The Single Person: Protecting Your Assets from the Cost of Nursing Home Care

April 24, 2014

Filed under: MassHealth,Medicaid (MassHealth) — Alexis @ 6:21 PM

If your loved one is single and would like MassHealth to pay her nursing home bill, then the basic rules are these: (1) She medically requires nursing home level care, (2) she has no more than $2,000 in “countable” assets (that’s money in the bank, retirement accounts, life insurance, etc.), and (3) she has not made any sizeable gifts in the last five years.  This post focuses on options if she has over $2,000 in liquid assets.

The most important thing to remember is that you want to do what you can to give your loved one in the nursing home the best quality of life you can – keeping in mind that she is frail, perhaps cognitively impaired, not living in her own home anymore, not really in charge of what she eats and when, and other basic comforts.  I usually tell clients to “spend down” on things that their loved one really enjoys – a new tv for her room?  Books on tape?  New clothes?  An iPad loaded with pictures of the grandchildren?  One client loved chocolate frappes from Friendly’s – so as part of her “spend down,” her niece bought a few hundred dollars’ worth of Friendly’s gift certificates and brought her aunt frappes at least twice a week.  The little things make a big difference.

In addition to spending down on the “little things,” you can place extra assets into a “pooled trust.”  This allows you to have a “savings account” for things that will inevitably come up while your loved one is in the nursing home.  For example, if there is a family wedding and you want to bring your loved one home for the weekend, you can use the pooled trust to pay for a wheelchair van and 24-hour aides.

Another example is the “bed hold.”  If your loved one needs to leave the nursing home, say to go to the hospital, MassHealth will pay to hold the room for only ten days.  If your loved one will be out of the nursing home for longer than that, and you want her to be able to keep her room (i.e., not be moved to a new room upon her return), then you can ask the pooled trust to pay for the room until the elder returns.  These are just two examples of things that MassHealth doesn’t cover – and the $2,000 that they permit the member to keep in her own name certainly won’t cover, either.

What happens if you own a home and sell it, putting you over the $2,000 limit?  Once you sell the home and have more than $2,000 in the bank, you are no longer eligible for MassHealth.  One approach often used at this point is to pay for the nursing home privately for some stretch of time, and then spend down on useful things and move some funds into the pooled trust to bring your own account back down to $2,000.  Again, having the funds in the pooled trust gives you a savings account for the things that MassHealth won’t cover and that the minimal assets in your own name won’t either.

If you would like to explore whether placing your funds in a pooled trust is right for you, please call our office.  We are here to help.