Grandmother has been in a nursing home since July 2011 as a Medicaid applicant. She is pre-deceased by her husband and only child. Of her 3 grandchildren, I was the one she asked to be POA back when my grandfather passed away. My siblings have never had much interest in helping to settle her affairs with regards to getting her qualified for Medicaid, getting her home sold, etc. I've pretty much been on my own with my boyfriend helping me as much as he possibly can with all of the "process". The nursing home periodically calls me advising me that my grandmother has not yet qualified and that she's been there since July 2011 and they haven't been paid. They even mention that I may have to pay pricately for my grandmother's care while she is there.
I am faaaaaaaaar from wealthy. I am a renter and I lease the car I drive, I have my own bills to pay on the monthly basis on top of paying the utilities at my grandmother's home until it gets sold (its been on the market for months!). But I feel stressed about the potential of finding myself as being financially responsible for all of these expenses that have been incurred thus far. Aside from her home, which is on the market, she has no monies to pay for these expenses. The nursing home gets her social security so that's why I've since had to pay the utilities on her home but was not able to pay for a few credit card bills that she has so she actually has accrued additional debt since the NH started getting her social security cause I can't afford to pay all of her expenses as well as my own. I definitely cannot afford to pay her bill at the nursing home which by now is over 60K. I'd like to know if anyone else has found themselves in a similar situation where aid that you applied for for your loved one was not granted. Am I (along with my 2 siblings) legally required to pay for her NH care expenses? Will they garnish our wages? What happens when one doesn't qualify and the family just doesn't have the financial means?
In general, while we'd all like to hang on to the family money, it's there to care for the people who earned it. Medicaid is a program for those who have virtually no assets. So most people have to "spend down" their assets to qualify. There are exceptions so if significant assets exist, it can pay to see an attorney to see what legitimate avenues exist for protecting the assets. Spouses do get certain amounts that they can keep as do disabled children (in many states).
Good luck. It's not always easy to understand these programs.
Carol
Your aunt has to spend her $40,000 on her own care (or a large part of it) before she will be eligible for Medicaid. If the money is taken of and put in your name that will be considered a gift and will stay on record for 5 years.
To find out if there are any legitimate ways to preserve some of Aunt's assests she should consult an attorney whose specialty is elder law. The attorney can also explain what she can/should spend that savings on. DO NOTHING with the money before consulting an elder law attorney.
So You want to get all the legal on the property. Most of the counties have this online and the downloads are cheap. Like $8.00 for a deed of trust. You need all legal filed on property to see just where you stand in all this. Like If neighbor "bought" property via a QCD for loco amount and has actually filed at courthouse. Then with all these, go to see his neighbor with the filings you got from courthouse & the tax assessor statements and tell them you & the family are going to have to make a decision....either you are going to have to file exploitation of elderly charges against them on the fraudulent "sale" OR dad will have to be made an emergency ward of the state and the state then will the one that will go after them and it will not be pretty either way. Rehearse all this in advance and record the visit (aren't smart phone great!). The solution is either they the pay FMV or cancel the sale.
My guess is they have no $$ so you can get a sale reversed done. I'd make nice at courthouse to see what steps you need to do this. Tax assessors office staff are really helpful. (assessors office staff not tax collectors office) You want to see if dam land can be companionized to homestead. This could be a pretty simple filing if it's all contiguous. Some places (I know about this from dealing with abandoned property after Katrina) have companionization for contiguous as a form to fill out with maybe the HUD-1 statement attached. If this is done, then dam land is part of homestead property & value of homestead usually increases by exactly the amount in the last tax assessor bill. Once done all is OK as an Homestead property exempt asset for Medicaid.
