UCwangciso lweNgxaki yeNgxaki yeMedicaid yeKhaya loMongikazi oluNgxamisekileyo kunye noKhuseleko lweMpahla yoMlingane¶

Xa umntu omdala okhulileyo ehlaselwa yintlekele, ukuphuka kwe-hip, okanye ukuqhubela phambili ngokukhawuleza kwesifo se-Alzheimer kunye noshintsho olusuka ekuvuseleleni isibhedlele ukuya kukhathalelo olusisigxina lwexesha elide kwi-Skilled Nursing Facility (SNF), iintsapho zifumana ukothuka kwezemali kwangoko. I-inshurensi yezempilo esemgangathweni kunye ne-United States ** i-Medicare Part A ayihlawuleli ukhathalelo lwexesha elide lokunyamekela kwikhaya labahlengikazi ** emva kokuba ukuvuselelwa kwezakhono zexesha elifutshane kuphelile (ngokuqhelekileyo emva kwe-20 kwiintsuku ze-100). Ngequbuliso, iofisi yeshishini lekhaya labalupheleyo inika usapho intlawulo yabucala ye-9,000 ukuya kwi-15,000 yeedola zase-US ngenyanga* (okanye i-1,200 ukuya kwi-1,800 yeeponti ngeveki e-United Kingdom), ekhokelela amaqabane awoyikayo kunye nabantwana abadala ukuba benze iimpazamo ezimbini ezibuhlungu: ukutyikitya i-akhawunti yokwamkelwa kwabantwana okanye i-akhawunti yokwamkelwa komntwana okanye i-akhawunti yomntwana enika umntwana intlawulo yobuqu. imali egciniweyo yomzali kwizizalwane ephula inyanga ezingama-60 (iminyaka emi-5) yeMedicaid Look-Back Period.

Akunyanzelekanga ukuba ubhuqe, uthengise ikhaya losapho, okanye uhlwempuzeke iqabane elisempilweni ekhaya ukuze ufanelekele umntu omthandayo Long-Term Care Institutional Medicaid, nangona isigulane sele sihleli kwibhedi yekhaya labalupheleyo namhlanje ngaphandle kokucwangciswa kwangaphambili. Umthetho we-Federal Medicaid (42 U.S.C. § 1396r-5) useka amandla Ukhuseleko lweNgcaciso yoMlingane ** oluvumela "uMlingane woLuntu" otshatileyo ohlala ekhaya ukuba agcine yonke indawo yokuhlala yentsapho, isithuthi esinye, izinto zomntu, ukuya kwi- ** 154,140 yeedola kwiimali ezibalwayo zomtshato, ukugcinwa kobudlelwane bomtshato kunye nokugcinwa komtshato ngonyaka. 3,853.50 yeedola ngenyanga yomvuzo odityanisiweyo, ngelixa ivumela abafaki-zicelo abangatshatanga okanye abatshatileyo ukuba baguqule imali engaphezulu kwimpahla ekhululwe ngokusemthethweni kwangoko. Esi sikhokelo sibonelela ngamanyathelo angxamisekileyo ngokukhawuleza ukumisa uxinzelelo lwezemali lwekhaya labahlengikazi olungekho mthethweni, ukuphepha izohlwayo zokujonga ngasemva, kunye nokwenza inkcitho engxamisekileyo yeMedicaid.

Yenza oku ngoku¶

1. Ungaze usayine isivumelwano sokungeniswa kwikhaya labalupheleyo ngegama lakho okanye “njengoMqinisekisi wezeMali.” Ukuba umzali ujongene nemeko engxamisekileyo yezonyango ngexesha lengxabano, tsalela umnxeba kwinombolo yakho kaxakeka yasekuhlaleni (911 eUnited States naseKhanada, 112 kwiManyano yaseYurophu, 999 eUnited Kingdom) okanye ujonge yethu amanani kaxakeka ulawulo. Phantsi komanyano uMthetho woHlaziyo lweKhaya labongikazi (42 U.S.C. § 1396r©(5)(A)(ii)), indawo ithintelwe ngokungqongqo ekufuneni umntwana omdala okanye umntu wesithathu ukuba aqinisekise intlawulo ngokobuqu njengemeko yokwamkelwa; sayina ngokungqongqo njengokuthi "uMmeli ophantsi kwegunya leGqwetha le [Igama lomzali], ngaphandle kobutyala bezemali."
2. YIMA ngokukhawuleza phambi kokuba unike isipho, utshintshe, okanye wongeze igama lomntwana kuyo nayiphi na iakhawunti yebhanki, itayitile yendlu, okanye itayitile yemoto. Ukukhupha imali okanye ukuthengisa ipropati ngexabiso elingaphantsi kwexabiso lemakethi elifanelekileyo phakathi** kweenyanga ezingama-60 (iminyaka emi-5)** phambi kokufaka isicelo seNursing Home Medicaid (iinyanga ezingama-30 eKhalifoniya, ukukhutshwa) kubangela ubukhali I-Medicaid Transfer kunye ne-zero ye-Penal kunye ne-zero ye-Penal* Ukhuseleko lweMedicaid iinyanga okanye iminyaka.
3. Ungaze uthengise ikhaya losapho okanye ukhuphe ii-akhawunti zomhlala-phantsi ukuze uhlawule ikhaya labalupheleyo phambi kokuba udibane neGqwetha loMthetho oMdala okanye umcebisi we-SHIP. Kwisibini esitshatileyo (okanye umntu omdala omnye ofake isiteyitimenti esityikityiweyo esithi "INjongo yokuBuyela Ekhaya" ukuya kutsho kwi-equity caps ye-713,000 ukuya kwi-1,071,000+ yemali yokuhlala* EXPTimali yentlawulo imali esetyenzisiweyo yemali yexabiso lemali EMPS yimali yokufumana imali yexabiso lemali yexabiso ukufaneleka, ngelixa ukuthengisa indlu kuguqula ikhaya elixolelweyo libe yimali eninzi eyakuthi ithathwe likhaya labongikazi.
4. Funa ukubala okusesikweni "koVavanyo lweZibonelelo / Umhla we-Snapshot" ukuba umhlali wekhaya lokunyamekela abantu utshatile. Phantsi kwemithetho ye-Spousal Impoverishment, iqabane elisempilweni elihlala ekhaya (Iqabane lasekuhlaleni) linelungelo ngokusemthethweni lokugcina ukhuseleko **Isibonelelo seSibonelelo soMlingane woLuntu *Isibonelelo seSibonelelo soMlingane IsiBonelelo seNkxaso kunye neSibonelelo seNkxaso (CSRA) (MMMNA) ngoko ke abaze bashiywe beswele.
5. Guqula "Ii-Asethi eziBalwayo" zibe "Ii-Asethi eziXolelwayo" ngokusemthethweni ukuba ufuna inkcitho ephantsi kwangoko phambi kokuphela kwenyanga yekhalenda. Endaweni yokuhambisa imali eyongiweyo engaphezulu kwikhaya labalupheleyo okanye uyinike ngokungekho mthethweni, abafaki-zicelo banokuchitha imali ebalwa ngokusemthethweni kwixabiso lexabiso lokuthenga: ukuhlawula ityala, ukuhlawulelwa kwetyala okanye ukulungisa ikhaya ** ITrasti yokuNgcwaba nokuNgcwaba eBhatala kwangaphambili**, ukuthenga ukhathalelo lwamazinyo olufunekayo, iindondo zamehlo, okanye isitulo esinamavili, okanye ukwenza i-Medicaid-compliant spousal annuity.
6. Ngenisa isicelo se-"Medicaid Pending" kwaye ubambe ilungelo lakho ngokuchasene nokukhutshwa ngelixa urhulumente eqhuba ifayile. Phantsi kwemithetho yokukhutshwa kwekhaya labongikazi (bona isikhokelo sethu ukuxhatshazwa kwekhaya labongikazi, ukungahoywa, kunye nokukhusela ukugxothwa), isibonelelo sobuhlengikazi esiqinisekisiweyo se-Medicaid asikwazi ukukhupha umhlali ngenxa yokungahlawulwa ngelixa isicelo se-Long-Term Care Medicaid silindele ngokusebenzayo kunye ne-arhente karhulumente.

