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Old 01-21-2016, 05:55 PM
 
663 posts, read 482,219 times
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Let's keep this about single people....and not bring spouses into consideration. I ask this because so many financial discussions here become about spouses one wants to protect and while that's useful to many, this thread is about singles and in North Carolina specifically. Please feel free to open a another thread about spouses.

Link to article I'm referencing:
When Medicaid in North Carolina Will Pay for Long-Term Care in a Nursing Home | Nolo.com

I'm pulling snippets out of the article and I want to be sure I'm understanding this correctly (bold is by me):

"...If you don't receive SSI, and you are 65 or older, blind, or disabled, you must have income below $973/month for a household of one ....... (in 2014).

If your income is above the limit, you still might be able to qualify for Medicaid if you have medical expenses that meet or exceed the amount of extra income you have. The Division of Medical Assistance (DMA) will calculate how much your monthly income exceeds the Medicaid income limit and then will multiply that amount by six. This amount is your Medicaid deductible. Once you satisfy your deductible, you are eligible for Medicaid for a period of six months. After six months, DMA will assess another deductible.

You can satisfy your deductible by showing DMA that you have medical expenses, including nursing home charges, that equal or exceed your deductible. You do not have to pay medical bills for them to count towards your deductible; you just need to show proof that you incurred the expenses. Because nursing homes are so expensive, the Medicaid deductible is a common way for nursing home residents to become eligible for Medicaid...."


Based upon the above, let's say I'm 65, and my income (I'm making this figure up here) is $3000 (I don't know if their $973 is gross or net, so I can't speak to this either - do you know?). I read this thus: $3000 (my "income") - $973 (their income limit) = $2027 which is how much my income exceeds the Medicaid income limit. They then multiply the $2027 by 6, which is = $12,162.

So from that I get that I would have to pay my deductible of $12,162 before Medicaid would kick in. At least for 6 months. So, let's say that deductible buys me about a month at a SNF. (I have no idea how much time $12k would actually buy, and the article says that in 2012 the average NC SNF was $228 a day ---I think that's wrong, or at least not the sort of facility I would be in...I think the figure would be closer to $400 a day...so I'm using $400. FTR, I would spend down some assets to get into a better place, and hope they'd keep me once I spent my way down to Medicaid status).

The article further states (later) that I get to keep about $45 a month for personal items (and $2000 in assets). Yippee.

So do you read the above as correct?

But, there's more: here's something that shocked me:

"In North Carolina, your home is exempt up to an equity value of $543,000, as long as you intend to return there or if your spouse or another dependent relative lives there. In addition, one car is exempt if it is used for transportation for yourself, your spouse, or a dependent relative. Personal belongings and household goods are also exempt. Retirement accounts are counted as assets to the extent you can withdraw money from them."

Seriously?? I can keep my home, car, furniture, family china, etc? That's just SOOOO very different from the horror stories I've read about other states. And frankly, FAIR. I feel like, sure, I'll spend down what I have in assets...no need to feel like a thief getting a lawyer (but I would...I want my home! I totally get why someone might do that) to wrestle to keep one's home, car, stuff. Take all the green...just leave me in peace among the things I've loved and let me have my home in my old age. (Please, no negative comments about wanting "things"...we all have them...and for me, it's the dining room set that the extended family gathered around many times a year for over a quarter of a century...mine was the house they all came to....now they're scattered to the winds, but still, a small contingent still loves it...and so do I)

Have I read this right? I'm holding off on the happy dance until I hear otherwise (but I'm poised!)

And, frankly, if it doesn't look like I'd go back home, well, they can have it. I'm not saving it for anyone. But if there's even a chance I can go home, I want to! Who wouldn't? (Frankly, the "way out" so many consider may well be because of losing home, car, everything when they *do* have a chance to get out of a SNF...but that's another thread.)

Just to reiterate: The above is just about a nursing home. The 2nd page of the article discusses assisted living and home health care, and I'll get to that at a later date. This is for single people, in NC, concerning SNF and Medicaid.

Last edited by crusinsusan; 01-21-2016 at 06:04 PM.. Reason: to italicize the article
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Old 01-21-2016, 06:22 PM
 
Location: Prescott AZ
6,138 posts, read 9,111,221 times
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Susan; The thing is most of the nursing homes that take Medicaid are not the ones you would want to be in. The kind and level of care in a Medicaid home is probably too low for your standards, so I wouldn't get too excited about this just yet. You can, of course, research which homes will take Medicaid and then decide if you want to do a happy dance !!!
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Old 01-21-2016, 06:27 PM
 
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Same in Texas. I think the federal base guideline for exempting a home is 505K and then each state amends that.