Did anyone explain the whole "SOC" or copay requirements? Dad under Medicaid must pay all his monthly income to the NH less $60. There will not be any $ for dad to realistically pay for anything on the homestead. Ever. So family is going to have to pay for everything (taxes, insurance, utilities, repairs) from here on out. Upon dads death the property is subject to a MERP claim. (A class 7 claim for TX probate). If the property is empty, then all the costs family has paid is an exclusion to MERP claim. If you go this route, it is critical that you start documenting costs & keeping receipts. Now MERP has other exemptions & hardships. You really need to review those (this is on tx Medicaid DADS site & somewhat better described in the TAC -Tx Admisinstrative Code) to see if the homestead property will meet any of them. If they do, it can -IMHO- make sense to keep property for the possible years & years if family has the deep enough pockets to pay for all on dads house without stressing their own finances. If you are struggling to pay your own property tax, then keeping dads place just won't work. most family end up placing house up for sale. If you do this and have a Realtor listing agreement (not FSBO), you need to ask Medicaid about the possibility for a diversion of some of dads copay/SOC to pay for utilities insurance etc at the house while it is on market.
Also since dads situation is complex, realize that you are probably going to be filing appeals on everything. Id suggest these get both faxed to dhhs/dads and mailed. For mail, it goes out certified with return registred receipt, this will run maybe $8.00 at uspo. The fax, I'd send those from a kinks/ fed ex location as you want a transmission report that shows date & time & confirmation. Doing appeals is very timeline sensitive. Appeals in many ways is actually good, as you are going to be dealing with higher level caseworkers - probably in Lubbock office. They know their stuff and an get things expedited or clarified. The local caseworker really is more about doing a quick review against a set checklist of required documents ( like award letters) for the initial Medicaid app.
Now even with you all doing all this, you are going to need an attorney. Since its complex I'd try to have one NAELA certified. But realize you can save significant fees if you do & get a lot of the documents and details done yourself.
Per chance is dam land subject to LCRA?
Ok now speaking of Medicaid pending, he was admitted on this, correct? This is mucho importante classification as if it's there then the nh has to accept just dads copay or hs "SOC" for payment. Otherwise the NH can require private pay. Nh may want to see the appeal hearing letter to place in their file. Hearing will likely be 3 months out so it does give you time to get organized & legal started.
Now about the dam land (now you have to admit its funny to type this), I'll do another post on my suggestions
For what it;s worth, for both my mom & MIL, the Medicaid caseworker did an on-site review @ their respective NH within the first week of admission. I would mention in the letter that it appears that the state required action for Medicaid was not done & completed in a timely manner.
My late MIL died before she was approved for Medicaid (TX) and my SIL dogged it down for months and MIL was approved retroactively about a year later and then for even more fun the NH sent my BIL a check for about $ 100.00 months later which we assume was whatever was MIL balance in her personal care allowance trust. Now BIL did not pay the outstanding NH bill and really there was nothing the NH could do as the application was under appeal. Yeah they sent past due letters but MIL had nothing and we all live out of state so nothing NH could really do as none of us signed off to be financially responsible for MIL. Now for my MIL her bill @ death was to cover just a few months of NH care so overall maybe 25 -30K. Enough money to warrant the follow-up and SIL has the personality to pitt-bull on stuff and be organized to follow-up. Now I mention this as doing the appeal and follow-up etc will be likely an on-going process for many many months and only you can decide if you want to to use a GodFather analogy "go to the mattresses" on all this. If the bill is like 5K as it was just for a month or so and if neither you or any of your siblings can be held personally responsible for whatever NH balance of dad's bill, then the NH basically has to eat the debt. Yeah they can send all sorts of letters but really what can they do. If your dad was at the point of impoverishment to qualify for Medicaid then dad has no assets. Well maybe he may have had a home but that will be tied up in MERP's claim or lien (if he had a home, please post that as MERP is it's own mouse-maze to navigate). You know if the NH gets all huffy, then you or whomever will be dad's executor as per dad's will can send them a letter that as per your state law for probate you will be opening probate. Now like in my mom's state (TX) you have 4 years to do this, so delaying presenting letters testamentary for probate (which is totally under the executors purview unless there is something pressing financially like a foreclosure) is fine and the NH just either has to wait and then file their bill with all other creditors in probate court OR they can just write the debt off.
