What happens when after all the rigormorole with applying for Medicaid, the applicant is denied or penalized?

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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?

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Hi Shai,
I don't think you'd be held responsible. Medicaid qualification takes time. The house being for sale may be slowing things down, but Medicaid can put a lean against that to use at the time of sale. Try contacting the long-term care ombudsman for your area on your state website or at www.ltcombudsman.org. Here, you'll type in the Zip code of the home. This person may be able to advise you or help point you in the right direction. Good luck.
Carol
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You are not responsible for your grandmother's debts, except to the extent you can pay them out of her funds. I hope that you did not sign something taking responsibility when she went into long term care.

Is Medicaid taking forever, or was she actually turned down? If she was turned down, does that mean she has some resources that disqualify her? If so, the solution is to spend down the resources. If this is over mistakes on the application that make her appear unqualified, then those mistakes have to be fixed. You need to know what disqualified her (if that happened) and then fix it.

I really, really feel for you. I don't know which was harder to deal with the first year -- my husband's dementia or the bleepin' paperwork. I had the assistance of an elder law attorney and I STILL had to spend down more than the lawyer advised and redo the application. Yikes! But there is light at the end of the tunnel. Do whatever it takes to bring the application to a successful conclusion, and your burden will get significantly lighter.
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The social worker in the nursing home is too blame-if she was doing her or his job the application would be pushed through the only way she would be turned down is if she had more money then allowed and then they only have to have her spend down-you are not responsible -I would not put any more money into her house-she should be on medicaide pending and not costing anyone any money-do not sign anything if they want their money they will have to get off their duff and do things properly.
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luvmom, you really need to careful with a reverse mortgage.

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.
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Ronnie - imho they are looking for patterns of spending on their assets to see what could be subject to a transfer penalty. And then documentation as to why it's not subject to a transfer penalty. I think it's not the amount per se, but the pattern that makes the application subject to more review.

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.
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No, Moe, that isn't how it works. Medicaid is not a program that everyone is entitled to because they've paid into it or paid taxes. It is not like Medicare. It is reserved for people who are not able financially to take care of themselves and who have a medical need for care. I don't think that is how it should work, but my opinion and $5 will get you a nice coffee at Caribou.

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.
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Some states can take longer than others for the Medicaid NH approval process.
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!
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About the credit cards,this is sticky. Depending on what state she lives in, if she does not pay on them, then they can go to collections and if there is a judgement against her a lien can be placed on the house. This process requires a full legal process and her getting served so maybe 2 years to do. If there is a lien, it is a real PIA to deal with when it goes to close on the sale of the house. Some Realtors are experienced in dealing with this, other's not. So ask.

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.
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Thanks so much for all of the encouraging and informational responses! This is actually my second time going through this Medicaid qualification process; the first time was for my grandfather and likewise, my siblings were nowhere to be found to help in any form or fashion. In any event, getting him qualified was “different” and from what I’m going through now with my grandmother.
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.
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On dam land & homestead, the first issue I'd deal with is the property "sale" dad did to neighbor for both. now if dad sold them both for fair market value then dad should have the $ from the sale. Get the tax assessor statements for both parcels to see what the county (& therfore the state) has for them. October is a good as assessors are about to mail statements for January pament. Now if he sold them & got paid FMV dad will have use that for spend down to pay the NH. No harm, no foul.

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?
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