What happens if someone in a nursing home is denied Medicaid because they gave away money within the past 5 years?

I don't consider that fun, CM. And I fume when I see it happening.

I like the ones when the firefighter with the bad back puts his winning tug of war team photos up on Facebook, or asks for sponsorship because he's running a marathon. The more brazen the better! Like Alfred Doolittle in 'Pygmalion', who has no principles - "can't afford 'em" - and incontestably points out that his needs are just as real: he doesn't eat any less than the deserving poor, and he drinks - oooooh - a *lot* more.

Yes I have seen it with my own eyes. I used to do home care visits in bad neighborhoods where there were 60" flat screen TV's that the average middle class worker like me can't buy. And the kid with the sneakers? Saw him in a bank with his mother after he got expelled from 9th grade for fighting in school - 16 yrs old. 
Do you really think it doesn't happen?
Really?
And the cost doesn't fall on those less able to pay. The costs fall on the average middle class worker, like myself and my neighbors. 
Do you know how many good, competent primary care physicians continue to retire as they can't practice medicine the way they want to, have to see 25 patients to break even with government mandated reimbursement rates, not taking Medicare or Medicaid patients, only commercial pay patients, when we need more primary care providers and have a nation wide shortage? When our physician sent us a letter stating he was going "concierge" medicine 7 yrs ago when the ACA became law? We couldn't afford $5K annually to keep him. 
I am in the trenches every day. You wouldn't believe what I see with my own eyes. It's terrible and healthcare is only going to get worse. I feel for the younger people now cause when they are our age there will be nothing left for them. I don't mind paying my health insurance premium- to me that is a priority and I don't want the government picking the doctor I want to see either. 
There are two sides to everything, just because I don't agree with your opinion I still respect it. 

Of course it *happens*. Just not enough to make enough of a difference to make it the most important problem to solve. And in that it eats into the public fund it does impact on the people who really need the support most.

(They probably nicked the t.v.)

Exactly. The people that need it the most don't get it.

There is one situation that everyone is very silent about. I like to think they're silent because they're too embarrassed to speak.

Residential social care homes used to be owned and run by local authorities. Not very cost effectively, and not very care effectively either, but they were there. They provided a safe environment for elderly people without the means to care for themselves.

It has become increasingly the norm for local authorities to close their care homes, and instead purchase placements from private providers.

Okay so far...

The providers began by accepting local authority referrals. Because the homes tended to be of rather better quality than the old LA ones, this became a bit expensive for the public purse.

So the LAs devised contracts, with the idea being that economies of scale and guaranteed turnover would compensate for a reduced per capita fee.

I'm sure you're way ahead of me here...

As time has gone on, the LA rate has steadily reduced in proportion, with the result that private pay rates have steadily risen in proportion and are now more or less manifestly subsidising LA referrals.

Which would be fine, if it were acknowledged and agreed to by all parties. But it isn't acknowledged, it's just done. Elderly people are being taxed by stealth, and nobody is prepared to discuss it.

If I still had any rich relatives and was keen that they should not be fleeced, I would be extremely careful to ensure that their care homes did not accept local authority referrals. My hypothetical relative could always make suitable donations to charities instead if she felt it her duty.

I imagine a similar sleight of hand takes place in the US in facilities that accept Medicaid, does it?

I am not quite understanding this analogy- social care homes being NH or AL? Or subsidized housing?
I'd love to discuss it further but our systems and perhaps terminology in the US are different.

They go by different labels but they do the same job, more or less. LA - sorry, this wasn't clear - stands for Local Authority in this context: the town or borough or county council, whichever public sector organisation it is that deals with local services such as schools and housing and social care. Because we're both much smaller and *much* more crowded - you have 84 people per square mile, we have 650 - authorities will generally have to cover similar sized populations but in (usually) more manageable geographical areas.

The types of provision range, as they do in the US, from care in place, to sheltered housing = IL, to residential care homes = AL, to nursing homes; and as in the US there are plenty of blurry lines. We are also at last beginning to catch up with the continuing care facilities within retirement "villages"/communities model, which I believe - I may be wrong - began in the US.

Thank you, Katiekate, that needed to be said.

Under IDEAL situations what happens is this---
#1 Two people are married and have worked outside the home for as long as they physically can.
#2 They start savings via traditional methods (IRA, company retirement plans)
#3 They find a good investment counselor.
#4 They put into their portfolio long-term care.
#5 In the meantime, planning carefully they should have paid off a home mortgage loan.
#6 They should be able to gift funds to an adult child WITHOUT thought of reimbursement.

To add (Since my post was for an ideal situation)--
Elders are scammed out of money by grandkids who should be ashamed of such requests.
Plus telephone scammers will get that last dollar out of the elder EVEN IF IT'S THE ELDER'S LAST BIT OF MONEY.

