Here in my area, none of the assisted living facilities accepted Medicaid. So, there is no "look back" involved with an assisted living. EmmaR's advice is good. Many of the "better" continuous care and nursing homes only allowed a limited number of Medicaid clients at a time (if they accept it at all), and as one explained to me, they liked to "reserve" those slots for their previously self pay assisted living clients who have depleted their resources. So, when a nursing home is required, you do have to find one that accepts Medicaid and has a spot open. The "look back" starts at the time of application for Medicaid. In this state, if you own a home, and are single or widowed (I don't know about married couples, that wasn't what I had to deal with), your home MUST be put up for sale; and maintaining the expenses of that home is not the concern of Medicaid and they give you no allowance for that beyond the $1500 in assets that you are allowed to have (and any life insurance is included in that sum). So you either have to default on payments or hope that a family member will step in to pay taxes, fees, utilities etc. And hope that it sells quickly. Once that home sells, (assuming that there is money received from the sale) then Medicaid stops: you must use this money to pay the nursing home until it is all gone, then re-apply to Medicaid. In this state (Ohio) you are allowed to keep $40 per month for personal expenses out of your SS. The rest goes toward the nursing home, and Medicaid pays the remainder As for the gifts-- if the case worker decides that the $20k in gifts was designed to deplete, preserve, or shelter assets in order to qualify for Medicaid, the application could very well be denied. But they do understand that grandma will give money gifts for birthdays etc, and if the money was gifted in such small gifts to various people over several years, it won't raise a red flag. Hope that helps. Oh, there is another option in this state: it is possible to receive Medicaid or other state funds to maintain someone in their own home, paying a caregiver to attend them (which CAN be a family member). I didn't look into this since my family member required too much physical care, not just supervision and assistance.

I had to go through this same thing with my mother a few years ago. I have practically become a self educated Medicaid guru. We had taken care of my mother and supplied over 50% of her income for well over 20 years when I realized that at some point in time she would have to go on Medicaid. The first thing we did was stop listing her as a dependent a because I discovered the 5 year look back period and never wanted that hanging over our heads if and when we might need her to be on Medicaid. Once she was on Medicaid I kept meticulous records of all expenditures for her from our income as well as from hers. After the initial application, you still have to fill out annual income reports but if she is already in LTC, then they will do it IF her income is going straight to them. After approval by Medicaid, she will be allowed to keep assets of a total of $2000 max. THe LTC facility will take all of her income minus the $2000 and she will be allowed to have $50 a month stipend (at least in my state) but she can never have over $2000 in assets at any given time. What is a nightmare is if the person comes into money once they are already on Medicaid. THen you have 30 days to spend that down adn the records/ receipts have to reflect the expenditures were for the Medicaid recipient. . My mother was not in a LTC facility at the time she received $12000 from a pension plan we knew nothing about and I had a month to spend $10000 or go through the entire hassle of reapplying for Medicaid. I managed to spend it all on her in that time period as there were some things we needed desperately to better manage her care but it was a real headache. Had she already been in a LTC I would have done what has been suggested to you from others here and that is to just use it for her LTC charges until it has been exhausted. Then the LTC can aid in applying for her and will make it easier for you. While you can have an irrevocable burial plan, you can not use her funds for a lawyer- at least I was told that wasn't allowed in our state (CO). You also can not prepay for anything for her save for the burial plan. Do however, take her to the dentist if she needs dentures for instance and get those, take her to the eye dr, get her needed items to make her life easier in the LTC- a smaller easy to see TV, a DVD player, a cell phone or phone for her room, personal care items she can use there- perhaps a recliner or better walker or wheelchair, any clothing she may need, the nursing home supplies Depends and such so don't invest to heavily in those, a small dorm fridge, a stereo for her room, a laptop computer anything that will make her feel more at home in the LTC and that she needs as long as you keep receipts proving w/o a doubt it was for her and her only. Keep in mind also that the LTC you have her in now, may not keep her once she is on Medicaid, they allot only so many beds to Medicaid residents and could tell you you'll have to find another LTC facility once she is on Medicaid. Hopefully she did not give any great sums of money to her children, grandchildren or relatives in the past 5 years - otherwise the state may request/ require that money be returned or they can deny Medicaid coverage based on that. Applying for Medicaid for people who have any/ had any assets in the previous 5 years is a slippery slope at best. If you or your husband were in charge of her finances, you will also be under scrutiny until they approve application and afterwards if you continue to be in charge of her finances. Once my mother went into LTC, I turned all her financial dealings over to the LTC- made life much easier for me. I wish you all the best. as I know how difficult it is to be a caregiver. I was caregiver to both my parents for 10 years and then solely to my mother for the past 14 (total 24 years of caregiving - started when I was 32) and for a few months also cared for my MIL at the same time. While your parent is living in a LTC is not a perfect answer, staying sane and healthy yourself and keeping your marriage stable and happy as well as having a relationship with your children is also of utmost importance. I did not realize how tired everyone was and how much I had missed with my husband and children and how much time and effort I had actually put into caring for my mother at home as long as I did until she had been in LTC for about 4 months and I realized she probably should have been in an LTC much earlier. While I can't see her everyday any more, the fact that she was forced to go to LTC due to a health issue I wasn't equipped to deal with at home nor were the funds available for 24 hour care, I realize that may have well saved not only her life, but perhaps my health and marriage as well. I am still her primary health care advocate and fight for her rights every day. i check up on the nursing home and her two- three times a week. They never know when I'll be there or what time. Keeps them on their toes. Just be very very careful with her finances and assets.You don't want to get a personal bill for everything you have. Medicaid has done some terrible things to caregivers in the past. Medicaid can be ruthless when it comes to finances.