flowchart TD
    A["Abaphezulu bafuna uKhathalelo lweSigxina loLondolozo lweKhaya loLondoloza (i-Medicare Rehab Ending)"] --> B{"Ngaba uMhlali weKhaya loLondolozo utshatile okanye akatshatanga/ungumhlolokazi?"}
    B -->|"Utshatile (Iqabane elinye elihlala ekhaya)"| C["Cela iMithetho yokuPhucuka koMlingane we-Federal (42 USC 1396r-5)"]
    B -->|"Akatshatanga, Uqhawule umtshato, okanye Umhlolokazi"| D["Uphicotho oluBalwayo vs. Ii-asethi eziKhululiwe ngokuchasene ne-$2,000 yoMda woMntu ngamnye (Ephezulu kwi-CA/NY)"]
    C --> E["Ikhaya, Imoto e-1, kwaye Ukuya kuthi ga kwi-154,140 yeedola ze-CSRA ekhuselwe kuMlingane woLuntu + iShift yoMvuzo (MMMNA)"]
    D --> F["Khusela iNdawo yokuhlala esisiseko 'ngeNjongo yokuBuyela Ekhaya' okanye uMkhathalelo wokuKhululwa koMntwana"]
    E --> G{"Ngaba ii-asethi eziBaliweyo ziseNgapha koMda weLizwe?"}
    F --> G
    G -->|"Ikho: Imali Enokubalwa Ngakumbi"| H["Yenza iNgxaki yezoMthetho ichithe-Phantsi PHAMBI kokuphela kweNyanga (UNGAZE I-Asethi yesipho kwi-5-Year Lookback)"]
    G -->|"Hayi: Ngaphakathi koMda weAsethi"| I["Jonga uMvuzo weNyanga ngokuchasene ne 'Income Cap' (Sebenzisa uMvuzo oQinisekileyo / iTrasti yeMiller ukuba iyafuneka)"]
    H --> I
    I --> J["IFayile yeSicelo seMedicaid soNyango lweXesha elide (I-Trigger 'Medicaid Pending' yokuKhuselwa kokuKhuselwa)"]

Kutheni i-Medicare iyeka ukuhlawula emva kwe-20 ukuya kwiintsuku ze-100 (Izakhono vs. Unonophelo lwe-Custodial)¶

Eyona ngxaki ixhaphakileyo yezemali ekuguga kwenzeka malunga ne-** Usuku lwe-20 ukuya kwi-Day 35 ** ye-post-hospital yokuhlala kwi-Skilled Nursing Facility (SNF). Iintsapho ziva esibhedlele ukuba "i-Medicare igubungela iintsuku ze-100 ze-rehab yekhaya labahlengikazi," kuphela ukufumana i-Notice of Medicare Non-Coverage (IFom CMS-10123)* kwiiveki ezintathu kamva echaza ukuba i-Medicare coverage iphelile kwiiyure ze-48 kwaye intsapho kufuneka ihlawule i-400 ukuya kwi-500 yeedola ngosuku ukuqala ngoLwesine.

