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A family I know is having to jump through all kinds of hoops because their Mom has been placed in assisted living and is running out of money. When her house was sold she divide the money 3 ways giving both her sins a third and keeping a third for herself. The son kept her at homefor two years and then decided to put her in a nursing home. They are having to come up with all kinds of receipts proving how her money was spent. Is it always this hard to get assistance from Medicare and Medicade? Are they suspected of using her funds inappropriately or is this just standard procedure when you apply for assistance.

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It's just standard procedure. I know I was surprised to read that Medicaid goes back 5 years to see how monies were spent and if a parent had handed over large sums of money to the grown children, money that could have been used by the State for Medicaid for the care of that parent. Of course none of us have a crystal ball to know if one's parents would need Medicaid, and the parent is thinking he/she is doing a good thing by giving their children, grandchildren, and other relatives money. It can be so complex.

Sadly, there are cases where money was handed over to the grown children knowingly, the children and/or parent just didn't want Medicaid to get their hands on the money. Thank goodness not everyone uses that approach, otherwise Medicaid would be bankrupted or in order to fund Medicaid our taxes would go through the roof.
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It was a mistake for her to divide the money 3 ways because the money given to the two sons is looked upon as gifts if they were given within the five year look back that medicaid does in the application process. Yes it is this hard to get assistance from medicaid when they have to do further research into how a person's money was spent. They probably are not suspected for using her funds inappropriately, but wondering where all that money went to and what did they do with it. They will probably end up telling the sons to use the money they received to pay for their mother's care until it is all spent or paid back before medicaid will cover her. It is a sad situation all around. It sounds like the money was divided to help protect the sons' inheritance, but without knowing that if she ever needed medicaid that they would look back 5 years and ask questions about the money.
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Standard procedure is to request proof of assets, income and medical expenses (assisted living) for the past 5 years. If they don't see any large transfers of assets, cash or property, they don't usually get into asking for receipts. But if they see large checks, they'll want to see where that money went. They're pretty strict about people gifting money and property to families, then applying for Medicaid. Also, they require you to recertify every year, which means you fill out paperwork showing current assets and income to show that you still qualify.
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There is a look back of usually 5 years. Generally it's not so difficult, however there must be proof that mom's funds were used for mom's care when applying for Medicaid. You can contact the local Area Agency on Aging or bureau of Senior Services, they will have info or can direct you to someone that will be able to assist you.
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Lots of good suggestions here, but basically the elder should use funds to pay for their own care before going to the taxpayer to get the money. And the presumption these days should be that an elder will need nursing home care at some point. That money they want to hide from Medicaid to preserve an inheritance really is a kind of theft from taxpayers and if everyone accepted it as OK, Medicaid would go under very quickly.
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The sale of the house was recorded locally and dovetailed into the states database. So house sale to the penny is a known amount.

AND in the Medicaid application you have to provide their awards letters, so again it's known to the penny what their income is.

Say mom sold house for 100K 3 years ago, gets 1K in SS & 1K in retirement every month, and is in AL that costs 3K a month since she sold her home. In theory mom should have a nest egg of 64K left from the house. She is only short 1K a month to pay for AL. So 3 years = 36k she has spent. 64K should be available. Let's say mom has spent 20k on dental; 10k on preneed funeral; 4k on new hearing aid. Mom has the cancelled checks,etc on these too. Even with these expenses Mom still should have 30K. But if mom has zero assets, then medicaid needs to look to see if any gifting happened & if so issue a transfer penalty.

But this mom gave 2/3 of the proceeds to her sons. That is gifting and not allowed. Medicaid requires that all assets are used for their care & their needs. If not the state can place a transfer penalty on the parent. Based on what you described, i bet what the state is doing is trying to establish just how much of a transfer penalty will be placed against mom. that is why all the documentation is being requested.

Transfer penalties are very sticky. If the sons have not seen an elder law attorney, they need to is my suggestion & ASAP. Once a penalty is issued, all medicaid payments will be stopped for the penalty period as the elder is ineligible for Medicaid. The parent will have to private pay to stay & someone ( the sons) will have to sign off on a contract to be financially responsible. Or if they can't then mom moves into one of their homes till the penalty period of time is cleared. A 64K penalty for TX Medicaid would roughly be 412 days of ineligibility. That is a long long time to private pay or have mom move in......

Per chance are you the girl friend of one of the sons?

Penalty varies by state as its set at your states reinbusrement rate as the main interger to do the penalty formula.
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Nope no connection whatsoever. But from the sound of all these answers it looks like they cooked their own goose. Too bad for the daughter in law.
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WARNING ,
fly by poster here but give me credit for at least pretending to help . when her funds run out she can sell her oxycodone for 25 bucks each . its a chunk of change when you consider how many are in a bottle ..
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