Financial planning tips for a senior friend with nothing

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ThankYouJack
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Financial planning tips for a senior friend with nothing

Post by ThankYouJack »

I know someone who's in his 70's and hardly has anything - maybe $10k in a checking account, maybe $1k / month from social security, lives in an apartment. The person receives some help now and is doing pretty well just living very modestly, but my concern is longer term - if assisted living is needed or a nursing home, major medical condition, etc. I don't think he qualifies for medicaid due to his checking account balance.

Any tips to help this person plan for the future? It doesn't seem like much can be done, but if he is able to qualify for medicaid (maybe upgrading his old, beat-up car) that would help qualify and be an initial step?

It looks like nursing home care can be around $8k / month or more so I'm wondering how does it not bankrupt the average person and what does the nursing home do once someone runs out of money?
terran
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Re: Financial planning tips for a senior friend with nothing

Post by terran »

He'll need to spend down his checking account below $2k if he needs to get on medicaid for long term/nursing home care, but no reason to do that until such a thing is needed, I don't think, if he's doing fine with his current situation.
InMyDreams
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Re: Financial planning tips for a senior friend with nothing

Post by InMyDreams »

It seems unlikely that he could save enough dollars to pay for a nursing home himself.

You don't indicate the type of help he receives right now. It seems likely that he might get help with some of his living expenses right now. But - does he want help?

Off hand - he might be able to get assistance with Medicare premiums and deductibles - a SHIP counselor could probably be able to tell him.

What about subsidized senior housing? Food stamps? Meals on Wheels? Senior center lunches?

Getting to know what the local County Adult and Aging Services (or similar name) may have a lot to offer him, including helping him find other applicable programs.

Depending on his current abilities - a local county Aging Service may offer employment to seniors as companions to other seniors. OTH - if he's not so able, perhaps he would want a senior companion to visit him.
niagara_guy
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Re: Financial planning tips for a senior friend with nothing

Post by niagara_guy »

Is section 8 housing a possibility? In some areas the wait time is years, so applying now would be good. I believe he could prepay some expenses (like a funeral) to reduce his cash without violating the rules but not sure.
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GerryL
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Re: Financial planning tips for a senior friend with nothing

Post by GerryL »

Our county aging services office is actually aging and veterans services. Is he a veteran? There may be some additional services available if he is. As someone upstream noted, the county services are a good place to start. They deal with these scenarios everyday.
Retired Bill
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Re: Financial planning tips for a senior friend with nothing

Post by Retired Bill »

Simple answer is when run out of money by spending it on nursing home costs, the state picks up the tab. By its complicated like any other federal/state government program.
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Re: Financial planning tips for a senior friend with nothing

Post by Sandtrap »

InMyDreams wrote: Sat Sep 18, 2021 8:27 pm It seems unlikely that he could save enough dollars to pay for a nursing home himself.

You don't indicate the type of help he receives right now. It seems likely that he might get help with some of his living expenses right now. But - does he want help?

Off hand - he might be able to get assistance with Medicare premiums and deductibles - a SHIP counselor could probably be able to tell him.

What about subsidized senior housing? Food stamps? Meals on Wheels? Senior center lunches?

Getting to know what the local County Adult and Aging Services (or similar name) may have a lot to offer him, including helping him find other applicable programs.

Depending on his current abilities - a local county Aging Service may offer employment to seniors as companions to other seniors.
OTH - if he's not so able, perhaps he would want a senior companion to visit him.
+1
Not much can be done unless he reaches out for himself to contact the above resources. He may very well be able to tap into these resources now. Creating that "network" of help and assistance now prepares for the future as well.

The above resources can also consult for management of finances, budgeting, etc. It is "what they do".

Proactive is a good thing.

j :D
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HomeStretch
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Re: Financial planning tips for a senior friend with nothing

Post by HomeStretch »

Public assistance programs including Medicaid (for healthcare for a low-income person and, when/if eligible, in-home assistance or skilled nursing for a person without means) are your friend’s likely long term support plan. Medicaid may not doesn’t cover Assisted Living facility fees in full or at all in your state.

For someone without means it may make sense to get qualified for Medicaid as soon as eligible (even if it’s just for healthcare while living independently) in order to pave the way more easily for future needs. In your friend’s case, his $8k (= $10k - ~$2k) of assets would need to be spent down before becoming eligible in the future for additional Medicaid-paid services such as an in-patient skilled nursing facility (SNF) or some reimbursement towards home care. Medicaid applications (prepared with or without the assistance of a paid attorney) are taking 3-6 months to be approved by the state Medicaid agency in my area.

