r/Medicaid 5d ago

Selling Mom's car and possiblity of nursing home in future

My mom is 89, has multiple health issues and has started falling. We're hoping she never needs nursing, but it's not impossible that this could happen.

So, she's doesn't need to drive anymore and is aware (she's scared to drive at this point because she knows she's having difficulty). I know that she can't simply give the car to a family member or sell it for a token price without it most likely causing a Medicaid penalty if Mom does have to go to nursing. It will most likely look like a gift that has to be paid back before Medicaid would cover nursing, from what I understand. Mom has very little money in the bank and would very quickly run out of money if she needed to be in nursing, btw, so if she goes to nursing, she will definitely need Medicaid. She's in Alabama, the threshold is around $2K left in funds iirc.

Anyway, not sure the best course to take with this car. I think at this point it's probably to sell the car, making sure we get bluebook price. No one else in family has a clue about this and they were just gonna sell it cheap to a granddaughter, and while in theory I'm ok with that, that car is worth about $16K in bluebook and we can't pay that for her nursing care ourselves is mom ends up in a home. I told them no, it's probably a bad idea to sell it for less than FMV.

Option 2 was to just keep it, and I guess sell it after she passes. But I don't know how long that will be, the car will sit there and rot away and depreciate. My sister wants to let it sit, and not renew tags or pay insurance, which she says you can legally do if it's not being driven. This sounds like a bad idea to me, and also means it can't be driven even occassionally by a friend to keep it running well - it would just be letting it sit. That sounds like a bad idea to me. My family keeps coming up with these options that make no sense and I feel a little nuts being the only one saying that's a bad idea, but it makes you doubt yourself.

Option 3: Sell it now, put the money in her bank account, and I think, encouage her to use some of it for things she needs (like hearing aids). Maybe not spend it all, as we're not trying to do a Medicaid spend down right now -- we don't know for sure if she'll ever need nursing. But if she does, the money from the sale of that care will pay for a few months nursing and be gone, so she should probably use it for things she could use but simply can't afford right now or is trying not to buy because she has so little cash in the bank. She also needs work done on her trailer that she can't afford, though I'm not sure if it's wise to recommend she put money from the car sale into that, because what if she spends thousands and ends up in nursing next year and isn't living in the home anymore, anyway? Hmm, but maybe she should go ahead and get those things fixed, it would make things easier for her at home, I think.

Answer: I think it might be to sell it now, but only if we can get fair market value as noted on kelly bluebook. We would probably sell to Carmax - do we check for the personal sale value or trade-in value? I guess personal sale?

As an aside, what the heck would happen if we ended up in a medicaid penalty and she was in the nursing home and they denied coverage because she did sell that car for like $100 to a granddaugher? And they said ok, you have to pay $15,900 worth of care before Medicaid will cover? Let's say that was enough for 90 days of care. Could a family member take her home for 90 days and try to care for her, and then the Medicaid kicks in? Or is it a matter of the first 90 days of care would have to be paid by someone before Medicaid would kick in, doesn't matter if you took her home for a while or not? I'm not advocating they do this, but I am curious what the hell people do when they get in the situation of a Medicaid penalty and no one has the money to pay the penalty period. I'm trying to keep it all straight, but there are other family/friends involved her live closer to her and are with her a lot, doing stuff for her, and they aren't really clued in on concerns on Medicaid lookback.

3 Upvotes

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u/Blossom73 5d ago edited 5d ago

She can sell the car for fair market value, and use it to private pay for her care until she's at $2000 in countable assets.

She shouldn't give away her home or car, or sell them for less than fair market value, as that can disqualify her from receiving Medicaid for a period.

Read about the lookback period for long term care Medicaid in Alabama.

https://www.medicaidplanningassistance.org/medicaid-eligibility-alabama/amp/

If someone incurs a penalty period for LTC Medicaid, and cannot afford to pay it, or private pay for nursing care, they're essentially out of luck until the penalty period is done.

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u/fizzy-logic 5d ago

But does that mean that she has to be in a nursing home and paying privately during the penalty period, or the family can take her home and care for her during that time period of however many days the penalty is for? I don't want this to happen, but I would like to understand how it works (especially in case my mom or family gives away or sells the car cheaply without telling me and there's no way for me to fix it, I want to understand what we're in for).

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u/Blossom73 5d ago

By "take her home", do you mean transfer the home to their names? Or move in with her, and care for her at her home?

https://www.medicaidplanningassistance.org/penalty-period-divisor/amp/

If she were assessed with a penalty, she'd essentially just be responsible to pay for her own care until the penalty period is up, whether that's at her home, or in a facility.

