Emergency Nursing Home Medicaid Crisis Planning and Sousal Asset Protection¶

Wachikulire akadwala sitiroko, kuthyoka kwa chiuno, kapena matenda a Alzheimer's mwadzidzidzi komanso kusintha kuchokera kuchipatala kupita ku chisamaliro chanthawi yayitali mu Skilled Nursing Facility (SNF), mabanja amakumana ndi vuto lazachuma nthawi yomweyo. Inshuwaransi yokhazikika yaumoyo ndi United States Medicare Part A samalipira chithandizo chanthawi yayitali chosungira anthu okalamba kamodzi kokha kukonzanso kwanthawi yayitali kumatha (nthawi zambiri pakadutsa masiku 20 mpaka 100). Mwadzidzidzi, ofesi yamabizinesi akunyumba yosungirako okalamba imapatsa banjalo ndalama zolipirira payekha za 9,000 mpaka 15,000 US dollars pamwezi (kapena mapaundi 1,200 mpaka 1,800 pa sabata ku United Kingdom), zomwe zimatsogolera okwatirana omwe ali ndi mantha komanso ana achikulire kuti alakwitse zinthu ziwiri: kusaina bilu yolola mwana wamkulu kapena kupereka chindapusa kwa makolo omwe ali ndi vuto. ndalama zomwe makolo amasungira kwa achibale mophwanya ** miyezi 60 (zaka 5) Medicaid Look-Back Period **.

Simukuyenera kubweza ndalama, kugulitsa banja, kapena kusaukitsa mwamuna kapena mkazi wathanzi kunyumba kuti muyenerere wokondedwa wanu ku Long-Term Care Institutional Medicaid, ngakhale wodwalayo atakhala kale pabedi lanyumba yosungirako okalamba lero popanda kukonzekera. Lamulo la Federal Medicaid (42 U.S.C. § 1396r-5) limakhazikitsa chitetezo champhamvu cha Spousal Impoverishment Protection chomwe chimalola kuti "Community Spouse" wokwatirana akukhala kunyumba kuti azisunga banja lonse, galimoto imodzi, katundu wake, mpaka 154,140 dollar muzosunga zowerengera zaukwati, kubweza ndalama zambiri zapachaka madola 3,853.50 pamwezi a ndalama zophatikizana, kwinaku akuloleza osakwatira kapena osakwatiwa kuti asinthe ndalama zochulukirapo kukhala katundu wosaloledwa mwalamulo pomwepo. Bukuli limapereka njira zadzidzidzi kuti muyimitse kukakamizidwa kwachuma kunyumba ya okalamba, kupewa zilango zoyang'ana m'mbuyo, komanso kugwiritsa ntchito ndalama zadzidzidzi za Medicaid.