Ukuqonda umgaqo osemthethweni phakathi kwe-Medicare Part A kunye ne-I-Long-Term Care Care Medicaid sisiseko sokucwangcisa ingxaki:

• I-Medicare iCandelo A (Ukubuyiselwa kweSikhono seXesha elifutshane KUPHELA): Ukulandela ukuhlala esibhedlele kwezigulana ezi-3 ezinzulwini zobusuku, i-Medicare yeSigaba A ibandakanya i-100 ekhulwini leentsuku ze-1 ukuya kwi-20, kwaye ihlawulisa i-inshurensi yokubambisana yemihla ngemihla ye--204 yeedola ngosuku (ihlaziywa ngeentsuku ezi-21 ngonyaka) Umgaqo-nkqubo owongezelelweyo we-Medigap), KUPHELA ixesha elide njengoko isigulane sidinga kwaye sithatha inxaxheba kwimihla ngemihla "Ukunyamekela kweZakhono" (ezifana ne-Physical Therapy yemihla ngemihla, i-Occupational Therapy, i-Speech Therapy, okanye i-IV eyinkimbinkimbi / ukongiwa kwamanxeba). Usuku oluchanekileyo lokuhamba kwesigulane okanye bafuna kuphela ** "Unonophelo Lokugcinwa"* (uncedo lokuhlamba, ukugqoka, indlu yangasese, ukutya, kunye nokulawulwa kwengqondo), ** I-Medicare Part A ihlawula i-$ 0 **, nokuba isigulane sisebenzise kuphela i-18 kwiintsuku zabo ze-100. (Ukuba ukholelwa ukuba i-rehab inqunyulwa ngaphambi kwexesha ngelixa umntu omdala esenokuphucuka, faka isibheno se-QIO ngoko nangoko usebenzisa isibhedlele esingakhuselekanga okanye isikhokelo sokukhupha irehab.)
• I-Long-Term-Term Care Institutional Medicaid (uLondolozo oluGqibeleleyo + Ukhathalelo lweZakhono): Xa umntu omdala efuna ukhathalelo olusisigxina lweeyure ezingama-24 kwikhaya labalupheleyo kwaye akanalo i-Inshurensi yoLondolozo lweXesha elide, iMedicaid yinkqubo kawonke-wonke ephambili eUnited States ehlawula i-10,000 yezigidi zeedola zokuphumla ekhaya. ubomi umhlali, kanye zemali kunye neklinikhi ("Nursing Facility Level of Care") imithetho yokufaneleka ihlangatyezwane.

Ukubalwa xa kuthelekiswa ne-Exempted Assets: yintoni iMedicaid ekuvumela ukuba uyigcine¶

Ukuze uvumeleke kwi-Long-Term Care Institutional Medicaid kuninzi lwamazwe ase-US, umfaki-sicelo wekhaya labalupheleyo "Izinto eziBalwayo" (izibonelelo ezingakhululiyo) kufuneka zibe ngaphantsi kwe-2,000 yeedola ngosuku lokugqibela lwenyanga (qaphela: I-California iwucime umda we-asethi ngokupheleleyo njenge-2024 kunye ne-3 ye-asethi iphakanyiswe ngaphezu kwe-2024 kunye ne-3 New York, iidola*).

Nangona kunjalo, i-Medicaid ayifuni ** ukubala yonke into onayo kuloo mda we-2,000 yeedola. Imithetho ye-Medicaid ye-Federal kunye ne-state yahlula yonke impahla kwi-Exept (engenakubalwa) ye-Asethi* onokuthi uyigcine ngokukhululekileyo, kunye ne-Ii-Asethi eziBalwe ekufuneka zikhuselwe okanye zichithwe phantsi.

Ukhuseleko lwe-Federal Sousal Impoverishment (xa elinye iqabane lihlala ekhaya)¶

Ngaphambi kokuba iNkongolo yenze umthetho we- Medicare Catastrophic Coverage Act ka-1988 (42 U.S.C. § 1396r-5), xa umyeni wangena kwikhaya labalupheleyo, esi sibini kwafuneka sichithe phantse yonke imali esasiyigcinele ubomi baso ukuya kutsho kwi-2,000 yeedola ngaphambi kokuba i-Medicaid incede, ishiya umfazi osempilweni ekhaya ehlwempuzekile. Namhlanje, i-Federal Umthetho Wokuhlwempuzeka Kweqabane wahlula isibini esitshatileyo sibe Iqabane Elisekwe kwiziko (kwikhaya labalupheleyo) kunye Neqabane Loluntu (elihlala ekhaya okanye lizihlalela) kwaye likhusela zombini impahla kunye nomvuzo wenyanga womlingane ekhaya.

1. Ukukhusela uLondolozo loMtshato: Isibonelelo sezibonelelo zoMlingane woLuntu (CSRA)¶

Phantsi komthetho we-federal, i-Medicaid idibanisa zonke ii-asethi ezinokubalwa zelinye iqabane (kungakhathaliseki ukuba igama likabani na kwi-akhawunti yebhanki okanye nokuba basayine isivumelwano sangaphambi komtshato) kwaye ivumela ** Iqabane Loluntu** ukuba ligcine isabelo esikhuselweyo esibizwa ngokuba yi Community Spouse Resource Allowance (CSRA):

• Obona bukhulu CSRA (2024/2025 Federal Standard): Ukuya ku 154,140 yeedola (ihlengahlengiswa inyuke nganye kaJanuwari ngexabiso lokunyuka kwamaxabiso) kwimali eyongeziweyo yokonga ulwelo, KUNYE nendlu yosapho ekhululweyo, imoto enye, kunye nemingcwabo ehlawulwe ngaphambili, ngelixa Iziko ligcina i0 idola2* eyongezelelweyo.
• "100% Ezona zizwe zininzi ze-CSRA" vs. "50% Amazwe aqingqiweyo":
  • Kwi- ** 100% States ** (efana neFlorida, eTexas, eNew York, ePennsylvania, eGeorgia, naseColorado), uMlingane woLuntu ugcina ngokuzenzekelayo ** i-100 yeepesenti yezinto eziphathekayo zesibini ukuya kwi-154,140-dollar yesilingi **.
  • Kwi- 50% I-Snapshot States (efana ne-Ohio, i-New Jersey, i-North Carolina, i-Virginia, ne-Indiana), uMlingane woLuntu ugcina **isiqingatha (50%) se-asethi ezibalwayo ezipheleleyo zesibini ** njengoko kulinganiswe kwi- "Umhla we-Snapshot" (usuku lokuqala lokuqala oluqhubekayo lwe-30-day ye-federal yokuhlala esibhedlele), i-RA kunye nomgangatho wokuhlala esibhedlele ngosuku lwe-30 I-30,828 yeedola ** kunye ne **Ubukhulu besilingi ye-154,140 yeedola **.