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u/fizzy-logic 5d ago

By "take her home," I mean if for some reason there is a medicaid penalty and they say you have to pay for the first 90 days on your own (for instance). I do not mean transfer her home to their names, I mean if someone could either go stay at her home and take care of her there, or take her back to their own home and take care of her, for those 90 days (or however many). Does that cover the penalty period at which time Medicaid could be approved? It sounds like, from what you're saying, the family could in fact take care of her and not have to be able to come up with that money?

Also, as I understand it, you can't apply for Medicaid coverage for a nursing home until you are in the nursing home bed, so if they then deny due to a penalty, you will have accrued however many days in a nursing home already that I guess have to be paid somehow? You're just stuck? Would they let her back in the nursing home once Medicaid kicks in if there's an outstanding bill?

I'm very much hoping nothing like this happens. And due to various health issues of our own, I'm not so sure we could give Mom care at home. Because we wouldn't get to the point of considering a nursing home unless she couldn't walk/toilet herself, something along those lines of needing that degree of care. My sister is actually willing to change adult diapers or whatever is needed and thinks she can handle the care, but she works full time and has physical conditions that mean she really shouldn't be trying to do any heavy care for someone (as do I). She says she's willing to do it anyway, but she simply may not be physically able to if/when the time comes. She has done this level of care for a relative before, so I know she means it when she says she's willing, but it may not work out for her to be able to.

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u/Blossom73 5d ago edited 5d ago

Yes, she can serve out any penalty period by being cared for in her home by family or whoever she chooses, at her own expense.

I've never heard of a requirement that someone already be in a nursing facility to apply for long term care Medicaid.

There's some LTC programs, called waivers, that will provide Medicaid funded care for a person in their own home.

But either way, the applicant has to be assessed to determine what level of care they need. Generally if they need 24/7 care, they'll only be able to receive LTC Medicaid in a facility.

Some states also have a long term care program where a family member can be paid by Medicaid to care for a family member in their home.

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u/fizzy-logic 5d ago

Thanks, that's the part I really didn't know about. Still don't want to get into a penalty, but that's interesting to know what happens if we should. I know a little about this, been dealing with stuff with my MIL who is in assited living (who is not in same state as my mom, some rules may differ). She's not on Medicaid, eventually will definitely need the nursing home as she is in assisted living now and they are at the edge of saying her condition is bad enough she can't stay anymore. Anyway, in looking into this for her, I talked to nursing homes we visited about what happens when she runs out of money in AL (this was before now, when it looks like she'll need nursing even while she would've had money to pay for AL herself). I was asking what happens if she's not qualified for nursing healthwise by the time she runs out of money, and was told she was already in a state she would surely qualify for Medicaid.

So in further discussion of how we would apply when she's low on cash, they said she would have to already be in a medicaid bed in their nursing home at the time she applies for Medicaid to pay for her nursing care, she can't apply before she's out of money (well, down to $5K where she is), and while she still has money she would either be in the AL or moved into nursing as private pay with the last of her funds. I was told to make sure it's a medicaid pending home so she can be there even with no cash to pay, becasuse I was told she has to be down to the amount of assets that would allow her to be eligible for Medicaid to pay for nursing (which in the state we are in with my MIL is $5K)

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u/someguy984 Trusted Contributor 5d ago

Some states allow for a pre-paid funeral agreement so you could use the funds for this purpose, check your state.

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u/fizzy-logic 5d ago

Thanks, my mom actually did that several years ago on her own.

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u/GlassProfile7548 5d ago

3 is the way to go.

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u/snowyandcold 5d ago

You don’t have to worry so much about fair market value or KBB value with a dealer as you do with a private sale. If you’re selling to a dealer without it being a trade in, that’s usually a pretty straightforward way of showing that what they paid was fair market value. If you were really worried you could take it to two places and get an offer, then keep documentation to show you got the best you could.

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u/fizzy-logic 5d ago

I guess the other hard thing I was struggling with is that I feel bad stopping Mom from giving that car to my niece or sister (or selling it cheaply to them) when they both could use a better car and can't afford one. I don't mind them getting it if we knew for sure Mom wasn't going to need nursing one day. But she's 89, has multiple health issues, and is falling down at times and not always able to get back up on her own (she lives alone, no family lives in the same state as her).

We don't know if she'll ever need nursing, and my sister may end up being able to provide care at her own home if mom gets to the point she can't live alone anymore (Mom doesn't want to live with them, but if it's that or a nursing home she may do it). It seems wise to not give away money or assets at this point because a nursing home within 5 yrs is quite possible - but she's also not a definite path to one at this point. I worry I'm preventing them from getting a car they need, but also, I know if Mom needs nursing, I'm not sure what the hell we do if that car was given away within the 5-yr lookback period. So that's part of why I'm even questioning what to do, I guess.

