We’re in spend down mode with an elderly family member who is in an extended care facility and out of medicare coverage, which is limited to 100 days.
Her physical and mental conditions have deteriorated horribly over the last 5 months, and there is zero chance she will ever go home again.
I’m not sure how rules vary state to state, but in Ohio Medicaid starts paying when some specified low level of assets/income is reached. [Not quite sure of the details, but liquid assets must approach zero – hence “spending down”, and income must be LESS than the Fed poverty level.]
While the person is living, they don’t make you liquidate real estate, as far as I can tell. Then, when that person passes on, they come after retained assets, including the value of the home, for restitution.
I’m too close to this situation to think objectively about fairness. And none of her heirs are counting on the estate for any monetary purpose.
But that’s just us. This situation strikes me as a de facto inheritance tax of up to 100% on people of low to moderate means.
How many people lose the ability to pass ANYTHING on to children and grandchildren because personal assets are devoured by a final illness?
Jazz, sorry about your family member. My mother was in assisted living, then nursing home, her last ten years, in North Carolina. She was able to be private pay much of that time, then she had to go Medicare/Medicaid, at which point she had to have no more than $2k in assets. Her funeral was pre-paid, no insurance left, etc. Her real estate had been sold right after she was widowed and that’s what allowed her to be private pay for as long as possible. She was a stroke survivor and had to have more care than I was able to provide in my home. When Medicare was first enacted, as I understand it, people were spending everything they had in one last critical illness. Now, we have found ways to extend “life”, and it puts the poor souls in penury before they die, just the same, except that now it lasts for years instead of weeks or months. Mother’s situation convinced me to buy long term care insurance, but that’s not possible for everyone.
I think the spend down amount in Ohio is $1500 plus a prepaid funeral, so the funeral plans should be made soon if not already.
When I get some more time this weekend I will look up the regs.
I have been on both sides of this issue, and have some of your mixed feelings on the spend down.
On one hand when I am the last to go (my spouse is already gone) I probably should cover as much of my own bills as possible, keeping in mind Medicaid may spend from thousands to hundreds of thousands for my care.
On the other hand what is the social duty of the government to care for me.
Jazz my thoughts are with you. I found that the spend-down caused an emotional reaction because it is another strong signal of the change that is happening. But I reminded myself that it is not an inheritance tax, it is a person using savings for good purpose. Medicaid, thank goodness, is there when savings are gone. It’s a program that is absolutely critical to the middle class–including millions of people who don’t yet realize how important it is.
In recent months, I’ve heard a couple of relatively well-off 50-somethings talk about their retirement plans, which include large inheritances that they expect to get in the next few years. They worry about the potential spend-down. Having had poor parents, this bothers me. But beyond that, I wonder if this says something about how the disappearance of defined benefit pension plans is just now hitting baby boomers (aged 50-66) in the face. These plans, not unlike Social Security, once provided more than money–they provided some future independence and a measure of assurance that you just can’t get from the stock market or parents’ savings.
I was reading a digby post on the dishonest stupidity of blaming so called violent video games for real assualt weapon violence as exampled by the Newtown incident. It occured to me that such video games actually serve a benefitial purpose in our rather war oriented America. How better to induct young and impressionable men and women for a twelve year stretch of real warfare in the middle east than to have spent their adolescent years practicing drone controls and rapid response to suddenly appearing objects. Given that the military seems unconcerned about collateral damage control I would think that reacting to the wrong stimuli isn’t a negative as the games make it. Oh, I forgot, the unidentifiable, unexpected mass killer is what we are now concerned with. I guess I was mislead by the NRA take on cause and effect. That seems to be, identify all the potential mass murderers ahead of their acting on their impulses and it will be safe to allow high capacity assault rifles to be made available to everyon else. Except the relatives of potential mass murderers. Then we would only have the unexpected perps with assault weapons to concern ourselves with.
Jack, re: How better to induct young and impressionable men and women for a twelve year stretch of real warfare in the middle east than to have spent their adolescent years practicing drone controls and rapid response to suddenly appearing objects
i saw that first hand with my youngest nephew…every time i visited my sister, he was engrossed in those games…after graduation, he enlisted…just got back from an 11 month tour guarding an airbase near the iran border…needless to say, my sister went through hell with each middle east news story…
Just in case it wasn’t apparent I was being sarcastic regarding the usefulness of training on violent video games. It may improve eye hand coordination and reaction times. The inclination to be violent is well engrained in our American culture. Only a small fraction of our population needs any indoctrination to kill. That’s what armies are for and its patriotic to enlist and serve one’s country even if our policies no longer represent an inclination towards world peace. The middle east ain’t WW II though the underlying rationales are similar.
reading The U.S. Will Again Produce More of the Nitrogen Fertilizer it Uses for Agriculture at Big Picture Agriculture, i drifted back to the World Meteorological Organization annual report on 2011 greenhouse gases;
according to the EPA: “Agricultural soil management is the largest source of N2O emissions in the United States, accounting for about 68% of total U.S. N2O emissions in 2010”
nitrous oxide is 298 times more heat trapping than equal emissions of carbon dioxide over a 100 year period and also contributes to the destruction of the ozone layer, which screens harmful ultraviolet rays from the sun…
since CO2 levels were at 390.9 parts per million (ppm) in 2011, and atmospheric NO2 was about 324.2 parts per billion in 2011; a back of the envelope calculation puts the contribution of NO2 to global warming at about one quarter that of CO2
maybe someone oughtta check my math..
