How do we try applying for medicaid to help pay nursing home when she makes too much w/ benefits to reduce VA Benifits for medicaid approval?

Well as a person who works daily with this issues I have a number of questions.
What state does she live in?
How much is her income?
How much does she have in assets/resources such as cash in the bank, CD's etc.
Is she in the home currently and is your father alive?
What type of VA benefits does she receive?
Has her doctor stated she needs 24/7 care for her ADL's aka custodial care?
I could help with this, without pay of course. If you wish. I will watch for your response

GeriSW has a good grasp on this. In general, you have to spend down the assets before you can get Medicaid - at least in North Dakota, where I live, we did. My parents were allowed tokeep very little. And the five year look back period is an issue now, where they will not exclude anything given away in the past five years from her assets.
I'll be looking for Geri's input, as she can help us all with this.
Carol

What questions do you need to ask the elder lawyer we first went to an accountant who was going to help us see if we woukd qualify for medicade but after meeting him and taking papers with investments and our bills and our insurance paper 12 days later he said he could not help but would fax over our investments to an elder lawyer and then he would meet with me the nursing home wants the husband to leave rehab but said I had to have daily 8 hr aides in place before we could discharge him which will cost us $4500.00 a month and I just want to know if we qualify for medicade-the husband is not giving me any help or support and with my health I am not sure I can care for him at home-can the nursing home tell me how many hrs of help he has to have and the social worker is not up on the rules for medicaide and is giving us wrong info I am so overwhelmed at this point I can not think straight.

Austin, I can see why you are overwhelmed! The paper work is a nightmare. The thing about Medicaid is that your assets do have to be spent down. An elder lawyer may be able to help you in some states, but states have the say. They follow Medicaid rules (Federal) if they want funding, so most do. That means you can’t have much besides your house and car before they will pay.

I don't think the nursing home can tell you the number of hours of aides you have to hire, but social workers from social services may be able to do an evaluation, and then maybe they can get you some help.

But Medicaid is for those who can no longer pay, and unfortunately, the amount of money you have must be very little in order to get help. Your Social Services people can help you there, but if you can find an elder attorney, I'd go there first.

The social worker from the nursing home is not the person who knows Medicaid. Medicaid is complicated and these social services are specially trained. They are specialists with your county/state. Usually a social worker at a nursing home is there for discharge purposes. It all gets very confusing as everyone's job is limited. That's why a legal representative is good if you have significant assets. If you don't, the Medicaid people can help you sort it out. Once you go to see them, they will want records of everything and will need proof of all of your assets (and your husband's if there are things that are separate).

The elder lawyer will need to know all of your assets, too - how much money is coming in, bills owed, property owned, cars, everything, in order to help you. The attorney can’t help you without knowing everything you have.

I hope you can go that route first. It's all a nightmare when you aren't feeling well and don't know what to do with your husband. Our hearts are with you.
Carol

First off,if a doctor is discharging an elder from a Nursing Home to home likely their custodial care needs are not high enough to met the standard of Long Term Care in a Nursing Home. This simply means that the elder can be cared for in the community and will not qualify for placement YET in a Nursing Home. You see the current standards for placement in a Nursing Home require a doctor or the state social worker to say an elder needs 24/7 care with their ADL's. The second standard to receive assistance from the state in the form of Medicaid is that the elder either be receiving SSI/SSP and deemed blind or disabled or 65+ and need a nursing home. Now there is Medicaid assistance if an elder has more income and it is the Home and Community Based Servives Waiver-Medicaid Waiver. There are 2 standards that need to be met. 1-Be Nursing Home eligible as determined by a doctor and/or state social worker. 2-Receive no more that $2,022.00 in income per month and have no more that $2,000.00 in assets/resources. The standards here are for an individual. My allowable space is almost up and there are a couple of additional pieces of information that you all need to know in order to qualify and pay for a nursing home.

Very well put, Eric. I hope you continue. The five year look-back is important, too. They will check back five years to see if you've given away any substantial assets in order to qualify for Meidicaid. Medicaid is for those who truly can't pay their own way.

