Q) My 94 year old mom is currently covered by Medicare/Medicaid. Due to her failing health she now lives in an assisted living home. Because of her limited monthly income of $711 from Social Security and $141.80 pension, money has been loaned to her over the past many years to help cover living expenses.
We are now faced with paying back those loans so will need to sell her home place. The income from the sale of her home property will first be used to pay off those loans. If there is money remaining after loans are paid, I would expect that money to be used for her care so no further loans will be need to be made.
How will Mom’s Medicaid coverage be affected by this ONE TIME additional income from the sale of her property?
Thank you for your assistance.
A) DEPARTMENT OF HEALTH & HUMAN SERVICES
Centers for Medicare & Medicaid Services
Section 1917(a): Medicaid Liens
Section 1917(a)(1)(B) permits states to place liens, subject to certain exceptions, on real property
owned by a Medicaid beneficiary who is an inpatient of a nursing facility, intermediate care
facility for the developmentally disabled, or other medical institutions, where the individual is
receiving Medicaid coverage for the institutional services where certain other conditions apply.
One of the other conditions is that the Medicaid beneficiary has to be required, as a condition of
receiving services in the institution, to spend for costs of medical care all but a minimal amount
of his or her income for personal needs. The rules for “post-eligibility treatment of income”
(PETI) are contained in 42 C.F.R. 435.700 et seq., which identify discrete categories of
individuals who are subject to the PETI rules. MAGI individuals are not described in these
provisions, and as such, these rules may not be applied to MAGI individuals under the current
regulations. As a result, MAGI individuals who receive coverage for LTSS may not have liens
placed on their real property at this time (see below for a broader discussion regarding the PETI
2. Section 1917(b): Estate Recovery
Under section 1917(b)(1)(A), states are required to seek recovery, for Medicaid beneficiaries
whose real property may be subject to a lien authorized under section 1917(a)(1)(B), from the
estates of such individuals for amounts equal to the medical assistance correctly paid on their
behalf. Under section 1917(b)(1)(B), states must also seek recovery, for Medicaid beneficiaries
who were 55 years old and older when they received medical assistance, from the estates of such
individuals for amounts at least equal to medical assistance paid on their behalf for nursing
facility services, home and community based services (HCBS), and related hospital and
prescription drug services, or, at state option, for any other items and services under the state
plan (with the exception of Medicare cost-sharing).