My mother it seems is getting ready to lose everything, he has almost 400 k in a account hat somehow is exempt from it and it is going to his two daughters, and my mothers 401k is going to get drained. The house that they live in, in NY is in the daughters names and has been for 7 years. She owns a home in NC which was going to be her retirement home. We are getting conflicting info, she has been told that she has to move into the home in NC, even though they have no home in her or his name in NY. Which is impossible since he is in NY and is sick and for now will getting in home care. So it seems she will have too sell her only home in NC or leave the state and move there now.
Medicare is a national, federal program that pays for hospitalization, medical and other direct health care services and providers and medications. MedicAID is the program that will pay for long term care facility like a NH. MedicAID is totally an "at-need" program in which they have to be impoverished and needing a specific level of skilled nursing care.
MedicAID is a joint federal and state program. BUT each state runs their Medicaid program under their own rules but under an overall federal guideline. Since it is a State program, the states require that you have to be a resident of the state to qualify. Medicaid allows for you to have your home & 1 car as a totally exempt asset BUT the home has to be in the state you are applying in and has to be your primary residence. The vacation or 2nd home in North Carolina will not be viewed as an exempt asset for Medicaid in New York state.
Because she owns property in another state, NY regards the property in NC as being an unexempt asset that will keep her from ever qualifying for Medicaid in NY. If she wants to go onto Medicaid in NY, she would need to sell the NC home and use the proceeds in the sale for her spend-down before NY Medicaid will pay for her care. But if she wants to keep the NC house, then she will have to move to NC and do whatever to make the house her primary residence and apply for Medicaid under how NC runs their Medicaid program.
Some states require that you have to do things to establish residency before you can get any state benefits. You should speak to someone in NC to see what the nursing home and health care situation is in NC and then compare it to what they may get in NY. Could be the same or could be better or worse.
That they live in a home in NY owned by his daughters makes no difference. It is the daughters asset, even if he gave it to them, it is theirs now for 7 years and beyond the Medicaid look-back. The 400K must not be in his name or tied to his SS# so that is why it doesn't count in his/their assets. If he had a business, it could be in the federal ID of the business and beyond Medicaid review. It could be that his daughters really did good proactive Medicaid planning years ago. But anything they currently have as an asset can combine for the spend-down, like your mom's 401K. If she is the "community spouse" and not going into the NH, she will be allowed to keep a pretty good amount of money to enable her to remain living in the community. Most states have this at about 112K. If he hasn't yet applied for Medicaid, they can determine where the spend-dwon goes to....like to pay off things on the NC house, or buy a funeral/burial policy or get lots of dental work done. Community spouse stuff is kinda sticky and with the whole out-of-state property issue, they really should get an elder law attorney to go over all this with them to make sure they understand what they can or cannot do. Just out of curiosity what is his daughters take on all this? Good luck.