Medicaid lookback. How do we handle this?

Have you had a consultation with an Eldercare attorney who is familiar with Medicaid in their state?

Not sure how Medicaid handles married couples. In my State the cap for monthly income is just over $2300 for a single person. If you go over the 2300 you can't get Medicaid. There is something called a Miller Trust. The overage goes into it every month to be able to get Medicaid.

If one is placed, the other is considered a Community spouse. They remain in the home, have a car and enough or all of the monthly income to live. Assets can be split with the recipients half being spent down and applying for Medicaid before it runs out.

The bank should be able to supply u with all 5 years of statements. Medicaid needs to make sure there was no "gifting". Large amts of money will need to be backed up. Maybe they had to replace a roof. Had major plumbing done. If any gifting, it will cause a penalty.

I suggest you talk to a Medicaid casework. Or an elder lawyer who should be well versed in Medicaid.

FWIW what some states seem to be doing now (& I think this is due to Covid as so much is backlogged) is requiring last 6-8 months and the month of the application bank statements for past 4 years. So if an application is done Jan 2022, caseworkers will want July - Dec 2021 and January ‘20,’19, ‘18, ‘17. If you or hubs is their POA, you take that POA document and them to the bank to put in a request for back records and to have y’all as signatory on all their accounts. This way you can go online to do the many whatevers that will come up.
They can go online an request their taxes from 2016 forward, & you help them do this.

BUT I’d be way way WAY more concerned about how to deal with them and their future if it’s the situation where 1 of them needs a NH but the other is kinda pretty much ok for continuing to live in their home or in IL or a AL. So that spouse is the “CS” aka community spouse for LTC Medicaid rules.

if this is the situation, I’d fold it and just find a CELA level of elder law attorney and let them deal with the details on doing a NH/CS “at need” filing. It’s more complicated and not imo ever a DIY.

Please keep in mind that LTC Medicaid is “at need” for BOTH financials and medical eligibility. If they cannot both show to be “needing skilled nursing care” in a NH, Medicaid LTC may not be available. If your state does not include AL & MC as covered by a Medicaid waiver, then that type of placement will be private pay. Sometimes it end up being the NH spouse goes onto LTC NH Medicaid and the CS stays in their home or their kids home and they apply for community Medicaid IHHS services. And for more fun in this, they are different applications.

im guessing that they have been in their home and this is a long slow progression into needing help. If that is the situation, they may not have a thick medical chart to clearly & easily show to be “at need” for skilled care. The vast majority of those entering a NH come in after a bad fall via being in a hospital (MediCARE pays) then discharged for rehab at a LTC facility w a rehab unit (again MediCARE pays) and then after they stop progressing in rehab (MediCARE stops paying), they then segueway from being a MediCARE patient to doing an application and become a Medicaid Pending resident. The hospitalization is gonna provide for a thick file with codes and notes that show skilled needed; that a Medicaid caseworker can flip through and check off on as SNF needed. And the facility has been paid via Medicare rehab benefit which pays like triple what Medicaid ever pays. So the NH is happy 😊.

Family often focus on the financials but the medical part is just as important. Please pls pls give some thought & research into if their medical history will show “need”. Just being old, forgetful, not being able to do “medication management”, needing help bathing, is not necessarily enough to be at need for a NH. A MD note stating SNF needed on its own will not automatically mean ok for LTC Medicaid as the state will do their own needs assessment. A good CELA atty will have suggestions as to how your state evaluates applications for both the medical & the financial part.

I agree with BarbBrooklyn… each state has their own variation of the policies so everything you read here may or may not apply. If you are in SC I can recommend an attorney who is excellent and the consultation visit is free. I learned the hard way, before you meet with any attorney, ask about their fee structure. I also learned the hard way that not all attorneys are as experienced or as up to date on the latest law changes as they apply to your personal situation… and no two situations are the same. If either of your parents are veterans, definitely ask about VA benefits… they only have a three year look back the last I heard… at least in SC. I also learned some states have their own variations of Medicaid and VA benefits and that can even vary from one VA hospital to another. The most important thing I have learned is do not “deny yourself” from any benefits due to misinformation… let each agency you deal with do he denying based on facts as they apply to you. We have had several instances of delayed benefits because we “knew” we were not qualified and did not apply as early as we could have. I “think” Medicaid may have look back procedures that even if you don’t have certain information they may be able to identify various sources. They should understand you can’t possibly know or your parents may not remember every bank they have used for a short period. Eldercare (or estate planning) attorneys should even be considered for younger folks because you never know when a crisis might occur and your life is turned upside down. Most attorneys will do whatever you ask, but only a truly experienced one in each specialty can do the best job in your personal circumstance.

Do they have taxes going back further than the two years?

I don't see them being on Medicaid making that much money a month, they would be on Medicare.
Id you plan on putting them in a Nursing Home, which I wouldn't do to my worse enemy because get are all horrible and not a nice place to live your remaining years.

