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I have been a senior's power of attorney for both financial and medical for 3 years, I have never taken any compensation for my services. Is there a legal limit that I am allowed to take before a medicaid claim is made? I am trying to understand my legal rights and limits before we are at that point. Thank you for your time, I look forward to your response.

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Jeann -thank you for your information which proves there are answers out there that are not pasted on correctly. When my husband needed home care I was told to apply for medicaide and he would get 5 hrs a day five days a week-I did not believe them which was good because they did not have the staff. I was told he could get paratransit for 3 dollars a trip not true -we lived 1/4 of a miles away from the buss stop-even though the buss would pass my house often. I never was told about sposual refuseal so if he went on medicaide I would still get some of his pension or SS. So get things in writting and see a good elder lawyer for advice-there is help if you can learn about. I could have kept my husband at home if I had had what Jeanne had as stated above.
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Catttails - how informative! & spot-on.

Yep if you want to be financially compensated, it needs to be in accordance with your community standards of what caregivers are paid, based on what you do and perhaps on your special circumstances (like you are a CPA and do their financial management or other professional level work with a degree) and with a "personal services contract" done by an elder care attorney in your county. The elder issues you a 1099 EOY and you pay taxes on the income too. If it's a legit job that is what needs to happen.

If you don't and the elder needs to apply for Medicaid for NH then the $$ "paid" to you can be considered gifting and a transfer penalty imposed for the amount of $ paid to you. If you end up dealing with transfer penalty you'll really need an attorney to work it out for you anyways if you want to fight it, so pay now for legal or pay later.....and now is better and alot less stressful.

Transfer penalties are sticky to deal with in that most often it comes up AFTER they are in the NH and have qualified for Medicaid. The elder passes the initial review to become "Medicaid Pending" by the NH. They get in and family thinks all is OK. Then you get the transfer penalty letter and also the NH gets one too. At that point, you are faced with having to pay out the amount of penalty before Medicaid will go back to paying. The NH will make someone sign off a financial agreement (not the elder) too, which can be enforced. Otherwise mom has 30 days to move. Once this happens it will be tough to find another NH as basically word is out and it's private pay or no admit. This is a total panic situation to find yourself in and an awful predicament to place your elder in.

Penalty rates vary by state as it's based on the state's NH reinbursement rate. For TX its about $ 145.00 a day and TX is a low rate. So if Medicaid determines you have a transfer penalty of 10K that means there needs to be private pay for 70 days before Medicaid will start again. The elder is still qualified for and in the Medicaid program but Medicaid ineligible for payment until the penalty is paid.
Transfer penalties are hard to get around as the $ trail is there as the Medicaid applicant basically signs off on an all access pass to all their financial and personal information. Since Medicaid (a joint federal & state program) is administered by each state differently, each state may or may not be as detailed in digging out info as another. Some assets - like a home, land or auto's - are just keystrokes away for a caseworker to find out about their value and history of transfer. Some states have contracted out the Medicaid recoup process & those states dig deeper as their contract awards them for finding things to keep from paying Medicaid.
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I think I will throw my two cents in, for what it is worth. I live in Washington state. My father had a major stroke in July 2011. The only help from Medicare was to cover his home health visits after he was released from the rehab unit and moved into our home. Home health is a short term program and lasts from 6 to 8 weeks. It's goal is to help the family get in sync with the patients needs. They help with bathing, they offer a physical therapist, a nurse, etc., but this is short term. When they are done they are done and Medicare help in providing in home care stops there.

I found through our local Area on Aging that additional in home help could be provided. The assistance was based on the fact that I was over 60, retired and had no income of my own. It was not based on my dad's income and my husband's retirement income was also not considered. I received 30 hours per month, to be used as needed, until I no longer needed the help; meaning my father no longer needed the help.

There were programs via Medicade, that would have provided 5 hours per day of in home help. At that time, we chose not to go that route. Eventually, my dad did go on Medicaid.

I think there is some confusion between Medicare and Medicaid. My experience was that Medicare only covered the home health, short term services, that kick in when a elderly person leaves the hospital or rehab unit and comes home.

Ahtoo12: I think you are up the creek on any contract that gives you past compensation. Should you attempt this, it is quite likely that the senior in your care will have difficulty qualifying for Medicaid.

In short, if you want to get paid, get a legal contract. Payment starts then. Retroactive payments are a no no.
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I think I will throw my two cents in, for what it is worth. I live in Washington state. My father had a major stroke in July 2011. The only help from Medicare was to cover his home health visits after he was released from the rehab unit and moved into our home. Home health is a short term program and lasts from 6 to 8 weeks. It's goal is to help the family get in sync with the patients needs. They help with bathing, they offer a physical therapist, a nurse, etc., but this is short term. When they are done they are done and Medicare help in providing in home care stops there.

