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My wife and I receive social security checks which 100% of them go to maintaining our home & basic living expenses (namely food). We have no savings, our daughter helps us tremendously to manage month to month, yet I have a spend down of close to $400 for Medicaid which is an extreme hardship.

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I am not sure that it works with everyone, but I do know that if you dont ask, you wont get any help. my mom had to apply for a widows check through social security. They do not want us to know this, because she lived for many years with barely anything and they knew my dad had passed while on social security. We happened to find out by mistake. Then we had someone at the social security office slip and told us that they would accommodate for living expenses. Her new humana agent told us that since I stay home for her and get no income that we could increase our family size through her social security and get another accommodation. I would never say to take my word on it, but it is worth a try.

Now for a social worker you can contact their PCP, or get one through the hospital if they ever are admitted. Then last option would be to call APS adult protection service) and just ask them questions for info. You can call your local health dept too. Good luck to you all
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Dragonflower is absolutely right. They should be teaching financial aspects of 40-50 even 60 year long retirements to today's middle- & high- schoolers. More and more seniors are now living for 30-40 years after their last job. If longevity trends continue, people will need to work much longer, to save that much more money. My own family is crimping and saving 20 percent because we're very concerned with how there are NO helps for middle-classed. To us, we feel lucky we have jobs even without college degrees, we have a home, 2 old cars (go from.A to B) and our kids aren't spoiled. They need to teach hard-core savings values in the schools.
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In reading over all of the above posts, I must add something. Social Security was NEVER intended as a retiree's sole income, and not meant "to live on." It was only meant to provide approximately 1/3 of a retiree's financial needs. The other 2/3 were meant to come from (1) pensions and (2) personal savings.

SS is never a sufficient income level to enable a person to afford a mortgage and the upkeep on a house, even with two SS checks coming into the household.

When the SS act was passed in 1935, the retiree benefit was meant to protect seniors from "total impoverishment" - not to enable them to live comfortably.

So, I am always left shaking my head. Why do retirees believe that they are supposed to be able to live middle-class on SS alone?
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As others noted, Medicaid is state-specific; each state manages their own Medicaid and sets their own rules.

However, having said that, Medicaid was NEVER intended for middle-class people. It was created for persons at or below the federal poverty income level.

The Medicaid formula is based on (1) income, (2) assets and (3) family size. For example, let's say a couple has a fairly low income but has a 401K and a second vehicle. Medicaid would say that you need to sell the second vehicle and dip into the 401K to pay for your own medical expenses.

In the case of a spouse who needs to go into a nursing home, the remaining spouse is allowed to keep the house, one vehicle and a small amount of income. But everything else is supposed to go towards nursing home care. Medicaid is NOT going to pay a dime until a person is fairly impoverished.

Again, I want to stress that Medicaid was never intended for middle-class persons. A lot of people don't understand this.

BTW....the worst thing adult children do is to help their parents pay their bills. This financial assistance could be considered as "income" from the standpoint of qualifying for Medicaid and it will delay when the parents can "spend down."

If they need help, better to pick up a few extra groceries for them when they do their own shopping, take them out to dinner once weekly, etc.
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Medicaid questions are always state-specific, so the ideas in this post can't be applied as an answer to LIFleaBag1934"s question. But their situation does sound dire, so I wanted to pass along some ideas that could provide hope for people who feel caught in the middle of Medicaid's income rules.

If the question is about home care services paid by Medicaid, the Medicaid agency in my state (Massachusetts) has regulations that allow people who have income over the Federal Poverty Limit to pay a deductible amount over the course of 6 months, and then qualify for Medicaid during the rest of the year. The deductible in my state is the amount that the family’s income before taxes and deductions exceeds the income standard for a six-month period. This deductible can be met when your out-of-pocket medical bills equal or exceed the deductible amount. There are many expenses that can quickly add up to meet the deductible: Medicare premiums and other health insurance premiums (which can be credited prospectively) medical treatment co-pays, over-the-counter remedies, supplies for incontinent adults, foot care, lifeline monitoring, alternative medical treatments such as acupuncture, and, of course, home health care.

If the question concerns a spouse who is already in a nursing home, federal law provides that "if either spouse establishes that the community spouse resource allowance (in relation to the amount of income generated by such an allowance) is inadequate to raise the community spouse’s income to the minimum monthly maintenance needs allowance" the state can allow an amount of assets adequate to provide a minimum monthly maintenance needs allowance (MMMNA). In my state, the community spouse may receive income in excess of the MMMNA if there are exceptional circumstances resulting in significant financial duress that justify the additional monthly income.