As you noted, a SNF is expensive. SNF daily rates (which are mostly all inclusive) and Medicaid reimbursement varies by state. In my area the going SNF rate is $17k - $20k per month (all semi-private rooms). There is a long wait at the “better” facilities (3-5 years if you are trying to enter the facility on Medicaid from day 1). For someone with means, they can move up on the waiting list if they agree to private pay for 6-12 months and the facility agrees to accept Medicaid after that (once the person reduces countable assets to $1600 and their application is approved by Medicaid). For assistance with a Medicaid application, a person with means can hire an attorney for $6k - $10k. Once a single person is in a SNF on Medicaid, their retirement income such as Social Security goes to the skilled nursing facility/to reduce Medicaid’s cost, net of any incidental healthcare costs paid first and $75/month the person gets to keep for personal items (clothes, haircuts, etc.).

If your friend’s health declines, one way a person without means gets admitted immediately to a SNF is after a 3+ day hospital admission discharge. If the doctors decide the person cannot live safely at home and no one (such as family) is available to provide care, the hospital social worker works to find an available Medicaid bed to discharge the patient to. The state requires rehab facilities (under Medicare) and SNFs to report “available beds” to identify such rooms for patients upon discharge. You don’t get your choice of facility but you enter the SNF on Medicaid on Day 1.

I am not an expert. My n=1 from a very recent experience with a family member.

You are a good friend. Best of luck to your friend.
Last edited by HomeStretch on Sun Sep 19, 2021 2:04 pm, edited 1 time in total.
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TexasPE
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Re: Financial planning tips for a senior friend with nothing

Post by TexasPE »

niagara_guy wrote: Sat Sep 18, 2021 8:49 pm Is section 8 housing a possibility? In some areas the wait time is years, so applying now would be good. I believe he could prepay some expenses (like a funeral) to reduce his cash without violating the rules but not sure.
I'll put in my standard recommendation to contact an Eldercare attorney. Medicaid is state-dependent and some of the rules are arcane.

https://www.naela.org/

In my state, years ago an ElderCare attorney (not the family lawyer) showed us that the relative could prepay a funeral, purchase a life insurance policy and set up a spending account for clothing, haircare, etc., keep their home and car, pay for home and car insurance etc. without violating the state's Medicaid rules. In my state they did a 5-year look-back at the person's finances before approving Medicaid - a financial misstep would have delayed or even make Medicaid unavailable until monies are restored, etc.

IMHO this isn't the time for a 'do-it-yourself' approach to qualifying for Medicaid. YMMV
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dbr
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Re: Financial planning tips for a senior friend with nothing

Post by dbr »

My experience is that if you get seriously debilitated public assistance can take very good care of you -- maybe.

People that stay healthy but are poor are on their own except that many means of support from housing subsidies to food stamps do exist.

$10k in a checking account can evaporate in no time at all.

Finding expert advice from an attorney or from Social Work resources is most helpful. The comment about social workers discharging seriously medically or psychiatrically ill patients to care does seem to be one path that I have experienced. Another resource for military veterans is federal but especially state VA programs, including a veterans home if your state has any.
Topic Author
ThankYouJack
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Re: Financial planning tips for a senior friend with nothing

Post by ThankYouJack »

Thanks all. By assistance, most of the help is public assistance - like subsidized housing. I can ask him to contact the county department of aging or even an elder care attorney if needed.
Northern Flicker
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Re: Financial planning tips for a senior friend with nothing

Post by Northern Flicker »

HomeStretch wrote: Sun Sep 19, 2021 9:23 am Public assistance programs including Medicaid (for healthcare for a low-income person and, when/if eligible, in-home assistance or skilled nursing for a person without means) are your friend’s likely long term support plan. Medicaid doesn’t cover Assisted Living facilities.
That depends on the state.

Assisted living is covered by medicaid in the state where I reside-- it saves the higher cost of a skilled nursing facility for those who need less assistance. I don't know if it is officially called assisted living.

The quality of medicaid-based facilities varies significantly from state to state as well.