2. Ukukhusela uMvuzo weNyanga: Ubuncinci beNyanga yeSibonelelo seSibonelelo seZifuno (MMMNA)¶

Umthetho we-Federal usebenzisa imithetho emibini eyahluke ngokupheleleyo kwi-Mvuzo yeNyanga (iitshekhi zoKhuseleko loLuntu, ipenshoni, i-annuities) kwizibini ezitshatileyo:

1. Umgaqo othi "Igama elikwitshekhi" yoMvuzo woMlingane wasekuhlaleni: Nokuba yeyiphi inyanga nenyanga yoKhuseleko lweNtlalo okanye isheke yomhlalaphantsi ehlawulwa kwi Igama loMlingane wasekuhlaleni yeye- 100 lepesenti yoMlingane wasekuhlaleni. Nokuba ingakanani imali yomhlalaphantsi yeqabane elisempilweni okanye itshekhi yoKhuseleko lweNtlalo, iMedicaid ayinakuchukumisa nepeni enye yomvuzo wenyanga woMlingane woLuntu ukuhlawula ukhathalelo lwekhaya labalupheleyo leMlingane.
2. Umvuzo oShiftayo ophuma kwiqabane leKhaya lokongiwa uye kuMlingane wasekuhlaleni (i-MMMNA): Ngokuqhelekileyo, umhlali wekhaya labalupheleyo kwi-Medicaid kufuneka ahlawule uninzi lwenyanga yakhe yenyanga yoKhuseleko lweNtlalo kunye netshekhi yomhlalaphantsi ukuya kwityala labo lekhaya labongikazi ("Ityala lesigulane / iSabelo seNdleko"), egcina kuphela intwana IiMfuno zoMntu eziyi-50 kwi-dollar eyi-1 ye-Personal Needs **NANGONA KUNJALO , ukuba osempilweni Umlingane woLuntu ekhaya unomvuzo ophantsi wenyanga owabo, ngaphantsi korhulumente Ubuncinane beNyanga yeSibonelelo seeMdingo zeNyanga (MMMNA), ukusuka ku 2,555 yeedola ukuya kwi-3,853.50 yeedola ngenyanga, i-Medicaid ivumela i-Spostituation yabo yonke kwaye idlulise i-Instituation yabo yonke i-Institual qho ngenyanga uKhuseleko loLuntu kunye netshekhi yomhlalaphantsi ngqo kuMlingane woLuntu nyanga zonke ukuze iqabane ekhaya lifikelele kumgangatho wengeniso enokuhlalwa yiMMMNA.

Iinyanga ezingama-60 (iminyaka emi-5) yokuJonga emva kwexesha kunye nendlela yokuphepha izohlwayo zokuGqithisela¶

Xa intsapho ifumanisa ukuba umzali ongenaqabane une-80,000 yeedola kwi-akhawunti yokonga kwaye kufuneka abe ngaphantsi kwe-2,000 yeedola kwi-Medicaid, ithuku labo lokuqala lihlala lisithi: *"Masibhale itsheki ye-78,000 yeedola kubantwana namhlanje, okanye sithengise indlu kaMama kunyana wakhe nge-dollar enye, kwaye ngomso ufake isicelo se-Medicaid."

Isebenza njani iMedicaid Transfer Penalty Divisor (kwaye kutheni ingumgibe)¶

Ukuba i-Medicaid ifumanisa ukuba umama wakho unikele nge-70,000 yeedola* kubantwana bakhe kwiminyaka emithathu edlulileyo, i-Medicaid ayibuzi abantwana ngembeko ngemali; endaweni yoko, i-Medicaid ibala Ixesha leSigwebo sokungavumelekanga ngokwahlula isixa esinesiphiwo ngenyanga yelizwe I-Penalty Divisor (umndilili weendleko zenyanga zekhaya labalupheleyo kwilizwe lakho, umz., i-10,000 yeedola):

Okubi nangakumbi, phantsi koMthetho wokuNcitshiswa kweDeficit Reduction Act, ukuba iwotshi yesohlwayo seenyanga ezisi-7 AYIQALA ukuphawula kude kube yimini umama wakho (1) ehlala kwikhaya labalupheleyo, (2) ngenye indlela yaphuka (ngaphantsi kwe-2,000 yeedola), KUNYE (3) ingenise isicelo seMedicaid. Ukuba abantwana sele bechithile i-70,000 yemali yeenyanga ezintathu ezidlulileyo kwaye i-70,000 yeedola ibanjwe yimali yeminyaka emithathu edlulileyo. engahlawulwanga 10,000-dollar-ngenyanga amatyala.

*(Ukunyangwa kwengxaki ukuba isipho sele senziwe: Ukuba umntwana omdala usenayo imali enesiphiwo, ukubuyisela i-100 lepesenti yemali ephiwe kwi-akhawunti yebhanki yomzali "inyanga" isohlwayo sodluliselo ngokupheleleyo ukuze ke isetyenziswe phantsi ngokusemthethweni kwizinto ezixolelweyo, okanye igqwetha loMthetho waBadala linokuphumeza inxalenye *"Isipho kunye neNkxaso-mali yeNkxaso" iNgxelo yeNkxaso-mali.