The take away concept here is: Mediciad regulations in many states make it possible for people to qualify for coverage. The regulations are intended to help people continue to live safely at home. The benefits of getting help from an elder law attorney who understands your specific circumstances usually make it worthwhile to consult a professional advocate near you.
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I will tell you what I did and how it works. If you do what others assume to be correct medicaid with send you a notice. That notice will make you faint. Just spending money properly is not how you go about spending down. You might not need to notified an elder care attorney. Please do not let people suggest what to do unless they know for a fact that it worked for them. I'm not trying to scare you. Also if your daughter helps you it is no ones bz. Stop guessing seriously. This behavior is not going to help.
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It's terrific that you have completed the spousal refusal form, but that is not enough. In New York anything I've a little over $800 put you in a spend down position. Do not take this lightly. It will not go away and even with the spousal referral you are not protected. Contact an approved trust. Make sure it's in your state approval list. In by the is one in Rochester that charges a smaller fee than all TV others. Here's what happens. In order if necessity.
1. Spousal refusal
2. Trust application. Rochester charges an application fee of $240.
3. Once approved into the trust, you pay the trust the overage or the amount you want, but it MUST beat least the amount of the overage, plus $20 management fee.
So as an example in NY state. Let's say your dad gets $2,000. Instead of paying the rent let's say its $1,500.you give the trust at the very least $1,200 and add $20 so send the check to the trust for $1,220.
Now that will protect his check and pay your rent with a few of $20. I consider this the cost of insurance for my husband. I also have the trust take an automatic withdrawal so it's done and paid right away. I also make sure I give the trust the full amount of rent so it's not in two Payne td and just a smoother transaction over all. So the cost for using the protective trust (makes sure it's approved or your state or $money will be taken by medicaid. It's a $20 fee a month for protection. Then once per year in January there is an additional fee of $50 for audit. Medicaid was about to take my husband money. Seriously they reading and prepared and waiting to take money from bank. Thank god at that time I had proof that the trust received my application and the trust notified them. Otherwise it would have been too late. So for everyone out there who thinks they are safe. You are not unless you follow thru with a protective trust.
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Make the call, Mallory. They factor in medical expenses as an offset to income.
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All of the available programs are reserved for "extremely low income" people. Is there any program for those who are above the x-low limit, but not wealthy. That is what I would assume anyone who owns a home and pays a mortgage is. Perhaps we don't know the complete info.
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Mallory, if her income is extremely low, she could qualify for supplemental security income (SSI) and/or some states provide additional aid. Yes, call the county office of the aging and explore what is available.
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So, if my mom could use more Social Security, all I have to do is contact their Social Worker, and mom can get a higher check every month? Really?
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Annajane, thanks for that insight. This may sound silly, but how does one get a social worker? My dad has one by default through his dialysis center (she's been a complete & utter godsend), so I know they are very helpful. My mother is just starting her health journey and does not have one yet.

Jeannegibbs - nothing yet, but I'm optimistic. It is indeed the low income threshold, which truly confuses me considering the cost of living here as I've mentioned. I've definitely going to try Annajane's suggestion and call SS directly & become that "dog with a bone" if you will.
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LIFleaBag1934, your plight haunts me. The basic problem is your state's incredibly low income threshold level, isn't it?

