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My mom was in a PACE program for six months before she passed in January. I'm aware that PACE goes to Medicaid estate recovery after death, so I wasn't surprised when the questionnaire showed up from the company that does estate recovery for NY state. In fact, just before she died, I conferred with a lawyer about estate recovery. She had a very small monetary estate and no property except a one-half life estate interest in the home I shared with her, she deeded her half to me in 2015 and retained life estate. I had heard that NY state does not go after life estates like some states do, although they can change their practice at any time. The lawyer I talked to in January said NY has not been doing this so I could breathe easy and just her probate assets would be subject to recovery.



I'm just concerned about how to fill out the questionnaire, however. She legally didn't "own" her half of the house after 2015, but the questionnaire doesn't really give you a place to say anything but "yes" or "no" to the question "did they own real property"? Should I check "no" with no comments? Or check "no" and write in "life estate on 50% of deed" in the "other information" section? Or check "yes"? I don't want to get in trouble by misrepresenting anything, but on the other hand it really isn't a probate asset and shouldn't be part of recovery. (It's more of a NY state practice than a NY state law... under federal law, NY state COULD go after it, but in practice they don't, this is the latest legal advice I have personally received and also read from the NY Bar Association)



So just wondering if anyone has any insights into this questionnaire and if I should go back to the lawyer with any concerns about completing it.

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If 2015 was over 5 years before she got Medicaid help, its not relevant now IMO. Was the house mentioned in her application? If not, then you say nothing now.  

Whose name is on your tax bill, if just u, Mom does not own the house.

If she turned her half over to you, then she was taken off the deed?
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She was in a PACE program and not chronic Medicaid, so there was no application for chronic care. Until this year, NY did not do a lookback for home based waiver programs like PACE, so the question never came up. (She entered the PACE program in 2023.) She never went into long-term care. So I presume they are trying to recoup the cost of six months of PACE.

Life estate is not quite the same thing as full ownership; the person with life estate has possession (and in NY, their name is still on tax bill because people with life estates are required to pay the taxes on property) but they don't have other ownership rights. The form asks "did she own a home." It's unclear to me whether she did, because what does "own" mean in this context? (She had possession, but legally couldn't exercise other ownership rights such as selling the property.)

The 5-year lookback is really just about applying for Medicaid, I thought. Estate recovery, I think, is a separate issue? In some states they aggressively go after life estates for recovery, even though they aren't probate assets; but (as of now) I'm told my state doesn't. But, since that could change at any time, I would rather not mention it, unless I legally have to! The form to fill out is very vague.

Since I posted this, I did set up an appointment with a lawyer to get legal advice, but I'm still interested in insights on NY state recovery process. In any case, I don't expect the state is seeking recovery on a huge amount as she was only in a PACE program, but I am unsure what happens after you fill out the questionnaire.
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AlvaDeer Apr 17, 2024
Great, W. Glad you are on your way to an attorney. For complicated things, esp. those things that are relevant to your own state, it is always best to have good advice of an expert. Remember we are just caregivers with an opinion, often enough. While we may have some little background the stress is on the "little" and when you need solid advice you cannot afford to be wrong. Best out to you.
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Well - NAL buttttt imo - you could look at it this way…. She personally did not own her home as the time of death; it changed with a new title issued in 2015 from being in just in her name to being titled into a Life Estate and your own personal ownership of 1/2. Semantics!

That is what I’d suggest you ask the attorney if it’s seems ok to do and then you check “no” on the form.

BTW that letter and the questionnaire form is a NOI aka a Notice of Intent as in for the State or its outside contractor intent to start to do the required attempt of Medicaid Estate Recovery. There should be a fixed timeline as to when the State needs the responses to the questionnaire back. If back in time, It will get evaluated as to if there seems to be reasons for doing a recovery and then that path gets taken. If you do not file it, then it seems the State has to assign a recovery file for the deceased and see what turns up.

Yeah, LE seem to be a toss up for recovery. They can get complicated if State or its contractor digs in to want to do a recovery as then the LE ends up needing a value on the % share of property done based on actuarial tables….. and that’s not easy to do… like usually tax attorney or CPA do these. So it good you are taking with an attorney on this as if it goes amiss you will need legal that know the Medicaid rules and State administrative codes & laws related to property rights and real estate to get your filings done correctly.

Yes you are right that it is the LTC Medicaid program (aka “chronic”) that does the 5 yr lookback on assets and any asset movements for eligibility. If the LE was done in 2015, she would have been past any transfer penalty issues for LTC Medicaid either 1 month after the tile changes & transfer date in 2020 or anytime in 2021. She was quite outside the lookback for 2023.

PACE placed into community Medicaid category and some States do not include community Medicaid costs paid to be included in the MERP tally. Although as you said, all that can change by the State lege. Her NYS PACE application would have had to have this clearly indicated with an acknowledgment signature somewhere in her application for a MERP attempt be done. Try to find her copy of the PACE application to take to the attorney visit.

If you don’t mind, out of curiosity, would you mind sharing what her tally was for 6 months of PACE and how many days did she go to the Center? Did they provide any in-home care, like over the weekends? Here’s why I ask… there’s a real increase in PACE related ? on this site. What most are told is that you need to be a “dual” aka on Medicare and Medicaid to enroll onto PACE. The centers really press on that to be done and my take on this it’s because administratively is way easier for billing and general program coordination for everyone to be “duals”. But you do NOT have to go onto community based Medicaid to enroll in a PACE…. you can just be on Medicare and pay a set by your State premium to cover the Medicare Part D drugs costs and long term services the Center pays for. Someone this week posted their Dads PACE premium would be 6K a mo, for my State last I looked it was 4K.
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Weisk72 Apr 19, 2024
I do not know what the financial costs were for her 6 months of PACE. She paid a $30 monthly spenddown or copay or whatever. I assume it was between $4K-$6K a month, probably on the lower side of that. She also had a four-day hospitalization (tests, palliative care) and four days of home hospice,. (The night after we started the process of nursing home placement, she went to ER and an undiagnosed end stage brain tumor was discovered; it had been masked by other conditions she was known to have. She died a week later, so the NH admit process never actually began.) She went to the Center two days a week, and had two task-oriented aides (about 20 min each) per day, five days a week. Durable equipment, bed, wheelchair, meds, etc.
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