I found through our local Area on Aging that additional in home help could be provided. The assistance was based on the fact that I was over 60, retired and had no income of my own. It was not based on my dad's income and my husband's retirement income was also not considered. I received 30 hours per month, to be used as needed, until I no longer needed the help; meaning my father no longer needed the help.

There were programs via Medicade, that would have provided 5 hours per day of in home help. At that time, we chose not to go that route. Eventually, my dad did go on Medicaid.

I think there is some confusion between Medicare and Medicaid. My experience was that Medicare only covered the home health, short term services, that kick in when a elderly person leaves the hospital or rehab unit and comes home.

Ahtoo12: I think you are up the creek on any contract that gives you past compensation. Should you attempt this, it is quite likely that the senior in your care will have difficulty qualifying for Medicaid.

In short, if you want to get paid, get a legal contract. Payment starts then. Retroactive payments are a no no.
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ahtoo 12 I would like to express my thoughts on this matter. First of all, it is always refreshing to hear that a person took care of business and care of an elder in need before they thought about "how will I benefit". The whole priority factor in the Power of P.O.A. is a trustworthy, selfless, putting someones needs before your own act. If you thought about yourself first you wouldn't have to ask this question.
I completely understand that your duties should be compensated, if you have acted "in the benefit" of the Principal. This is what medicaid wants to prove.
For example if you have been taking the elder to the Dr's, making sure they are taking meds as prescribed or care needs have been in order, bathing, dressing, activities, food, clothing, etc.. If you can clearly provide proof of these things and have been spending the funds they have to provide the elder with a decent quality of life, paying the bills for them keeping the home life decent and safe, promoting safety and health care needs, etc. It should be apparent in your records. This is what I believe medicaid looks for in the application process. Put it this way if you have to be payed for a job well done and you need to be paid to help someone that gave you the duty to do an act for them, that is your duty by law. Read your papers, call the local medicaid office for info on the application process ask them what is allowed for "look back period" laws etc..
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You are certainly right, vc345vc355, Medicare and Medicaid are very different programs. The original poster, ahtoo12, mentions Medicaid so that is how I was responding. Elderly waiver is part of the federal Medicaid program. Different states have different names for it, I believe.
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jeannegibbs
Medicaid is different from Medicare.
Services on each program are different, as to the senior's needs and eligibility.
Based upon Medicare, I worked for a home health care co, as a caregiver we are clearly instructed, Medicare client's are ONLY allowed 2 hr to get a list of duties preformed for the client. Now each client case is different, some are ONLY a certain number of times per week. Medicare CLOSELY monitors these clients through the agencies. As a caregiver I can tell you it is totally IMPOSSIBLE to get EVERYTHING done, based upon Medicare's guidelines.
Who ever put these guidelines in place I can reassure you, has NEVER tried to do the work. Again every case is different some clients have both Medicaid and Medicare... My experience has been with Medicare.... here is a list of duties expected to be preformed, within the set limit of allowed time. This is a discription of PCA job duties.

Job Duties of PCA Caregiver
1. Assist with walking
2. Assist with light exercise *per MD orders if applicable
3. Transfers to wheelchair
4. Transfers to bed,
5. Transfers to commode
6. Plan and prepare meals,
7. Clean up kitchen including put dishes away
8. Monitor food expiration dates,
9. Prepare & make future meals
10. Make beds and
11. Beds change linens, as needed
12. Light housekeeping to include dusting and vacuuming
13. Clean Bath room
14. Assist with bathing,
15. Assist dressing
16. Assist grooming
17. Incontinent change, keep clean and dry
18. Laundry wash/dry
19. Laundry put away
20. Laundry if needed ironing
21. Take out garbage
22. Run errands (pickup prescriptions,)* needs prior approval
23. Engage in physical and mental exercises
24. Provide medication reminders
25. Engage in activities (games, memory books)
26. Companionship

SENIORS ARE NOT CHARGED FOR THESE SERVICES...THIS IS WHAT MEDICARE PAYS FOR AGAIN BASED UPON THE SENIORS NEEDS AND THEIR DISABILITIES.... THERE IS NO CHARGE TO SENIORS. THE CONTRACTS ARE BETWEEN THE ENTITIES INVOLVED. SENIORS ARE NOT INVOLVED.. THE ENTITIES THEREFORE SET THE RULES, POLICY & PROCEDURES.

I have never heard of "Elderly Waiver program " but it definitely sounds good for seniors, do you know if it is a State or Federal program?

I hope the Article below gives some clarity ...

************Medicare and Medicaid are very different. *********

Medicaid is a federal program for low-income, financially needy people, set up by the federal government and administered differently in each state. (This program is called Medi-Cal in California.)