Have you come up with any viable options? I'm wishing the best for you!
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We had the same problem until, we got a hold of SS and explained our hardships. A social worker could help tremendously. They found her living expenses were more than she could afford and they raised her check to accommodate.
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BridgesBurnmr1, I don't quite understand the scenario you describe, because it seems fraudulent, and more specifically, if the daughter gives $420/month it only serves to disqualify them (not qualify them). In addition, even if they magically do get qualified, and use the money to pay mortgage, if they take any excess money out of their bank as cash, they would have to tell the Medicaid or SS office exactly what they used that cash for. There's no way to "make" things appear to be zero....Medicaid or SS/SSD is much smarter than these types of ploys.
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It seems to me that whatever might help in the short term, the costs of maintaining the desired way of life will be too great - the best answer is to make life changes - whether moving to an apartment, getting rid of the car and its associated costs, etc.
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The answer offered by pamstegma give a hug.... caught my attention. Her instructions to you seemed backwards to me, however, such as it is, her simple couple of lines is the closest to solving your problem, except for the fact that it works just the opposite. Example: she suggests that the daughter stops assisting in those areas mentioned like heating oil etc. and, well that is also sort of backwards .. and this is why - for every dollar that the daughter is contributing, that , and the total sum of each equivalent dollar's assistance to the parents....IF REPORTED MONTHLY TO SS, SS will not consider the 1st 20 dollars as income....400 (-) minus the 1st 20 dollars of any income deemed or earned means they SHOULD REDUCE your monthly benefit check by $380.
So, the daughter should chip in $420.00. Then LIFleabag1934 or actual benefits recipient SHOULD REPORT THIS TO SS MONTHLY, and you just watch how damn fast they snatch that $400 bucks! This adjustment brings your benefit down to meet the monthly asset limit. When that check comes each month, pay your mortgage and removed the rest out of the account imediately as cash. Keep the account at zero until next month's check and repeat, maintain the daughter's assistance with the $420 bucks which is reported to SS monthly as income and they (SS) MUST adjust each new check. NOW be it known - SS makes these rules, not I. This is how SSI would be worked out. I could be wrong, but I see nobody getting a SSI check that would cover a typical
mortgage payment. So, if your benefit check is regular retirement SS check, I must ask this of you...... are you on Medicaid or Medicare?
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A home is an asset. Everyone gets too emotionally attached to their homes, but the truth is, nobody is given keys to a house when they turn 18....it is a purchase and a choice you make to buy a home.
It's equally true that nobody just gets a free ride in life, and especially not in retirement. Everyone must work. Everyone has choices to make in how they spend their money. If you earn a basic wage and carefully save, and also buy insurance including long-term nursing home insurance, there is absolutely no need for anyone to be going on Medicaid. The US is 18 trillion in debt right now and unfunded liabilities (things like nursing homes, welfare, Medicare, Obamacare) are estimated to be 100 trillion. How much is a trillion dollars? If you spent a million dollars a day ever since year 1 (I would say the year Jesus was born but someone will.get offended) that only gets to 750billion, still not even 1 trillion. This country has a HUGE DEBT problem--I'm not trying to be political, but this debt
Is not.going to disappear. My point is, if you're expecting "government" (i.e. taxpayers now and for next 150 yrs) to bail you out, I cannot say that that is a Rational Idea. To put it mildly. Everyone who owns a house HAS ASSETS that must be used for their needs....if your needs increase, you sell your house and live someplace less expensive. And you certainly shouldn't be paying a cable bill.
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It's terrifying getting old in this country-no one seems to care. Medicaid is so confusing-why can't states simplify the process?
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The house is an asset. They do know that if they are put in long term care, the state can come after the house for any unpaid bills? My grandmother went through this. Don't have anything as an asset on paper. If anything sell the house to your daughter for just enough to pay off the mortgage on your end w/o profit. Its hard but this country wants you paper poor before you qualify for anything :(
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I don't think you can get a reverse mortgage when you are on Medicaid, because Medicaid counts the money you get as income.
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LilFlea daughter - I'm in beyond total agreement that RM is bad bad idea.

About the $ qualifications, it isn't so much that SS is different but that Medicaid is. Although Medicaid is a joint federal & state program, EACH state manages or administers it's own program uniquely. So what works for qualifications or income level for TX is going to be different than for NY. State law differences is especially important when it comes to how Medicaid and it's MERP program runs on property and probate after death. Has anyone talked with you all about what MERP is?

House is your & mom's name, right? but parents are legally married & mom has done a "spousal refusal", right? So how is house set up for ownership if mom dies first? Does she have life insurance policy that will pay off the mortgage or will you have to? Does Dad inherit mom's share of the home? Or it all reverts to you?
Since mom & dad are a married and dad is on Medicaid, does MERP have the ability to file a claim on house? - does spousal refusal apply for MERP? Now mom can get the MERP spouse exemption but if she herself ever needs to file for Medicaid, then MERP has to file to recoup her costs. If that happens, you will have to pay off whatever her share of the value of the house is for you to own the house
completely. I bring this all up, because it would be awful for you all - all 3 of you - to be up against the wall in affording the house and all it's costs especially the mortgage, only to a few years from now having to sell it to settle the required MERP recovery.

If you are having $ issues now and a mortgage, dealing with MERP is likely to be difficult as doing the point/counter-point with MERP requires a deep enough pocketbook to pay for house related costs for years & years and through probate is not an issue for you the ultimate owner of the house (well imho that and a good sense of humor and pitt-bully detail-driven approach to dealing with paperwork)

Its so common for any of us to be totally emotional on a home. I went through all this in dealing with having a home gone by Katrina and having so many many of our friends & their parents having homes gone. But sometimes you have to stand back and take a reality check on if a house and its costs are affordable. For your parents sake - especially for your mom - I hope so but try to be realistic if all this works for the long view. Also try to find out exactly what MERP can do on the house and if spousal refusal is a defense to a MERP claim/lien. Good luck.
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AlisonBoBalison, there are two separate financial requirements: the amount of assets you can have, and the amount of monthly income. For LIFleaBag1934 the issue is the INCOME, not the assets. NY state says if your income is more than $825/month (!!) that you will have to use the amount over that to "spend down" your care bills. It is kind of like a deductible on insurance.
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My dad isn't on the mortgage (my mom & I are), so I don't believe reverse mortgage is an option - not to mention I've always been weary of it.

