rhondabm Asked January 2012

My parent is unable to stay alone anymore. Can the state actually refuse him care?

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My father was recently placed in a rehab after a hospitl stay. It doesn't look like he will be able to return home by himself. In order for Medicaid to cover his stay in a nursing home we have get rid of all his assets. If he gifts me his assets, (which I know the law says it has to be over 60 months) Can the state actually refuse him care? I mean if he is impoverished then he is technically a ward of the state right? They can not just throw him out into the street.

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igloo572 Jan 2012
Rhonda - How each state approaches Medicaid qualification and how a NH deals with Medicaid residents is really dependent on your states's laws both for assets, filial responsibility and probate. If your dad gets SS then he has an asset which the NH will need to get in order for him to stay there. I've done Medicaid and dealt with IL, NH & hospice issues for my mom & my MIL. It can be maddening at times.

He does not have to get rid of ALL his assets.But they have to be at a certain level and in certain categories in order for him to qualify for Medicaid. Most NH admissions come from a hospital discharge. If an individual covered by Medicare is discharge from a hospital to a NH for continued care (rehabilitation) after an inpatient hospital stay of at least 3 days, Medicare will cover 100% of the first 20 days and MAY pay up to 100 days, subject to a co-payment by the patient of $141.50 per day for days 21 to 100 (for 2011). Medicare does not pay for the many months and years that some people reside in a nursing home for long-term custodial care. In general, Medicare is limited to short-term acute care.
But this Medicare paid period of time in the NH is when you need to get the documents together to apply for Medicaid for him and spend down his assets. This is kinda where you are at w/your dad. So if you need 2 months to spend-down and do the co-pay for Medicare, think about going that route to give you more time to get everything done to have him be "Medicaid Pending" for the NH.

Medicaid rules are determined by each state & are state specific even though it is a federal & state program.For NH Medicaid eligibility, an individual must show that:
1) are 65+,
2) medical condition requires that level of skilled Nursing care,
3) monthly income is less than their states max (about $2,020.00),
This is the “income test” – how much $ do you make.
4) countable assets are less than $2K
This is the “asset test” – how much $ do you own.
5) not gifted away anything of value during the look-back period.


The eligibility $$$ are different if there is a community spouse.The max look-back is 5 yrs. Most states require 3 – 6 mo. of financials with Medicaid application. Can require more financials if something pique’s interest.A “transfer penalty” can happen when items are gifted below value. Penalty different for each state as it is based on the states average NH costs.

All assets are counted for the asset test, unless the assets fall within the short list of "noncountable" assets:
- personal possessions,
- a vehicle,
- their principal residence, provided it is in the same state in which the individual is applying for coverage & the house may be kept with no equity limit if "community spouse" lives there; otherwise the equity limit is 500K (750K in some states)
- prepaid funeral plans (irrevocable, no cash value/NCV)
- small amount of life insurance (usually $1,500 & NCV)
All other assets (savings, stocks, whole life) are counted.These must “spend down” to get to their states asset max to qualify.

The financials are what most folks focus on. But remember that they also need to medically qualify for skilled care for Medicaid. The fact that he is already in the rehab part of a NH works in his favor in qualifying medically.

If your dad doesn't have a funeral/burial plan purchases, then use part of his $ to buy that. This is totally OK but needs to have no cash value. A good funeral home is used to doing this to be Medicaid compliant. The insurance is a bit more sticky in that it is hard to get a policy for someone old & infirm but they are out there but will pretty much cost the face value - but it does provide for $1,000 - $ 1,500 in $ for the family to have upon death rather than go to the NH. You can also spend $ on getting a new hearing aid, glasses, an expensive walker, clothing and dental work. Dental is good because most Medicaid do not cover dental. If Dad should need dental later on, you or other family will have to private pay for it as most procedures aren't covered. Between funeral and dental & other costs, this could easily run 10 - 25K in spend-down.

If he has a home, you can pay off the mortgage, advance pay utilities, insurance, taxes, do repairs or maintenance agreements to spend-down.Totally legit because the $ needs to be spend on them, their care or their homesteaded property.
If he hasn't done legal: DPOA, MPOA, Guardianship in case of Incapacity, a will, etc. then spend-down to get all the legal done. Again totally legit spend-down.

Being made a ward of the state is pretty serious. If it happens, then you and any family have no say on anything related to your dad or his care. I've been executrix twice & spent more hours in probate court than I can remember. The guardianship hearings are held here too. Can be very sad. Often the elder will get shipped out to a NH in a remote county because they need to bring up the #'s or worse. The court will appoint a guardian (usually an attorney) who will control all Dad's $, any assets he may still have and whatever he gets from SS &/or retirement. The attorney will be paid from dad's assets. You will have no say on it or his care. Once he is a ward of the state and you did not come forward to be his guardian it is super hard to change that legally.

Someone will have to sign off documents for your Dad to stay in the NH once Medicare payment time is done. In those documents will be a responsibility notice for financial that says your dad or his assigned is responsible for payment. Now if he is applying for Medicaid, the NH may take "Medicaid Pending" which means his monthly income less his personal needs allowance must all b paid to the NH while the application is being processed and the NH accepts his monthly income as payment in full for the month (this assumes he will be OK'd by Medicaid). If they don't do MP, then you have to private pay until the application is approved. Then you get the difference back.I think that until Medicaid approved the NH can do a 30 day termination notice whenever and if you don't get him, he will be placed in APS. Once he is on Medicaid, the NH can still do a 30 day notice but has to find another NH for him to be transferred to. Can be anywhere in the state where there is a bed.

If he has significant about of $, then get an elder care attorney to work with you to draw up everything so that it will pass his states Medicaid review.Asset transfers will show up so it's hard to get around this.Really. Good luck.
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rhondabm Jan 2012
I have not had a chance to research much the only information I have been provided is from the social worker at the rehab he is in. He lives in a very rural area and I have not found any agencies that provide at home care for any length of time.
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Patti4Mom Jan 2012
Aren't there any other alternatives? Is he a Veteran? Can he get Aide and Attendance for at home care? How much have you had a chance to research other options? Just asking.
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