Legal Question in Elder Law in Michigan

I am currently in the process of buying an elderly womans home. She is going to live in it until she passes. She wants to pay off some debt, then give the rest to her daughter. She is very worried that the state will take away her care because of the money and she can not afford to lose the care as she is in the end stages of her life. My question is if i buy this house will she lose her care with the money she recieves?

Asked on 4/24/12, 5:15 am

1 Answer from Attorneys

Don Rosenberg Barron, Rosenberg, Mayoras & Mayoras, P. C.

It depends on what the source of her financial assistance is. It sounds like she is on the Medicaid Waiver and if she sells her home then she converts an exempt asset to countable cash. What is the purpose of the sale? If she is on the waiver it would be devastating for her to lose the benefit.

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My practice is limited to specializing in issues concerning disability, estate, long term care, nursing home, Medicaid and special needs planning. I am the Chairman of the Board of Directors of the Alzheimer’s Association - Greater Michigan Chapter and member of the Association's executive committee; Member of National Academy of Elder Law Attorneys and have been listed since 1991 in the Academy's Experience Registry. Also I am the immediate past Chair of the Governing Council of the Elder Law and Disability Rights Section of the State Bar of Michigan. I am also a Charter Member of the Academy of Special Needs Planners and Member of the Financial and Estate Planning Council of Metropolitan Detroit. I have been selected in years 2009, 2010 and 2011 as a "Superlawyer" which designates that I am in the top 5% of lawyers in the country in my field. I am also an accredited attorney with the US Department of Veterans. In 2010 I was selected by Hour Detroit Magazine as 5 Star Wealth Manager in the area of estate planning and was recently selected again for 2011. Finally, I have been rated by AVVO ( as Superb (10 out of 10). Avvo is a company that independently rates attorneys throughout the country.



What is MI Choice?

MI Choice Waiver Program is also known as Medicaid Home Based Community Care. This is the Medicaid program that provides assistance to those persons in need and want to remain in the community as opposed to in a nursing home. MI Choice is a statewide program designed to give older adults and people with disabilities more choices in receiving long term supports. It provides a variety of services in a person’s home that are similar to those provided in a nursing home. There are three requirements in order to become eligible for this program: fixed monthly income cannot exceed $2,094, must be asset qualified for Medicaid and meet a level of need requiring long term care - nursing home care.

Which services are included?

Many services are available: personal care, homemaking, respite for caregivers, adult day services, home-delivered meals, transportation, private duty nursing, personal emergency response systems, chore service, counseling, home injury control, medical equipment and supplies, client/caregiver training and nursing home transition. A new option allows clients more control in directing how services are delivered.

Who can participate?

Low-income adults of all ages who have disabilities significant enough to qualify for nursing home care are eligible for MI Choice. People already living in nursing homes are eligible if they are able to live safely at home with supportive services. Income can be no greater than $2,094/month and be able to qualify for Medicaid within 60 days. The income of a spouse is exempt and spousal asset protections apply. It is important to note there are many planning strategies that allow any spouse to qualify for Medicaid and thus the waiver. People living in unlicensed assisted living facilities are eligible, but those in licensed assisted living facilities are not.

How does the program work?

A registered nurse and a social worker will visit the person in his/her home or of in the Nursing if a NFTI, to determine what family members and friends can do to help and what outside services are needed. The nurse or social worker provides a list of qualified agencies from which the client can choose, and contacts agencies if the client desires. After services are started, the nurse or social worker continues to monitor the person’s condition and living situation to determine if more or less assistance is necessary.

What is the current status of program and priorities to a long waiting list?

Recently this program has become in disarray. The program has been around since the 1990's but has never been very meaningful until 2010 when new “priority” classes were created within it. The program has always had an extensive waiting list, currently 2-3 years for general population. When the new priority classes were created, it allowed those who qualified to leap-frog the general waiting list and become a priority at the top of the list.

The current priorities of the MI Choice Waiver are:

Category 1 (highest Priority) - children aging out from children's waiver (not applicable to us).

Category 2 – Nursing Home Transition Initiative commonly referred to as NFTI. This category are for persons already in a nursing home who want to and can safely and reasonably transition home. When the NFTI category is satisfied then Category 3 is given assistance.

Category 3 – Diversion (people who are at home who want to stay there). This category is for those persons that meet a certain strict criteria of being in an immediate and imminent risk of requiring a nursing home level of care.

Category 4 - everybody else (general population)

It is hard to predict how long one has to remain on the waiting list. It depends how many persons are listed on the waiting at the different categories and now the wait times have been compromised as a result of the State of Michigan economic climate and budget woes. As a trend, we are seeing the Assessments for Category 3’s, Diversions, taking a minimum of 9 months, and often longer (from the date of their enrollment). Category 2’s, NFTI’s are being provided anywhere from 30-90 days. I need to emphasize these are trends and there is no guarantee that these wait times are actual or even close to the trends.

With respect to the NFTI transitions, it is important to understand persons under this category are in a nursing home and must remain there until his/her assessment. If a person is a Diversion they will need to wait at home until they are notified of the assessment.

In regard to a married couple, if one spouse is in a nursing home, even temporarily, and becomes a category 2 - NFTI, it would be necessary to complete a Medicaid Application immediately. Medicaid would pay for the cost of his/her care while he/she is in a nursing home. Once he/she is assessed, he/she can transition back home.

No matter which road a person takes it is important to consider the completing a Medicaid application or examine possible strategies to qualify for Medicaid immediately. Therefore, when a person’s wait is over, they will be ready to receive services.

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Answered on 4/24/12, 5:37 am

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