How to NOT be responsible for parents' nursing home costs.

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Here is an interesting article that claims one of the most common reasons for issues with Medicaid not covering NH costs is that the application is not filled out correctly. Even though nursing homes will usually submit the application for free, it is not a bargain! According to this PBS article, it pays to have an elder care lawyer involved, even if only to review the application before it is submitted.

http://www.nextavenue.org/article/2012-07/could-you-be-forced-pay-moms-nursing-home-bill

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Thanks for posting the article, Jeanne.

I think that what the Medicaid caseworker is looking for is "patterns of spending". The caseworker has their SS statement and their retirement(s) statements and can easily figure out how much they get in income each year. Then I bet they have a set amount based on your area as to normal living costs, then add to that if they are already in a facility (like they are private paying for IL or AL). So it is a simple math problem to determine how much they should have in their bank account. If the # doesn't see right, then they do a drill down to look at the banking statements.

When I did my mom's NH application, all the documents were turned into the NH in one big (over 100 pages) document dump. I made them sign a receipt for it too along with an attachment listing the documents. The NH did nothing regarding my mom's documents except to package them along with their bill to the state Medicaid program. OK I take that back, they did copy the county tax assessor statement on my mom's house, and they did add up my mom's monthly income to make sure she was under the $2,094.00 that the state of TX has as it's maximum income. But nothing else did they "help" with. Providing the required documents falls totally to the family or the applicant to do. I do think the NH industry is totally misleading in telling family that they will assist in filing. More on this below......

Whenever dealing with anything governmental, I think a document dump is the way to go. The fatter the file the better. The initial caseworker told me that he had 10 minutes to evaluate the initial application. So if you are missing a "required" - like not including citizenship documentation, or SS statement - then you automatically get place in the "info not provided" pile which generates a letter from the state with a specific time frame to provide whatever or be declined. But it clears it off the caseworker's desk. For my mom initial review, there was two issues, her naturalization document and her life insurance policy and the problems with them were kinda the same. The naturalization paper was from the 1940's and was a copy of the original; for her insurance it was from the 1960's an old-school style super long and over 30 pages legal size, tiny print. Now the new naturalization stuff and newer insurance is a straightforward, easily readable document, 1 page with a single seal and a couple of signatures. That is what the caseworker is used to looking at.....well for my mom's stuff, he had to stop and start to carefully read stuff and he does not have the time for that. I was lucky in that he called me rather than the letter, so I was able to fax over a notarized page of my mom's old passport so that took care of the whole citizenship thing; but for the insurance, well the caseworker does not have the training to evaluate what an insurance policy is (nor should he), so I got a broker who held a TX insurance sellor license to do a on his letterhead statement that it was a term policy. Again faxed over the next day to the caseworker. Caseworker was happy because he now has even more documents to add to my mom's file and the fatter the file the better. If I was an elderly person or had limited capabilities or just not used to dealing with minutia, it would have been impossible to do this in quick time. I would be in the Medicaid application maze of hell.

I think there has been a sea-change in how the states now approach Medicaid. My DH did his mom's application in 2004 and it was much simpler and not as detailed. She went into a NH in New Orleans on Medicaid, then when Katrina hit, her NH like all of them, went to TX to have the residents dispersed. She managed to get herself into a community based program so off Medicaid for NH. She eventually needed to go back into a NH and so a new Medicaid application needed. The NH "assisted" her application and there were problems after problems, checks for $ 60 and for $ 200 which needed documentation from the NH. We weren't doing it, but BIL was as he lives closer. It is my belief that the NH want the application to stall as then the resident is declined (from "documents not provided") from Medicaid, and then the family has to figure out a pay to private pay the NH for momma. My MIL died before being accepted on Medicaid too, she got sepsis and went from the NH to the hospital then to a free-standing hospice unit and died about 2 weeks later @ hospice (thank you Medicare). NH sent a nice private pay rate bill to my BIL too. Now my SIL dogged the Medicaid application on after MIL died and it was almost 10 months later and it got approved. (Oh also NH turned it over to collections during this period too.) But most people just won't or can't do whatever is needed to just push an application through according to the requirements. The NH industry knows this and knows that there exists an opportunity to get private pay out of family if momma is declined from Medicaid. It is to their advantage if the application is declined and you signed off to be financially responsible or if momma still has her home (which explains why they made a copy of my mom's home ownership and had it on their internal file on her @ her NH #1).

Most folks just don't have the time or the attention to detail to make the Medicaid application flow if there are things beyond the simple only SS and no property situation. When I was doing Medicaid for my mom, I had just come off years of dealing with insurance companies; SBA; FEMA; Corps of Engineers and city permit stuff related to Hurricane Katrina and was one experienced bad *itch to deal with red tape so the Medicaid application was a cakewalk after all that. But it should not be this way. I just cannot see how an 82 year old can do what is needed to get her 88 year old DH onto Medicaid and in a NH on their own. it should not be so difficult to understand & get though the system.

As the article said, you need an elder law attorney to keep from making mistakes.
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It's not just the income that matters to Medicaid, but also the out-go. In the past, any debit of $200 or more was questioned, but I have heard that they are getting even more picky about it. What they are looking for is money going out of the bank account for purposes of transferring assets tor property others within the last 5 years in order to qualify for Medicaid. That's a big no-no. So keeping a detailed documentation paper-trail on expenditures is also very important. I'm in this boat now as a POA as well. UGH, UGH, UGH!!
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Thanks, Jeanne ... I, too, have been assured by various assisted living facilities that they would "assist with" or out and out "file the" Medicaid applications "when the time came" ... and I always wondered how they could possibly do that, when from everything I'd read, Medicaid required a level of detail beyond what such a facility could possibly have? The recommendations in this article make a great deal of sense.

I don't know if my Dad will outlive his finances, but just in case I have to apply for Medicaid on his behalf somewhere down the road, I am keeping every receipt and every original bank statement, and taking copies of every unusual check that I deposit into his account (such as refunds from various companies), as well as recording what they were for (because I've read that people have had to explain even small deposits years later on Medicaid applications). I imagine that trying to track down this sort of detail under a 30-day deadline while your application is "active" with Medicaid is something of a nightmare ... so even though chances seem 50/50 I'll won't ever be using these records, I think it's safer to maintain them, just in case. :-(
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Thanks Jeannie, This was a good article. I filed my Mom's Medicaid applications at the county office myself, first for community care and later for institutional care. It all ended up OK. Yes there is so much information they want that the nursing facility cannot readily provide, and if you go ahead and sign papers that they fill out without at least reviewing them yourself or with an attorney, you might be leaving out critical information (like certain assets and income) and then sign your name/POA name, you could be liable for making a fraudulent application!
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