There are social workers who specialize in medicaid spend downs. This won't be difficult with $10K in assets. This usually can get implemented when the need for the care arises if there are not assets to try to preserve for a spouse, but it would not hurt to investigate before the need arises.
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Re: Financial planning tips for a senior friend with nothing

Post by HomeStretch »

Northern Flicker wrote: Sun Sep 19, 2021 1:32 pm … Assisted living is covered by medicaid in the state where I reside-- it saves the higher cost of a skilled nursing facility for those who need less assistance. I don't know if it is officially called assisted living. …
Yes, I recall your post now. That is a great benefit if your state’s Medicaid program fully covers Assisted Living fees for room & board and care. My state only covers a portion of the monthly Assisted Living fee for a person needing a lesser amount of assistance with a documented # of Daily Living Activities. So after asset spend down or purchasing a Medicaid-compliant annuity to qualify for Medicaid, a person like OP’s friend with a small monthly income from SS/$8k annuity couldn’t afford their portion of the AL fee, which starts at $7k/month with an add-on care package in my area.
Last edited by HomeStretch on Sun Sep 19, 2021 2:36 pm, edited 1 time in total.
Ependytis
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Re: Financial planning tips for a senior friend with nothing

Post by Ependytis »

My aunt was in a similar situation. She did OK living in a low-cost apartment in a low cost of living area. I would recommend that you or your friend become educated on the social services available as others had mentioned. Where things started to go south is when she tried to buy a car with the little remaining assets she had. I think this was the result of dementia. Does your friend have family or a friend that could help when it comes to that? It seems that some people will take advantage of others when given a chance. Best of luck to your friend.
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arcticpineapplecorp.
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Re: Financial planning tips for a senior friend with nothing

Post by arcticpineapplecorp. »

terran wrote: Sat Sep 18, 2021 2:48 pm He'll need to spend down his checking account below $2k if he needs to get on medicaid for long term/nursing home care, but no reason to do that until such a thing is needed, I don't think, if he's doing fine with his current situation.
this is not correct. the resource limit is based on one's income.

if one's income (total including SS, pension, annuity, etc) is less than $2382 a month (gross, before med part b deduction) then an individual can keep $8000 in total countable resources to qualify for medicaid to cover long term care. This is NMP or non money payment medicaid.

If one's income is more than $2382 a month (gross), then s/he can only keep $2400 in countable resources. This is MNO or medically needy only medicaid.

If one is quoting a $2000 resource limit, that is for SSI, not long term care. This is SSI related medicaid.

once someone is eligible for medicaid for long term care, they pay their income to the nursing home each month (called their cost of care contribution) except $45 each month which they can keep from their income (known as their personal needs allowance).

to the OP, your friend really doesn't have anything to worry about because he'll either be below the resource limits to qualify for medicaid from day 1 at the rate he's going, or he will have to spend down assets, which won't take long.

If he hasn't prepaid for his funeral he might want to do that before he runs out of money.

Also, he should start keeping his bank statements if he hasn't because medicaid will want to see some or possibly all of his bank statements for the 5 years proceeding application for medicaid for skilled care (known as the lookback period).
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Re: Financial planning tips for a senior friend with nothing

Post by terran »

arcticpineapplecorp. wrote: Sun Sep 19, 2021 2:16 pm
terran wrote: Sat Sep 18, 2021 2:48 pm He'll need to spend down his checking account below $2k if he needs to get on medicaid for long term/nursing home care, but no reason to do that until such a thing is needed, I don't think, if he's doing fine with his current situation.
this is not correct. the resource limit is based on one's income.

if one's income (total including SS, pension, annuity, etc) is less than $2382 a month (gross, before med part b deduction) then an individual can keep $8000 in total countable resources to qualify for medicaid to cover long term care.

If one's income is more than $2382, then s/he can only keep $2400 in countable resources. This is NMP or non money payment medicaid.

If one is quoting a $2000 resource limit, that is for SSI, not long term care. This is MNO or medically needy only.

once someone is eligible for medicaid for long term care, they pay their income to the nursing home each month (called their cost of care contribution) except $45 each month which they can keep from their income (known as their personal needs allowance).
Perhaps there are different rules for medicaid for the elderly/long term care. The $2000 resource limit applies to both SSI and Medicaid, at least for the disabled. I'm not going to spend too much time on it, but many of the references I'm finding to an $8000 resource limit are for PA, so I wonder if perhaps that's where you live? Maybe there are some state specific resource limit exceptions.
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arcticpineapplecorp.
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Re: Financial planning tips for a senior friend with nothing

Post by arcticpineapplecorp. »

terran wrote: Sun Sep 19, 2021 2:31 pm
arcticpineapplecorp. wrote: Sun Sep 19, 2021 2:16 pm
terran wrote: Sat Sep 18, 2021 2:48 pm He'll need to spend down his checking account below $2k if he needs to get on medicaid for long term/nursing home care, but no reason to do that until such a thing is needed, I don't think, if he's doing fine with his current situation.
this is not correct. the resource limit is based on one's income.

if one's income (total including SS, pension, annuity, etc) is less than $2382 a month (gross, before med part b deduction) then an individual can keep $8000 in total countable resources to qualify for medicaid to cover long term care.