Chitani izi tsopano¶

1. Musasayine pangano lovomerezeka kunyumba ya okalamba m'dzina lanu kapena ngati "Financial Guarantor." Ngati kholo likukumana ndi vuto ladzidzidzi panthawi yakusamvana kwachipatala, imbani foni nambala yanu yazadzidzi (911 ku United States ndi Canada, 112 ku European Union, 999 ku United Kingdom) kapena onani zathu manambala angozi directory. Pansi pa federal Nursing Home Reform Act (42 U.S.C. § 1396r©(5)(A)(ii)), malo ndi oletsedwa kufunikira kuti mwana wamkulu kapena munthu wina azitsimikizira kuti alipiridwa ngati wololedwa; sayinini mosamalitsa monga "Wothandizira Woyimira Pansi pa [Dzina la Makolo], popanda mangawa anu azandalama."
2. IMANI nthawi yomweyo musanapereke mphatso, kusamutsa, kapena kuwonjezera dzina la mwana ku akaunti yakubanki iliyonse, chikalata cha nyumba, kapena udindo wagalimoto. Kupereka ndalama kapena kugulitsa katundu pamtengo wochepera wamsika mkati miyezi 60 (zaka 5) musanalembe fomu yofunsira Nursing Home Medicaid (miyezi 30 ku California, kutha) kumayambitsa kuopsa kwa Medicaid Transfer ndi ziro zosiyanitsidwa *ndalama *ndi kuchotsera *ndalama. Kupereka kwa Medicaid kwa miyezi kapena zaka.
3. Musamagulitse nyumba yabanja kapena ndalama zopumira ntchito kuti mulipire nyumba yosungira okalamba musanakambilane ndi Elder Law Attorney kapena SHIP phungu. Kwa okwatirana (kapena wamkulu wosakwatiwa alembe chikalata cha "Cholinga Chobwerera Kunyumba" chosaina kuti afotokoze ndalama zokwana 713,000 mpaka 1,071,000+ pamtengo wotsalira wanyumba* EXPT ndi ndalama zoyambira* kuyenerera, pamene kugulitsa nyumba kumasintha nyumba yosaloledwa kukhala ndalama zambiri zomwe nyumba yosungirako anthu okalamba idzalanda.
4. Funani chiŵerengero chovomerezeka cha "Resource Assessment / Snapshot Date" ngati wokhala ku nyumba yosungirako okalamba ndi wokwatira. Pansi pa malamulo a federal Spousal Impoverishment, mwamuna kapena mkazi wathanzi yemwe amakhala pakhomo (Community Spouse) ali ndi ufulu mwalamulo kusunga kutetezedwa Community Spouse Resource AllowanceZosamalira* (CSRA) (MMMNA)** choncho sakhala osowa.
5. Sinthani "Katundu Wowerengeka" kukhala "Katundu Wosatulutsidwa" mwalamulo ngati mukufuna kugwiritsa ntchito ndalama nthawi yomweyo mwezi wa kalendala usanathe. M'malo mopereka ndalama zochulukirapo ku nyumba yosungirako okalamba kapena kuzipereka mosaloledwa, olembetsa atha kugwiritsa ntchito ndalama zambiri kusagula mtengo wamtengo wapatali: kulipira chiwongola dzanja, kubweza ngongole kapena kukonza nyumba ** Maliro a Maliro ndi Maliro Olipiridwatu**, kugula chisamaliro chofunikira cha mano, magalasi a maso, kapena njinga ya olumala, kapena kulipira ndalama zapachaka zogwirizana ndi Medicaid.
6. Tumizani pulogalamu ya "Medicaid Pending" ndipo perekani ufulu wanu wosachotsedwa pamene boma likukonza fayiloyo. Pansi pa malamulo a federal oletsa anthu okalamba (onani kalozera wathu pa nursing home abuse, neglect, and eviction defense), malo osungirako anamwino ovomerezeka a Medicaid sangathe kuthamangitsa wokhalamo chifukwa chosamulipira pomwe pempho loperekedwa la Long-Term Care Medicaid likudikirira ndi bungwe la boma.

flowchart TD
    A["Senior Requires Permanent Custodial Nursing Home Care (Medicare Rehab Ending)"] --> B{"Is the Nursing Home Resident Married or Single/Widowed?"}
    B -->|"Married (One Spouse Living at Home)"| C["Invoke Federal Spousal Impoverishment Rules (42 USC 1396r-5)"]
    B -->|"Single, Divorced, or Widowed"| D["Audit Countable vs. Exempt Assets Against $2,000 Individual Limit (Higher in CA/NY)"]
    C --> E["Home, 1 Car, and Up to $154,140 CSRA Protected for Community Spouse + Income Shift (MMMNA)"]
    D --> F["Protect Primary Residence via 'Intent to Return Home' or Caregiver Child Exemption"]
    E --> G{"Are Remaining Countable Assets Still Above the State Limit?"}
    F --> G
    G -->|"Yes: Excess Countable Cash"| H["Execute Legal Crisis Spend-Down BEFORE End of Month (NEVER Gift Assets in 5-Year Lookback)"]
    G -->|"No: Within Asset Limit"| I["Check Monthly Income Against State 'Income Cap' (Use Qualified Income / Miller Trust if Required)"]
    H --> I
    I --> J["File Long-Term Care Medicaid Application (Trigger 'Medicaid Pending' Eviction Protection)"]

Why Medicare stops paying after 20 to 100 days (Skilled vs. Custodial Care)¶

The most common financial crisis in aging occurs around Day 20 to Day 35 of a post-hospital stay in a Skilled Nursing Facility (SNF). Families hear at the hospital that "Medicare covers 100 days of nursing home rehab," only to receive a Notice of Medicare Non-Coverage (Form CMS-10123) three weeks later stating that Medicare coverage is ending in 48 hours and that the family must pay 400 to 500 dollars per day starting Thursday.