You know what happened with your dad in his spending 300K for his later years care isn't that uncommon. In many ways it was fortunate that he had the funds to be able to choose where to live. Really if they live long enough they will eventually run out of money & family caregivers will run out of steam. Good luck & keep a sense of humor if you decide to pursue the appeal process.
How it got explained to me that is simple is:
1. SS is an "investment based" entitlement. What you pay into SS or "invest" into SS via your paycheck and taken out in FICA, is what your investment pays out to you. So like for my late MIL it was like $ 500 a month as she was in her late 80's so her working years were low income compared to now BUT for those of us who worked in good jobs the go-go years 1990's - early 2000's, our SS payout is going to be 2K - 3K a month. You can go on-line to see how many quarters you or your spouse has worked to see where you are on maximizing out your SS payout (like 62 vs. 70 or you taking yours now and delay your hubby's till 70 then you switch). Or if you're been married more than once & divorced to see which hubby's SS you want to claim. There's also SS survivors benefits & SSI for disability which are needs based. Despite what is in the media, imho, regular SS is totally good till about 2030, then it will need to go to paying .70/.75 on the dollar less at current investment rates. But that's a discussion for another forum........
MediCARE is a "general" entitlement everybody over 65 qualifies (there are a few exceptions) and we pay into it via FICA when we work and it still gets taken out of our SS when we retire. Right now it's about $ 100.00 a month for my mom taken out of her SS check and she is in her mid90's & in a NH.
MedicAID is a totally "at-need" program in which you must qualify BOTH financially and medically for MedicAID. It's not just being low-income but low-income and having a required situation that Medicaid will pay for. For the elderly they usually need to show the medical need for "skilled nursing care" which by & large means being in a NH. Now some states do a Medicaid waiver to divert NH $ to AL or home based care but not all states do waivers or waivers are limited in scope. The waivers are often called community based diversion programs. Medicaid serves all ages from the WIC program (WIC = Women's, Infants & Children which provides for baby food, milk, breast pumps, and other food items for babies & toddlers & breast feeding mom's too from a set list of qualifying products each month for a limited time);to preventive dental for kids; to mental health services; to NH costs for the elderly or others needing skilled nursing care.
Medicaid is like 65% of payments to NH. MedicAID for NH and for some other services (like mental health in-patient) are subject to MERP - Medicaid Estate Recovery Program. MERP means the state can place a claim or a lien on any assets of the deceased estate to recover or recoup some of the Medicaid costs paid. If your family member gets Medicaid and they still have property like a home, or ranch or farm or other asset (like they inherit something) then the state can try to recover the proceeds of the sale of all those assets to payback the costs of the NH the state paid for. MERP rates vary by state but the big new thing with MERP is that states are contracting it out to companies who approach it as a debt collection agency and get a % of the recovery. It will not be pretty.
What is the difference between Medicare and Medicaid?
Medicare
Medicare is an insurance program. Medical bills are paid from trust funds which those covered have paid into. It serves people over 65 primarily, whatever their income; and serves younger disabled people and dialysis patients. Patients pay part of costs through deductibles for hospital and other costs. Small monthly premiums are required for non-hospital coverage. Medicare is a federal program. It is basically the same everywhere in the United States and is run by the Centers for Medicare & Medicaid Services, an agency of the federal government.
Medicaid
Medicaid is an assistance program. Medical bills are paid from federal, state and local tax funds. It serves low-income people of every age. Patients usually pay no part of costs for covered medical expenses. A small co-payment is sometimes required. Medicaid is a federal-state program. It varies from state to state. It is run by state and local governments within federal guidelines. To learn more about your state Medicaid program and other options available to you, use the insurance and coverage finder.