So do I. Congratulations on realizing your need and setting out on this journey of learning about your money and how to work with it effectively. There are two basic issues ... one is your income and how to deal with it to make each of those dollars coming in work most effectively. The other is your asset base and how to manage it to make it grow well, working harder for you than for the other guys ... and avoiding having too much of snipped off by the purportedly big-deal managers to slip into their pockets. Better to learn what you're doing, over the years, and become your own manager! Pay yourself those fees that they charge (probably wise to deduct the cost of some of your mistakes, as you learn). In the investment group that I've attended monthly for about 7 years, we call them the tuition fees in the University of Learning How to Manage Your Own Money! I bought some equity-based mutual funds over 20 years ago, charging 2.5% of the value of the current asset value of the account, annually. When you multiply 2.5 by 20+ ... what do you get? 50% of the value of my asset, right? Is that the original asset amount? No - the creeping value of the asset as it grew, over time. I started a thread (I think over on KT) a couple of weeks ago asking whether people had ever seen stock certificates grow like rabbits! Had a person bought 1 share of JNJ at the beginning of 1970 (I'm using this for illustration, not suggesting that you should buy it, or not buy it) about how many shares would they think that they'd own, now? If you go to Yahoo->Finance and put JNJ in the "Get quotes" box at upper left, you'll get a page that shows a lot of info about current situation of the shares, including a chart at lower right of the stock price movements today. Clicking at a long-term period under that chart will show you share prices over your choice of various periods ... plus info about several stock splits - twice 3:1, and 4 times 2:1. What does that produce? 1->3->9->18->36->72->144 ... right? Price in 1970 $180./share (in dollars each of which was "worth" a lot more than each dollar is now). Current price about $63.00. That is, $180. grew to about $9,072. How do you like them apples? Not only that ... I read somewhere a while ago about a numberof stocks which had increased their dividend annually for 25 years ... I think JNJ has increased theirs annually for 40 years, if I'm not mistaken. Which adds some sugar to the applesauce, right? When did you ever hear of a Guaranteed Investment Certificate acting like that? Also wise for you to learn to deal with both income and assets in a tax-effective way. If you can reduce taxes now, often a good idea to do so, if the system at issue is useful in your case. Deferral is frequently a good idea, as well, when available. In Canada, a number of people look at the current rate on a GIC and at the rates paid by a stock, and say they like the interest rate better than the dividend rates usually offered. But when Canadians earn a dividend on a Canadian stock, the tax rate used to be lower, and last year the system of calculation changed to make it even lower again. I can't believe how many Canadians I've run into over the years who didn't know that! Quite often ignorance carries a substantial price. I think that I've said to thousands, over the years, that learning how money works is an interesting hobby ... **that pays well**!! (I've said it so often, around here, that I think that people must be getting sick of hearing it!) Not only that, if you put your dollars into a investment where their numbers are guaranteed not to shrink ... they're almost always guaranteed not to grow either. I bought a stock over 40 years ago for about $4. and change, which at that time paid about a (tax-advantaged) nickel or a dime. Over the years the value of that stock has gone up, down and sideways. I could have sold it last May for about $107. ... and it pays me an annual dividend now of $3.48. There's one catch - it has been doubly involved in the U.S. sub-prime mortgage debacle. The share price dropped to the $80.s, then recovered to near $100., then slipped back into the $80.s ... and in the past few weeks, as the sub-prime issue got more complex, far-reaching and distressng, the share price dropped down through the $70.s, into the $60.s, closing since the first of the year in the $60.s ... and I suspect that the dividend rate will likely be cut. Am I about to sell it? No. I paid $4.20 over 40 years ago, and if I sell now, I deduct the $4.20 amount that I paid from the current $68.20 or so, leaving me with $64.00 capital gain. I divide that by 2, leaving me with $32.00 on which I must pay tax at my usual rate (i.e., added to the top of my other income this year). But it does leave me with the other $32.00 realized free of tax. However, I'm getting close to 80 years of age (79 next Wed.) and my current tax bracket is lower that will be the case if I leave all of those assets intact till I kick the bucket - for then some of them will be taxed at lower rates, but after that's used, others will be taxed at higher rates until they get to the top rate, and my executor will have to pay that