Understanding the legal line between Medicare Part A and Long-Term Care Medicaid is the foundation of crisis planning:

• Medicare Part A (Short-Term Skilled Rehabilitation ONLY): Following a qualifying 3-midnight inpatient hospital stay, Traditional Medicare Part A covers 100 percent of days 1 through 20, and charges a daily co-insurance of 204 dollars per day (adjusted annually) for days 21 through 100 (usually covered by a Medigap supplemental policy), ONLY for as long as the patient requires and participates in daily "Skilled Care" (such as daily Physical Therapy, Occupational Therapy, Speech Therapy, or complex IV/wound nursing). The exact day the patient's mobility plateaus or they require only "Custodial Care" (help with bathing, dressing, toileting, eating, and dementia supervision), Medicare Part A pays $0, even if the patient has only used 18 of their 100 days. (If you believe rehab is being cut off prematurely while the senior can still improve, file an immediate QIO appeal using our unsafe hospital or rehab discharge appeal guide.)
• Long-Term Care Institutional Medicaid (Permanent Custodial + Skilled Care): Once a senior requires permanent 24-hour custodial care in a nursing home and lacks private Long-Term Care Insurance, Medicaid is the primary public program in the United States that pays the 10,000-dollar-per-month nursing home bill indefinitely for the rest of the resident's life, once financial and clinical ("Nursing Facility Level of Care") eligibility rules are met.

Countable vs. Exempt Assets: what Medicaid lets you keep¶

To qualify for Long-Term Care Institutional Medicaid in most U.S. states, the nursing home applicant's "Countable Assets" (non-exempt resources) must be below 2,000 dollars on the last day of the month (note: California has eliminated the asset limit completely as of 2024, and New York raised the individual asset limit to over 31,175 dollars).

However, Medicaid does not count everything you own toward that 2,000-dollar limit. Federal and state Medicaid regulations divide all property into Exempt (Non-Countable) Assets that you can keep freely, and Countable Assets that must be protected or spent down.

Federal Spousal Impoverishment Protections (when one spouse stays at home)¶

Before Congress enacted the Medicare Catastrophic Coverage Act of 1988 (42 U.S.C. § 1396r-5), when a husband entered a nursing home, the couple had to spend almost their entire life savings down to 2,000 dollars before Medicaid helped, leaving the healthy wife at home in poverty. Today, federal Spousal Impoverishment Law divides a married couple into the Institutionalized Spouse (in the nursing home) and the Community Spouse (living at home or in independent living) and protects both assets and monthly income for the spouse at home.

1. Protecting Marital Savings: The Community Spouse Resource Allowance (CSRA)¶

Under federal law, Medicaid pools all countable assets owned by either spouse (regardless of whose name is on the bank account or whether they signed a prenuptial agreement) and allows the Community Spouse to keep a protected share called the Community Spouse Resource Allowance (CSRA):

• Maximum CSRA (2024/2025 Federal Standard): Up to 154,140 dollars (adjusted upward each January for inflation) in countable liquid savings, PLUS the exempt family house, one car, and pre-paid funerals, while the Institutionalized Spouse keeps an additional 2,000 dollars.
• "100% Maximum CSRA States" vs. "50% Snapshot States":
  • In 100% States (such as Florida, Texas, New York, Pennsylvania, Georgia, and Colorado), the Community Spouse automatically keeps 100 percent of the couple's countable assets up to the 154,140-dollar ceiling.
  • In 50% Snapshot States (such as Ohio, New Jersey, North Carolina, Virginia, and Indiana), the Community Spouse keeps one-half (50%) of the couple's total countable assets as measured on the "Snapshot Date" (the first day of the senior's first continuous 30-day hospitalization/nursing home stay), with a guaranteed federal Minimum CSRA floor of 30,828 dollars and a Maximum ceiling of 154,140 dollars.

2. Protecting Monthly Income: The Minimum Monthly Maintenance Needs Allowance (MMMNA)¶

Federal law applies two completely different rules to Monthly Income (Social Security checks, pensions, annuities) for married couples:

1. The "Name on the Check" Rule for the Community Spouse's Own Income: Whatever monthly Social Security or pension check is payable in the Community Spouse's own name belongs 100 percent to the Community Spouse. No matter how large the healthy spouse's own pension or Social Security check is, Medicaid cannot touch a single penny of the Community Spouse's own monthly income to pay for the Institutionalized Spouse's nursing home care.
2. Shifting Income FROM the Nursing Home Spouse TO the Community Spouse (The MMMNA): Normally, a nursing home resident on Medicaid must pay most of their own monthly Social Security and pension check toward their nursing home bill (the "Patient Liability / Share of Cost"), keeping only a small Personal Needs Allowance (PNA) of 50 to 130 dollars per month. HOWEVER, if the healthy Community Spouse at home has low monthly income of their own, below the state's Minimum Monthly Maintenance Needs Allowance (MMMNA), which ranges from 2,555 dollars to 3,853.50 dollars per month, Medicaid allows the Institutionalized Spouse to divert and transfer a portion (or all) of their monthly Social Security and pension check directly to the Community Spouse every month so the spouse at home reaches the MMMNA livable income floor.