Carol

Carol and Eric I really thank you both for your commets I feel a little folish for blindly following what the social woeker at the nursing home told me I thought she was sure of her facts we have a meeting sometime this week but yesterday he started going into CHF because they switched his meds around and I am going to see an elder lawyer after our accountant faxs our assests to him he still has all my paper work my husband is not helping me at all with this so it is hard but you have given me some very good advice and I now know the social worker has no right to tell me how maney hours of aides I have to hire her way will cost $4500.00 a month and she is not aware if he is placed it will not be in her nursing home but she does not need to know that-again thank you for your assistance.

Hang in, Austin. It's a lot of stress, and you are already stressed, but you'll get through it. Keep us posted on how you are doing.
Carol

There is something entitled "Spousal Impoverishment" which simply put ensures that a community spouse-the one who remains in the home, does not have to go broke to ensure their loved one receives care. It allows a maximum of $104,000.00 to remain with the community spouse. This number is rounded to the nearest dollar but it is pretty close. There is also a monthly needs maintenance amount that is allowed so the commuinty spouse can maintain their living expenses as well as a monthly housing amount. As I recall the monthly needs maintenance amount can be as high as $2,400.00 a month and the monthly housing something like $500.00-although this may be a bit low. Now you also needs to know that their is a rule called "name on the check" which means just that. Yours is yours his, his. So when all is said and done an Elderlaw Attorney is crtical to assist with eligibility. BTW GeriSW and EricJ are one in the same. Didn't mean to confuse.

Eric thank thank you so much for your information I will take this information to the Elder Attorney and have been crunching the numbers and plan to tell the social worker that I will decide how many hrs aide coverage I will get for my husband it is too bad there is no rules on how much a nursing home can bend the rules for their benefit thanks to you and Carol I am not going into this blindfolded and since things are getting down to the line you are so good to help me out when you are so busy yourself I sure hope I will be able to pay this forward some day.

Good for you, Austin. Eric has a lot of information. The numbers may be a bit different for different states, as nursing home care costs are different. Also, in-home care costs and benefits may be different. But Eric has the general numbers.

Look up the Medicaid waiver for your state, too, and make sure the elder attorney checks into that. Generally, the spouse can keep the house if one of a couple goes on Medicaid, but a lien will be placed on it by Medicaid if money spent gets that far. The elder attorney will know rules for your state (make sure this person knows Medicaid very well - you don't want any nasty surprises). You'll feel better once you've had legal counsel.

Take care, Austin,
Carol

The elder attorney that I deal with is helping us to do things accordingly. First he said due to my father's service and his VA requirements, he does qualify for VA benefits. Next the paperwork for that... nightmare!! Especially when a parent does not keep good records or does not share information.

Then he sent off our information to a VA specialist that reviews applications. They tell us depending on assets or investments what balance my parents are allowed to keep in assets before applying for VA benefits.

I'll say this.... my elder law attorney was able to define the asset requirement for my parents, set up a legal transfer of any excess funds based on that requirement, and then file the VA benefits.... he has a list of letters of thank you's from his clients out on the front desk. Its nice to see he makes the process as painless as possible.

It is not a quick process to do, but if you have the right people assisting you (typically not government help), then they make the process a lot easier. Plus an attorney that deals in elder law is going to know more of the in's and out's than a regular attorney. Mine has been a huge help!!!

Did you also know for Michigan that attorneys cannot charge for helping with VA benefits? If they do they can be reported. Veteran's are able to receive that help at no charge. Now what they may charge for is any additional paperwork needed outside of the VA benefit aspect, but still it saves a lot of money in the long run.

I am slowly becoming an expert on medicaide -my eyes were opened to day I can not understand why my life insurance is condidered an asset for me I would have to die and then it would not be my asset I can not take it with me-it is a long hard proccess but maybe someday I will be able to help others at least give them some tips and why oh why did the husband buy so many policies and why is my 401k an asset I sacraficed for years for it- why did I not spend it before now-I was too frugal -my co-workers had another word for it. And why did the first elder lawyer give me bad advice and we paid him plenty upfront.

