I am confused about being penalized after Medicaid pick ups. I has no choice but to put my mom in a home, will I be penalized?

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I never intended to put my mom in a home. She has diabetes, liver disease & is a Dialysis patient. I left my good paying job to be her full-time caregiver. She sold her house 6 months ago & made approx. $80K. With this money, I bought a dependable used SUV for $22K, paid back my husband who shelled out $10K for my dad's creamation & work done to sell her house. $6K+ to my sibblings. We dip into this account for food costs & some bills since my husband has been out of work as an Ironworker. She has had hallucations for a few years but has gotten to the manic stage just in the past few months. Pass 2 weeks, she has fallen over 13 times. We have tried Abilify & Seroquel without luck. These meds made her into an invalid to the point where I had to hand feed her & wipe her after bathroom breaks. She wakes up every 2 hours at night because of people in her room or she sees bugs swarming her. She's confused & even tried too her leave the house at 4am looking for me. My husband helps as much as he can but we are sleep deprived & I'm afraid to drive home some nights. I even thought she may have had a silent stroke since she is so not herself. If I have no choice but to put her in a home for own safety. How would medicaid pick up the cost once her money is gone but she hasn't gone the mandatory 5 or 7 yrs without money to her name? She does get social security. I cannot afford to pay back the money that was spent. Anyone know how this works. My dad didn't leave anything but debt.

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Hi..
You are doing an amazing job taking care of your mom! I have nothing but admiration for those attempting to manage these intense situations at home.
To answer your question:
1. Document everything! The re-payments you have made to yourselves and the purchase of the SUV should not be a problem nor should money being spent on living expenses as long as they are for her benefit. You may be challenged on living expenses if the transfers are going from an account in her name to an account in yours and the transfers seem to high.
2. Given the numbers you disclosed above she will still be "over-resourced" for Medicaid eligibility (no more than $2,000 in assets). From what you are describing it sounds as though continued home care is going to be untenable. I would suggest that you begin the process protecting her funds for her benefit now.
Two methods I would suggest that will allow her to qualify for Medicaid immediately or when required are:
a. Create a Personal Services Contract between you and your mother where you are paid to care for her. This will allow you to transfer a lump sum amount equal to the value of the contract without penalty. Here is an example of how it works: A rate of pay is established, say $20 per hour. This is multiplied times the number of service hours per week (make it reasonable even though this is a full time job, I know, so let's say 15 hours per week). Multiply this times 52 weeks. This sum is now multiplied times the number of years of her life expectancy according to the appropriate tables. For example, if mom is 85 the HCFA table states her life expectancy is 6.62 years. This would allow for up to $103,272 to be transferred from her to you without Medicaid penalty. Caveat: this is a taxable event. If you do this after admittance to a NH the authority will not appreciate 15 hours per week; it should be no more than 5.
b. The other alternative which can be used in conjunction with (a) above is the transfer of funds to a Supplemental Needs Trust. This irrevocable trust is established by a 501c3 non-profit organization. The funds transferred to the trust are available for her health, maintenance, and welfare (she will need money even when receiving benefits to pay for things Medicaid does not pay for). She will immediately be eligible for Medicaid. Caveat here is that funds remaining in the trust at her demise go first to the state to "pay Medicaid back" before residual goes to heirs.
Before readers start screaming at me that this is not fair please keep in mind that this planning is NOT so that the family can benefit and the state foots the bill. The purpose of this planning is to make sure that money is available for mom while on Medicaid as there will be plenty of expenses that will need to be satisfied. Anyone who has had a loved in a nursing home knows how this adds up and adds up quick, particularly if the loved one's medical situation is complex as it is in this case.
Good luck, my prayers are with you....
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I'm not sure I understand the question. Are you thinking that it is time to place Mom in a nursing home, but you are afraid that how she spent the money from her home sale will disqualify her for Medicaid? Some of those expenditures are clearly allowable. Repaying a loan for a funeral, and money spend to sell the home, for example. Others are not so clear. Did she buy you a van so that you could take her to appointments, etc? Is she paying you for your caregiving help over the last few years? I think you need to talk to an estate planner or an elder law attorney, and lay all the cards on the table. What are your mother's options at this point?

You might also select the nursing home you'd like to use, make sure they accept Medicaid, and talk to their financial person about applying for Medicaid.

The lookback rules aren't intended to prevent people from paying legitimate debts. They are trying to prevent someone from giving all her money away, to relatives or others, and then saying "now I qualify for taxpayer support."

You were hoping this would never come up, because Mom would never need nursing home care. I can understand that. Get some experienced help in straightening this out.

Good luck!
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Thank you for your help. Yes...she bought me a SUV so I can drive her around to dialysis treatments & her multiple doctor appointments since she doesn't drive. I just had to admit her into the ER last night after her treatment because she was confused & disoriented...the techs said they hoped that after being dialized, she would be better but wasn't. I left her at midnight while she was coherent but within 3 hours she was screaming that she was kidnapped, etc. Now she is mad at me for leaving her there. I know this is all part of "normal" behavior for people with signs of dementia. They think she may have Lewd Body Disorder. If the medication doesn't work...I may be forced to look into nursing care. I feel horrible. Physical & medical issues are hard enough but mental issues just make matter so much worse. I will contact someone to help with the living situation. Thank you again.
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I took my husband who has Lewy Body Dementia to the ER last month. This is something I try to avoid, but it sometimes can't be helped. No one -- admitting, nurse, doctor, had ever heard of LBD. I am certainly glad I brought with me the list of drugs that should not be given to people with suspected LBD! My son and I stayed with him the entire time he was in ER. We know that demented persons are easily confused and upset in strange environments (and what could be stranger than an ER?) and that their behavior deteriorates. That can prompt an ER doc, who knows nothing of LBD, to give drugs that can be life threatening. Sigh. So I will never leave him alone in an ER. Family presence helps keep him calm and the issue of antipsychotic drugs is less apt to come up. He was admitted to the hospital, and I'll never leave him alone there, either. We discussed this at a family meeting this summer, so the kids weren't surprised when I told them we needed to set up shifts to stay with Dad. He is home now and doing well.

But I digress. Your issue is how to pay for nursing home care if it is needed. Start the ball rolling! It is better to get the qualifications out of the way and not need nursing home care than to need it and be starting from scratch.

Good luck to you.

BTW, Lewy Body, especially in the early stages, is more treatable than some of the other forms of dementia. I advise you to find a doctor well experienced in this disease for Mom. Too many throw up their hands and say nothing can be done. Not so. True, it cannot be cured, but treatment can greatly help quality of life.
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