with lady bird johnson either. LBD 's are done in only 5 or 6 states. They have to be written just right to be valid. Not a DIY project IMHO.
One issue with keeping an elders home whether your planning on using the ladybird deed to avoid probate or not, is that once they go onto Medicaid, they have to do a copay of all their income to the facility. They have no $ anymore. All costs on the home - taxes, insurance, maintenance,etc - will have to be paid for by family from now till their death and the through probate or after death legal process. Elder could live another 6 mos or 6 years and you better be able to pay for everything house for whatever time frame. It's kinda like having a 2nd or 3rd home but without any guarantee of ownership so runs a risk. Most cannot afford a 2nd home or like risk, so the house gets sold.
I can explain the acronyms at another time. But, to the other question. Yes, Medicaid is mandated to recover assets only if that person becomes permanently institutionalized, such as, permanent nursing home placement. After the beneficiary dies any property or accounts in her name can be subject to recovery but if these are joint accounts this does not apply. Always speak with an elder lawyer before placing a parent into long term institutional care.
I'm a RN who works in long term care. Yes, a pooled income trust is a way for a Medicaid benificiary to still use their income and receive long term care at the same time. As stated before, if anybody makes over 809 a month they will not qualify for Medicaid, because Medicaid is based on income unlike Medicare which is awarded to people who have worked at least 10 years and reach 65, develop chronic renal failure or are on disability for two years. Through what program is your mom receiving long term care? Is she in a MLTC, MAP, PACE, a waiver program or is coming directly from your local county? Thanks
thecolemanlawfirm/Qualified_Income_Trust.php
Don
Igloo, you make some good points about unexpected expenses that may arise while subject to a pooled trust arrangement.
The aspect that troubles me just as much though is the potential for fraud on the part of management agencies. Medicare has been plagued by so much medical fraud just from the extended health care field.
It's such a large and extended operation that I would think it would be difficult to monitor already, but with the temptation of accessing trusts, the potential might I think exist for abuse.
Still, it reflects that Medicare is attempting to provide assistance to those with some assets, perhaps too many to qualify otherwise but insufficient to provide longer term care.
My undestsnding is that pooled trust method is similar to how a Miller Trust works in that the overage goes into a kitty that is distributed by the trust either to pay for their care or needs but instead of being drawn up by an attorney for an individual (& all strictly used for costs by that individual in a Miller) is is done by SW in a state form and the overage $ goes to an account of $$$ shared by ALL in the pool. (We looked into doing a Miller awhile back as we have RR retirement in our family and RR pays really high $$$$ but not quite enough for full NH costs).
How these work depends on your state laws - most have it so that all income goes to pay towards their needs so no accumulation of funds OR if the excess builds it all goes to the State upon their death. With miller all income & assets revert to state whether the month of accrual or upon death.
What I'd be concerned about is IF & HOW the pooled trust is set up is flexible to allow for easy diversion of moms monthly income to pay her housing and living costs. Most of the time a miller is done is when they are in a NH - which has fixed costs - so they dont need to determine where their income goes. But your mom is living in her home......what happens if say her homeowners insurance premium increases, or she needs to get a tree cut down ASAP, or something else that blows a hole in her budget? Will she have $ to do that or is it that once her overage $ goes into the pool it is no longer hers to be spent? It sounds like mom is really tight budget wise right now.....what happens if next October she has a 2k plumbing bill? If her $ is in the pool, can it be easily gotten back to mom? done via an series of paperwork with the state....or there is no getting back?
If so family will need to pay for whatever costs on her home or her needs from now till mom moves out of the house. Can family afford this for however long mom is in her home? I'd suggest you clearly have a agreement done as to reinbusrement for those costs from either her estate or sale of her home if need be. It may be that doing this now will be viewed as Medicaid avoidance. Has it been clearly explained to you & mom just how moms home will be viewed by the state after her death by MERP? You may find that if mom is at the point of possibly needing a NH, that it could be better to go & move her into one; sell house & use the proceeds to private pay for her care and do other allowed spend down and put off needing Medicaid.
There was a really good aging blog done by the NYT & an article on pooled trusts done by Tara Siegel a couple of years ago. Google it as it names attorneys with NY state experience on pools.
vjrussolaw/resources/faqs/pooled-trust-frequently-asked-questions/
From an initial reading, it seems as though the long arm of Medicaid is reaching into trusts to access the assets, pool and leverage them. From what I read, Medicaid can benefit from the income (and gains??) on the assets.
Apparently it's a way of allowing people with assets in trust to still qualify for Medicaid, but with restrictions on the way the assets are used and managed.
I get the impression that Medicaid will either itself manage or appoint a firm to manage the trust's assets - i.e., pooling them with other trusts. I can just see investment firms climbing all over each other to get their hands on managing Medicaid recipient's trusts and billing Medicare for it.
See the section on the list of services which can be used with the funds. It does include supplemental home care services.
Don
Grace + Peace,
Bob