In the application you have to provide information on all mom's assets - house, car, other property, insurance policy, bank accounts, funeral & burial stuff plus info on their income (SS, annuity or retirement). That get's looked at to see if anything has a cash value and if so, that needs to be cashed out and used to pay for them 1st. How far back on banking depends on your state or your NH. I've dealt with Medicaid for my mom & MIL both in TX, different NH in different cities and they had a different list of what they wanted submitted to them for the Medicaid application. (The NH submits it to the state to the caseworker assigned to the NH and along with their bill).
For my MIL, when she was in IL (HUD program), she would write the state-paid caregiver checks each month to get stuff for her (liquor mainly), $ 200 - 300 a month. She also got the Texas star card so in theory she should have had no need to be paying someone for stuff. She went into a NH "Medicaid Pending" and had to provide 2 years of bank statements. The checks became a issue as to gifting. My BIL had to do a letter on this, so that it wouldn't be viewed as gifting. Still her application was declined because there was no documentation on the amounts. At the time of her death, her application was under Medicaid appeal and got approved after a more detailed letter submitted about 3 months later.
For my mom, the initial application wanted 6 months of bank statements AND a letter from her bank as to the disposition of all accounts for 3 years prior from the bank. So it was a 3 1/2 yr review initially. Fortunately as her CD's expired, they were not renewed and the proceeds all went into her single checking account. So the pattern of divestments of banking assets was clear. My mom was in IL before moving into NH so that showed a pattern of spending each month for the IL and it's related costs, so it made sense that every year 30/35K spent on IL. My mom still has her home, so those costs are 10/15K a year. Income is $ 1,800 a month or 22K a year. So every year, she would have to spend about 25/28K of her savings to pay for IL and home costs. Say mom had 100K and then 4 years later needs to go into a NH, well her pattern of spending would be that @ 25/28K a year for 4 years, she has spent all her money and now qualifies for Medicaid. Now if my mom had just been at home those 4 years and the applied for NH, then she still should have the 100K and if she didn't, then the state would look to see where the transfer or gifting was going and disapproving her Medicaid application until the transfer penalty was paid.
Medicaid for most states, is the biggest drain on state budget. So declining an application is a positive for the state. If you see Medicaid in the near future, I'd start keeping a log on where she spends her money. Like Quickbooks, that way you'll be totally familiar with what's what and can respond to any ? the caseworker or NH has as to her finances. Most caseworkers want them to qualify but you have to provide to them the hard-copy documentation so they can approve it.
Under FHA backed RM, if the owner moves from the house, the reverse mortgage is out of compliance on the agreement. Please go over the agreement to see what the policy reads and what the options are. Just in case.
When you do a FHA backed RM there are 4 things that can be a problem:
FAILURE TO PAY - property taxes, homeowners/flood/wind insurance
. The RM holder can require a lot more insurance that you might have carried. Or a bigger deductible that you would get. They can attach this policy to the RM. I've seen this happen especially with flood insurance, which most folks don't have.
MOVING TO A NEW RESIDENCE- if reverse mortgage property stops being your primary (homestead not filed), you are required to pay your loan
BEING OUT OF THE HOME FOR MORE THAN 1 Yr - the loan will come due.
ALLOWING THE PROPERTY TO DETERIORATE - being away for a while, the house falls into being unkept, the loan could be called in. After Katrina, some homeowners who had RM, got letters w/very detailed questionnaire as to the status of the home, how it was being secured, status of repairs, utility information - done within just a couple of months after Katrina. This was all about calling in loans that looked like they were in areas with uncertainty.This was a real nightmare to deal with. And that was in 2005 before the real estate market tanked.
Two of the big reverse mortgage players, Bank of America & Wells Fargo, got out of the new reverse business last year. They were like 50% of the market too - they still service & honor the old loans but do not write any new ones. They did it because alot of the homes with RM now are negative-equity so they were taking/ looking a future losses on those RM's done in the go-go real estate years.
If you have a RM, whatever you do, DO NOT contact the RM holder to tell them mom has moved. Go and see a financial advisor or elder law attorney first to come up with a game plan on how to deal with this so that she can either protect her assets or come up with a plan to negotiate the pay-back terms or string out the equity on the house if RM holder make it go to sale.