Austin, my heart is breaking for you. Yes, life insurance (any cash value) is an asset in the eyes of Medicaid, therefore there is no insurance left for those you got it for. Everything is an "asset."

The other thing is what you learned the hard way: Not every elder attorney or person who calls themselves an estate attorney is up on all of the intricacies of Medicaid. References are vital. Credentials are vital. Trust is vital. Even then, one can get an attorney that isn't as in tune with changes in Medicaid law as he or she should be. You want someone who specializes in estate work and Medicaid law, not someone to whom it is a side issue. Bad legal advice can, as you know, be worse than none. It's a tough world out there. Hang in and please do pass what you learn on to others. It will give you some satisfaction, anyway.


Carol

Carol you are a Godsend and I an grateful for any and all advice and am keeping a running log of everyone I talk to at least I know he is getting the care he needs that has been too much for me for so long, I am sure my son will not be happy about him not commimg home and I feel sad and quilty for my part but the lawyer said I could get guardenship over him and so disapointed that our debts are not subtracted from our assets he said there is a way ti handle it but I would lose all my credit but he is allowing me to take a small CD that has matured to pay down our debt some and will everyone helping me and my trust in God some day this will just be a large experience-thank you again and for all those who build up my spirits.

When shopping for an Elderlaw attorney look for those that are credentialed by the National Academy of Elder Law Attorneys (NAELA). All of the referrals we make in our work are to those credentialed by the NAELA. It is critical to receive the best representation because certain of the documents filed effect others such as when an individual applies for the Veterans Administrations Aid and Attendance Pension and Medicaid or Medicaid Waivers, especially in this order. Many states for instance are now asking that a person apply for the VA Aid & Attendance Pension or stipulate that they are not eligible. If eligible you are required to make application so the state may leverage other dollars to reduce their contribution to Nursing Home care. If a person is deemed ineligible for the Pension it may, and I repeat may raise a red flag as the elgibility standards are similar. SO it is so very important to consult with an Elderlaw Attorney so that every allowable dollar that can be "Sheltered" can be legally. This will also provide piece of mind that when applying for the various entitlement programs we can be certain of our answers and the impact they will have.

Well all I know is thank God for the elder law attorney and financial advisor I have.

I am working on getting VA benefits for dad and of course dealing with Medicaid isn't too far behind.. The one thing that my ELA told me is that due to my parent's assets we had to create a trust in my name and transfer all but the minimum assets allowed to my trust. I was really nervous about being taxed as my income and I was told that my accountant needs to file a 709 indicating the transfer which also states taxes have been paid on it. They also suggested in liquidating the life insurance that I should take taxes out due to present government administration then when its in my trust acct just put it in a money mkt to draw the same interest over time.

I think its all in the professionals that are hired. Don't take one person's word for it either. Do some research on your own.

This is all an ugly process so get as informed as you can.

Well said, Mitzi. There are trusts that work and those that don't. Everything needs to be set up just right. It's scary business, and people need to know who they are hiring.

Carol

Eric - I very much apprecate all your information on medicaide if my husband had been realistic about his condition we could have avoided what mess I am going through now and if we had not listened to our first elder lawyer telling us as late as one year ago that our debts of credit card balances would be subtracted from our assets we would be better off or I would because my husband refuses to help me out at all with this mountain of redtape I did get a good local elder lawyer and the social worker at the nursing home he is in is helping me because I am overwhelmed esp, since I had silent strokes a few years ago, I had no idea applying for it was going to be so hard,

I couldn't agree more Carol! My elder law attorney came highly recommended. I also questioned him because he talked about things I had never heard of. He said it was because so many people do not hire those to use the law correctly.

I asked my acct questions my atty told me about. So far, although I'm still not through this, he hasn't lied to me yet.

Find elder specialists. Just because they deal in an area does not make them elder specialists.

Austin, I've been working on VA benefits for the past 9 months. Even that is a PITA.

Do what you need to and we're here to listen!