If at all possible, let them remain in their own home and hire Caregivers.

While as others have said each state is going to be a little different I can tell you what we are experiencing as we are going through this for my mom rite now. In CT they are requiring every statement from the current year up to the time of application and Dec statement from the 4 years previous to that which we needed to order from her bank. They will need explanation for any large deposits or withdrawals. The other big difficulty for us has been they are also requiring her divorce decree’s, my mom and dad were divorced over 45 years ago! But so far those have been the biggest hiccups and aren’t impossible to do just a little time consuming.

Save yourself a lot of grief and get a consult with a reputable elder law attorney who is well versed in Medicaid and Community Medicaid (in-home) care. You will be guided and told what to do and what not to do; as well as what legal options your in-laws have. My attorney did all the filing for me for my mother and it was worth the fee to have it done correctly and without delays.

Goldie2, I think what they mean is like my mom sold her home and all the money was deposited into her account. Just an example. Both of our names are on the account, but I think that money would be counted as hers if we applied for Medicaid.

Start with copies of their tax returns. If they had the professionally prepared, (like H&R Block), get the copies of those years. Also go to their bank & get bank statements for each month, going back as far as you need.
You may have to have power-of-attorney for finances in order to do this. If they have already given this to you, you should have no problem. If not, it's time for a talk.

I don't think anyone so far has mentioned Certified Medicaid Planners (as alternative to elder law attorneys). If you're interested, go to the website of Paying for Senior Care. The page I'm looking at right now has an excellent (understandable) summary of what Planners do, how to handle Medicaid when only one spouse needs it, etc. (I'd post the link but I'm not sure if we're allowed to do so on this forum.)

Also, the American Council on Aging offers free help in initially finding a Medicaid Planner on their "Medicaid Planning Assistance" page.

There's no denying that either choice involves some expense, but keep in mind that this expense meets the look-back requirements for acceptable expenditures (assuming you use your in-laws' money to pay for it, NOT your money) during the 5-year period.

Applying for Medicaid is a complex procedure, and it is all to easy to make a mistake no matter how well you think you understand the requirements. As others have said, every state is different. Do look into hiring either an elder law attorney or a Medicaid Planner to guide you through this. It's well worth the expense.

Be aware, too, that a nursing home is not their only option. Medicaid also covers home health care, although I don't know if there are criteria that dictate when recipients MUST move from home to a nursing home (for example, if they need 24-hour care). Again, you will learn all this from an attorney or planner.

This is a tough time for all of you. I wish you as uncomplicated a Medicaid process as possible!

Contact your local area agency on aging. www.eldercare.gov to find the right agency. They provide lots of information and are funded with federal and some state money. Each area has volunteers who have undergone speciality training (updated often) about helping people (seniors and disabled) who need help paying for health care.
They can 'show you the ropes' and may have a short list of elder law attorneys that other clients have reported good results after working with them.
Medicaid is a payor of last resort (after all other possible benefits are in place and the assets are spent down to the dollar amount specified in each state.
Medicaid is the only public benefit program that pays the cost of residential nursing home care. (Medicare can pay part of the cost of rehabilitative care in a nursing home.)
It's a process. Don't try to get it all done at once, just get going and try to get one or two bits at a time. Keep copies of everything.
Documentation means proving that the elder is the person they claim to be, have documentation of all of their income and assets, and meet clinical criteria for nursing home care.
Good luck

lauriecat: Imho, do yourself a favor by retaining an elder law attorney for this issue.

I’m going thru this now. The BEST and legal way is thru elder care lawyer. Medicaid is strict. If you mess up information or looks like you are hiding money you will be denied. There’s a lot of leg work involved as well and it takes TIME. Don’t delay 💜

You will need to search out the taxes and the account statements from years past. Go to the Medicaid sites. If all records have somehow disappeared you are left to somehow get this information the best way you can. I sure do recommend the elder law attorney as others have; you can't afford to make a mistake in all this. Your parents pay for this as a part of the cost of managing as POA for them.

It's tough. Our father had $5000 left in a retirement account, and owned his home. Because a precious caregiver neglected him for so long, we had to spend the money on carpet and repairs to keep his house standing.
He had 0 left in the retirement account, but that didn't matter. Even whe he deeded his house to my brother and me so that we could help him keep up with taxes, the answer was no.
Between him and me, we barely lived under the poverty line, but no one would help. He got $800 a month for SS, and he had medicare and a supplement that we paid out of pocket.
By the time the 5 years went by, he had died. :(
At one point, I truly wondered how anyone could get medicaid. It seemed to be deemed only for young women with kids. At least in our experience. Something really needs to be done in the states for our elderly. They are the most vulnerable, and seem to get the least care.

It took us four months here in Florida to finally get the Medicaid waiver! It seems like eternity when you’re going through it. We couldn’t afford a lawyer. It was me making numerous phone calls and providing endless information to our agency for aging. You’ll get there if you’re determined.