We’re in spend down mode with an elderly family member who is in an extended care facility and out of medicare coverage, which is limited to 100 days.
Her physical and mental conditions have deteriorated horribly over the last 5 months, and there is zero chance she will ever go home again.
I’m not sure how rules vary state to state, but in Ohio Medicaid starts paying when some specified low level of assets/income is reached. [Not quite sure of the details, but liquid assets must approach zero – hence “spending down”, and income must be LESS than the Fed poverty level.]
While the person is living, they don’t make you liquidate real estate, as far as I can tell. Then, when that person passes on, they come after retained assets, including the value of the home, for restitution.
I’m too close to this situation to think objectively about fairness. And none of her heirs are counting on the estate for any monetary purpose.
But that’s just us. This situation strikes me as a de facto inheritance tax of up to 100% on people of low to moderate means.
How many people lose the ability to pass ANYTHING on to children and grandchildren because personal assets are devoured by a final illness?
I rally don’t know how to think about this.
JzB
Jazz, sorry about your family member. My mother was in assisted living, then nursing home, her last ten years, in North Carolina. She was able to be private pay much of that time, then she had to go Medicare/Medicaid, at which point she had to have no more than $2k in assets. Her funeral was pre-paid, no insurance left, etc. Her real estate had been sold right after she was widowed and that’s what allowed her to be private pay for as long as possible. She was a stroke survivor and had to have more care than I was able to provide in my home.
When Medicare was first enacted, as I understand it, people were spending everything they had in one last critical illness. Now, we have found ways to extend “life”, and it puts the poor souls in penury before they die, just the same, except that now it lasts for years instead of weeks or months.
Mother’s situation convinced me to buy long term care insurance, but that’s not possible for everyone.
jazz:
I think the spend down amount in Ohio is $1500 plus a prepaid funeral, so the funeral plans should be made soon if not already.
When I get some more time this weekend I will look up the regs.
I have been on both sides of this issue, and have some of your mixed feelings on the spend down.
On one hand when I am the last to go (my spouse is already gone) I probably should cover as much of my own bills as possible, keeping in mind Medicaid may spend from thousands to hundreds of thousands for my care.
On the other hand what is the social duty of the government to care for me.
Tough questions. No easy answers.
just a footnote to my earlier comment: the NO2 above should have been written as N2O, nitrous oxide..
Jazz my thoughts are with you. I found that the spend-down caused an emotional reaction because it is another strong signal of the change that is happening. But I reminded myself that it is not an inheritance tax, it is a person using savings for good purpose. Medicaid, thank goodness, is there when savings are gone. It’s a program that is absolutely critical to the middle class–including millions of people who don’t yet realize how important it is.
In recent months, I’ve heard a couple of relatively well-off 50-somethings talk about their retirement plans, which include large inheritances that they expect to get in the next few years. They worry about the potential spend-down. Having had poor parents, this bothers me. But beyond that, I wonder if this says something about how the disappearance of defined benefit pension plans is just now hitting baby boomers (aged 50-66) in the face. These plans, not unlike Social Security, once provided more than money–they provided some future independence and a measure of assurance that you just can’t get from the stock market or parents’ savings.
This comment has been removed by the author.
I was reading a digby post on the dishonest stupidity of blaming so called violent video games for real assualt weapon violence as exampled by the Newtown incident. It occured to me that such video games actually serve a benefitial purpose in our rather war oriented America. How better to induct young and impressionable men and women for a twelve year stretch of real warfare in the middle east than to have spent their adolescent years practicing drone controls and rapid response to suddenly appearing objects. Given that the military seems unconcerned about collateral damage control I would think that reacting to the wrong stimuli isn’t a negative as the games make it.
Oh, I forgot, the unidentifiable, unexpected mass killer is what we are now concerned with. I guess I was mislead by the NRA take on cause and effect. That seems to be, identify all the potential mass murderers ahead of their acting on their impulses and it will be safe to allow high capacity assault rifles to be made available to everyon else. Except the relatives of potential mass murderers. Then we would only have the unexpected perps with assault weapons to concern ourselves with.
Jack, re: How better to induct young and impressionable men and women for a twelve year stretch of real warfare in the middle east than to have spent their adolescent years practicing drone controls and rapid response to suddenly appearing objects
i saw that first hand with my youngest nephew…every time i visited my sister, he was engrossed in those games…after graduation, he enlisted…just got back from an 11 month tour guarding an airbase near the iran border…needless to say, my sister went through hell with each middle east news story…
Just in case it wasn’t apparent I was being sarcastic regarding the usefulness of training on violent video games. It may improve eye hand coordination and reaction times. The inclination to be violent is well engrained in our American culture. Only a small fraction of our population needs any indoctrination to kill. That’s what armies are for and its patriotic to enlist and serve one’s country even if our policies no longer represent an inclination towards world peace. The middle east ain’t WW II though the underlying rationales are similar.
i knew you were being sarcastic, Jack, but sarcasm didnt preclude the truths in what you said…