Point taken freqflyer and has been experienced (appliances, big jobs on the house). I must say it has always worked out. It isn't the best way to live at all, but if my mom wants to keep this house I'm going to do everything I can to help her do it so she can live out her life in her dream home.

What I have learned from this thread is that SS is different in practically every state, which is stupid to me, but what can you do. I still don't understand why the standard of living for Medicaid in NYS is $825 when nowhere in this state can you live on that and pay rent/mortgage/insurance, life insurance, medical insurance, utilities, car insurance, food and have much left over on that or, the $1,196 my dad gets per month. That's the overarching issue & question at hand, is my dad missing out/doing something wrong that this is his existence? On one hand he "makes too much" which precludes him in some cases from getting straight free services.
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Be careful with reverse mortgage. Go to someone who has a good honest reputation. I'm not very clear on this but it made it to the news. The dishonest ones would do the paperwork with both spouses. When it came to signing, only the husband signed. They reassured husband. He died wife left out in the cold. But the more common problems was not reading the fine print and following it. Very important- those fine prints.
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LIFleaBag1934 daughter, are your parents willing to go without eating to keep that house? What happens if the furnace goes out and needs total replacement? One time I had three appliances that needed replacing in an one month span.

Alison, I would give reverse mortgages a thumbs down... the ads on TV make it sound so easy, but once the mortgage holder passes on, then it could become a nightmare.... the loan becomes due and payable, and if the heirs cannot refinance the house, then the house has to be sold or it goes into foreclosure. I saw the down side of reverse mortgage when my boss' wife had passed away, he couldn't stay in the house they had owned for 30 years even though the house was willed to him because his name wasn't on that loan, he couldn't re-finance, thus he was forced to sell.
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Is there any benefit in considering a reverse mortgage for this situation? If there is equity in the house, but extra cash is needed to help with bills, that may offer the assistance needed for time being.

If the wife isn't currently in need of Medicaid, isn't she allowed to keep up to $109,560 in non-exempt assets?

I don't know that I have any helpful advice to offer, but I'm currently trying to understand more about the Medicaid rules & regs myself.
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Hi everyone, this is LIFleaBag's daughter, thank you for your responses. The house is a very touchy subject, especially for my mother. They worked so hard to get this house and when the recession hit, they - as many others - were affected greatly financially. The house is the only thing of true value they have left. My mother is VEHEMENT about not losing, selling or doing anything else with it. There have been several conversations, not to mention in the state in which we live (NY), cost of living is ridiculous no matter where you go. My parents are both very independent and do not want to go a senior living community for various reasons, mostly because of the space they have/have gotten used to. The house is like their crown jewel, they will do whatever it takes to keep it. BTW, payments are up to date, its just as my dad stated, everything goes to the house and I have to step in to plug the holes on other basic essentials.

My mother wrote a spousal refusal letter for my dad to receive Medicaid, all he gets is a SS check which is $400 over the $825 single person limit in NY - which is outrageous considering NO ONE could live on that in this state, ever. It's mind-boggling the spend down is so high, which precludes him from getting other services (i.e.: SNAP that he could benefit from).

Indeed Igloo, getting old in the US is not going to be pretty. We do not value our seniors in the least.
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Bookmarking this question, since it applies to my situation. Best of luck!
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Jeanne - its probably a #'s game on the house sale to make it be a win-win. If they have under whatever the asset ceiling for well spouse even with the house sale, then it could work I would imagine. Like house $ to them is 42k and under the max of well spouse asset limit as most states have it at 119k, I just don't have enough familiarity how states look at $ when both at home but 1 on Medicaid. For 1 in NH, the 119 is the new baseline in most states.

What I see as a red flag in this is for LilFlea, is IF finances are tight and there is a mortgage, it is so easy to get behind on payment. The mortgage holder doesn't care if it goes to foreclosure, they already have done this to others and have a system set up for it. if they get behind, it is in the mortgage holders best interest to foreclose rather than the time to work something out. This is why it's important that IF they can refinance to get low interest and more manageable mo payment that they do it now & before there is an issue.

On another tangent, I think that this big push to PACE is to get totally away from the states dealing with doing the complex medicaid determinations that often are just subjective for community care situations. My state of LA is pretty well over passing out medicaid waivers (even with a huge waiting list) with the Medicaid diversionary $ going to PACE & it's set capitation. Pace centers need big population enrolled to be profitable, so they are going to sign up a lot who are not daily costing Medicaid or Medicare presently. The one just a few block from us (benson center) seems to have lots of "well" elderly going there. The issue for the "not so well" is that if you really need lots of more complex services, pace is going to have to disenroll you (to NH or back to day to day at home care done by family) as the really ill cost too much to have as a participant. The #'s are going to look really good for what PACE is supposedly saving but will be deceptive.

Looking at my crystal ball, gettin' old in the US is not going to be pretty...
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