ohtheinsandy t1_j7ch3h4 wrote on February 5, 2023 at 7:46 PM

Hello, I’m a previous PA state worker in Long Term Care Medicaid, and I worked for a nursing home getting Medicaid for our residents, so I have experience here, but not as a caregiver.

The short answer is, yes, there is a way you can get to keep the house after your father passes, but I would definitely seek out an elder care attorney to make sure it’s done right. (Look for a lawyer that specializes in elder care - I wouldn’t trust any other kind in this situation. I have met way too many lawyers who will do what you ask but have zero experience)

The long answer: If your father uses Medicaid (not Medicare) to pay for a caregiver, that is considered Long Term Care and he is subject to estate recovery after he passes. I assume this is what you’re seeking - it is very common for family to seek getting payment for caregiving, because it is more than a full time job in of itself. This is called Home and Community Based Services (HCBS) or “waiver services” in PA. Estate recovery means that PA will try to recoup expenses from any assets your father may have left after he passes, which can include the house.

However, there is a guideline in Medicaid rules that a house can be transferred to you without penalty in this very specific situation: -must be a son or daughter of the Medicaid recipient -must have lived in the recipient’s house for at least 2 years -must have provided care to the recipient that prevented the recipient from having to go to a nursing facility (verified with a letter from a doctor)

I’ve seen this referred to as the caregiver exception. This exception exists, I believe, because Long Term Care is very expensive for the state. So if you can prove that you’ve basically saved them money by providing caregiving for at least two years prior, that is at least worth the value of the house to them.

I don’t know how long you’ve been living in your father’s house, but it sounds like you would qualify for this exception. I would start this process ASAP, even if he’s not on Medicaid yet.

Again, DEFINITELY go through an elder care attorney to get this set up, so it’s all done correctly. But feel free to ask me any questions if there’s anything I missed.

KyaDash OP t1_j7crylq wrote on February 5, 2023 at 8:59 PM

Thank you, a lot of this has been very informative.

And to respond to some of the points: He is and has been on medicaid (and medicare) for a sizable amount of time, it's just now that we're exploring care management sorts of things.

I have certainly lived with him for the quoted period (several times over); I put off/abandoned plans to move out to go to school...10 years ago now for medical/mental well being reasons for my mother (primarily the latter) and never managed to "leave ~~escape~~ the nest" as it were. Not even taking into account cases where he had come down with flu/pneumonia or otherwise, I've been practically speaking a full time caretaker for him since covid hit, triply so since my mother passed in Dec 2020, honestly to what is very likely an unhealthy degree. House duties, cooking, grocery shopping, medical appointment attendance as well as scheduling/handling most affairs in that sort of realm.

Asset wise, sans the house, which to be frank isn't even in the best shape itself, and the quite dubious condition vehicle I/He inherited when my mother passed, there's not much of anything; At most a small balance carried month to month after expenses are dealt with from his monthly social security payment.

He seems very suspicious/incredulous that this (the asset recovery thing) is actually a thing due to various friends or acquaintances of his that have done similar things as either the giver or the givee.

ohtheinsandy t1_j7cvmyh wrote on February 5, 2023 at 9:24 PM

Caregiving is no joke. Kudos to you for the years of hard work you’ve put in. I haven’t done it personally but have encountered many caregivers in my line of work. It’s understandable to doubt that estate recovery happens in PA. The state only looks at transfers of assets (like houses) for a period of 5 years prior to applying to Medicaid, so many people avoid the problem entirely by transferring property early. And the enforcement of estate recovery varies. I noticed the state being more aggressive with estate recovery in the past few years though, so I personally wouldn’t take the chance. Another side note - it is way easier for a living person to transfer a house than it is to go through probate after the person passes away to gain ownership. That is why I would work on this ASAP.