on some of those realized capital gains, then. Also ... since I have no spouse (to which the tax-deferred retirement account could be transferred, tax-free at the moment, to be added to her assets, to provide her with income and on her death to have the residue added to her income and taxed then, at whatever rate) they'll be added to my income in that year, as well. Likely taxed at top rate. I've thought of selling some of the stocks that I've held for years, in order to have the taxable portion of the capital gain taxed now, at my usual lower rate ... ... but if I do that, I have fewer dollars to re-invest, to go on not only growing, but adding to earnings in those years, until my demise. As it is, I add those $3,000. or so that I'm required to withdraw from my tax-deferred retirement account annually to my annual income. Do you think that I should follow the advice of some hot-shot financial advisors who tell how to get that payment out tax-free? Borrow $50,000. to invest it in a variety of stocks, using well over $100,000. (I wish!) of stock certificates as collateral, making it a fully secured line of credit, at interest of 6%, i.e $3,000. per year, using my $3,000. annual payout from my retirement account to pay the interest. My deal with the lender is that I pay interest only on the loan. As the loan is used for investment, the interest is deductible. As an old fart that doesn't want to take heavy risks, I invest in some quality Canadian stocks - paying about 3% interest, and as they are taxed at low rate, I have about 2.5% after-tax income, which in other circumstances I would use to help pay the interest on the loan. Suppose I'd borrowed that money 15 years ago, paying interest only through those years. If my Dad died and left me $50,000. as a legacy, and I took it to the bank to pay off the loan, how much would I owe them? That'd be $50,000., right? That would have bought a lot of good things, 15 years ago ... much more than now. I gained from inflation. Suppose you'd put $50,000. into the bank, 15 years ago, and the bank paid you the agreed upon rent on your money, in the years between ... and you went to collect the value of your GIC today ... how much would the bank give you? Right! Exactly $50,000. That would have bought a couple of good cars, 15 years ago ... not now. I gained from inflation ... you lost. Such strategies should be used with discretion, taking into account various possible scenarios, some of them quite unattractive, with the operator able to deal with them without serious inconvenience. I never want to see my friends get margin calls on such loans, unless they're able to meet the shortfall, whether with other assets ... or immediate cash. Good wishes for using both your income and assets increasingly skillfully! As you have further questions, feel free to ask. If some of them seem a bit too private for you to feel comfortable with discussing in this public place, I'm sure that several of us who have responded here would be pleased to offer you our opinions should you contact us privately. ole joyful

is there a big difference between the medical coverage provided under Medicare vs Medicaid? Medicare is available, at age 65, to those who paid into the Medicare system. You are eligible for premium-free Part A if you are age 65 or older and you or your spouse worked and paid Medicare taxes for at least 10 years. Some people aren't in the Medicare system and therefore aren't eligible without certain exceptions. Though it pays for medical expenses, etc., it does not pay for nursing homes. Medicaid, basically, pays for the medical care, including medicaid accepting nursing homes or long term care facilities, for those who can't afford it. For the purposes of this discission - and others on the same topic in the past... it often comes down to differing camps of opinions, ie. those who can pay but don't want to vs those who cannot pay. Sometimes it's a little difficult to discuss spenddowns in anticipation of applying for Medicaid without sounding like one is making a judgment. Who in their right mind wants to work their whole life then have to spend the retirement nest egg for nursing home care instead of leaving legacies to children or leaving a spouse well provided for - but those who have assets and can pay should be "private pay" residents of nursing homes. My Father, mercifully, got his wish to die at home, but my Mother spent the last year of her life in a nursing home as a private pay resident. And why? Because she could afford it and it was the right thing to do. Many people who have assets and could well pay for their last years in nursing homes, etc. want to protect inheritances for children - or whatever- and find ways of impoverishing themselves by giving all their assets away. Once the estate is given away, they apply for Medicaid. Medicaid is well aware of this and should some unreasonable transfers of wealth and assets occur during the established 5 year lookback period, Medicaid will be withheld or reduced until those assets are made up - and the likely source for Medicaid to recoup these assets is from the person(s) to whom they were transferred.