I think in most situation there was no scamming of the elder. They 'gifted' some money to help a relative out. They were not expecting payback. No one was thinking 5 year look back. Maybe they were thinking about the limit on gifting that the IRS sets. Why isn't medicaid taking into consideration that limit the IRS sets? Why was this changed to 5 years? I remember when my grandmother went into a NH it was a 2 year look back.

Because....with 5 years the for profit medical facilities can scoop up even more money from those who cannot afford their prices. The goal is to shift as much wealth from the bottom to the top as they can.

Wow...digging into this a little deeper about a grandparent giving money to their grandchildren tells of a scam that is going on now. Very scary!

Going through the applying for medicaid process with my dad has taught my husband and I a lot. As we age we plan to put money aside in cash (no record of it anywhere). It is easy to do. Just get cash back on purchases, make a few extra ATM withdrawals and set the money aside. Easy and will add up quickly. This will then be our stash for things like helping our grandkids or kids with college expenses, weddings, or whenever else we want to gift money. This way there will be no record of gifts made. We can keep our stash of cash in a home safe or safe deposit box, etc. Will still have our investments, etc. Just will have a stash of cash for things we don't want the government to know about.

Again, better to consult an eldercare lawyer for at least a consult first about what can and can't be done. I am so glad I did this, and we sure aren't rich. We are now in the process of letting the lawyer file for Medicaid plus doing everything else he has instructed - set up a QIT (Miller Trust) with half mom's money plus open a regular joint checking account with the other half of her money with my sibs and my name on it that we will NOT be touching till after mom's gone and the State of Ohio sees it first. (Mom's name and SS are not on this joint account). All financial and banking accounts must show $2000 or less at the end of the month. Mom's period of Medicaid ineligibility will be for the next 16 months, and we will be paying the memory care out of the QIT and her regular checking account for that period. I admit I truly do not understand every detail of how this works, but I do trust my lawyer that all will be okay and that I did the right thing.

So, Katiekate, is it your position that doctors and health-care providers should not be compensated for services and goods they provide? No for-profit health care?
Imo, if the government took over the health-care system entirely, more money would be lost to the fraud, graft, and corruption that is rampant in government enterprises than is ever disbursed as profits to health-care investors. And, the availability of good health care would disappear.
To avoid the 5-year look back period, keep 5 years' worth of assets in reserve instead of giving it away. If you don't have enough assets to keep you 5 years, don't be giving any away, and you will qualify for Medicaid when the time comes. By the way, I don't think Medicaid disqualifies you over a few $5 birthday gifts to your grandkids. It's the $5000 gifts that could become an issue.

I agree with Agingmyself above. Again my question was, does the government run anything "efficiently"? Not that I have seen. Look at the VA, for one. That is a government run mess, has been for decades. They are constantly understaffed with doctors and nurses, a vet can't see a provider for months, care is substandard all around.
As for single payer healthcare, all those elective hip replacements and knee replacements our elderly population (not so elderly either) will have to wait to be scheduled as the available providers (diminishing in numbers daily) will be taking care of emergent cases unscheduled that come up without planning.
Big pharma? While I don't agree with the endless advertising they do, they have made great strides in all types of diseases these past decades - diabetes care, cholesterol medications, cancer treatments, high blood pressur, Humera (a wonderful med for many conditions). These drugs have prolonged many people's lives- from the poor to the 1%. I have no issue funding big pharm as someone has to pay those brilliant clinical research PhD's that perform studies that go on for years if they produce the great medications that are available now.
Physicians and nurses should work for nothing? Or peanuts?
The physicians I know (a large percentage) practice medicine because they love it- they have brilliant minds, caring hearts and feel stymied by the regulations and restrictions placed on them by the government and health insurance companies as the government puts restrictions on charges, criteria for treatment protocols, what medication they can prescribe. Try being a doctor these days. To have to see 25 patients a day to break even. Physician offices don't even hire RN's anymore in their offices.
Reform malpractice insurance. Physicians opt out of performing direct patient care due to high malpractice insurance premiums, especially OB/GYN. Brilliant physicians opt not to deliver babies now as they are afraid to get sued, when often the mother neglected to seek prenatal care even though prenatal care for free is offered in most rural and urban areas.
Doctors are leaving medicine. The US must recruit physicians and nurses from out of our country to provide services as the baby boomer physicians retire.
Not to mention people not taking the initiative to take care and assume responsibility for their own health and well being.
Thankfully that is improving a little, but not much.
A competent and caring doctor is worth any price they charge. Priceless. But in geriatrics, especially, they are too rushed, deal with so many constraints placed upon them by the government as that is often who is paying in the geriatric age range and generally are working another practice to support their income due to very low reimbursement rates. And Medicare/Medicaid continue to lower the meager amounts they receive as it is.
I am not a fan of a single payor system. Sure everyone points to the countries that have it but in truth those countries are much smaller than we in the US and the tax rate in those countries are huge! 40-60% of personal income. No VAT tax here as they have in those countries on top of their high personal income tax.
But this is just my opinion, and I welcome others. It's all good as at least we are having a conversation that needs to be had.
Take nursing homes,for instance. Your loved one in a nursing home doesn't get to see their regular PCP, they see the nursing home's medical director as in many cases their regular PCP doesn't have privileges to see a patient in the nursing home. Last time I checked CMS website, the patient in a nursing home is required to have chart review and a MD at minimum, once a month. That is a CMS regulation. Ditto your PCP often assigns their patient's care to hospitalists these days as they haven't applied for priveleges to go to that hospital to treat their own patient! Who makes those laws? Centers for Medicare and Medicaid. Why do PCP's opt to do this? They have no time to leave their practice to drive, park and see several patients in one hospital and then get in their car and go to another. Federal regulations. Physician time. It's a quagmire. That's why we baby boomers need to be advocates for ourselves and our loved ones and understand how the system works. And governmentrjn doesn't assure success nor efficiency. 

