Can a Medicaid lien be placed on joint assets?

A fellow caregiver asked...

Can a Medicaid lien be placed on joint assets? My mother's doctor has told us that our mother needs to go into an assisted living facility in Iowa. She has an income of $669.30 from Social Security. All bank accounts, the family home, the car and bank accounts are in mom's, mine and my sister's name. Will the assets that are in all our names be forfeit if mom goes into assisted living and is helped financially by Medicaid.

Expert Answer

You've got a complicated situation to untangle, and in the end you may need the help of a lawyer who is experienced in Medicaid matters. But here are the things you and Medicaid will have to sort out.

First, when Medicaid decides whether someone is eligible for coverage -- in this case, for care in an assisted living facility -- it looks at all of the applicant's income and assets. In your mother's situation, it would have to determine how much of the family assets belong to your mother -- meaning, how much is actually available to her to spend without your or your sister's permission. One likely possibility is that you each own one-third of the value of the assets. But your mother might own more or less than that, depending in part on where the assets came from and whom the assets are used for. For example, if the money in the bank accounts came from a source that was your mother's alone and is used exclusively to care for your mother, the fact that your and your sister's names are also on the account might not reduce your mother's interest in the accounts to only one-third.

Even if your mother has more in assets than Medicaid would normally allow for someone to qualify for coverage, your mother might still be eligible because Medicaid in Iowa, as in most other states, does not pay the full costs of assisted living. Instead, it pays for care services provided in the facility, and has a monthly cap on the amount it will pay. Depending on what your mother's particular facility charges, your mother or your family will likely have to pay a considerable amount every month above what Medicaid pays. Because of this, Medicaid is likely to allow your mother to keep assets and qualify for coverage, but at the same time require that she "spend down" those assets to pay for the amount of her assisted living facility costs that Medicaid does not pay. Again, the amount may depend on determining how much of these assets belong to her and how much to you and your sister.

These eligibility and spend down questions can be complicated, and the rules and procedures vary from state to state. So, you need to contact an Iowa Medicaid office and begin the process in order to find out exactly how eligibility is determined there, and what they will require from you and your mother regarding the question of ownership of the assets. You may also want to check with the local bar association, asking for a referral to lawyers familiar with Medicaid eligibility.