Medicaid can take a while. For my mom it took 6 mos and I am very OCD on paperwork and follow-up. She went in Jan got approved June and Medicaid paid retroactively to Jan.There still is billing bs related to the lag time as to health care providers and pharmacy costs and reinbusement for those 6 mos. With my MIL, her Medicaid approval came in after she died and they had to refund the deposit my BIL paid only after my SIL filed a complaint with TXDHHS. Maddening!
1. Did someone other than your aunt (let's call her "Jane Jones") sign off on paperwork that they personally are the responsible agent or party for her during her stay at the NH? If you signed the whatever's as"Jane Jones" or as "Ann Smith as DPOA for Jane Jones", then you are not responsible for whatever happens after Jane Jones (your aunt dies). Your DPOA ends on death. But if you signed it as "Ann Smith", then you probably signed off to be responsible and the NH could come after you for the 24K. So which was it? Please tell us you have copies of the paperwork! So review them to see what's what. Imho that will determine what kind of letter you will send return registered mail to the NH.
2. When they die, their debts die with them. Although that sounds clear and final it might not be. In some states the medical debts incurred in the last few months can be a claim or lien against the estate. In TX, where my mom is, those debts are a class 1 claim in probate BUT are limited to 15K and also include all funeral and burial debt. Now the executor has to post a notice in the paper that probate is open and the debtors have a set period of time to file their claims. If they do and there are property/assets, then you have to pay off claims in order of importance. For the executor or the probate attorney this is a huge area of opportunity for negotiation here, especially if the estate is small or there is a house to sell in this current real estate market and you think probate could on run out to the maximum (4 yrs in TX). Now if auntie didn't have any assets some executors never go to probate, then there is no real way for the NH to file a claim or lein. NH has to just eat the debt or hound family to pay. So what is auntie's estate situation?
3. Why was auntie denied Medicaid for 6 mos? Was it due to a transfer penalty?
Or requirement to cash in insurance policy? Or some other asset transfer? edical denial? Appealing the denial will really depend on why she was denied. What is aunties' state time frame on doing an appeal. Most states have strict appeal requirements. It will be on the denial letter as to the appeal process. Personally I would file an appeal if you still have time to do.
So I’ve received notification that my grandmother was not fully approved (at least not until 2014); ancillary vs non-ancillary. This “penalty” has pretty much been imposed as a result of her home having been moved into a Trust.
[History: When getting my grandfather qualified, we had to have him removed from the Deed on their home to leave it solely in my grandmother’s name. Since she still lived in the house, it was not factored into any spend-down and whatnot to get him qualified. Once he passed away, my grand-parent’s attorney had me place the house into a Trust. That was less than 5 years ago so when now getting my grandmother qualified, the infamous “5-year Look Back” comes into play and the Trust is pretty much not “enforceable” for the lack of a better word. In NJ, a Medicaid recipient cannot own a home. If there are any exceptions to this rule as there are in other states, my grandmother did not qualify for any such exception.]
The Trust itself was set up properly, but her needing Medicaid within the “5 year look back” period is the issue. She has been penalized pretty much for the transferal of the home (a pretty sizeable monetary asset) 2.5 years ago out of her name exclusively and into the Trust. So we are in the process of having the house removed from the Trust and transferred back into her name so it can then be realized as my Grandmother’s . Once we are able to provide proof of the home being back in my grandmother’s name to go along with the documentation of the home already being on the market (we put it on the market back in December), we are confident that “conditional” full qualification will be granted. “Conditional” in that her case will be re-evaluated periodically until the home is sold and those monies accounted for; at this time, we don’t anticipate those monies creating yet another set of problems.
Texas & I think, Florida, have the homestead protected from unsecured debt liens. So cc debt can't get a judgement placed on the house. Don't know about others.