If one's income is more than $2382, then s/he can only keep $2400 in countable resources. This is NMP or non money payment medicaid.

If one is quoting a $2000 resource limit, that is for SSI, not long term care. This is MNO or medically needy only.

once someone is eligible for medicaid for long term care, they pay their income to the nursing home each month (called their cost of care contribution) except $45 each month which they can keep from their income (known as their personal needs allowance).
Perhaps there are different rules for medicaid for the elderly/long term care. The $2000 resource limit applies to both SSI and Medicaid, at least for the disabled. I'm not going to spend too much time on it, but many of the references I'm finding to an $8000 resource limit are for PA, so I wonder if perhaps that's where you live? Maybe there are some state specific resource limit exceptions.
yes, it can differ by state and since the OP didn't tell us the state we don't know whether it's really $2000 or higher for the resource limit:
Medicaid Income Limits

States use one of two approaches to determine if an individual meets their Medicaid income limits. There are income cap states, which are said to have “categorically needy” Medicaid. And there are non-income cap states, which have “medically needy” or “spend-down” Medicaid. Income cap states, which may also be called special income rule states, set a hard income limit at 3 times the SSI payment amount, also called the Federal Benefit Rate (FBR). In 2020, this limit is $2,349 a month. Please note, in most cases, this figure is for nursing home Medicaid and Medicaid HCBS Waivers. Those applying for personal care assistance and other long-term care support via a state Medicaid plan generally have a lower income limit. Which varies based on the state in which one resides. Being over the income limit does not mean one cannot still qualify for Medicaid in income cap states. See the section, “Qualifying and Applying for Medicaid” below.

Non-income cap / medically needy states allow applicants who have income over the limit to still qualify for Medicaid if they have high medical bills relative to their income. In simple terms, one can “spend down” their excess income (the income over the Medicaid limit) on medical bills / care assistance. Once one has spent their income down, in Medicaid-speak, to the Medically Needy Income Limit (MNIL), they are eligible for Medicaid for the rest of the spend down period. (This period differs based on the state, but is between one and six months.) The MNIL limit varies greatly based on the state in which one resides, but tends to be somewhere between approximately $107 and $1,050 / month. Learn more about the medically needy pathway to eligibility here.

Medicaid Asset Limits

Medicaid applicants’ financial resources are also a major factor in eligibility. Resources are also referred to as “assets” and “countable assets.” Most states’ asset limit for a single individual is $2,000, though the range for 2020 is between $1,600 and $15,750. Having said that, there are a considerable number of exceptions made when determining what qualifies as “countable”. For example, the Medicaid applicant’s primary home, vehicle, jewelry, clothing, and furniture can all be considered “non-countable” or exempt assets.

source: https://www.payingforseniorcare.com/medicaid
the limits are also different for single people than for married people who can qualify for a spousal protected share where the community spouse can keep higher resource limit depending upon different factors like whether resources for a community spouse are countable or excluded (401ks, IRAs, qualified retirement plans are excluded for community spouse) and depending upon the total countable resources as of date of admission (which determines how much the community spouse can keep).

to the OP if you're curious contact your local assistance office that handles medicaid and ask them your questions.
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Jovby
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Re: Financial planning tips for a senior friend with nothing

Post by Jovby »

He will likely need mediCAID in the future if he experiences a decline in function. Consulting with a lawyer to set up a plan up now is a good idea, as there is a 5 year look back. Among other benefits, mediCAID (in CA) has a program called IHSS which will pay for (limited) in home caregivers. This can extend the amount of time someone can safely stay at home, and delay entry to a nursing home (most Senior's goal).
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Re: Financial planning tips for a senior friend with nothing

Post by HomeStretch »

arcticpineapplecorp. wrote: Sun Sep 19, 2021 2:16 pm this is not correct. the resource limit is based on one's income.

if one's income (total including SS, pension, annuity, etc) is less than $2382 a month (gross, before med part b deduction) then an individual can keep $8000 in total countable resources to qualify for medicaid to cover long term care. This is NMP or non money payment medicaid.

If one's income is more than $2382 a month (gross), then s/he can only keep $2400 in countable resources. This is MNO or medically needy only medicaid.

If one is quoting a $2000 resource limit, that is for SSI, not long term care. This is SSI related medicaid.

once someone is eligible for medicaid for long term care, they pay their income to the nursing home each month (called their cost of care contribution) except $45 each month which they can keep from their income (known as their personal needs allowance). …
These amounts that I bolded and underlined may vary by state as they are different in my state. I am not an expert but am going through the Medicaid application preparation process for long term care with an experienced attorney and the state agency that handles Medicaid. The countable assets in my state are $1,600 and the monthly personal needs allowance is $75/month. Edit - Although in my case the applicant is not single, they have a community spouse which may impact the amounts.