The 60-Month (5-Year) Look-Back Period and how to avoid Transfer Penalties¶

When a family realizes that a single parent has 80,000 dollars in a savings account and needs to be under 2,000 dollars for Medicaid, their first instinct is often: "Let's write a check for 78,000 dollars to the kids today, or sell Mom's house to her son for 1 dollar, and then apply for Medicaid tomorrow."

How the Medicaid Transfer Penalty Divisor works (and why it is a trap)¶

If Medicaid discovers that your mother gifted 70,000 dollars to her children three years ago, Medicaid does not ask the children politely for the money; instead, Medicaid calculates a Penalty Period of Ineligibility by dividing the gifted amount by the state's monthly Penalty Divisor (the average monthly cost of a nursing home in your state, e.g., 10,000 dollars):

Worse still, under the Deficit Reduction Act, that 7-month penalty clock does NOT start ticking until the day your mother is (1) living in the nursing home, (2) otherwise broke (under 2,000 dollars), AND (3) submits a Medicaid application. If the children already spent the 70,000 dollars three years ago, the mother is now trapped in the nursing home with zero money and 7 months of unpaid 10,000-dollar-per-month bills.

*(Kuchiza ngati mphatso idapangidwa kale: Ngati mwana wamkulu akadali ndi mphatsoyo, kubwezera 100 peresenti ya ndalama zomwe adapatsidwazo ku akaunti yakubanki ya kholo "kuchiritsa" chilango chakusamutsa kwathunthu kotero kuti chingagwiritsidwe ntchito mwalamulo pazinthu zomwe sanachotsedwe, kapena loya wa Elder Law atha kupereka gawo *"Mphatso ndi Medicaid * Chidziwitso"

Kupatula Zinayi Zovomerezeka pomwe kusamutsa nyumba kapena ndalama kumayambitsa ZERO¶

Lamulo la Federal (42 U.S.C. § 1396p©(2)) limalola wopempha nyumba yosungirako okalamba kusamutsa **malo okhalamo ** kapena katundu wake kumagulu anayi a mamembala a banja ngakhale tsiku loti apemphe Medicaid ndi zero 5-year-back-year-back:

1. Kusamutsa kwa Mwamuna kapena Mkazi: Kusamutsa chuma chilichonse kapena chikalata chanyumba pakati pa anthu okwatirana ndi 100 peresenti kumasulidwa ku chilango.
2. Kusamutsira kwa Mwana Wakhungu Kapena Wopunduka Kwamuyaya (wamsinkhu uliwonse): Kholo lingasamutsire katundu kapena nyumbayo mwachindunji kwa mwana amene akwaniritsa tanthauzo la Social Security la kusaona kapena kulumala kosatha (kapena ku Sole Benefit Disability Trust / Special Needs Trust kwa munthu wolumala wosakwanitsa zaka 65) wopanda chilango choyang'ana kumbuyo.
3. ** "Kukhululukidwa kwa Mwana Wosamalira" (Kusamutsa Banja Lawo):** Kholo litha kugamula nyumba yawo yoyamba yabanja ** 100 peresenti yaulere komanso yomveka bwino (yopanda kuyang'ana kumbuyo kwazaka 5 NDI tsogolo la Medicaid Estate Recovery)** kwa mwana wamwamuna kapena wamkazi wamkulu yemwe:
   • Amakhala m'nyumba ya makolo mosalekeza kwa zaka ziwiri (2) zathunthu nthawi yomweyo kholo lisanalowe kunyumba yosungirako okalamba, NDI
   • Kupereka chithandizo chatsiku ndi tsiku (chotsimikiziridwa ndi kalata ya dokotala ndi zolemba za chisamaliro) zomwe zinachedwetsa kholo kufunikira kovomerezeka kunyumba yosungirako okalamba m'zaka ziwirizo.
4. Kukhululukidwa kwa "Sibling With Equity Interest": Kusamutsa nyumbayo kwa m'bale kapena mlongo yemwe ali ndi chiwongola dzanja chaumwini m'nyumbamo ndipo amakhalamo osachepera chaka chimodzi (1) wamkuluyo asanalowe kunyumba yosungirako okalamba.