And there are nice Medicaid nursing homes. Just look around.
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Old 01-21-2016, 06:40 PM
 
663 posts, read 482,219 times
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Quote:
Originally Posted by PhxBarb View Post
Susan; The thing is most of the nursing homes that take Medicaid are not the ones you would want to be in. The kind and level of care in a Medicaid home is probably too low for your standards, so I wouldn't get too excited about this just yet. You can, of course, research which homes will take Medicaid and then decide if you want to do a happy dance !!!
Yep...I would do lots of research to find a good one. Then, get my foot in door, pay and pay, and then hope they'll keep me. I *think* the trick is to find a place that is good, and oft won't accept Medicaid persons...but *will* keep them once you get in. Tricky business, to be sure.
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Old 01-21-2016, 06:43 PM
 
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Quote:
Originally Posted by Clemencia53 View Post
Same in Texas. I think the federal base guideline for exempting a home is 505K and then each state amends that.

And there are nice Medicaid nursing homes. Just look around.
I'll try and find the federal baseline for exemptions. Half a mill is fine by me. If anyone else can find this from a reliable source, I'd appreciate it.
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Old 01-21-2016, 06:53 PM
 
663 posts, read 482,219 times
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hmm... I'm thinking there isn't a federal exemption: (bold is from me)

Medicaid and the principal residence - 360 Degrees of Financial Literacy

"However, assets that are exempt for the purpose of determining Medicaid eligibility can still be attached to reimburse the state for its costs. The federal government encourages states to seek reimbursement from Medicaid recipients for Medicaid payments made on their behalf. To this end, federal law allows a lien to be placed on your home at the time you become a permanent resident of a nursing home. (A Medicaid lien makes it impossible for you to sell your home or refinance your mortgage without paying the state whatever may be owed.) But not all states have adopted laws providing for such liens. Even if your state has adopted such a law, a Medicaid lien can't be imposed on your home during your lifetime while specified relatives (such as your spouse) lawfully live there."

This sounds like a general statement regarding the fed, but the article I posted speaks of NC (and Clem speaks of TX). Of course, a problem arises around the words "...permanent resident of a nursing home." Does permanent mean for the rest of your life? If so, how in the world do they determine that you will be there for the "rest" of your life? What with medical advances and all.

If the lien is placed, will they wait until after my demise for payment?
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Old 01-21-2016, 07:09 PM
 
33,046 posts, read 22,121,606 times
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That's right folks, you can own a half million dollar house and get free stuff but if you have nothing except $1000 a month SS, you're just outta luck.

Is this a great country or what?
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Old 01-21-2016, 07:17 PM
 
6,356 posts, read 5,091,511 times
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Quote:
Originally Posted by freemkt View Post
That's right folks, you can own a half million dollar house and get free stuff but if you have nothing except $1000 a month SS, you're just outta luck.

Is this a great country or what?
You can still qualify for Medicaid, but once you cross the bridge, that 500k house goes to Uncle Sam.
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Old 01-22-2016, 12:06 AM
 
6,692 posts, read 3,777,453 times
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Quote:
Originally Posted by freemkt View Post
That's right folks, you can own a half million dollar house and get free stuff but if you have nothing except $1000 a month SS, you're just outta luck.

Is this a great country or what?
No, you get Medicaid automatically to pay for your nursing home stay. You qualify. You are not outta luck.

The reason the value of the home is so high is because seniors often have lived in their homes a long time, and the houses have appreciated in value. But to the senior, it's still the same old house they've had for decades. It's their home, and they hope to be able to return to it. BUT the govt WILL PUT A LIEN ON THE HOUSE, so when the person dies, the govt gets the house.

So you see....that person would get no more than you got. Except, of course, that she had to PAY FOR IT with her possessions, upon her death. YOU GOT IT FOR FREE.
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Old 01-22-2016, 04:08 AM
 
33,046 posts, read 22,121,606 times
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Quote:
Originally Posted by bpollen View Post
No, you get Medicaid automatically to pay for your nursing home stay. You qualify. You are not outta luck.

The reason the value of the home is so high is because seniors often have lived in their homes a long time, and the houses have appreciated in value. But to the senior, it's still the same old house they've had for decades. It's their home, and they hope to be able to return to it. BUT the govt WILL PUT A LIEN ON THE HOUSE, so when the person dies, the govt gets the house.

So you see....that person would get no more than you got. Except, of course, that she had to PAY FOR IT with her possessions, upon her death. YOU GOT IT FOR FREE.

The way I read it, a single person living on $1000 a month does not qualify unless they have a sufficient level of out-of-pocket medical expenses.

Let's assume a person qualifies for Medicaid, there's still the problem that it's hard to find a nursing home that will accept a Medicaid recipient.
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