OmgWhatNow Asked February 2014
If Medicaid is denied what should I do?
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How does one afford a nursing home? Nobody can take care of grandma forever.
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Probably the only to get around this are 3 possibilities:
1. set up a special needs trust account for an already qualified disabled child who the elderly parent was providing care or support for. Like an 85 yr old mom sets up a special needs trust for her 65 yr old son who had polio in the 1960's and who is moms dependent & member of her household. OR
2. Mom files a report with police & APS naming the persons gifted $$ as stealing from her & coercing her to have given them her money. The police then get an arrest warrant on them. The police report, warrants & APS investigation will provide the documentation for an exemption to be done by Medicaid on the gifted $$. Mom & her DPOA will have to go nuclear to get #2 done.
3. Decide what room mom is going to move into for 5 years & what shifts family share & do whatever to make the giftees do their share.
The transfer penalty starts the date of the filing of the Medicaid application. So you either have to wait 5 years & a day to file to get around a penalty or start the penalty period the date the application is submitted. If mom goes into a NH Medicaid pending and a transfer penalty hit happens, realize that the facility will be notified of the penalty by medicaid and the NH will come after whomever they can in family to get the bill paid. If yours is a filial responsibility state, it will become your legal issue to deal with as the NH will come after whomever to get paid & the DPOA faces negligence issues, etc.
The choices are stark & limited.
"But are you familiar with the various exceptions to the penalty, and will you be able to argue that such exceptions apply in your case, thereby avoiding any penalty?" (it didn't explain what they are, but we will be looking for them, because we know already what we cannot physically do)
Thanks, anyway.
Barely making it, she could not begin to be able to try to "pay back the gift b/c it was received within the 5 years prior to ...." Would hope there would be exceptions to "paying back the 'gift'" where it was re NEED, not extraneous $$.
Were she to need to go to a NH
TP will be a # of days situation. A state that pays a high R&B rate - like many on the east coast - will have a shorter penalty oeriod. Keep in mind that Facility will get ineligibility letter as well as the elder and the elders point person. You or other family will be asked and expected to pay during the TP days.
Now you can appeal the ineligibility & during the appeal they continue to be consider medicaid pending at the NH. You want to file an appeal, comprende? The blue book value is somewhat subjective & can be lowered with supporting documents. Like if there are photos to show damage to car; a litany of repair bills that show car has serious problems, it's on a recall list, the penny saver has almostnidentical cars selling for less than value, etc. It will be up to you to get any documentation found, organized and sent for getting an appeal. Getting car value reduced if it's an older car should be pretty easy to do if you provide the documents to the caseworker.
Most states allow for a small insurance policy with a cash value if it is going towards funeral or burial. Usually about $ 1,500.00. This can be in addition to any pre-need, pre-paid funeral & or burial policy already done (the funeral/burial needs to be NCV - a no cash value policy too in order for no issues with Medicaid).
You need to look at the policy to see if it is TERM or WHOLE LIFE. Whole life usually has a cash value and those seem to be required to be cashed in before Medicaid will approve. Term doesn't pay till after death, and if it doesn't have any build-up of cash reserves or dividends paid, then term life policies just continue to exist under Medicaid. But if the policy isn't paid up, then somebody other than your mom will have to pay the premium as mom won't have any of her SS or other retirement monthly income to pay on it once she is in a facility by & large.
Please make sure that whatever you sign at the facility, you NEVER EVER sign anything as just your name. If you can have mom sign off on all the paperwork that is the best. She should be able to if she is just going into AL. But if she can't, please sign whatever as "Jimmie Linn as DPOA for Mary Jane Jones" or "Jimmy Linn in her limited capacity as DPOA for Mary Jane Jones". And be sure to get a copy of each & every page of the entire contract too. Good luck and try to keep a sense of humor in all this!
What I think the initial caseworker looks at 3 things: 1st to see that all the documents required are in; and 2 that there is no cash value on any items; and 3rd then looks at a "pattern of spending" that makes sense. If in the initial level one review of the application, there seems to be something not quite right then the application goes to a higher level where they look for transfer asset issues. This is one reason why the application take months to get cleared for approval as someone within the state's Medicaid department is running a program to do match ups on property ownership or get their old taxes to see what their income was, etc. You sign off for to allow for an all access pass to the state when they apply for NH Medicaid (and no you do NOT get the cool lanyard to hang around your neck & I'm with the band T shirt to wear either!). Some states are now outsourcing some aspects of Medicaid compliance too.
If she has given away everything recently in a poorly-conceived plan to 'hide' it from the government, then she will probably still qualify for Medicaid, but there will be a period where she is expected to pay her own way with the money and assets she gave away (either by getting them back or coming up with money another way). That period of time depends upon how much she gave away.
You have to get all these documents together in order for the Medicaid caseworker to evaluate their financial status to qualify for Medicaid. The NH reviews it too - as they need to look at it to see if they think there will be a problem for "Medicaid Pending" (not all facility do Medicaid Pending even if they take Medicaid so you need to make sure the ones you look at do).
Also although the whole financial $$ issues are what most fixate on, mom / gran will also have to medically qualify for Medicaid for NH. She will need to show the need for "skilled nursing services". So think if she is at that point. Just because they are old or have dementia, those in & of themselves are not enough for NH placement. They need to require "skilled nursing services" for Medicaid. So speak with their current MD to see if they will do a letter on this - this can often be an unexpected issue for those who are in their home and move to a NH. Most NH admissions come from a hospital discharge (the usual story is that they had a fall, were hospitalized for 3 or more days and now are discharged to a NH for "rehab" and all these costs are MediCARE paid), so for those there is a fat medical file to justify the need for skilled nursing. When they are @ home, that tends not to exist so you may find you have to take a few months to create the file for this. My mom was in IL (private pay) and moved from IL to a NH (Medicaid pending). She totally bypassed the AL stage (private pay). It meant seeing her gerontologist who also was a medical director of a NH and doing visits every 4 to 6 weeks with testing done. The day she was a 10% weight loss and a bad H & H and a couple of other things, he wrote the order for skilled nursing care needed. So she had the fat medical file needed for Medicaid. Had I just moved her from IL to NH without all this, she would have been denied as it was not medically necessary.
So start gathering up & finding her documents to show she is impoverished at whatever level Medicaid requires in your state and speak with her doc. Good luck.
Wrong. If push comes to shove, abandon grandma to the state. There isn't a single state that can force you to be someone's caretaker if you don't want to be. If you call 911 and have them pick her up and absolutely refuse to go and get her, the state WILL place her in a facility. It sounds worse than it is. Nobody is going to deny you visitation. You can visit as often as you like. Who pays? The state. They won't have a choice if she's 'abandoned'.