Has anyone ever had to use the Medicaid Waiver Program?

Medicaid is a joint federal and state program. Each state however administers or manages their Medicaid program uniquely as state laws factor in as to how Medicaid is done especially as to probate and property laws and to how funded in state budget,  Like for example some states allow for liens (including Medicaid liens) to be actually placed on ones homestead once on Medicaid but other states do NOT allow this to ever happen as ones homestead is viewed as untouchable except for secured lending rpthat has the homestead as collateral. 

Under federal guidelines set in Bush era DRA 2005 (deficit reduction act), all states must now have an Estate Recovery system (MERP) to attempt to recoup all costs paid by Medicaid for services for those on long term programs over age 55. It’s not limited to LTC programs in a NH or Al but all sorts of long term programs paid by Medicaid including community based & in your home programs.

MERP does have all sorts of exclusions and exemptions well as a cost benefit / cost effectiveness requirement. But doing any of these and doing them successfully imo is totally on the family or heirs to deal find out about and deal with. If the elder wishes to continue to own their home by & large Medicaid allows for that. But doing this requires - in my experience-family to pay all property costs from day 1 of medicaid till beyond death; requires someone to keep detailed documentation as to property costs and any other costs allowed as exemptions then file all to MERP within their tight timeframe; and the ability to open probate if need be. If the elders home still has a traditional mortgage (horrors!) this could be quite a tidy sum paid each month. 

What seems to happen based on posts on this site is that family is all gung ho on mom’s house initially...... Family is all Kum-by-ya on “gumming not taking maws place”.... Then Lil’ Sissy cannot pay the property tax, Big Bro cannot contribute anymore as he has his kids college costs, lil bro could care less after a couple of months, and someone has a kid who thinks grans house is their own crash party pad.... Eventually everything falls to the dutiful DPOA usually a daughter to do and pay for on a house that none of them own and may never own yet may expect to get their “share”. It is not realistic to continue to keep mom’s place. House ends up being sold within the first year of mom’s being in a NH and then all the $ from the sale used as a spend down by the parent in a NH (as they are now ineligible for Medicaid due to house sale $). Family who paid house costs are kinda out of luck as parents cannot reimburse them easily as Medicaid looks at this as “gifting”. Keeping the home can be done but imo someone better have a realistic expectation of qualifying for exemptions/ exclusions to MERP; have the ability to keep detailed document on all costs; and do whatever documentation needed for the exemptions; be able to afford all property costs till beyond death and perhaps probate costs as well AND be comfortable with the risk associated with a property that you do not actually own and may not own. Otherwise the best plan may be sell it ASAP and before ever applying for Medicaid as they will have more facility options if they are private pay.

Really take pen to paper and look at all the property costs to see if it’s even feasible for you (not the elder) to afford. You know your family best, so give some though as to whether there will be issues within family on how property is being dealt with (especially input from in laws). If this flat doesn’t make $$ sense, then sell it. If it kinda makes sense, then look at the MERP exemptions list and meet with a elder law atty to discuss how to best approach the documentation & legal needed (or changed like in a codicil) and who to legally deal with filings after death as usually it’s a probate atty & probate court who deal with disposition of assets of the estate rather than elder law. Finding probate atty with MERP experience may be a challenge. 

Also keep in mind that many states have turned MERP over to outside contractors who approach it more as a debt collectors (get % of Recovery). If your state uses an OC, they are very proactive and with very tight, timeframe system for documentation. 

A "gift" is something that has already been given, during the life of the person doing the gifting. The will has NOTHING to do with it.

So, if MIL is currently giving money to adult children, etc, giving away her house or selling it for under market value, those are "gifts".

How her will is written has NOTHING to do with Medicaid.

If she goes onto Medicaid, Medicaid recovery (MERP) will take its part BEFORE there is any inheritence distributed to the heirs.

Your MIL's adult children are probably concerned about their inheritance. Thus, if they can get someone (YOU) to take care of her for little or no compensation, they are happy about that. It preserves their inheritance.

It's not fair. Or ethical. You need to tell your husband to put YOUR health and welfare above his and his siblings possibly inheritance.

What’s in the will only matters if her estate actually has assets at the time of her death AND if those assets still exist to be distributed as per the terms of the will AFTER any claims or liens against the estate are settled. Distribution after debts are done. 

If she goes onto Medicaid, due to MERP, the state is required to attempt a recovery of all costs paid by Medicaid. BUT in order to go onto NH Medicaid they have to basically be impoverished with 2k max in nonexempt assets. So the only asset would be her home (exempt during her lifetime) or if she has a life insurance policy that has her estate as beneficiary. 

Really imo if you do not have a realistic plan for paying everything on her home AND will likely qualify for exemptions or exclusions to MERP AND are prepared to go probate if need be, then what is likely is that the costs Medicaid pays for her care will surpass the value of the home if she is like most elderly with a modest home maybe 209-259k in value. There likely will be no inheritance.

Now getting family w/expectations of inheritance to understand may not be easy...

Yes, I've used it in Minnesota for two different family members. I don't know what it is like in Michigan, but in MN it was extremely helpful.

I have been doing more research on this and if we were to use the waiver it sounds like medicaid can come back on us and ALL of the others to recover what medicaid has paid.

Don't know much about the Medicaid WAIVER program, but in California the government is entitled to seize assets of the Medicaid recipient when s/he passes--in order to recoup the healthcare costs used while the recipient was alive. Of course it's not as simple as what I've described and possibly each state is a little different. Maybe you can either talk to the agency directly where you would apply and see if an appointment can be set up for a consult or they can refer you to other agencies who can give you the lowdown on Medicaid in your state. 

Lost, MERP does not "come after" family for the costs of care unless monies or properties have been gifted by the aid recipient.

I would rather have whatever is in her best interest, but there are, I feel, too many moving parts. I thought it sounded more simple, but not so much, and I am unsure I can do any of this.

Barb Brooklyn, what exactly does gift or gifted mean? In the will or before or after. There has been no gifting of property or any money, but the will states each of her children are willed 25% and my mil 25%, which is really dumb, imo. But apparently, so I have been to, the law allowed for this and has been since changed.

Igloo, right, and hence the problem with the "heirs". And the "home" or as I tend to call it, pos, is NO where close to that value. It is a double wide trailer that she and her deceased husband lived in quite comfortedtly and the ss check paid their bills.