Mitzipinki Thank you for your information every bit helps and working on it every day the social worker has been very helpful esp. since I lost it the other day inher office and cried but I was at the end of my rope and have called the lawyer a few times- I hate to have to ask for help but he told me it was wise to let the social worker help my appointment with the the social service in our county is 7/2 I wanted to see the lawyer again before I went there but he said to keep that appointment and the husband can stay in the nursing home because he is on medicaide pending I know I will have to eventualy pay something but hope it is less than the $8000.00 for 2 months for 7 hr. daily aides.

Well Austin, that is roughly $19/hr which is actually a low end cost (if I did the math correctly).

Hopefully things will work out for you. I know I never saw all this provisions responsibility happening to me, and I've had to learn legal, financial, AL, caregiving all on the fly. Fortunately God has put some awesome help around me.

Sometimes social workers can be a great resource. Some I've encountered are a waste, but there are some extremely helpful people out there and if you go in grateful to them and thanking them, they tend to open up a bit more and find additional resources.

Austin, just take care of you. The rest will work out!! Your husband is covered for now. Don't let these stressors get to you (D'OH... I hate that phrase!). We want to see you around for a long time!

Austin, hang in. Mitzipinki recognizes, as do I, that some of our phrases seem trite. "Easy for you to say, etc." But you do know we've all "lost it." Most of us have been through these red-tape nightmares, and most of us have seen the good, bad and ugly of people we hire. Some are angels, however. So don't give up. We don't like asking for help and appearing vulnerable, but we are, in fact human. Humans are meant to help each other. Take care and know you are in our hearts.
Carol

My name is RHaley, I live in Strasburg, VA. I am sending this on behalf of my Mom, Dad, and sister. All 3 are disabled and live in the same house, my sister is confined to a hospital bed (I pay for my sisters home care), my mom is in a wheel chair unable to walk, stand, or get herself in and out of bed or off the toilet, she is on Medicare. My father recently fell several times, he is retired disabled, he also has Medicare. He fell on Monday and now will not walk because he is saying he can't. They are now in a hardship in there home due to no help. I am married, I have to commute 124 miles a day to my job. I get up at 2:30 am in the morning and I am at work by 4:45 am, I do not get home until 6:00 or 6:30 pm in the evening. I have one friend who is helping them a little but she has a life also. Is there any way that we can get assistance for them???? My father is mad at me because I told him I could not do everything and he said I was just abandoning them. Which I have not, I am just so frustrated because I do not know what to do or who to call. Can someone please help me???

Yes, RHaley, there is plenty of help available for you. Appropriating it is the hard part. It takes a lot of time, phone calls, and paperwork. Your local County Commission on Aging can provide resources. (Depends what direction you want to go.) What happens when you can no longer keep up, and their needs become greater? There's respite care, day care, in-home care, and professional managers. What do you think best fits your situation and needs?

Of course you can't do it all! Don't let anyone put guilt on you. Get in touch with your county aging services to see what can be done. A lot depends on finances, but it could be your parents and sister should all be on Medicaid. You need professional help to figure this out - people who know your state laws and Medicaid laws. Medicaid is different from Medicare. It's for low income folks with disabilities. Please check with your county aging commission or adult social services. You can also go to your state's Web site and find a phone number for aging services. They should be able to direct you to local services.

Good luck. You definitely need help with all of this.
Carol

Eric wrote:

"There are 2 standards that need to be met. 1-Be Nursing Home eligible as determined by a doctor and/or state social worker. 2-Receive no more that $2,022.00 in income per month and have no more that $2,000.00 in assets/resources."

Dragonflower writes:

This is absolutely correct! Medicaid is intended for the "medically indigent" which basically means "low income and limited resources." I cannot stress this enough. It was never intended for middle-class people who own a house, a car and have a middle class income arriving into the household every month from any sources (pension, dividends, IRA, Social Security, interest income).

While each state manages its own Medicaid, there are certain things that are fairly uniform from state to state. You are required to "spend down" your assets to qualify for Medicaid, as others have pointed out. Your entire "asset package" is examined to determine if you qualify. Start making a list of all assets that could be liquidated from all sources.

