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Family Caregiver Case Study

Meet Regina

Meet Regina, 80 years old. Regina’s husband died 10 years ago and she has been self-reliant for most of that time, living in the same house for 50 years. Lately, her health has taken a slight turn for the worse. She is becoming more forgetful as of recent, and her diabetes has begun causing health issues with her mobility, and simply getting daily tasks done. A very new development has been incontinence in the nighttime. These are some Activities of Daily Living, as defined by Medicaid: toileting, transferring, and possibly undiagnosed dementia.

Her daughter, Cathy, has been coming over to her mother’s house and assisting when she gets off work as a semi-retired teacher. Cathy still needs some income from her job just to keep afloat with various bills of her own and her mother but wishes she had the time to take care of her mother full-time. She also knows she cannot afford a helper to look after her mother, but she is becoming more nervous about leaving Regina alone for long periods of time. Her preference would be to fully retire and take care of her mother on her own.

Regina’s income is $2,400 per month, which is technically over the income limit for her state but is not enough money to hire an In-Home Careworker. In addition, Regina has some modest savings for emergencies–roughly $25,000–and she owns the house she lives in, worth $150,000. These all seem like difficult problems to Cathy, who just wants to make sure her mother is taken care of but doesn’t want to sell her mother’s home or use up her ample savings to achieve Medicaid.

$ 10000

Worth of Assets Preserved
Thanks to Eldercare Resource Planning


  • Establishing an in-home caregiver for Regina.
  • Granting full Medicaid eligibility for Regina.
  • Ensuring Cathy still has an income stream.



Cathy decided to enlist the help of ECR Planning’s Certified Medicaid Planners in order to make sure that she submits the application correctly on the first attempt. This way she made sure that she can start taking care of her mother full-time as soon as possible without sacrificing her financial stability.

Meeting Income Limit

The very first barrier to Regina’s Medicaid eligibility will be the fact that she is over the income limit for her state. Luckily, her state allows for something called a Qualified Income Trust, or QIT.

A QIT is a helpful tool to help Regina represent an income that is below the limit in her state. A Certified Medicaid Planner can walk Cathy through the steps of setting up this QIT. While these types of Trusts may seem simple at first, if they are created incorrectly it can cause additional problems with Medicaid.

Meeting Asset Limit

Next, Regina is over the asset limit in her state. Her house, although a considerable asset, is not a countable asset because she only has one property and is currently living in that residence. However, her savings are countable by Medicaid and will present an issue. With the goal of eventual Medicaid eligibility, the Certified Medicaid Planning team can establish a “Caregiver Agreement” for Cathy. This means that Cathy can act as the full-time caregiver for her mother, and they can create a paper trail that Regina would pay Cathy a set amount per month for her assistance. Because of this, the money Regina is paying Cathy would not appear as “gifting” to Medicaid when it came time to apply. This Caregiver Agreement and spend-down on care has to be done carefully to avoid delays, additional out of pocket costs, or financial repercussions when it comes time to apply for Medicaid. This would look something like: Regina pays Cathy $3,000 for the next 8 months until she has only $1,000 left. This means she will be under the asset limit for her state, and will get to keep her house.

The Outcome

Once the path has been cleared for Regina’s Medicaid eligibility, the state would pay Cathy directly for hours that she took care of her mother. All of this is done to free Cathy up to fully retire from her current job, take care of her mother part-time or full-time, and still receive a financial cushion for expenses; whether from her mother’s savings, or from the state.


With the help of Eldercare Resource Planning, all of these steps are possible. However, it is important that things are done in the correct order, with proper timing in mind.

This will ensure Regina’s Medicaid application is not denied, and that the Caretaker Agreement is set up properly, both of which are major hurdles that can create additional financial issues if not done correctly.


$ 10000

Over $25,000 worth of assets preserved thanks to the help of Eldercare Resource Planning.

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