Medicaid Eligibility- The "Care Giver" Child Exception

I am writing in regard to NJAC 10:71-4.10.  This administrative code provision addresses exempt transfers for the purpose of Medicaid eligibility.  This involves a "care giver" child exception.  If the New Jersey Division of Medical Assistance and Health Services rejects the real estate transfer as an exempt transfer, can the NJDMAHS place a lien on the property?  If the property is transferred to the caretaking child, and only the caretaking child's name appears on the deed, can the NJ DMAHS in any way jeopardize the caretaking child's legal title to the property?

Also, if the NJDHAHS deems the real estate transfer to be ineligible for the exception transfer, can you explain wha the effect will be in terms of the eligibility period for Medicaid.  

Can the NJDMAHS pursue an estate recovery action for the cost of the nursing home that was paid by Medicaid against the estate of the decedent/former nursing home resident?  If so, what types of property can the NJDAHS attach?  Bank accounts?  Stocks or mutual funds?  Life Insurance proceeds?  Transfer on Death accounts?

As a family member in the care taking position, I don't want to act under this position, have title to the property transferred to my name, in some way compensate my siblings for the real estate, and then later be subjected to a lien on the property by the state.  This does not seem fair to me. 

Kinda annoying to reach the bottom after responding to certain sections only to find out that this transfer hasn't even taken place.  :)  I didn't change the answers (respond as I read) in light of this development.

It's not clear why you're anticipating this cascade either, since it's not a terribly complicated process to prove that a child was a primary caregiver for a couple of years before the person needed to enter a nursing home.

Your questions basically ask whether certain actions are possible, and the only possible answers to both are "yes".  Sure, they're possible, but if the transfer was bona fide and the situation met the proper requirements, I should think a competent local real estate attorney could deal with the fall-out as it relates to any lien on the property.

Also, if the NJDHAHS deems the real estate transfer to be ineligible for the exception transfer, can you explain wha the effect will be in terms of the eligibility period for Medicaid.  

"Can the NJDMAHS pursue an estate recovery action for the cost of the nursing home that was paid by Medicaid against the estate of the decedent/former nursing home resident?"

Again, only possible answer is "yes".  But if the person met the asset requirements for Medicaid except for the house and the house was properly transferred to a child, then it's not clear what the agency would hope to get.  How could someone qualify for Medicaid assistance with assets beyond a couple grand outside of the house (you talk about bank accounts, stocks, mutual funds, etc.)?  A surviving spouse is presumed not to exist.

Thank you for the timely and informative response.  I have seen decisions where the transfer was rejected and the child was serving in a caretaking capacity.  The NJ MDMAHS has rejected these types of transfers when they were in fact legitimate and the decisions have had to be appealed to the NJ Appellate Division.  The issue can in fact be complicated.

Correct--the agency is supposed to seek recovery and it the transfer was not squeaky clean it might be reversed --or involve additional costs to defent that is was in fact clean enough. Ergo I'd go to considerable lenghts tomake sure the  transfer fit the rules.

And as a practical matter I 'd not pay off any other heirs until the property was beyond recovery --and I'd think that a deal to pay off others -before or after-- would be most suspect that this was in fact a transfer designed to avoid Medicaid recovery --it has disaster written all over it unless you can find case law in that jurisdication which supports that it is an OK transfer.  My thinking is your share is protected as the care giver--but NOT the shares of non qualifying  persons!!!