Let me pass this by you guys. My 91 year old Mother has been in a Nursing home for several months, requiring long term care due to injury and illness. She is getting to the point of needing to apply for Medicaid. The Nursing home is telling us there has been changes in Medicaid (Pennsylvania Medical Assurance) that now requires her to apply for Medicaid when her assets drop to below $20,000 (about two months of care). I think it used to be when she would have run out of money, i.e a bill she can't pay. Not a big issue except that, from what I've read, the 5 years gift look back starts when she makes the application and a few thousand dollars of those gifts are real close in timing. We are talking a month, maybe two here. In this market, it would be tough to sell her $40,000 home. Scraping up that gift money for repayment isn't going to be easy.
Just wanted to confirm the latest date she can apply for Medicaid without penalty. She won't be able to pay her, say September 15th bill, which will be about $10,000.
It seems like the op's mom has only been in NH for a few months and the gifting went on close to 5 years ago. Mom probably didn't realize then that she was going to need this level of care, or didnt know Medicaid regs.
I find that many people are shocked to find out that they need to use their own money to pay for long term care.
Whomever received the money will have to get busy and scrape it up to repay it. Selling the house doesn't negate the penalty period for the money gifted. She was in care at the time of the gifts, I find that hard to hear, who takes money from an old person in a nursing home and then wants the taxpayers to pay. I just don't believe that anyone should accept money from seniors, ever.
I would hire a professional to help with the Medicaid application so I completely understood what is going on and how to ensure that she continues to get the care required. It will be worth the money no doubt.
I agree with the advice up thread to talk to someone at Medicaid about the timing of the application and how much the penalty will be.
I empathize with your situation it is clear that there was no intention to defraud and your parents are clearly generous (and I'll bet frugal) people.
The SW at the NH may also be a good source of advice about this.
Thanks for the suggestions/comments. The goal I have is to delay the application as much as we can legally, so the payback of these gifts aren't an issue. I hate trying to game a system and being less than honest. I could just give her the $10,000 for the month she needs to keep piece in the family (i.e pay back their gifts).
So otherwise we apply when the Home suggests, and disclose all the gifts we know about (I wouldn't be surprised if other small ones come out of the woodwork during review). The Home administrator mentioned that if we don't pay gifts back before we apply, it becomes more of a hassle and there is a penalty, which is a period of days Medicaid delays payment. (gift / $343 currently). If the Home's self pay rate is about $343 a day, then its a wash financially anyway. It looks like, if we know about a gift, pay it back before applying is the preferred method. If they find more gifts, we pay back then. I don't expect more than $10,000 we don't know about. She does not have a car (that old clunker was gifted maybe four years ago and subject of a different discussion)
In New York State, a current resident cannot be discharged for non payment if their Medicaid application is pending. That may not be true in all states.
If the "gifts" were done in small increments, it may not even be noticed. Think about it, they are looking thru 5 years of bank statements. Moms caseworker took 4 a year making it 20. They would be looking for large amounts.
I think I would go with the penalty. Maybe other members could chime in.
"Please note, there is no maximum penalty period. The state in which you reside has an average monthly cost of $4,000 for nursing home care and you gifted $60,000 during the look-back period. This means you will be ineligible for Medicaid for 15 months.Jun 28, 2019"
This is interesting
https://www.forbes.com/sites/markeghrari/2014/08/08/the-medicaid-penalty-period-explained/#7ffeda3f2ee4
Trying to find info if the gift is paid back, if there is still a penalty. No luck so far.
So what I get out of the info I did get, is if Mom gifted 10k and the NHs in your area charge 10k a month, Moms penalty period is one month? 5k-2 month penalty?
But it seems most Lawyers will tell you to try to avoid the under-reporting mistake, however. Just like any other income or assets.
I don't have a link handy
What's done is done, those small gifts, in particular, was them feeling good about helping with grandchildren's college education. They were not trying to hide money from Medicaid and had sufficient income for living expenses. At the time, they were not planning to be needing Medicaid help as there is a wealth of community support.. We had forgotten all about the gifts until we looked through her bank record in preparation for Medicaid application.
It's easy to say pay it back... but if the recipient is destitute, they can't pay and the home will sue the siblings to recover. So yes someone will pay it back, if necessary. Yes there is an option to pay an elder lawyer $3000 (the going flat rate here), and be told out of luck anyway short of setting up vehicles/trusts thats not worth the 40K she has remaining. $3000 is a lot of money to these folks, especially to waste it. So if the answer is simply yes thats the way it is, we will deal with it, not that I would ever trust the competency of a Lawyer's office...... .
We were simply thinking of a selling home option, to give her 4 more months of self pay time, and by that time the gifts of over 5 years ago would become irrelevant.
I'd file for the Medicaid benefit when you need to, not when the nursing home says to. However, you may want to run this question by a lawyer from your state. One question shouldn't cost anything close to $3000. Call a few lawyers and ask if any give free consultations.
Or call the Medicaid office. They should know the rules.
Unless you have just filed the recertification for her, I don't know how the state or nursing home even knows the current asset balance. And if you sell the home, as you say you will, the asset balance may very well go above $20k.
My bet is the law says you MAY file for benefits once the assets are lower than 20K, not that you have to. Lots of people in my family don't have 20k in assets to start with! Call the Medicaid office and ask.
I applied for Medicaid for Mom in April when she had just about 20k. I was told I had 90days to spend down the 20k, get them all the paperwork they needed, including 5 yrs of statements, and get my Mom placed. I placed Mom on May1st. She paid May and June privately bringing her under the cap allowed of 2k. I called her caseworker confirming they got all the paperwork needed and July 1st Medicaid started paying.
So what I am saying, you need to apply now. The NH is trying to give you a heads up. Moms house does not count and either does her car. Be aware though, Medicaid will require Moms SS and any pension to be used to offset her care. This means, there will be no money for upkeep on her home. That would be your responsibility. If you sell the house, it has to be at fair Market Value. Medicaid may not allow you to be reimbursed for any out of pocket expenses. If you sell, Medicaid stops until u spend it down, then u have to apply again. The cap allowed cannot be spent on anything but her. She will get maybe $50 a month, in a Personal Needs Acct, for her personal needs.