Medicare was created to deal with the high medical costs that older citizens face relative to the rest of the population -- especially troublesome given their reduced earning power. However, eligibility for Medicare is not tied to individual need. Rather, it is an entitlement program; you are entitled to it because you or your spouse paid for it through Social Security taxes.

Although you may qualify for and receive coverage from both Medicare and Medicaid, you must meet separate eligibility requirements for each program; being eligible for one program does not necessarily mean you are eligible for the other. If you qualify for both, Medicaid will pay for most Medicare Part A and B premiums, deductibles, and copayments.

The information below provides the basics of each program.

************Medicare************

•Who is Eligible: Medicare covers almost everyone 65 or older, certain people on Social Security disability, and some people with permanent kidney failure.

•Who Administers the Program: Medicare is a federal program whose rules are the same all over the country. Medicare information is available at your Social Security office.

•Coverage Provided: •Medicare hospital insurance (Part A) provides basic coverage for hospital stays and posthospital nursing facility and home health care.

•Medicare medical insurance (Part B) pays most basic doctor and laboratory costs, and some outpatient medical services, including medical equipment and supplies, home health care, and physical therapy.

•Medicare prescription drug coverage (Part D) pays some of the costs of prescription medications.

•Costs to Consumer: You must pay a yearly deductible for both Medicare Part A and Part B, and make hefty copayments for extended hospital stays. Under Part B, you must pay the 20% of doctors' bills Medicare does not pay, and sometimes up to 15% more. Part B also charges a monthly premium. Under Part D, you must pay a monthly premium, a deductible, copayments, and all of your prescription drug costs over a certain yearly amount and up to a ceiling amount, unless you qualify for a low-income subsidy.

******Medicaid*********

Medicaid is administered by the 50 states; rules differ in each state

•Who is Eligible: Medicaid covers low-income and financially needy people, including those over 65 who are also on Medicare.

•Who Administers the Program: Medicaid is administered by the 50 states; rules differ in each state. Medicaid information is available at your local county social services, welfare, or department of human services office

•Coverage Provided: •Medicaid provides comprehensive inpatient and outpatient health care coverage, including many services and costs Medicare does not cover, most notably, prescription drugs, diagnostic and preventive care, and eyeglasses. The amount of coverage, however, varies from state to state.

•Medicaid can pay Medicare deductibles and 20% portion of charges not paid by Medicare. Medicaid can also pay the Medicare premium.

•Costs to Consumer: In some states, Medicaid charges consumers small amounts for certain services.
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vc345vc355, you are correct that when the government is paying the bill their rules apply. But I don't know where you are getting the "rules." For example, my husband has been on the Elderly Waiver program under Medicaid. When he became too sick to attend the adult day program he was enrolled in he was evaluated for home care help and was authorized for 32 hours a week for a PCA plus 3 hours for homemaking services. My mother is also getting home care services. She has a PCA, homemaking (cleaning) help, and a nurse visit. I'm not sure of the total number of hours, but it is based on her needs, not some "2 hour a day" limit.

It is much less expensive to maintain a senior in his or her own home than to pay for placement in a nursing home, and the waiver programs are geared for both the senior's welfare and also saving money.

In any case, someone intending to charge for services to a senior on Medicaid should consult a local attorney specializing in Elder Law. Rules do apply and it is best to know what they are and set things up to comply right from the start.
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JeanneGibbs and Reverse roles have pretty well nailed it as to what's what.
You need an experienced elder care attorney to do this, as one who has a practice in the county in which she resides as that cuts down on courthouse runs & cost.

Reindeer - LadyBird deeds are not valid in all states. It's valid in FL, TX, MI, OH. I think it's validity has been challenged in CA and KS. It seems that in TX how the LadyBird is written can be kinda critical so that it is not viewed by MERP as a regular life estate deed.
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Medicare has specific and strict guidelines, for caregivers, home health aides, i.e. services for seniors.
U.S. Govt ONLY ALLOWS FOR TWO HOURS A DAY FOR HOME CARE SERVICES...
THE GOVT DICTATES TO YOU WHAT YOU CAN AND CAN NOT DO!!!
WHEN THE GOVT PAYS THE BILL.
go to their website read it.
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I am a bit confused; you stated “I have been a senior's power of attorney for both financial and medical for 3 years”