They aren't pressuring me to go along with giving them the car, btw, when I told them concerns about the look-back period, my sister stopped that line of thought until we could find out more. Though my mom had no concerns at all, she's just like, you worry too much and she doesn't want to go to nursing, anyway. Of course, she won't be the one figuring out what to do if she needs nursing and there's a penalty.

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u/CrankyCrabbyCrunchy 5d ago

It’s better for mom to do a private sale for the car at its market value and use that money for her own care. It’s her time to do what’s best for her and not for a much younger person.

Depending on her insurance that will also dictate what facility she get can into. Medicaid isn’t taken at the few good places and Alabama is near the bottom in health care.

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u/MSalmon21 5d ago

If she falls in a penalty period, the facility will evict her and probably sue her for non-payment. Also, no facility will accept her as lo g she is penalized.

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u/MSalmon21 5d ago

First of all, did you made an assesment of all her assets? Is Social Security her only Income or does she has a pension.

Remember, she must pay to the facility her Income less an allowance of $30.00 even if she is with Medicaid. This is her responsibility.

Sell the car and the house in the fair market value. Then pay the facility in a spenddown way. Use it strictly in her nursing home care. Pay also other medical bills if she has any. Document everyrhing she uses hee money. If she has a life insurance WITH a cash value, you must liquid that cash value. The last known cash value limit in Alabama is $5,000.00 which is very generous. Make sure she is without money and comply with everything once the application is done. Please do the application as soon she runs out of money and please do it through the facility.

Once she runs out of money please apply to Medicaid, provide all the bank statements she used her funds as well any benefit verification for the life insurance, an award letter from SSA. Make sure she never ever gifted anything to anyone in the last 5 years. Once this is done, she would be good to go.

Please be advised as stated before, Medicaid does not cover everything, she must pay all her Income together less $30.00 to the nursing home and she should do that as soon she is applied to Medicaid. Do not ever try to use it for anything else than her care or she will be evicted and collection actions will start.

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u/fizzy-logic 5d ago

Does she have to sell the house even if she goes into nursing? I gotta look at some paperwork we've got, there was some kind of deed of her land to us (several acerage out in the country where her trailer is), and that's been more than 5 years ago. I think that protects the acerage from being sold, who knows. If it doesn't, it doesn't. I don't remember if that included the trailer, I'll have to check. If Medicaid wants the trailer if she has to go into nursing, that's fine. It will be a hassle to deal with, but it is what it is.

And remember, she's not on a definite path to the nursing home. We're not in spenddown mode. I'm just thinking that with her age and health, the time is past to give away any big assets as there is a real risk of nursing home in the future, not as a definite, though. I do know about her income, etc, this is just about the car right now.

And everything I've seen for Alabama is her asset limit on Medicaid is $2,000, not $5,000 like many other states.

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u/MSalmon21 5d ago

$2,000.00 is the asset, $5,000.00 for cash value in life insurance.

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u/fizzy-logic 5d ago

There was one more option I dropped: Let Mom lend the car to her granddaughter or my sister. This is what they had been doing (though my mom at first said she "gave" the car to the granddaughter, which worried me). My sis/niece live in a different state, the niece did insure it. I told sis she needs to make sure they've done all the need, that car is in mom's name with plates from a different state. She looked into it but couldn't find out (I think contacting the DMV would sort that out, but I'm drowning here in being the only one who seems to think of stuff we ought to check out, and I simply can't keep taking on more - and then I took on this about whether to sell the damn car, lol).

Anyway, maybe if niece or sis pays insurance and gets tags where they are, they can borrow but not own it. Not sure of the ins and outs of that. Mom does want to help them, I don't want to obstruct that if it's not going to cause her more problems. Or us that we (or I) will have to unravel.

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u/NotHereToAgree 5d ago

If the car is still owned by mom, it is her asset and the relatives in another state would not be able to register or insure it because it would not belong to them.

Sell the car to Carmax, if mom needs to go into a facility, she will use that money to pay for her care before it runs out and Medicaid kicks in. Your work arounds are clumsy and fraudulent and could delay your mom from getting care in a safe manner. If she needs nursing home care, bringing her home to wait out a penalty means she doesn’t need nursing home care, why make this so complicated and potentially illegal?

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u/snowplowmom 4d ago

Take it to a place like CarMax, and to a dealer, and get offers for it. In my experience, those offers will probably be lower than blue book rate. Get the offers in writing. Then sell it to a grandchild for that price, put the money in Grandma's account for her living expenses, and save the offers to prove to Medicaid that it was for market-rate, if it comes to that.

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u/snowplowmom 4d ago

BTW, something that you might want to keep in mind. If she does wind up on Medicaid, a child or adult grandchild might be able to move in with her and get paid by Medicaid to be her caregiver, thus keeping her out of the nursing home. It's cheaper for Medicaid, the grandchild gets a free place to live, and assuming that Grandma isn't in too bad shape, it can be a good experience for both of them.