Mndandanda Woyang'anira Zowonongeka Pamalamulo: momwe mungachepetsere ndalama zambiri m'masiku 30¶

Ngati kholo lanu kapena mwamuna kapena mkazi wanu ali kunyumba yosungirako okalamba lero ndi 20,000 mpaka 150,000 madola mu ndalama zowerengeka zakubanki pamwamba pa malire a Medicaid, **simuyenera kupereka ndalama zonsezo ku nyumba yosungirako okalamba **. Kuyenerera kwa Medicaid kumatsimikiziridwa ndi chithunzithunzi cha ndalama za banki pa tsiku lomaliza la kalendala la mwezi (kapena tsiku lofunsira). Mutha kugwiritsa ntchito ndalama zochulukirachulukira mpaka $2,000 pakati pausiku pasanakwane pakati pausiku pa tsiku lomaliza la mweziwo pogula zinthu ndi ntchito pamtengo wamtengo wapatali wamsika kuti mupindule ndi wopemphayo kapena mnzawo:

• Lipirani ngongole ndi nyumba zanyumba panyumba yosaloledwa: Lipirani kapena lipira ngongole yanyumba, ngongole yanyumba (HELOC), kubweza msonkho wanyumba, kapena ngongole ya kirediti kadi ya wopemphayo kapena Wokwatirana Naye.
• Konzani zinyumba zazikulu ndi kukwezera mwayi wofikira ku nyumba yoyambira yomwe salipo: Bwezerani denga lokalamba, ikani ng'anjo ya HVAC yatsopano, konzani bafa yokhala ndi shawa yopukutira, ikani kampando wapa njinga ya olumala, sinthani mawindo, kapena gulani zida zatsopano zakukhitchini za nyumba ya Mnzanuyo.
• Gulani Mapulani a Maliro ndi Maliro Osasinthika: Pitani kumalo oika maliro omwe ali ndi chilolezo ndikusintha madola 10,000 mpaka 15,000 mkwatibwi aliyense kukhala Chikhulupiriro chamaliro Osasinthika, malo oika maliro, bokosi la maliro, ndi mwala wamutu.
• Sinthani kapena sinthani galimoto yabanja yomwe yatulutsidwa: Gulitsani galimoto yakale (kapena magalimoto awiri akale) ndikugula galimoto imodzi yodalirika yatsopano kapena yachitsanzo mochedwa (kapena galimoto yofikira pa olumala) yolembedwa m'dzina la wofunsirayo kapena Wokwatirana Naye.
• Gulani zinthu zosaphimbidwa zachipatala, zamano, zomva, ndi zotonthoza kwa akulu: Gulani mano opangira mano kapena zoyikira mano, magalasi apamaso apamwamba kwambiri, zothandizira kumva za digito, chikuku chokhazikika kapena chopendekeka m'mlengalenga, mpando wonyamulira kuchipinda chawo chosungira okalamba, kompyuta yam'manja, ndi zovala zonse zolembedwa mayina.
• Pangani Medicaid-Compliant Single Premium Immediate Annuity (SPIA) (kudzera mwa Woyimira Malamulo Akuluakulu): Pansi pa 42 U.S.C. § 1396p©(1)(F)-(G), m’maboma ambiri mwamuna kapena mkazi wa m’banja (kapena wosakwatiwa amene akugwiritsa ntchito njira ya theka la mkate) akhoza kusintha ndalama zokwana madola masauzande ambiri kukhala ndalama zotetezedwa Medicaid-Compliant Immediate Annuity yomwe imasintha ndalama zonse zomwe mwamuna kapena mkazi wake amapeza pamwezi ngati ndalama zotetezedwa. osasinthika, osagawika, omveka bwino, amalipira pang'onopang'ono mwezi uliwonse, ndikutchula bungwe la Medicaid la boma ngati lotsala lopindula mpaka phindu lomwe liperekedwa.

Kuthetsa vuto la "Income Cap" (Qualified Income Trusts / Miller Trusts)¶

Pafupifupi theka la mayiko aku US (kuphatikiza Florida, Texas, Ohio, New Jersey, Arizona, Colorado, Indiana, ndi Georgia) amatchulidwa kuti "Income Cap States." Mu Income Cap State, ngati ndalama zonse zomwe wopempha ku nyumba yosungirako okalamba amapeza (Social Security + pension asanachotsedwe) zimaposa klzzwxh:40 1 dollar**, ngakhale nyumba yongira anthu okalamba imawononga madola 10,000 pamwezi, kompyuta ya boma idzangokana kukana kuyenerera kwa Medicaid** pokhapokhautatsegula akaunti yakubanki yosavuta yotchedwa Qualified Income Trust (QIT) / Miller Trust.