Izahlulo ezine ezisemthethweni apho ukudluliselwa kwekhaya okanye imali kubangela i-ZERO isohlwayo¶

Umthetho weFederal (42 U.S.C. § 1396p©(2)) uvumela umfaki-sicelo wekhaya labalupheleyo ukuba adlulisele indawo yokuhlala esisiseko okanye impahla yakhe kwiindidi ezine zamalungu osapho kwanangosuku olungaphambi kokufaka isicelo seMedicaid nge zero 5-isohlwayo sokujonga emva kweminyaka emi-5:

1. Ukutshintshela kwiqabane: Utshintshelo olungasikelwanga mda lwayo nayiphi na i-asethi okanye itayitile yendlu phakathi kwabalingane ikhululwe kwisohlwayo.
2. Ukudluliselwa KuMntwana Ongaboniyo okanye OneSiphene Ngokusisigxina (nakweyiphi na iminyaka): Umzali unokutshintshela iimpahla okanye ikhaya ngokuthe ngqo kumntwana ohlangabezana nenkcazelo yoKhuseleko lweNtlalo yobumfama okanye ukukhubazeka okusisigxina (okanye kwi- Sole Benefit Disability Trust / Special Needs Trust kumntu okhubazekileyo ongaphantsi kweminyaka engama-65) ngaphandle kwesohlwayo sokujonga emva.
3. ** "Ukukhululwa koMntwana onguMkhathaleli" (UkuTshintshela kwiKhaya loSapho):** Umzali unokuqinisekisa ukuba indlu yakhe yosapho ephambili ** i-100 leepesenti isimahla kwaye icacile (ikhululwe kokubini ukukhangela emva kweminyaka emi-5 KUNYE nekamva lokuBuyisa i-Medicaid Estate)** kunyana okanye intombi esele ikhulile:
   • Uhlale ngaphakathi kwikhaya lomzali ngokuqhubekayo ubuncinane **iminyaka emibini (2) epheleleyo ngokukhawuleza phambi kokuba umzali angene kwikhaya lokunyamekela abantu abadala, KUNYE
   • Kubonelelwe ngokhathalelo lwemihla ngemihla olubhaliweyo (oluqinisekiswe yileta kagqirha kunye neelog zokhathalelo) olulibazise umzali ekubeni afune ukwamkelwa kwikhaya labalupheleyo kule minyaka mibini.
4. Uxolelo lwe-"Sibling with Equity Interest": Ukutshintshela ikhaya kumzalwana okanye udade osele enenzala yobunini bobunini endlwini kwaye ehlala khona ubuncinci unyaka omnye (1) ngokukhawuleza phambi kokuba umntu omdala angene kwikhaya labalupheleyo.

Uluhlu Lokutshekisha lweNgxaki yoMthetho: indlela yokunciphisa imali enokubalwa ngeentsuku ezingama-30¶

Ukuba umzali wakho okanye iqabane lakho likwikhaya labalupheleyo namhlanje 20,000 ukuya kwi-150,000 yeedola kwimali egcinwe ebhankini ebalwa ngaphezu komda we-asethi ye-Medicaid, akuyomfuneko ukuba unikezele yonke loo mali kwikhaya labalupheleyo. Ukufaneleka kwe-Medicaid kugqitywa kwi-snapshot yeebhalansi zebhanki kwi-usuku lwekhalenda lokugqibela lwenyanga (okanye umhla wokufakwa kwesicelo). Ungachitha imali engaphezulu ukuya kutsho kwi-2,000-dollar threshold phambi ezinzulwini zobusuku ngosuku lokugqibela lwenyanga ngokuthenga iimpahla kunye neenkonzo ngexabiso lemarike elilungileyo ukuze kuxhamle umenzi-sicelo okanye amaqabane akhe:

• Hlawula amatyala kunye nezindlu zokubambisa kwikhaya elixolelweyo: Hlawula okanye uhlawule imali-mboleko yendlu, i-home equity line of credit (HELOC), iintlawulo zerhafu yepropathi, okanye ityala lekhadi letyala lomfaki-sicelo okanye uMlingane wasekuhlaleni.
• Yenza ulungiso oluyinkunzi kunye nophuculo lokufikeleleka kwindawo yokuhlala ekhululweyo: Faka endaweni yophahla oludala, faka iziko elitsha leHVAC, lungisa igumbi lokuhlambela elineshawari eneshawari, fakela isitulo esinamavili, utshintshe iifestile, okanye uthenge izixhobo ezitsha zasekhitshini kwikhaya leMlingane.
• Thenga iSicwangciso sokuNgcwaba esiHwulwe kwangaphambili esiNgarhoxiswayo: Ndwendwela umzi wokungcwaba onelayisensi kwaye uguqule i-10,000 ukuya kwi-15,000 yeedola ngeqabane ngalinye libe yiTrasti yokuNgcwaba eNgarhoxiswayo**, indawo yokungcwaba, ibhokisi, kunye nelitye lentloko.
• Phucula okanye utshintshe isithuthi sosapho esikhululweyo: Ukurhweba ngemoto endala (okanye iimoto ezimbini ezindala) kwaye uthenge imoto enye ethembekileyo entsha okanye esele iphelelwe lixesha (okanye iveni efikelelekayo ngesitulo esinamavili) enesihloko egameni lomfaki-sicelo okanye uMlingane wasekuhlaleni.
• Thenga izinto zonyango ezingagqunywanga, amazinyo, ukuva, kunye nokuthuthuzela abantu abadala: Thenga amazinyo emboleko okanye izifakelo zamazinyo, iiglasi zamehlo ezikumgangatho ophezulu, izixhobo zokuva zedijithali, isitulo esinamavili esilungiselelwe umntu okanye esithambekileyo, isitulo sokunyusela kwigumbi labo lokunyamekela abagulayo, ikhompyutha yethebhulethi, kunye newodrophu epheleleyo enempahla ebhalwe amagama.
• Yenza i-Medicaid-Compliant Single Premium Immediate Annuity (SPIA) (ngeGqwetha loMthetho waBadala): Phantsi kwe 42 U.S.C. § 1396p©(1)(F)-(G), kuninzi lwamazwe uMlingane wasekuhlaleni otshatileyo (okanye umfaki-sicelo omnye osebenzisa iqhinga lesiqingatha sesonka) unokuguqula amakhulu amawaka eedola eziziimali ezibalwayo zibe yimali ekhuselweyo Medicaid-Compliant Immediate Annuity eguqula isixa esibalwa senyanga yenyanga ibe yimali ekhuselweyo yenyanga, isibonelelo semali ekhuselweyo. ayinakuguqulwa, ayibeki, ilungile ngokwenyani, ihlawula ngezavenge ezilinganayo zenyanga, kwaye ibize i-arhente karhulumente yeMedicaid njengomxhamli oshiyekileyo ukuya kwizibonelelo ezihlawulweyo.