1. What type of POA do you have? There are several different types of POA, with limited and specific powers.
2. Who drafted the document? [A] Lawyer? [B] You and the senior?
3. What is your relationship to this senior? Where is the family?
4. You stated; “I have never taken any compensation for my services.” What exactly are your “services” you perform?
5. Handling one’s “financial and medical” does not require more than 12 hours MAX a month.
To pay monthly bills, open mail, review bank statements, deposits, keep medical records in order.
6. Has this senior been declared incompetent by a court?
7. Why is the senior on Medicaid?
8. What happened to the Medicare?
9. You did not mention if you where PCA or CNA, cert, caregiver?
10. You did not state if you are working or have been for past 3yrs, 24/7 caregiver?
11. There are so many variables to your purposed question.
12. You need to look up the laws where you live, and carefully read them. [Specifically POA & Elderly Laws & Medicare.gov]
13. If this senior has a Lawyer she has used in past years, I would consult with him, and a Lawyer
in Elder Law issues ASAP.
14. I HOPE YOU DO NOT RESIDE IN THE STATE OF NEVADA, SOME IF NOT ALL OF WHAT YOU ARE
OR HAVE BEEN DOING; ACCORDING TO NEVADA LAWS; IS CONSIDERED ILLEGAL; FALLS UNDER
ELDERLY EXPLORATION; ETC…
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The answer to this question depends on a lot. Are you living with them, or them with you? Are you changing diapers and assisting with 3 or more areas of their life they cannot do alone? Can the person be left alone? I went to a lawyer after a year of caregiving and he drew up a caregivers contract for me. My Mother moved in with me having dementia and couldnt walk. The first year I had her with no contract I got no retroactive pay once I got the contract. You cannot take any money until that contract is signed, and yes it can be signed by you acting as the persons DPOA. IF you want to draw this up and then take back pay for 3 years it could be a big court battle if siblings, children, or relatives are wanting a piece of the pie. Once drawn up you get approx $15 an hour for 8 hours a day. You do not get paid overnight because its considered your "daughterly duties." (or whomever you are taking care of in the same house). You must pay taxes on it and it amounts to 30% of the amount paid to you so you would owe a lot should you chance just taking money retroactively . You have to show back those three years of every penny spent on a spread sheet . The Caregivers Contract will cost you probably $2,000. As far as Medicaid goes, they want to know what you did and how long it took you to do it, etc, they are very exact on your caregiving. For example, bathing and dressing might be logged as 1 hour. Feeding 1 hour, etc...
I didnt do it for Medicaid. I did it for my Mothers care and supplies only, and she has now been with me for years and her money is long gone. Hope this helps answer a few things, get yourself to an Elder Attorney asap.
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See an Elder Law attorney sooner rather than later. Draw up a personal care agreement spelling out what services you provide and what the senior pays you. Also be certain that all expenses are paid out of the senior's account, not yours.

It is important to do this as early as possible. You don't want Medicaid to consider money you are being paid "gifts."
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My Mother sold a condo apartment in 2010 it sold for $80,000. Instead of putting her in a living assistance facility, I moved her into a apartment around the corner from my house. This made it easy to check on her and do daily errands housekeeping personal care ect. She attends day care and has a homemaker 3 days for 10hrs . This cost came to about $45,000. for two years.
I maintain her daily living with her SS. I alotted 10,000. in my name to offset my expenses. I took a early retirement age 54, and cut my income in half. Now the money has been spent I am going back to school so that I can get back in the workforce and build up my income again. I maintain my own home (single owner) and have car notes and other expenses that have fallen into a financial windfall because of this situation. I felt like I was fair and not selfish and now I have to pick myself up and dust my self off and recover. She is now eligible for medicaide (Global Option) and she can recieve these service under this plan which include more homemaker hours and more days of Medical daycare, plus I get 30 days of respite time. I have not had any time off for over 2 years. My sibling comes when he wants many 5 days a years for ONE day!
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Pizzazzy, go talk to an elder care attorney. You should be able to get a Lady Bird Deed on her home. It gives you an interest in her home so that Medicaid could not take a lien on it. Does she have a will leaving everything to you? You should be able to be paid a salary, but it must be reasonable and I believe you will have to file a 1099.
You really need to talk to a lawyer to protect your interest and to do it legally so there is no question. You cannot be paid for future care, but present care can be charged for.
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I would like an answer to this question, also. I am all of the above, plus housekeeper, errand runner, bill payer, diaper changer, bather, cook, taxi service to doctor and hospital, nurse, laundry person, dishwasher, etc., etc., etc.. In other words, I do everything but feed her and put her straw to her mouth. She can walk, just won't. All she does is eat, drink, smoke, and watch TV. I don't get paid a dime. I have no money of my own. I quit my job and moved in to care for her. I would love to know if I can can be compensated out of her income for the care I'm giving. If I ever have to move (if she were to die or move to nursing home or long hospital stay) I have put myself in a position where I have nothing. I'd be homeless and penniless.
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Good question and am looking forward to a reply....I too have been caring for my aunt for 8 years now...it costs money to drive them places, grocery shop, etc. Let's say we compesated ourselves $400 a month, is that too much for our gas, time, and the hardship it places others including ourselves in? I also have a husband and a physicaly demanding full time job. I also care for my mother but she needs very little and is happy I care for her sister....their brother insists I should compensate myself accordingly. Whatever that means.
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