flowchart TD
    A["Yang'anani Ndalama Zapamwezi Zomwe Wofunsira Nursing Home (Social Security + Pension)"] --> B{"Kodi Mukukhala mu 'Income Cap State' Ndipo Kodi Ndalama Zoposa $2,829/Mwezi?"}
    B -->|"Ayi: Pansi pa Kapu kapena 'Osowa Pachipatala Amawononga-Down State'"| C["Palibe Chikhulupiliro cha Miller Chofunika: Ndalama Zomwe Zimagwiritsidwa Ntchito Mwachindunji kwa Odwala Pagawo la Mtengo / Mkazi MMMNA"]
    B -->|"Inde: Kupitilira $2,829/Mwezi mu State Cap State"| D["Pangani Chikalata cha Qualified Income Trust (QIT / Miller Trust) Document"]
    D --> E["Tsegulani Akaunti Yodzipatulira Yopanda Chidwi Yotchedwa mu Dzina la QIT"]
    E --> F["Ndalama Zamwezi Zomwe Wolemba Wofunsira Deposit Amapitilira Kapu mu Akaunti ya QIT Mwezi uliwonse"]
    F --> G["Lipirani Mtengo wa Nyumba ya Anamwino ndi Mnzanu MMMNA Kuchokera mu Akaunti ya QIT Mwezi ndi Mwezi"]

• Mmene Miller Trust imagwirira ntchito: Yovomerezedwa ndi boma (42 U.S.C. § 1396p(d)(4)(B)), Qualified Income Trust (QIT) ndi chikalata chodalirika chamasamba 4 chomwe chimasainidwa ndi wamkulu kapena Wothandizira wawo pansi pa Mphamvu ya Attorney. Mumatengera chikalata cha QIT chomwe chasaina ku banki iliyonse, ndikutsegula akaunti yoyang'anira yomwe ili ndi mutu wakuti "[Dzina la Makolo] Qualified Income Trust," ndikusamutsa penshoni ya mwezi uliwonse ya wamkulu kapena gawo la Social Security mu akaunti ya QIT mwezi uliwonse musanalipire Gawo la Mtengo wa nyumba yosungira okalamba. Dola iliyonse yomwe yayikidwa mu Miller Trust imachotsedwa mwalamulo **kupatula ndalama zokwana madola 2,829 **, ndikutsegula nthawi yomweyo kuyenerera kwa Nursing Home Medicaid.

Kuteteza Banja Labanja ku Pambuyo pa Imfa "Medicaid Estate Recovery" (MERP)¶

Ngakhale nyumba yoyamba yabanja ndi saloledwa pamene wamkulu ali moyo, malamulo a federal (42 U.S.C. § 1396p(b)) amafuna kuti boma lililonse ligwiritse ntchito Medicaid Estate Recovery Programme (MERP) yomwe imayimba chiwongola dzanja kwa womwalirayo Medicaid pobweza ngongoleyo m'malo mwa omwe adamwalira.

Tetezani nyumba yanu yabanja kuti isadzachitikenso pambuyo pa imfa ya Estate Recovery pogwiritsa ntchito zishango zovomerezeka izi:

1. Mipiringidzo yokhazikika yotsutsana ndi Estate Recovery: Lamulo la federal limaletsa Medicaid Estate Recovery pomwe aliyense mwa achibale otsatirawa ali moyo:
   • A mkazi wotsalira (kulikonse kumene amakhala);
   • Mwana wosakwana zaka 21*; kapena
   • Mwana wakhungu kapena wolumala wazaka zilizonse*.
2. Gwiritsani ntchito "Lady Bird Deed" (Enhanced Life Estate Deed) kapena "Transfer on Death (TOD) Deed" m'maboma omwe amachepetsa kuchira ku Probate: M'maboma ambiri (monga Florida, Texas, Michigan, ndi ena), Medicaid Estate Recovery imangotenga katundu womwe umadutsa **kuyesa kwa khoti **. Kujambula Chikalata Chowonjezera cha Moyo Wanyumba (Lady Bird Deed) pomwe wamkulu ali ndi mphamvu zovomerezeka (kapena kudzera pa Power of Attorney yomwe imapereka mphamvu zopatsa / kudalira) imakhala ndi umwini wa 100 peresenti ya moyo wonse wa wamkulu (kupangitsa ziro 5-year-back-back chilango pa moyo), komanso kusamutsa kwa probate pa moyo wawo wonse.
3. Zofanana zapadziko lonse lapansi (UK Local Authority Care Cap, Deferred Payment Agreements, ndi NHS Continuing Healthcare):
   • Ku United Kingdom, chisamaliro chamagulu am'deralo chimatanthauza kuyesa (kukankhira pamwamba 23,250 mapaundi ku England) kunyozeratu mtengo wabanja bola ngati mwamuna kapena mkazi, bwenzi la boma, kapena wachibale wazaka 60 kapena kupitilira (kapena wosakwanitsa) akupitilizabe kukhala mnyumbamo.
   • Musanapereke khobiri ku nyumba yosungirako anthu okalamba ku UK, nthawi zonse muzifuna kuwunika kovomerezeka kwa NHS Continuing Healthcare (NHS CHC): ngati wamkulu ali ndi "zosowa zoyamba zathanzi" (zofunikira, zovuta, zosayembekezereka zachipatala), ** NHS iyenera kulipira 100 peresenti ya nyumba zonse zosungira okalamba ndi ndalama zomwe zimatanthawuza kuti ndalama zogulira okalamba zimatanthawuza bwanji ndalama, ndalama zogulira kapena malo ogona * eni ake.

