Our mortgage is in my husband's name with my mother-in-law as the co-signer. My mother-in-law has been in a rehab nursing home for the past week. Medicare only covers her stay there 100% for 20 days. My husband and I are in the process of re-financing our home together, but it is a long process. It looks like my mother-in-law will be heading into hospice care and I am told that Medicare will begin taking her SS and pension to cover the cost of room and board. Is there a possibility that they come after our home if we are not able to refinance in time? The timing here could not be worse.
This is what the State database is going to show and what the Medicaid caseworker will find first and foremost when they are doing their x checks for her LTC Medicaid application. Usually how the deed reads is how the recorded title reads. Post your answer as it will help us come up with possible options for your situation.
Secondly, you have got to, GOT TO, understand the differences btw MediCARE and Medicaid. There are articles on this site that go into this in detail. Right now, as she is in rehab, she is on the post hospitalization rehab benefit of MediCARE. MediCARE will pay 100% for up to 21 days only IF rehab remains necessary and she is progressing in her rehab. MediCARE can continue to pay up to a total of 100 days at 80% IF she still is at need for rehab. The 20% shortfall often is covered by her secondary health insurance to her Original Medicaid is if she has that. Otherwise it’s up the whatever your MediCARE Advantage Plan pays, or it’s private pay. It is mucho importante to understand that she needs to be participating in her rehab and progressing. If she is all “not gonna, it hurts”, maybe manana” the therapists are not going to make her. But will get written up as not progressing at best & noncompliant for care at worse. Either way MediCARE stops paying literally w in 24-48 hrs. once it’s in her chart “no progress”.
The problem morphs then into IF the plan is for MIL to stay in the NH OR if she is going to return home. So what is the plan?
if she is staying, then she goes from being a MediCARE rehab patient to a LTC resident. LTC is paid 3 ways: private pay, LTC insurance or Medicaid. Should she need hospice, she can go onto hospice & be in the facility, but MediCARE paid hospice does NOT cover the NH room&board bill. MediCARE hospice pays only the hospice agency costs. 70-80% in a NH are on Medicaid.
If she is going back to your home to live, she can apply for in home hospice. MediCARE will cover this. But realize it is limited…. Like maybe a aid comes by 2-3 times a week for a few hours. Maybe a RN once or twice a mo, All the rest of the time all her care and oversight is 100% on you and hubs. MediCARE hospice benefit is wonderful, but it is not a substitute for being under 24/7 oversight in a facility that a NH or MC would do.
If she’s staying in the NH & filing for Medicaid, she will have to submit 5 years of financial documentation. She cannot have more than 2k in nonexempt assets. If any $ moved from her to you to buy home, or pay on property costs (mortgage, taxes, insurance, utilities) and she is NOT on the title, then Medicaid will look into “gifting” aspects of all the $ move. Stuff like this will surface in the 5 yr lookback….. Medicaid will place a transfer penalty. Morphs into a problem as it takes 2-6 mos for Medicaid application to run its determination. If transfer penalty is placed, it will start from day 1 of her LTC stay at that facility. Bill will be significant. NH will do whatever to get bill paid, like get you to sign a contract or turn it over to collections which can get a judgement placed on her assets (like a home she is partial owner on).
Since you mentioned this, YES, almost all her mo income (SS, pensions) is paid to facility & required by Medicaid. It’s her copay. Medicaid not MediCARE. If you are relying on her $ to float your living costs or mortgage, all gone should she stay in NH & apply 4 Medicaid.
Again, really important everyone understands Medicaids requirements for income and assets; and 5 yr look back requirements.
If you need her income & she’s coowner, personally I’d not apply for Medicaid but take her home immediately after MediCARE rehab ends. Flat make it work till u can get past any penalty & take her off the title. Work w elder law & real estate attorney’s to do all this. Good luck.
If your MIL is a co-signer on your mortgage as said her credit secured the loan, unless she is on the deed, she does not own any part of your house so it has nothing to do with your MILs care.
Yes, Medicare pays 100% for the first 20 days. Starting with the 21st to 100th days, Medicare only pays 50%. The other is either out of pocket or her secondary insurance covers it.
Where I live the Rehab and Nursing home are in the same building so its just a matter of transferring from the rehab section to the NH section. If your MIL goes into Hospice Medicare will pay for the care but not the facility. So what happens now? Any assets Mom has will be needed to be spent down for her care. If no assets other than SS and maybe a pension, she will need to apply for Medicaid to pay for her care. Her SS and any pension will need to go to offset her care. If she owns a home, at this point it will be exempt but since her SS and any pension are going for her care, there will be no money for the homes upkeep. Medicaid will put a lean on the home when Mom passes that will need to be satisfied at the time the house is sold. There is a little more to how Medicaid recoups what they put out, but if Mom has no home its a mute point at this time.
You can have hospice done at home but you and husband will be the prime caretakers. Medicare pays for Hospice, Depends, Prescriptions, etc. You will get an aide, for how long and how many days a week seems to depend on the Hospice you sign up with. Normally its an hour for bathing 3x a week. A Nurse will be there about 3x a week but on call 24/7. You will be taught how to administer Morphine. Its a 24/7 committment. You can hire ur own aides but Medicare will not pay for them.
A problem arises if Mom is on your deed not ur Mortgage. If not on your deed then you have no problem. If she is on your deed, lets say she owns a third, you won't lose ur house but a lean will be put on her third. The lean will need to be satisfied at time of sale. More to this too but don't need to get into that now.
I will assume here that Mom was just a co-signer or you wouldn't be refinancing your home. If so, your house has nothing to do with Medicaid.
I would say that the decision to have Hospice come in should be done soon. You really don't want to go pass the 20 days that Medicare pays 100%. I have no idea how Medicare pays if a patient no longer does rehab and goes on Hospice at the facility. I will assume that since the patient can't do therapy that Medicare will stop paying. The person is transferred to the NH side, and if no money Medicaid applied for. But these are questions for the Social Worker and I would ask them soon.
Hoping Stacy and Igloo and a few others more familiar can help you with this. But you should always contact a lawyer in your area for final information that is relevant as medicaid, were she to ever need it, is a combined federal and state program and recovery may vary. In any nursing home situation it is unlikely that pension and SS will cover the monthly cost; all other assets will be up for grabs if the elder needs medicaid, and you need to know where your home stands in all this legally.
Also important to know years when deeds are done, who is on deeds and , again, you cannot make a mistake that is very costly in these matters; you need professional guidance. Hope others have valuable infor for you.
My mother-in-law was the co-signer on the home, so her name should be on the deed.