That’s not to quibble but more for anyone reading this thread as it is complicated stuff. The differences by state for these items may not be material and it may be safe to say that the amount of assets/income one gets to keep if utilizing Medicaid are very low. It can be difficult for a healthier community spouse who may be left with very little to live on and for their own long term care.
Last edited by HomeStretch on Sun Sep 19, 2021 3:05 pm, edited 1 time in total.
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arcticpineapplecorp.
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Re: Financial planning tips for a senior friend with nothing

Post by arcticpineapplecorp. »

HomeStretch wrote: Sun Sep 19, 2021 2:50 pm
arcticpineapplecorp. wrote: Sun Sep 19, 2021 2:16 pm this is not correct. the resource limit is based on one's income.

if one's income (total including SS, pension, annuity, etc) is less than $2382 a month (gross, before med part b deduction) then an individual can keep $8000 in total countable resources to qualify for medicaid to cover long term care. This is NMP or non money payment medicaid.

If one's income is more than $2382 a month (gross), then s/he can only keep $2400 in countable resources. This is MNO or medically needy only medicaid.

If one is quoting a $2000 resource limit, that is for SSI, not long term care. This is SSI related medicaid.

once someone is eligible for medicaid for long term care, they pay their income to the nursing home each month (called their cost of care contribution) except $45 each month which they can keep from their income (known as their personal needs allowance). …
These amounts that I bolded and underlined may vary by state as they are different in my state. I am not an expert but am going through the Medicaid application preparation process for long term care with an experienced attorney and the state agency that handles Medicaid. The countable assets in my state are $1,600 and the monthly personal needs allowance is $75/month.

That’s not to quibble but more for anyone reading this thread as it is complicated stuff. The differences by state for these items may not be material and it may be safe to say that the amount of assets/income one gets to keep if utilizing Medicaid are very low. It can be difficult for a healthier community spouse who may be left with very little to live on and for their own long term care.
agreed. which is why i said this is really not a problem for the OP's friend because if he only has $10k, then he's pretty close to being spent down already. Either a prepaid irrevocable burial reserve or one month (or less depending upon the state) of private nursing care would get him qualified for medicaid. There's no planning to be done now. But documentation/record keeping (keeping bank statements for 5 years) and not closing and opening accts for a new toaster would make things simpler. Every time you close/open accts, that's more paperwork to verify for medicaid. Keep it simple.
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Northern Flicker
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Re: Financial planning tips for a senior friend with nothing

Post by Northern Flicker »

Regardless, it will not be a problem to qualify for medicaid if skilled nursing care is needed. Remaining funds essentially will pay the facility until he is qualified. He will be allowed to keep some portion of SS each month to pay for essential things not provided by the facility (clothing, toothpaste, etc.).
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Re: Financial planning tips for a senior friend with nothing

Post by Mr. Rumples »

Unfortunately, your friend is not alone. In my area, the waiting time for assisted living when a person is on public assistance is over two years: there are no facilities; it's a national problem. A recent article about the condition in central VA (not posting a link due to the commercials attached) highlighted seniors living in their cars due to the housing shortage. Section 8 housing is limited; the locations are frequently not desirable and the wait lists are long. The other thing is the person might be buried by the local government in an unmarked grave if no arrangements have been made. The other resource are local religious groups with outreach.

(It really is sad. One of my best friends is pretty much broke. At age 70, he is now working two jobs, but he simply can't manage money and won't admit it.)
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Re: Financial planning tips for a senior friend with nothing

Post by phxjcc »

Northern Flicker wrote: Mon Sep 20, 2021 1:34 am Regardless, it will not be a problem to qualify for medicaid if skilled nursing care is needed. Remaining funds essentially will pay the facility until he is qualified. He will be allowed to keep some portion of SS each month to pay for essential things not provided by the facility (clothing, toothpaste, etc.).
^^^
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Services are out there.

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Re: Financial planning tips for a senior friend with nothing

Post by mptfan »

Did your friend ask for your advice?
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ThankYouJack
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Re: Financial planning tips for a senior friend with nothing

Post by ThankYouJack »

mptfan wrote: Mon Sep 20, 2021 10:26 pm Did your friend ask for your advice?
Not on Medicaid in particular, but I've helped this person in the past and I may be the best friend or family member to help down the road.

Even if I don't help I do have concerns for my friend, but most of the responses on here have helped ease my mind a bit so I'm glad I posted.
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