Shane1124--You've made some excellent points. There are two things I'd like to add. One is that there aren't enough med schools in this country, and I recall reading once that the AMA wants to keep physicians "scarce" to reduce supply so their income stays high. I don't know if that is still true, but in any case it takes considerable funding to develop a new med school, so it's good (at least for the US) that we can "import" physicians.

The other point is that there is a lot of inefficiency in developing new drugs. For example I uses to work with a company that developed biologicals, which are also overseen by the FDA. We found that they would misplace data such that we had to waste time resubmitting it, and their own standards were not always as high as those they set for the companies. (For example, when I asked if they had some specific data about a reference sample FDA had provided [and was required for an assay we were obligated to perform and submit], their answer was "we're not that formal" which became a company joke after I told my colleagues! ) Another thing is that although a product had been thoroughly tested and proven effective and safe in Europe, the FDA required the whole process to be repeated in the US, which wasted considerable time and money; perhaps this is being modified. I've seen instances in which the FDA "strains at gnats but swallows camels" when dealing with the licensing of products or simply makes incorrect assumptions that I won't go into here and now, but from my experience I cannot simply have "blind faith" in the FDA. It's simply just another government bureaucracy.

As the wife and business manager for my physician husband, I agree with most of what Shane and Bob have said. My husband is retirement age, but is still working part time because he loves what he does. Fortunately we have lived below our means for all of our working lives so we no longer need the income. Last month, malpractice insurance payment was due. Added to the other office overhead, we ended the month in the red and he got no paycheck. Government regulations and reduced reimbursements are making it hard for young physicians raising families and paying student loans. Here is an example: My husband performed a circumcision on a newborn on Medicaid. The charge was $285. Medicaid paid $56.58 (less than 20%) and we wrote off the rest. To provide this service, my husband had to drive to the hospital, visit with the mother to discuss the procedure and get a consent form signed. Then he had to scrub in, perform the procedure, monitor the infant for a few minutes, go back and give the mother an update, document all of this (some hospitals require written notes, others dictation), obtain billing information (name, address, Medicaid number), and drive back to the office. He gave billing info to the billing person who has to enter it into the computer and submit to Medicaid for payment. Then she has to follow up to make sure that the claim was received and paid, which sometimes doesn't happen for several months. If you do the math, it works out to barely over minimum wage for the hours my husband and the billing clerk spend on this procedure and the reimbursement contributes nothing to office overhead costs. If we change to a single payer (government) system and the reimbursements are this low, who will want to put in the time and money to become a doctor? I doubt that we will need more medical schools.

I am also thankful for the researchers who develop new life-saving medications. However, I feel that something needs to change so that we in the US are no longer footing the entire bill for their development. Patients in other countries are able to buy the same products at much lower prices. I recently read of a new treatment that will be supplied to the developing world for less than $1 per person but will cost about $200 per person in the US. This just doesn't seem fair.

My mother had 5 grandchildren and wanted them to have a money gift card, at least, 'for birthdays or Christmas', so even before she declined, I took $50 out of her checking account here and there and built up a little nest egg of money gift cards. It came to almost $500, not much, but it was there just in case. Mom went in a nursing home and got $50 or so from Medicaid for her own use, and that built up over a couple of years, too. I forgot what we did with that money, I know we gave it to the grandchildren after her death,  paid for engraving her headstone,  and a final little gift to charity- from mom.  That was just little stuff, Medicaid looks for large sums with no good explanation.  I borrowed $7000 from Mom a few years ago in case I needed it for a divorce.  That divorce never came about so I replaced it within three months back in her bank account, and you better believe, Medicaid questioned that transaction immediately!  

It is said to put your surplus money in a trust.
Then when spouse goes into nursing home money outside the trust is split in half. Patient pays our of his half until the funds are almost depleted, don't know the exact figure, then the can go on Medicaid. It is this way in the state of Michigan it's called something like preventing spousal destitution. Am I right about this?