Mafunso omwe amafunsidwa pafupipafupi¶

Kodi nyumba yosungira anthu okalamba ingandisumire ine ndekha (mwana wamkulu) kaamba ka bilu ya makolo anga imene sinalipire?¶

Ngati simunasaine pangano lovomerezeka ngati guarantor yaumwini ndipo simunabe, kubisa, kapena kusunga ndalama za kholo lanu kapena macheke a Social Security, malo osungira okalamba nthawi zambiri sangakupatseni mlandu wa bilu ya kholo lanu pansi pa malamulo a federal (42 U.S.C. § 1396r(c)(5)(A)(ii)). Komabe, samalani kwambiri misampha iwiri yomwe nyumba zosungira anthu okalamba ZIMACHITITSA bwino ana akuluakulu: (1) ngati muli ndi Financial Power of Attorney (POA) kwa kholo lanu ndipo mukulephera kupereka cheke cha mwezi uliwonse cha Social Security / penshoni ya makolo anu ku malo kapena kulephera kupereka zikalata za banki zomwe Medicaid anapempha, malowa akhoza kukutsutsani chifukwa cha "kuphwanya mgwirizano wa mgwirizano; ndi (2) m'maboma ochepa omwe ali ndi "Filial Responsibility Statutes" (makamaka ku Pennsylvania), makhoti nthawi zina amakhala ndi mlandu kwa ana akuluakulu pamene analepheretsa pempho la Medicaid kapena kusokoneza ndalama za kholo. Nthawi zonse lembani Medicaid mwachangu ndikulipira gawo lomwe kholo limafunikira pamwezi ndi wodwala pa nthawi yake.

Nanga bwanji ngati kholo langa ku nyumba yosungirako anthu okalamba ali kale ndi vuto la dementia ndipo sanasainepo Mphamvu ya Attorney?¶

Ngati kholo lanu lilibe chidziwitso chomvetsetsa ndi kusaina Financial Power of Attorney (POA) ndipo maakaunti awo aku banki, IRA, kapena chikalata chanyumba chimatchedwa m'dzina lawo, mabanki akukana kukulolani kuti mulowe muakaunti yawo kuti mutenge zaka 5 zowerengera kapena kuwononga ndalama. Choyamba, dziwani kuti aliyense amene akuthandiza wamkulu akhoza kusaina ndikutumiza fomu yofunsira ya Medicaid yokha ngati Woyimira Wovomerezeka kuti atseke m'mwezi wotsegulira, ndipo mabungwe a boma a Medicaid ali ndi mphamvu zoyang'anira kupempha mabanki mwachindunji kudzera pa Asset Verification System (AVS) ngati mudziwitsa wogwira ntchitoyo polemba kuti wopemphayo sangakwanitse. Chachiwiri, kuti mupeze ndikuwononga maakaunti aku banki omwe ali ndi chisanu, muyenera kudandaula mwadzidzidzi ku Khothi Lanu la Probate / Surrogate la ** Conservatorship / Guardianship of the Estate** (kapena pemphani chilolezo chotetezedwa ndi khothi lokhalokha kuti musamutsire katundu wa mnzakeyo kwa Wokwatirana Wathanzi Wadera).

Kodi Medicaid imabwereranso ndikutenga macheke a Social Security kuchokera pazaka 5 zapitazi?¶

Ayi. Nthawi ya Medicaid Look-Back Period ya zaka 5 (miyezi 60) sikukubwezerani ndalama zomwe makolo anu adagwiritsa ntchito movomerezeka kuti azipeza zofunika pamoyo wawo, lendi, zogulira, zothandizira, zothandizira panyumba, misonkho, kapena tchuthi m'zaka zisanu zapitazi. Kufufuza kwazaka zisanu kumangoyang'ana **mphatso zosalipidwa kapena kusamutsidwa pamtengo wotsika kwambiri wamsika** (monga kulemba cheke cha madola 10,000 kwa mdzukulu kapena kupereka kanyumba kwa mphwake ndi ziro madola). Malingana ngati ndalama za makolo anu zinagwiritsidwa ntchito pogula katundu ndi ntchito za kholo lanu (kapena mwamuna kapena mkazi), ndalamazo ndizovomerezeka 100 peresenti. Komabe, pewani kutulutsa ndalama zambiri za ATM kuti mulipire osamalira mwamwayi "pansi pa tebulo" popanda kulemba ** Pangano la Chisamaliro Chaumwini ** ndi ma risiti, popeza Medicaid imachita zochotsa ndalama zosavomerezeka ngati mphatso zosatsimikizika.