Ukusombulula ingxaki ye "Income Cap" (IiTrasti zoMvuzo oLungileyo / iiTrasti zikaMiller)¶

Malunga nesiqingatha samazwe aseMelika (kubandakanya iFlorida, iTexas, iOhio, iNew Jersey, iArizona, iColorado, iIndiana, kunye neGeorgia) zihlelwa njenge "Ingeniso yeCap States." Kwimeko ye-Income Cap State, ukuba umfaki-sicelo wekhaya labongikazi umvuzo wakhe wenyanga opheleleyo (uKhuseleko lweNtlalo + lomhlalaphantsi phambi kokutsalwa) udlula *2,829 ireyithi ye-SILI yonyaka, ireyithi ye-SILI yonyaka, i-30 yeedola ngonyaka ** i-dollar eyi-1 **, nangona ikhaya labahlengikazi lixabisa i-10,000 yeedola ngenyanga, ikhompyutha karhulumente iya ngokuzenzekelayo ** ukukhanyela ukufaneleka kwe-Medicaid ** ngaphandle kokuba uvule i-akhawunti yebhanki elula ebizwa ngokuthi ** I-Qualified Income Trust (QIT) / Miller Trust **.

flowchart TD
    A["Qwalasela uMvuzo weNyanga oPheleleyo woMceli weKhaya lokonga (uKhuseleko loLuntu + lomhlalaphantsi)"] --> B{"Ngaba Uhlala 'Kwi-Income Cap State' kwaye Ngaba ingeniso epheleleyo ingaphezu kwe- $2,829/ngenyanga?"}
    B -->|"Hayi: Ngezantsi kweCap okanye 'Abasweleyo ngokwezonyango bachitha-Down State'"| C["Akukho Trasti yeMiller ifunekayo: Ingeniso iSetyenziselwe ngokuthe ngqo kwiSabelo sesigulana seXabiso / iqabane leMMMNA"]
    B -->|"Ewe: Ngaphezulu kwe-$2,829/Nyanga kwi-Income Cap State"| D["Ukuphumeza uXwebhu lweNgxowa-mali eNgcalisiweyo (QIT/Miller Trust)."]
    D --> E["Vula iAkhawunti yokuJonga eMiselweyo engeyiyo inzala enesihloko kwiGama le-QIT"]
    E --> F["Umvuzo weNyanga woMfaki-sicelo wediphozithi Odlula iCap kwiAkhawunti yeQIT rhoqo ngenyanga"]
    F --> G["Hlawula iSabelo seKhaya lokonga ngeNdleko kunye noMlingane u-MMMNA Kwi-akhawunti ye-QIT ngeNyanga"]

• Isebenza njani iMiller Trust: Igunyaziswe ngumthetho wobumbano (42 U.S.C. § 1396p(d)(4)(B)), I-Qualified Income Trust (QIT) luxwebhu olulula olunamaphepha ama-4 olusayinwe ngumdala okanye i-Arhente yabo phantsi kweMandla eGqwetha. Uthatha uxwebhu lwe-QIT olusayiniweyo uye nakweyiphi na ibhanki, uvule i-akhawunti yokukhangela ezinikeleyo enesihloko esithi "[Igama Lomzali] I-Qualified Income Trust," kwaye udlulisele umhlalaphantsi wenyanga walowo uphezulu okanye idipozithi yoKhuseleko lweNtlalo kuloo akhawunti ye-QIT rhoqo ngenyanga ngaphambi kokuhlawula iSabelo seeNdleko zekhaya labalupheleyo. Yonke idola efakwe kwi-Miller Trust isemthethweni ** ayibandakanywanga kwi-cap yengeniso ye-dollar eyi-2,829 **, ngokukhawuleza ivula ukufaneleka okupheleleyo kwe-Nursing Home Medicaid.

Ukukhusela iKhaya loSapho kwi-Post-Death "Medicaid Estate Recovery" (MERP)¶

Nangona indawo yokuhlala yosapho ephambili ikhululiwe ngelixa umdala esaphila, umthetho womanyano (42 U.S.C. § 1396p(b)) ufuna ukuba urhulumente ngamnye asebenzise iMedicaid Estate Recovery Programme (MERP) efaka ibango ngokuchasene nongasekhoyo weMedicaid emva kokuba ehlawulwe amatyala* emva kokubuyiselwa kwetyala lakhe*

Khusela ikhaya losapho lwakho ekuBuyiselweni kwezindlu emva kokufa usebenzisa ezi zikhuselo zisemthethweni:

1. Imivalo esemthethweni echasene noBuyiselo lweNdawo: Umthetho we-Federal ukuthintela ngokungqongqo ukuBuyisa i-Medicaid Estate ngelixa nasiphi na kwezi zizalamane zilandelayo zisaphila:
   • A iqabane elisaphilayo (naphi na apho bahlala khona);
   • A umntwana ongaphantsi kweminyaka engama-21; okanye
   • Umntwanaongaboniyo okanye okhubazekileyo ngokusisigxina nokuba yeyiphi na ubudala.
2. **Sebenzisa i-"Lady Bird Deed" (i-Enhanced Life Estate Deed) okanye "i-Transfer on Death (TOD) Deed" kwimiqathango enciphisa ukubuyiswa kwe-Probate: ** Kwiindawo ezininzi (ezifana neFlorida, i-Texas, i-Michigan, kunye nezinye), i-Medicaid Estate Recovery ingabanga kuphela ipropati edlula ** i-court probate . Ukurekhoda iSivumelwano se-Life Estate Eyongeziweyo (iSigqibo seLady Bird) ngelixa umntu ophezulu enegunya lomthetho (okanye ngokusebenzisa iGunya leGqwetha elinika ngokucacileyo amandla esipho / ukuthembela) igcina i-100 yepesenti yobunini kunye nokulawula ubomi bomntu ophezulu (okubangela ** zero iminyaka emi-5 yokujonga emva kwesohlwayo ** ngexesha lokuphila), kunye nokudluliselwa ngokuzenzekelayo kwi-probate ye-probate.
3. Izinto ezilingana namazwe ngamazwe (i-UK Local Authority Care Cap, i-Deferred Payment Agrees, kunye ne-NHS Continuing Healthcare):
   • E- ** United Kingdom **, ukhathalelo lwentlalontle yebhunga lendawo lithetha ukuvavanywa (okwangoku ukukhaba ngasentla ** 23,250 pounds ** eNgilani) ** ayihoyi ngokupheleleyo ixabiso lentsapho yentsapho ** nje kuphela iqabane, iqabane loluntu, okanye isihlobo esineminyaka engu- ** 60 okanye ngaphezulu ** (okanye incapacitated) iyaqhubeka nokuhlala kwipropati.
   • Ngaphambi kokuhlawula ipeni kwikhaya labahlengikazi lase-UK, soloko ufuna uvavanyo olusemthethweni lwe-multidisciplinary ** NHS Continuing Healthcare (NHS CHC) : ukuba umntu ophezulu une- ** "imfuno yezempilo engundoqo" (iimfuno ezinzima, eziyinkimbinkimbi, ezingalindelekanga), i- **NHS kufuneka ihlawule ipesenti ze-100 yazo zonke ikhaya labahlengikazi kunye neendleko zokuhlala kunye nexabiso lemali okanye indawo yokuhlala kunye nexabiso lemali okanye i-commodation yemali. ngabanini.

Imibuzo edla ngokubuzwa¶

Ngaba ikhaya labalupheleyo lingandimangalela (umntwana omdala) ngokobuqu ngetyala elingahlawulwanga lomzali wam?¶

Ukuba awuzange usayine isivumelwano sokwamkelwa njengomgcini-mali wobuqu kwaye awuzange ube, ufihle, okanye ugcine imali yomzali wakho okanye iitshekhi zoKhuseleko lweNtlalo, ikhaya labalupheleyo ngokubanzi alinakukubeka uxanduva lomzali wakho ngokomthetho we-federal law (42 U.S.C. § 1396r(c)(5)(A)(ii)). Nangona kunjalo, yilumkele kakhulu imigibe emibini apho amakhaya abongikazi AYENZA ngempumelelo ukumangalela abantwana abadala: (1) ukuba ubambe i-Financial Power of Attorney (POA) kumzali wakho kwaye ngokungakhathali uyasilela ukubuyisela umzali wakho uKhuseleko lwezeNtlalo/itshekhi yomhlalaphantsi yenyanga kwiziko okanye usilele ukunikezela ngeziteyitimenti zebhanki ezicelwe yiMedicaid, isibonelelo sinokukumangalela "ngokwaphulwa kwesivumelwano sobugqwetha; kunye (2) kumazwe ambalwa kunye esebenzayo "iMithetho yoxanduva loFilial" (ingakumbi ePennsylvania), iinkundla ziye zabamba abantwana abadala ngamaxesha athile xa bethintela isicelo seMedicaid okanye bajike imali yomzali. Soloko ufaka isicelo se-Medicaid ngokukhawuleza kwaye uhlawule isabelo setyala lenyanga esifunwa ngumzali ngexesha.

Kuthekani ukuba umzali wam okwikhaya labalupheleyo sele enesifo sengqondo esixhalabisayo kwaye akazange atyikitye Amandla eGqwetha?¶

Ukuba umzali wakho akanakukwazi ukuqonda kwaye asayine i-Financial Power of Attorney (POA) kunye neeakhawunti zabo zebhanki, i-IRA, okanye i-deed yendlu ibhalwe ngegama labo kuphela, iibhanki ziyakwala ukukuvumela ukuba ufikelele kwiiakhawunti zabo ukuze uqokelele iminyaka emi-5 yeengxelo zokujonga emva okanye usebenzise imali ephantsi. Okokuqala, qaphela ukuba nabani na oncedisa umntu ophezulu unokusayina kwaye angenise ifom yesicelo sokuqala seMedicaid ngokwayo njengoMmeli oGunyaziweyo ukuba atshixe ngenyanga yokufayilisha, kwaye i-arhente ye-Medicaid karhulumente inegunya lokulawula ukucela ibhalansi yebhanki ngokuthe ngqo nge-Asset Verification System (AVS) ukuba ukwazisa umsebenzi wecala ngokubhaliweyo ukuba umenzi-sicelo akakwazi ukwenza. Okwesibini, ukufikelela ngokwenene kwaye uchithe phantsi akhawunti zebhanki engumkhenkce, kuya kufuneka ukuba ufake isicelo sikaxakeka kwingingqi yakho Probate / Surrogate's Court for **Conservatorship / Guardianship of the Estate** (okanye ucele umyalelo wokhuselo lwenkundla enye-transaction inkundla yokudlulisela impahla yeqabane elingakwaziyo kwiqabane loluntu elisempilweni).

