Medi-cal (Medicaid) Asset Lien Process; Nursing Home

[CrystalV]

What is the name of your state? California

My grandfather is in the advanced stages of Alzheimer's. My grandmother his caregiver, recently (suddenly) passed away. They own a mobile home; accessed value is approx. $40k, could probably sell for $100-125k (I work in the real estate industry).
After my grandmother’s passing, we had to place my grandfather in a nursing home. He’s currently receiving minimal Medicare benefits; we’re in the process of enrolling him in Medi-cal (at the direction of the facility). At the advice of this post, we did not transfer or gift the property and listed all assets on the Medi-cal applications. The mobile home and an old vehicle are his only assets he has. We’ve received a letter from Medi-cal requesting the registration the car and mobile home.
My question is, can someone please explain to me the Medi-cal recovery process for his stay in the nursing home? He’s currently in the nursing home under a 45-day VA granted stay; after which either Medi-cal or us have to pick up the tab (the latter, is not an option).
How does Medi-cal recover their money? Is the home signed over to Medi-cal (i.e. Grant Deed), or do they place a lien against the property? If they place liens against the property, is it based on the assessed value or the value that it might be sold for?
We’ve consulted an elderly-law attorney, but weren’t offered any suggestions or advice.
Any suggestions/advice would be greatly appreciated.

 

[BlondiePB]

My question is, can someone please explain to me the Medi-cal recovery process for his stay in the nursing home?

The state will place a lien on the property for the amount due. Upon sale, the state will recover the monies.

He’s currently in the nursing home under a 45-day VA granted stay; after which either Medi-cal or us have to pick up the tab (the latter, is not an option).

Unless you signed the papers incorrectly making you the guarantor of the bill, you are not responsible for the bill. However, you, as POA are responsible to pay grandpa's bill with his assests. Was grandpa placed in the nursing home after a 3 day or longer hospital stay that was medically related? If so and if he has Medicare, it is possible (possible being the operative word), that there may be more coverage with a co-pay.

If grandpa's is no longer going to live at his home, his home is considered vacant. You need to check his homeowner's insurance policy. Most insurance companies will not cover any incidents should something happen for vacant residences. Therefore, it would be wise to just sell grandpa's property and use the monies to provide for his nursing home care and make his final arrangements if they are not made and already paid for.

There's another Senior Member from CA who may have some input on this. I will alert her to your thread.

 

[rmet4nzkx]

You say that your father is in on a VA approved stay, what about medicare? The likelyhood of space in a VA retirement facility is close to nil for such a disorder, since residents must be in good health. If your father is a Mason THey have some homes, it does require signing over all their assets but they provide care until death, however I believe they must be competent when they move in, so that may not be an option.

Did your mother have a will? Once the VA and SSA benefits are gone and Medi-Cal kicks in they will place a lein on the Estate. With the average cost of a stay in a nursing home in California between 1,500-5,000 per month, the entre amount of your father's estate will be taken up even though his life expectiancy may be years.

There may be some options such as taking your father into your home in which case you would be paid to be his caregiver once he qualifies for Medi-cal, this may be a good option instead of going onto medi-cal because it would allow several years to redistribute his estate for his best welfare. The Mobile home could be sold and then you would have control over the care he receives and any alterations required to accommodate him in your home. At the point he qualifies for Medi-Cal, which could be sooner than you think, you could be paid to be his care giver. Fact is, care in even the best of facilities is costly and less than you could provide at home with outside assistance. Many patients, shall we say, fail to thrive once placed in a skilled nursing facility especially once the personal funds, SSA and VA run out, Medi-Cal doesn't pay as much and it may also limit things such as taking your father out for a meal or fresh air.

Don't forget your county will have many resources available through APS, contact them for program assistance.

Here is a link with information on this subject http://www.calregistry.com/housing/snf.htm

 

[CrystalV]

advice greatly appreciated

Thank you BlondiePB and rmet4nzkx for the information. Grandpa was not in the hospital prior to entering the nursing home. When grandma passed away, grandpa stayed with us for about 2 weeks; however his dementia requires 24 hour care...we all work, and don't want him to be alone during the day. We placed him in a non-VA nursing home, close to us, so we can visit daily. Although he hates being there, I'm relatively sure that he's not being mistreated. They do/did have a will; my grandmother left everything to grandpa, then everything to be split amongst the 3 children (the other 2, have completely washed their hands of the whole situation).
rmet4nzkx mentioned, "it does require signing over all their assets but they provide care until death", this is fine, and we have listed all his assets on the application, but I'm still confused as to how they recover their money. Do we sign a grant deed giving the home to medi-cal or ssi, or upon his death, we (the family) sell the property and give the money to medi-cal?
Regarding the homeowners insurance; the mobile home is located in a Senior Mobile home park (grandparents also own the land), and pay HOA dues, I'll have to look into that. If/when the assets are exhausted, will medi-cal pick up the rest? What happens if we left the house as-is for now, until after he passes? It’s still completely furnished, located about 100 miles from us, and with all that’s going on, it would be extremely difficult.
When we consulted the elderly law attorney, he mentioned that under certain circumstances the vehicle (currently non-operable), and the mobile home (because of the low value), might be “Exempt”. Any idea what those circumstances may be?
Thanks again for your responses!

 

[BlondiePB]

I thought that CA did not have trailers, Rmet (inside joke, Crystal).

Exempt property is property not subject to creditors and/or accountable to probate. In this instance, Crystal, you are allowing lein against property. It will not be exempt.

The trailer is 100 miles away. Why not just sell grandpa's property, be done with it, and pay his bills with the proceeds. When he is eligible, then apply for funds. To have vacant home insured, you'll need a central alarm system such as ADT or Brinks. These alarm companies usually require 3 year contracts. That's another unnecessary expense, like the HOA dues.

Gramps did NOT have an eligible Medicare admission to the nursing home. Is there any reason why he cannot be placed in an Assisted Living Facility (ALF)? They (ALFs) cost a lot less than nursing homes?

Make sure you thoroughly review the bill.

 

[rmet4nzkx]

Blondie,
In California, we don't have trailers, unless they are used as a recreational vehicle, please note this is a moble home not a trailer.

Selling the mobile home, after the family retrieving the personal belongings since it is so far away, would maximize the assets for grandpa's care without the additional costs associated with uptake or care of the movle home would indeed be a good idea. Donate the vehicle and check with the DMV re donaiton programs, there are several. An alternative would be to rent it out moble home that opens up a different can of worms.

If Grandpa is not so bad now that he doesn't qualify for skilled nursing facility assisted living may be an option for a while. If that is the case, home care may still be an option even if the family works, as there are Day care programs and other services available to seniors and their families. OP should apply for FMLA at their work no matter the Grandpa's placement, this allows for up to 3 months off per year for qualified workers. If the estate is liquidated, they could be reembursed for any loss in pay while taking care of Grandpa. Remember, Grandpa will still be receiving SSA and VA so there will be that income in addition to any pension and or receipts from the sale of the mobile home, don't expect much left upon his death, that is why it is important to transfer what ever personal items now. Even though the responsibility may fall on one child, the other sibilings may develope unexpected attitudes.