Kodi titha kusudzulana mwalamulo kuti mnzathu wathanzi azisunga zonse zomwe tasunga?¶

Nthawi zambiri, kupeza "chisudzulo cha Medicaid" sikofunikira kwenikweni ndipo nthawi zambiri kumasiya mwamuna kapena mkazi wabwino kwambiri kuposa kukhala m'banja komanso kugwiritsa ntchito zida za federal Sousal Impoverishment. Mukasudzulana, mutaya mwayi wopeza ndalama zolowa mbanja (MMMNA), mumataya ufulu wanu wolandira phindu la womwalirayo ngati wakwatirana ndi zaka zosakwana 10, ndipo mabungwe a Medicaid nthawi zambiri amatsutsa zisudzulo zomwe zatsitsidwa zomwe zimasainidwa panthawi yamavuto azachipatala ngati kusamutsidwa kwachinyengo. M'malo mwake, kukhala m'banja ndikugwiritsa ntchito Woyimira Woyimira Malamulo Ovomerezeka (CELA) kuphatikiza nyumba yosaloledwa, $154,140 CSRA, ndi Medicaid-Compliant Immediate Annuity kapena Court Support Order zimateteza 90 mpaka 100 peresenti ya ndalama zomwe okwatirana amasunga popanda kuthetsa ukwati wanu.

Magwero afufuzidwa¶

• United States Code and Centers for Medicare & Medicaid Services (CMS, United States): 42 U.S.C. § 1396r-5 (Kusamalira Ndalama ndi Zothandizira kwa Okwatirana Ena Okhazikitsidwa / Miyezo Yakusauka kwa Okwatirana: CSRA ndi MMMNA) ndi 42 U.S.C. § 1396p (Liens, Adjustments, Estate Recovery, Miyezi 60 Yoyang'ana-Kumbuyo, Kupereka Mwana Wosamalira, ndi Ndalama Zoyenerera / Miller Trusts).
• Federal Nursing Home Reform Act (OBRA '87, United States): 42 U.S.C. § 1396r © (5) (A) (ii) ndi 42 C.F.R. § 483.15 (Kuletsa Kufuna Zitsimikizo Zazachuma za Gulu Lachitatu pa Kuloledwa ndi Kutetezedwa kwa "Medicaid Pending" Okhala Otsutsa Kuthamangitsidwa).
• Social Security Administration (SSA, United States): Program Operations Manual System (POMS) SI 01130.100 kupyolera mu SI 01130.420 (Zomwe Sizinaphatikizidwe: Malire Okhala ndi Malo Okhazikika, Kukhululukidwa kwa Magalimoto Amodzi, ndi Ndalama Zosasinthika).
• National Academy of Elder Law Attorneys (NAELA) ndi National Consumer Voice for Quality Long-Term Care (United States): Malangizo a Crisis Medicaid Spend-Down Guides, Mapangano Osamalirira Anthu, ndi Chitetezo Chotsutsana ndi Zotolera Zosaloledwa M'nyumba za Anamwino.
• Department of Health and Social Care ndi NHS England (United Kingdom): Care Act 2014 Chitsogozo Chokhazikika (Annex B: Chithandizo cha Capital ndi Kunyalanyaza Nyumba Yaikulu ya Okwatirana ndi Achibale Azaka 60+) ndi * National Framework for NHS Continuing Healthcare (NHS CHC)*.

Maupangiri ogwirizana¶

• Kuzunzidwa m'nyumba za anamwino, kunyalanyaza, ndi chitetezo chothamangitsidwa
• Kutsutsa chipatala chosatetezeka kapena kutulutsidwa kwa rehab
• Kugwiritsa ntchito ndalama zazikulu komanso chitetezo chachinyengo
• Chipatala cha delirium ndi kulengeza zachipatala kwa okalamba
• Kusagwira ntchito kwadzidzidzi ndi kupulumutsidwa kwa akuluakulu odalira
• Nambala zangozi