If you find that dealing with all this just seems to be overwhelming, contact your local Agency on Aging to speak with a counselor. Most states have COG's - council of governments - which are regional planning bodies. The COG's tend to manage programs & get $$ to deal with things which have a federal/state partnership, like Agencies on Aging. Usually the ombudsman for NH works in your local AoA office at the COG - the NH ombudsman likely can get you some insight as to what's happening with your mom's application and how the system works.
Medicaid approval needs to be done on two fronts: medical and financial. With my mom's application there were appeals done to get her approved medically & her financial took 5 months.
Financial: for us, it was the NH business office who did the financial side and they were the cause of a 3 month delay in getting the application off. I am very OCD on paperwork and turned in an application that had all the items requested and it ran about 100 pages - this mainly due to my mom's insurance contracts (life insurance policy alone 30+ pages). You should be able to contact your states Dept of Health & Human Services (or whatever it's called) to find out where the application is and what items could be missing that they need. I hope you did NOT sign your name on the application - whatever you do sign it as " Jane Smith as DPOA for Mary Jones (your grandma) or just sign as "Mary Jones" - if you are her DPOA that is how you should always sign whatever. You are not personally financially responsible BUT have a duty to manage her financial & personal affairs as DPOA.
Medical: If she went from living at home to the NH, this often causes a problem with Medicaid and you & the nursing staff need to work with their old MD's to get the criteria in their medical history to show they need skilled nursing care. Just because they are old, or have dementia or incontinent, etc. is not enough. My mom went from IL to NH and bypassed going to AL. She was able to do this as she had a critical weight loss (more than 10% in 30 days), critical H & H and some other conditions. Sometimes the MD will need to change their meds – like go from Exelon pill to Exelon patch (more “skill” to apply); or change a med to one that needs to be compounded daily which you can’t do at home. Each state has it’s own criteria for admission under Medicaid. They will be evaluated at the NH and often are denied because they don’t have enough “critical” conditions because there is no history when living@ home. You will have to work with NH and your gran's MD’s to get whatever done to establish the need for NH if they are coming from being at home or IL. There is a whole medical appeals process in each state for this and separate from the financial appeals. For those still living at home without a huge disease history, becoming a patient of the MD who is the medical director of the NH is good as they will know how to create & write up the health history chart so that it passes Medicaid medical review.
The house: If the house was her homestead and principal residence then it is an exempt asset from Medicaid while she is alive. It does not need to be sold unless it is over 500K (750K in some states). Yes you are right in that all gran's $$ less whatever is her states personal needs allowance must go to the NH. So someone will have to pay for the taxes, insurance, utilities etc at the empty house. Imho paying the taxes and insurance need to be the top priority (you don't want to face a tax sale or liability against the house if something happens - Also most Realtors won't take a listing without full insurance on the property). If you are putting the house on the market, there will be other $$$ costs as you have to keep the yard and interior up and looking good and pay for that. If you do it yourself, you can't be reimbursed for it but if you hire someone to do it and have receipts, cancelled checks you can. Whomever is paying for house items, needs to keep VERY detailed records of this so you can be reimbursed from the proceeds of the sale otherwise the state will want 100% of the proceeds to pay for her NH costs.
My mom's very modest home would be a very difficult sale as it has years of delayed maintenance with foundation issues and is in a historic district. So it sits there empty and as her home is exempt from Medicaid, she qualifies for medicaid. The average cost to maintain my mom's house is about $ 300 - 500 a month but this is with minimal utilities running and pushing it to sometimes overgrown on yard upkeep. For us, this works and upon her death we will let MERP (Medicaid Estate Recovery) know that we will file a claim against the estate for all $$ spent on the home which will be paid from the eventual sale of the home.
have you spoken with a Realtor? What did they say regarding selling her home quickly? I interviewed 5 when I was trying to decide what to do. Full time ones who actively sell in my mom's neighborhood. The consensus was that the house would be a most difficult sell limited to cash or conventional buyers, go for at least 30% below it's appraisal plus needed staging & landscaping to be competitive. So it sits there empty. We are fortunate in that she has great neighbors who look out for the home and I go in often but not everyone is in this situation. Good Luck!