Social Security income and pension can be put towards the cost of either assisted living or nursing home care - I know, because when I had to put my late father in a home, these were used to pay for his care in addition to money from his personal savings, IRA income, etc. I was in charge of his financial arrangements, so I was very aware of every penny.

At the time when I was in charge of this stuff, the look-back period for assets was only 3 years. Since then, it has been extended to five years and will probably be further extended as people keep living longer.

As others have advised, you probably need to consult an attorney who specializes in this type of thing.

I consulted several Elder Law Attorneys, who offered some direction, but cost a LOT of money. My favorite was a volunteer for a Senior Center who said I could do all the work myself. He was such a blessing, that I'd pay for his services if I needed one for real. While you can do it alone, it is a great amount of work!!! The learning curve is great, as well. I sought resources, organized, applied, spent down, liquidated, applied again, and received a tremendous amount of help, from some wonderful people along the way. Some advice was poor, but most was helpful. Be careful who you listen to, including lawyers (no offense if you are one). Not all are ethical, but unless you have good discernment and counsel, you find out the hard way. Prayer helps. If you have the time, the benefits are worth the tiring effort. If not, there's many who will help along the way.

Our office for the ageing has an elder lawyer who works there one day a week and he was the one I hired-I did not know this at the time I hired him he was recommanded by our accountant. I did have to pay a retainer for 5 hrs of his time but if I did not need all the time I would get some money back and when my husband passed he offered to pay the whole amount back even though I was in his office for over an hour and have called him a few times but I told him to keep the check because I will probably need him as I go forward getting my husbands' life insurance and changeing the investments into my name.At our first visit he gave me a list of everything I would need for medicaide and lots of advice I tried to do all the leg work myself to save money because I knew medicaide would get every penny from me they could and did work on it for 3 weeks before my husband got very ill and then passed, do make the appointment with social services ahead before you get everything together because it takes up to weeks for an appointment and they will send you an application-first you sit down and cry then you get up and start the task and it is daunting even if you do not have everything in order keep your appointment because no matter how prepared you are they will want one more thing-this was told to me by my daughter who works in another county for social service in a different dept. and a lawyer does cost but if they know you have a lawyer on board they will take you more seriously-and even after he passed they wanted my to keep my appointment saying the nursing home would be sending some bills-I called the nursing home and found out what I owed which was not much and then firmly told social service I WAS not coming in. Do not spend every waking hour on the task it will drive you crazy just work on it part of the day every day, You may have to spend down before they get om medicaide but they will be cared for during this time in a nursing home and it will not take long for their extra money to be used up you can prepay their funeral expenses which is between $8000.00 and $14,000.00 in my state. Do not listen to anyone even a lawyer that you can hide money they know more about you accounts than you do and any addition or withdrawal of $1000.00 sends up a red flag going back 5 years and it will come back to haunt you if a lawyer tells you something that does not sound right run no matter how important he thinks he is-I wish I had the guts to name names but the lawyer I did use knew of him from what I had said about him and someday I am going to confront him maybe at one of his semiars after I eat the meal he provides I owe to to my husband who belived in him. If you can get a social worker to help you do it-take all the honest help you can and someday you will be able to help others they should give out degrees for getting medicaide and you will get it but it may be painful at the time-good luck

I have my mother in a nursing home in North Dakota. I have applied for Medicaid, about six weeks ago initially. They are still dragging the feet, evidently her life insurance policies are slowing this up. I assume she will have to empty out her life insurance policies. What do I do about the $10,000 bill that I just got. I paid the one for September with the money that she had in her account, then they told me I shouldn't have. All she has now is $3,000. Will she qualify for medicaid if she has the $3,000 in her account? She also get VA benefits from her first husband dying in WWII. Will she have to give those up? They told me at the VA to reapply for benefits, as there is an extra $100 they will give her that the nursing home can't take, is this really true? With all this paperwork and worry about finances, I am thinking twice now about behing honest about being burned out from caretaking for 5 years and having health problems, and mom is all upset about behing in the nursing home and trying to sue me and my sister.