Ngaba i-Medicaid ibuyela emva kwaye ithathe iitshekhi zoKhuseleko lweNtlalo yabazali ukusuka kwiminyaka emi-5 edlulileyo?¶

Hayi. Iminyaka emi-5 (iinyanga ezingama-60) iMedicaid Look-Back Period ayibuyiseli imali umzali wakho ayichithe ngokusemthethweni kwiindleko zabo zokuhlala eziqhelekileyo, irenti, igrosari, izinto eziluncedo, abancedisi bokhathalelo lwasekhaya, irhafu, okanye iiholide kule minyaka mihlanu idlulileyo. Uphicotho lweminyaka emi-5 lujonge kuphela **izipho ezingahlawulwanga okanye udluliselo ngaphantsi kwexabiso elifanelekileyo lemarike** (njengokubhala itshekhi ye-10,000 yeedola ukuya kumzukulwana okanye ukwenza indlu yomtshana kumtshana ngeqanda elinguziro). Logama nje imali yomzali wakho iye yachithwa kwizinto neenkonzo zomzali wakho (okanye iqabane lakhe), ezo nkcitho zisemthethweni ngokwe-100 ekhulwini. Nangona kunjalo, kuphephe ukurhoxisa izixa ezinkulu zemali ye-ATM ukuhlawula abakhathaleli abangacwangciswanga "phantsi kwetafile" ngaphandle kweSivumelwano soNyango loBuntu ** kunye neerisithi ezibhaliweyo, njengoko iMedicaid iphatha ukuhoxiswa kwemali okungabhalwanga njengezipho ezingaqinisekiswanga.

Ngaba kufuneka siqhawule umtshato ngokusemthethweni ukuze iqabane elisempilweni likwazi ukugcina yonke imali esiyongile?¶

Kwiimeko ezininzi, ukufumana "uqhawulo-mtshato lwe-Medicaid" akuyomfuneko ngokupheleleyo kwaye kaninzi kushiya iqabane elisempilweni libi kakhulu kunokuhlala litshatile kwaye lisebenzisa izixhobo ze-Sousal Impoverishment. Ukuba uyaqhawula umtshato, ulahlekelwa lutshintsho lwengeniso ye-Spousal Impoverishment (MMMNA) , ulahlekelwa lilungelo lakho lokufumana ilifa lenzuzo engaphezulu ye-Social Security yeqabane elingasekhoyo ukuba utshate ngaphantsi kwe-10 leminyaka, kwaye ii-arhente ze-Medicaid zihlala zicela umngeni kwizivumelwano zoqhawulo-mtshato eziye zaphunyezwa ngexesha lengxaki yonyango njengogqithiselo ngobuqhetseba. Endaweni yoko, ukuhlala utshatile kwaye usebenzise iGqwetha loMthetho waBadala oQinisekisiweyo (CELA) ukudibanisa ikhaya elixolelweyo, i-CSRA ye-154,140 yeedola, kunye ne-Medicaid-Compliant Immediate Annuity okanye uMyalelo weNkxaso weNkundla ngokuqhelekileyo ikhusela i-90 ukuya kwi-100 lepesenti yolondolozo lobomi besibini esitshatileyo ngaphandle kokuqhawula umtshato wakho.

Imithombo ijongiwe¶

• IKhowudi yase-United States kunye namaZiko e-Medicare & Medicaid Services (CMS, eUnited States): 42 U.S.C. § 1396r-5 (Unyango loMvuzo kunye neZibonelelo kuMaqabane athile aSekiweyo / iMigangatho yokuPhuculwa koMlingane: CSRA kunye neMMMNA) * kunye * 42 U.S.C. § 1396p (Iikhonkco, uLungiso, ukuBuyiselwa kweNdawo, ukuTshintshela emva kokuJonga emva kweeNyanga ezingama-60, ukuKhululwa koMntwana woMnakekeli, kunye noMvuzo oLungileyo / iiTrasti zeMiller).
• UMthetho woHlaziyo lweKhaya loLondolozo lwe-Federal (OBRA '87, eUnited States): *42 U.S.C. § 1396r © (5) (A) (ii) kunye ne-42 C.F.R. § 483.15 (Uthintelo oluchasene nokuFuna iziQinisekiso zeMali zeQela lesithathu malunga nokwamkelwa kunye nokukhuselwa kwe "Medicaid Pending" abahlali abachasene nokukhutshwa) *.
• Ulawulo loKhuseleko loLuntu (i-SSA, eUnited States): INkqubo yokuSebenza kweNkqubo yeNkqubo (i-POMS) SI 01130.100 nge-SI 01130.420 (iZibonelelo eziNgabandakanyiyo: IMida yokuLingana ngokuHlala okuPhambili, ukuKhululwa kweMoto enye, kunye neeNgxowa-mali zokuNgcwaba eziNgaguqulekiyo).
• ** I-Academy yeSizwe yamaGqwetha oMthetho oMdala (i-NAELA) kunye neLizwi leSizwe loMthengi kuMgangatho woLondolozo lweXesha elide (eUnited States):** *Izikhokelo zeCrisis Medicaid zokuchitha imali, iSivumelwano soLondolozo loMntu, kunye noKhuseleko oluchasene neMisebenzi yokuQokelelwa kweKhaya labahlengikazi abangekho mthethweni *.
• ISebe lezeMpilo kunye noLondolozo lweNtlalo kunye ne-NHS yaseNgilani (eUnited Kingdom): *UMthetho wokuKhathalela i-2014 iSikhokelo soMthetho (Isihlomelo B: Unyango lwe-Capital kunye nokungahoywa kweNdawo yokuHlala ePhambili kuMaqabane kunye neZizalwane ezineminyaka eyi-60 +) * kunye * neNkqubo-sikhokelo yeSizwe ye-NHS eqhubekayo yezeMpilo (NHS CHC) *.

Izikhokelo ezinxulumeneyo¶

• Ukuxhatshazwa kwekhaya labongikazi, ukungahoywa, kunye nokukhusela ukugxothwa
• Ukucela umngeni kwisibhedlele esingakhuselekanga okanye ukukhululwa kwi-rehab
• Ukusetyenziswa kwemali ephezulu kunye nokukhusela ubuqhophololo
• I-delirium yesibhedlele kunye nokuxhaswa kwezonyango kubantu abadala
• Ukungakwazi ukusebenza komnakekeli ngesiquphe kunye nokuhlangulwa kwabantu abadala abaxhomekeke kuye
• Amanani kaxakeka